背景:数字健康干预(DHIs)已用于改善老年髋部骨折患者的术后功能。然而,关于家用DHI的特征的信息有限,关于它们对该人群功能结局的影响存在争议。
目的:本研究旨在概述家庭DHI对老年髋部骨折患者术后功能预后的影响和特点。
方法:我们遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南进行了系统评价和荟萃分析。五个电子医疗数据库(PubMed,Embase,科克伦,ProQuest,和CINAHL)一直搜索到2023年1月3日。我们纳入了英国的临床试验或随机对照试验(RCT),涉及家庭DHIs用于老年髋部骨折患者的术后护理。排除的研究涉及未住院的患者,没有出院回家,不直接使用DHI,或无法访问的全文。PROSPERO的注册号是CRD42022370550。两名独立的审阅者筛选并提取数据(SP和NB)。通过与第三作者(KP)的讨论和协议解决了分歧。以家庭为基础的DHI的特点是在目的和内容方面,交货方式,和医疗保健提供者。评估的功能结果包括定时上行和下行(TUG)测试,短物理性能电池(SPPB),和功能独立性度量(FIM)。汇总测量是使用95%CI的平均差异计算的。偏倚风险使用RCT的风险2评估工具和非RCT的ROBINS-I评估。使用GRADE(建议评估的分级,开发和评估)。
结果:在2125项确定的研究中,16个被纳入系统审查,涉及1467名参与者。荟萃分析中包括6项研究(4项TUG,4对于SPPB,FIM为2)。基于家庭的DHI主要涉及沟通和反馈,教育,和远程康复。电话是最常见的送货方式,其次是基于Web的软件和移动应用程序。物理治疗师是主要的医疗保健提供者。荟萃分析显示,与常规护理相比,以家庭为基础的DHI改善了功能结局,TUG评分降低(平均差异=-7.89;95%CI-10.34至-5.45;P<.001),SPPB评分显著增加(平均差异=1.11;95%CI0.51-1.72;P<.001),FIM评分增加(平均差异=7.98;95%CI5.73-10.24;P<.001)。
结论:基于家庭的DHI,集成了通信和反馈,教育,在髋部骨折术后恢复的老年患者中,远程康复治疗在提高功能结局方面已证明是有效的.这些干预措施通常由物理治疗师管理,在促进和指导康复过程中发挥着至关重要的作用。然而,虽然现有证据支持这种干预措施的有效性,需要进一步的研究来增强我们的理解,并优化针对这一特定人群的家庭DHI的实施.
BACKGROUND: Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population.
OBJECTIVE: This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery.
METHODS: We conducted a systematic
review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
RESULTS: Of 2125 identified studies, 16 were included in the systematic
review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001).
CONCLUSIONS: Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.