接受心脏手术的患者可能会经历一系列生理变化,术后恢复时间长。患者及其家属在出院后常常对生活质量(QoL)感到担忧。电子健康干预措施可以提高患者的参与度,确保积极有效的健康管理,提高家庭护理质量和患者的生活质量,降低抑郁症的发生率。
这项研究的目的是评估eHealth干预措施对生理学的影响,心理学,以及成人心脏手术后患者的依从性,为临床实践提供理论依据。
我们对以下4个电子数据库进行了系统搜索:PubMed,Embase,CINAHL,和Cochrane中央受控试验登记册。平均值(SD)值用于计算所有连续数据的合并效应大小,包括QoL,焦虑,和抑郁症。如果使用不同的仪器获得相同的结果,我们选择具有95%CI的标准化平均差来表示组合效应大小;否则,使用平均差(MD)和95%CI。使用赔率比计算所有二分数据的组合效应大小。卡方分布的CohenQ检验和不一致性指数(I2)用于测试研究之间的异质性。如果数据中没有显著的异质性(I2≤50%),我们选择固定效应模型来估计效应大小;否则,使用随机效应模型。纳入研究的质量使用Cochrane偏倚风险工具进行随机试验(RoB2)评估。
搜索确定了3632篇论文,其中19人符合纳入标准。就物理结果而言,对照组的评分低于干预组(MD0.15,95%CI0.03-0.27,I2=0%,P=.02)。干预组和对照组之间的心理结局没有显着差异(MD0.10,95%CI-0.03至0.24,I2=46.4%,P=.14)。对照组的抑郁结果得分低于干预组(MD-0.53,95%CI-0.89至-0.17,I2=57.1%,P=.004)。大多数干预组的依从性改善。敏感性分析的结果是稳健的。几乎一半的纳入研究(9/19,47%)有中度到高度的偏倚风险。证据质量中等到较低。
eHealth改善了心脏手术后生活质量和抑郁的身体成分;然而,生活质量的心理因素没有统计学差异。电子健康对患者依从性的有效性一直存在争议。需要对数字健康进行进一步的高质量研究。
PROSPEROCRD42022327305;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=327305。
Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient\'s quality of life, and reduce rates of depression.
The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice.
We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2).
The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group\'s score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low.
eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required.
PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.