Miten sosiaali- ja terveydenhuollon vaikuttavuutta pitäisi tutkia?

Vaikuttavuutta arvioitaessa tutkimusasetelma on valittava huolellisesti. Milloin tehdään satunnaistettu kontrolloitu koe? Entä mihin käytetään vertaiskontrolloitua tutkimusta

Järjestelmällinen kirjallisuuskatsaus vaikuttavuudesta. Apuväline terveyden- ja sosiaalihuollon ammattilaisille, tutkijoille ja päättäjille

Lääketieteellisten järjestelmällisten kirjallisuuskatsausten määrät ovat kasvaneet voimakkaasti 1990-luvulta alkaen. Järjestelmällisessä katsauksessa pyritään toistettavuuteen ja vähentämään katsaukseen liittyvän harhan riskiä. Ennen katsaukseen ryhtymistä laaditaan tutkimussuunnitelma, jossa määritellään kriteerit katsaukseen hyväksyttäville alkuperäisartikkeleille, kuvataan mahdollisimman kattavan kirjallisuushaun teko, katsaukseen hyväksyttyjen tutkimusten menetelmällisen laadun arviointi sekä suunnitelma informaation yhdistämisestä. Tämän artikkelin tavoitteena on antaa yleiskuva järjestelmällisistä kirjallisuuskatsauksista, jotka tuottavat luotettavinta tietoa vaikuttavuudesta. Järjestelmällisistä kirjallisuuskatsauksista hyötyvät kaikki vaikuttavuudesta kiinnostuneet: terveyden- ja sosiaalihuollon ammattilaiset, tutkijat ja päättäjät

Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis

Objective To review and compare treatments (1) after primary traumatic shoulder dislocation aimed at minimising the risk of chronic shoulder instability and (2) for chronic post-traumatic shoulder instability. Design Intervention systematic review with random effects network meta-analysis and direct comparison meta-analyses. Data sources Electronic databases (Ovid MEDLINE, Cochrane Clinical Trials Register, Cochrane Database of Systematic Reviews, Embase, Scopus, CINAHL, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, DARE, HTA, NHSEED, Web of Science) and reference lists were searched from inception to 15 January 2018. Eligibility criteria for selecting studies Randomised trials comparing any interventions either after a first-time, traumatic shoulder dislocation or chronic post-traumatic shoulder instability, with a shoulder instability, function or quality of life outcome. Results Twenty-two randomised controlled trials were included. There was moderate quality evidence suggesting that labrum repair reduced the risk of future shoulder dislocation (relative risk 0.15; 95% CI 0.03 to 0.8, p=0.026), and that with non-surgical management 47% of patients did not experience shoulder redislocation. Very low to low-quality evidence suggested no benefit of immobilisation in external rotation versus internal rotation. There was low-quality evidence that an open procedure was superior to arthroscopic surgery for preventing shoulder redislocations. Conclusions There was moderate-quality evidence that half of the patients managed with physiotherapy after a first-time traumatic shoulder dislocation did not experience recurrent shoulder dislocations. If chronic instability develops, surgery could be considered. There was no evidence regarding the effectiveness of surgical management for post-traumatic chronic shoulder instability.Peer reviewe

DEVELOPMENT AND APPLICATION OF IMPLEMENTATION TOOLS FOR REHABILITATION GUIDELINES

Objective: To describe a project to develop guideline implementation tools (GItools) for rehabilitation guidelines, and a collaboration between a guideline producer and a healthcare organization to implement guidelines into care pathways. Design: Descriptive case study. Methods: A national guideline organization in Finland launched a 3-year project in 2015 to implement rehabilitation recommendations. Usability of the GItools was evaluated and improved, based on literature, workshops and surveys. An implementation plan guided the production of the GItools. An implementation plan was developed to integrate the shoulder disorders guideline into a care pathway at Paijat-Hame district rehabilitation unit. The implementation plan was produced in 3 facilitated workshops, which included brainstorming, snowballing, prioritizing and short lectures. Results: Twenty implementation plans and 119 different GItools for 22 guidelines were developed. The GItools, in particular patient material, were perceived as useful for the facilitation of guideline implementation. Four seminars and 14 sessions of continuous medical education were arranged. A plan was developed and executed for the implementation of the shoulder disorders guideline. Conclusion: It is feasible for a guideline producer to systematically include GItools into rehabilitation guidelines. This implementation project was an example of a successful collaboration between a guideline producer and a healthcare organization.Peer reviewe