目的:目的是系统评价远程医疗联合常规护理(当面访视)在神经系统疾病的治疗管理和随访评估中与常规护理相比的有效性和安全性。
方法:电子数据库MEDLINE,Embase,搜索了WebofScience和Cochrane中央对照试验登记册(2021年6月)。考虑了针对任何年龄的神经系统疾病患者的随机对照试验(RCT)。两名评审员一式两份独立筛选和提取数据,并使用Cochrane偏见风险工具评估随机试验的偏见风险(RoB2)。如果可能,计算了汇总效应估计值。
结果:在最初检索的3018条记录中,包括25项RCT(n=2335):中风11项(n=804),四(n=520)帕金森病,三(n=110)多发性硬化症,两个(n=320)关于癫痫,一个(n=63)关于痴呆症,一个(n=23)脊柱裂,一个(n=40)偏头痛,一个(n=22)关于脑瘫,一个(n=433)关于脑损伤。评估的远程医疗类型是在线访问(11项研究),远程康复(七项研究),电话(三),智能手机应用程序(两个)和在线计算机软件(两个)。除了中风,证据非常有限。与常规护理相比,发现远程医疗加上常规护理可以改善抑郁症状,功能状态,运动功能,执行功能,一般的生活质量,卒中后随访患者的医疗保健利用和健康生活方式。
结论:需要精心设计和执行的随机对照试验来证实我们对中风的发现,并为其他神经系统疾病提供更多的科学证据。
The aim was to systematically
review the effectiveness and safety of telemedicine combined with usual care (in-person visits) compared to usual care for the therapeutic management and follow-up assessment of neurological diseases.
The electronic databases MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched (June 2021). Randomized controlled trials (RCTs) on patients of any age with neurological diseases were considered. Two reviewers screened and abstracted data in duplicate and independently and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials (RoB 2). When possible, pooled effect estimates were calculated.
Of a total of 3018 records initially retrieved, 25 RCTs (n = 2335) were included: 11 (n = 804) on stroke, four (n = 520) on Parkinson\'s disease, three (n = 110) on multiple sclerosis, two (n = 320) on epilepsy, one (n = 63) on dementia, one (n = 23) on spina bifida, one (n = 40) on migraine, one (n = 22) on cerebral palsy and one (n = 433) on brain damage. Types of telemedicine assessed were online visits (11 studies), tele-rehabilitation (seven studies), telephone calls (three), smartphone apps (two) and online computer software (two). The evidence was quite limited except for stroke. Compared to usual care alone, telemedicine plus usual care was found to improve depressive symptoms, functional status, motor function, executive function, generic quality of life, healthcare utilization and healthy lifestyle in patients in post-stroke follow-up.
Well-designed and executed RCTs are needed to confirm our findings on stroke and to have more scientific evidence available for the other neurological diseases.