自决理论干预与糖尿病患者的常规护理:通过元分析和试验顺序分析进行系统审查
Anne Sophie Mathiesen1,2,3, Vibeke Zoffmann4,5,6, Jane Lindschou7
1Department of Endocrinology, Center for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. anne.sophie.mathiesen@regionh.dk.
Systematic reviews
|September 6, 2023
概括
自决理论的干预措施对糖尿病的结果,如生活质量或死亡率,没有显著的益处. 证据的确定性仍然很低,对大多数临床和心理社会措施没有明显的影响.
科学领域:
- 内分泌学和新陈代谢学
- 行为医学是一种行为医学.
- 健康心理学 心理健康心理学
背景情况:
- 自主支持的干预措施,包括自决理论 (SDT) 和指导自决,显示出改善糖尿病自我管理和结果的潜力.
- 缺乏系统审查,评估这些干预措施的好处和危害,同时通过试验顺序分析控制随机错误风险.
- 本综述特别探讨了基于SDT的干预措施的好处和危害,与糖尿病患者的通常护理相比.
研究的目的:
- 在糖尿病患者中系统地审查基于自决理论的干预措施的益处和危害.
- 用严格的方法,包括试验顺序分析,比较基于SDT的干预措施与通常的护理.
- 评估各种临床和心理社会结果的证据的确定性.
主要方法:
- 进行了柯克兰方法系统审查,包括SDT或指导自决干预的随机临床试验.
- 在多个数据库中进行了全面的文献搜索,截至2022年4月.
- 偏差风险,数据提取和结果评估 (生活质量,死亡率,不良事件,糖尿病困扰,抑郁症状,糖化血红蛋白A1c,动机) 由两位作者独立进行. 试验顺序分析和GRADE被用来评估证据的确定性.
主要成果:
- 纳入了11个随机试验,共6059名参与者,所有参与者都被评估为具有高偏差风险.
- 与常规护理相比,基于SDT的干预措施对生活质量,全因死亡率,严重不良事件,糖尿病困扰,抑郁症状或糖化血红蛋白A1c没有显著影响.
- 观察到对自主动机和减少动机的潜在有益影响,尽管有低确定性证据支持这一观点. 控制的动机没有影响.
结论:
- 基于自决理论的干预措施对糖尿病患者的初级或二级结果没有显著影响.
- 对所有评估结果的证据的整体确定性低至非常低.
- 需要进一步进行高质量的研究,以澄清这些干预措施的潜在作用.
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