Systematic evaluation of the clinical nursing pathway with the GRADE approach applied to functional exercise in patients with hip replacements before and after surgery

Objective: To evaluate the effect of the clinical nursing pathway applied to functional exercise in patients with hip replacements before and after the operation.Methods: The China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese science and technology journal database (VIP), PubMed, Web of Science, EMBASE, CBM and the Cochrane Library (2015-5) were searched for randomized controlled trials (RCTs) on clinical nursing pathways for functional exercise in patients with hip replacements before and after surgery from June 2015 to January 2010. The references included in the literature were also retrieved. To meet the literature standard, 2 reviewers independently selected and extracted data according to the inclusion criteria and assessed the risks of bias. RevMan 5.3 software was used in this meta-analysis. The quality of evidence was evaluated using grade profiler3.6 software, the level recommended for grading.Results: A total of 15 RCTs and 1248 patients were included. The meta-analysis showed that, in the clinical nursing path group, the Harris score of hip function [SMD = 3.35, 95%CI (2.53, 4.16), P < 0.00001] and incidence of thrombosis embolism [RR = 0.28, 95%CI (0.15, 0.53), P < 0.0001], pulmonary infection [RR = 0.33, 95%CI (0.14, 0.82), P = 0.02], urinary retention [RR = 0.22, 95%CI (0.09, 0.52), P = 0.0005], constipation [RR = 0.20, 95%CI (0.10, 0.40), P < 0.00001], patients' satisfaction for nursing care [RR = 1.26, 95%CI (1.17, 1.36), P < 0.00001] and shortened hospitalization times [SMD = −1.91, 95%CI (−2.39, −1.43), P < 0.0001]were statistically significantly better than those in the control group. However, in reducing joint dislocations [RR = 0.25, 95%CI (0.05, 1.15), P = 0.08], pressure ulcers [RR = 0.25, 95%CI (0.03, 2.19), P = 0.21], and incidence of complications [RR = 0.42, 95%CI (0.15, 1.12), P = 0.08], there was no statistically significant difference between the two groups. Funnel plot analysis of the average length of stay showed that there might be some publication bias in the literature. The GRADE evaluation results showed that the level of Harris scores for hip function was moderate and the incidence of thrombosis, urinary retention and satisfaction of patients regarding nursing were low, and the rest of the factors analyzed were very low.Conclusions: The effect of the clinical nursing pathway applied to functional exercises in patients with hip replacements before and after surgery was significantly better than that of routine nursing. However, it was restricted by the evaluation grade of the research results and the standardization and uniformity of the research. The results of the above study need to be verified by more high-quality RCTs