Factors associated with joint contractures in adults: a systematic review with narrative synthesis

The primary objective of the review was to collate the available evidence on factors associated with joint contractures in adults. A systematic literature search was conducted on MEDLINE, CINAHL, AMED, and EMBASE. Studies that involved participants aged ≥18 and assessed joint contracture as a primary or secondary outcome were included. Two independent reviewers screened studies against the eligibility criteria, performed data extraction, and assessed the quality of evidence. A narrative synthesis by domain and sub-domain was undertaken. The protocol was registered on PROSPERO: CRD42019145079. Forty-seven studies were included in the review. Identified factors were broadly classified into three major domains: sociodemographic factors, physical factors, and proxies for bed confinement. Sociodemographic factors were not associated with joint contractures. Functional ability, pain, muscle weakness, physical mobility, and bed confinement provided the most consistent evidence of association with joint contractures. The evidence regarding the relationship between spasticity and joint contractures remains unclear. Other factors might be important, but there was insufficient evidence to make inferences. The review identified and collated evidence on factors associated with joint contractures, which can be utilised to develop effective prevention and management strategies. Implications for rehabilitationClinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression.Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review.As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care.Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management. Clinical interventions based on the timely identification of risks related to joint contractures in vulnerable adults have the potential to prevent or ameliorate their development or progression. Quality and consistency of care for vulnerable adults would be enhanced by developing effective joint contracture prevention and rehabilitation strategies based on the evidence presented in this review. As many vulnerable adults are located in the community or non-acute care settings, strategies should target these loci of care. Structured risk assessments that can support non-physiotherapy staff working in these loci of care to identify risks related to joint contractures would provide an important resource for risk management.本综述的核心目标为系统梳理现有关于成人关节挛缩（joint contractures）相关影响因素的研究证据。研究团队在MEDLINE、CINAHL、AMED及EMBASE数据库中实施了系统性文献检索。纳入标准为参与者年龄≥18岁，且将关节挛缩作为主要或次要结局指标的研究。由两名独立评审员依据纳入排除标准筛选文献、提取数据并评估证据质量。随后按领域及子领域开展叙述性综合分析。本研究方案已在PROSPERO平台注册，注册号为CRD42019145079。本次综述共纳入47项研究。 本研究识别出的影响因素可大致划分为三大领域：社会人口学因素、躯体功能因素以及反映卧床约束状态的替代指标。其中社会人口学因素与关节挛缩未发现显著关联。功能状态、疼痛、肌无力、躯体活动能力及卧床约束，与关节挛缩的关联证据最为一致。关于痉挛与关节挛缩之间的相关性，现有证据仍不明确。其余部分因素或具有潜在相关性，但现有证据不足以作出确定性推断。 本综述系统梳理并整合了成人关节挛缩相关影响因素的研究证据，可为制定高效的关节挛缩预防与管理策略提供依据。 康复领域启示如下： 基于对脆弱成人关节挛缩相关风险的及时识别所开展的临床干预，有望预防或缓解关节挛缩的发生与进展。基于本综述所提供的研究证据制定有效的关节挛缩预防与康复策略，可提升针对脆弱成人的护理质量与护理一致性。鉴于多数脆弱成人分布于社区或非急性护理场景中，相关干预策略应针对性覆盖此类护理场景。开发可支持非物理治疗人员在上述护理场景中识别关节挛缩相关风险的结构化风险评估工具，将为风险管理提供重要支撑资源。 基于对脆弱成人关节挛缩相关风险的及时识别所开展的临床干预，有望预防或缓解关节挛缩的发生与进展。基于本综述所提供的研究证据制定有效的关节挛缩预防与康复策略，可提升针对脆弱成人的护理质量与护理一致性。鉴于多数脆弱成人分布于社区或非急性护理场景中，相关干预策略应针对性覆盖此类护理场景。开发可支持非物理治疗人员在上述护理场景中识别关节挛缩相关风险的结构化风险评估工具，将为风险管理提供重要支撑资源。