目的:比较远程康复与常规康复对慢性呼吸系统疾病(CRD)患者康复结局的影响。
方法:Cochrane图书馆,MEDLINE,搜索WebofScience和Embase,以收集自数据库建立以来至2023年11月14日关于远程康复治疗慢性呼吸系统疾病患者康复的随机对照试验(RCT)。两名研究者根据纳入标准独立筛选文献并提取有效数据。纳入研究的质量评估是通过使用RoB2(偏见风险2)工具单独进行的,然后使用RevMan5.3软件进行荟萃分析。
结果:根据纳入和排除标准,包括21项RCT,由3030名参与者组成,远程康复组1509例,常规康复组1521例。Meta分析结果表明,与传统康复相比,基于视频会议的远程康复显示出短期(≤6个月)结果的显着改善,包括6分钟步行距离(6MWD)(MD=7.52,95%CI:2.09,12.94),改良医学研究委员会呼吸困难量表(mMRC)(MD=-0.29,95%CI:-0.41,-0.18),COPD评估测试(CAT)(MD=-1.77,95%CI:-3.52,-0.02),HADS(MD=-0.44,95%CI:-0.86,-0.03),和圣乔治呼吸问卷(SGRQ)活动,影响,和症状评分。从长期来看(>6个月),尽管6WMD持续改善[MD=12.89,95%CI(-0.37,26.14)],mMRC[MD=-0.38,95%CI(-0.56,-0.21)],CAT[MD=-1.39,95%CI(-3.83,1.05)],医院焦虑和抑郁量表(HADS)[MD=-0.34,95%CI(-0.66,-0.03)],和SGRQ的活动,影响,干预组和对照组之间的症状评分,仅在mMRC和HADS中观察到统计学上的显著差异.不考虑时间因素,与对照组相比,干预组的FEV1%预测值和第1秒用力呼气容积(FEV1)/用力肺活量(FVC)(%)均有一定改善,但无统计学意义.
结论:远程康复治疗在增强患者的日常活动能力方面显示出短期益处,改善呼吸功能,提高心理健康状况,从而提高患者的生活质量。然而,进一步高质量,需要大样本随机对照试验来确定其长期有效性。
背景:本研究方案在PROSPERO:CRD42024509154中获得批准和注册。
OBJECTIVE: To compare the impact of
telerehabilitation versus conventional rehabilitation on the recovery outcomes of patients with chronic respiratory disease (CRD).
METHODS: The Cochrane Library, MEDLINE, Web of Science and Embase were searched to collect randomized controlled trials (RCTs) on
telerehabilitation for the rehabilitation of patients with chronic respiratory system diseases since the establishment of the database to November 14, 2023. Two researchers independently screened the literature and extracted valid data according to the inclusion criteria. The quality assessment of included studies was conducted individually by using the RoB 2(Risk of Bias 2) tool, followed by meta-analysis using RevMan5.3 software.
RESULTS: Based on inclusion and exclusion criteria, 21 RCTs were included, comprising 3030 participants, with 1509 in the
telerehabilitation group and 1521 in the conventional rehabilitation group. Meta-analysis results indicated that compared to conventional rehabilitation, video conference-based
telerehabilitation demonstrated significant improvements in short-term (≤ 6 months) outcomes, including 6-min walk distance (6MWD) (MD = 7.52, 95% CI: 2.09, 12.94), modified Medical Research Council Dyspnea Scale (mMRC) (MD = -0.29, 95% CI: -0.41, -0.18), COPD assessment test (CAT) (MD = -1.77, 95% CI: -3.52, -0.02), HADS (MD = -0.44, 95% CI: -0.86, -0.03), and St. George\'s Respiratory Questionnaire (SGRQ\'s) activity, impact, and symptom scores. In the long term (> 6 months), although improvements persisted in 6WMD [MD = 12.89, 95% CI (-0.37, 26.14)], mMRC [MD = -0.38, 95% CI (-0.56, -0.21)], CAT [MD = -1.39, 95% CI (-3.83, 1.05)], Hospital anxiety and depression scale (HADS) [MD = -0.34, 95% CI (-0.66, -0.03)], and SGRQ\'s Activity, Impact, and Symptom scores between intervention and control groups, statistically significant differences were observed only for mMRC and HADS. Without considering time factors, the intervention group exhibited some improvement in FEV1% predicted and the forced expiratory volume in the first one second (FEV1)/ forced vital capacity (FVC) (%) without statistical significance compared to the control group.
CONCLUSIONS: Telerehabilitation therapy demonstrates short-term benefits in enhancing patients\' daily activity capacity, improving respiratory function, and enhancing mental health status, thereby improving patients\' quality of life. However, further high-quality, large-sample RCTs are required to ascertain its long-term effectiveness conclusively.
BACKGROUND: This study protocol was approved and registered in PROSPERO: CRD 42024509154.