全关节置换术是全球最常用的骨科手术之一。远程关节康复最近已被用作全关节置换术后患者面对面康复服务的补充或替代。

目标

综合有关基于互联网的远程康复在缓解疼痛，运动范围，身体功能，健康相关的生活质量，自我效能，心理健康/问题以及全关节置换术后患者满意度方面的有效性证据。

方法

使用预先定义的搜索时间段，数据库和搜索词进行了文献检索和综述。采用了五阶段方法：问题识别，文献检索，数据评估，数据分析和展示。纳入英文和中文发表的研究。使用混合方法评估工具评估纳入研究的质量。

结果

纳入了22项研究，共有1179名参与者。其中19项在北美，欧洲和澳大利亚进行，3项在中国进行。有20项定量和定性研究。2003年和2017年之间的研究主要利用视频会议（n  = 11），而自2017年以来移动应用（n= 7）已成为主要模式。物理治疗师在17项研究中提供了基于网络的远程康复，而在3项研究中则由护士提供。大多数纳入研究报告称，与面对面的康复相比，基于互联网的远程康复在缓解疼痛，运动范围，身体机能和健康相关的生活质量方面显示出可比的改善。患者的满意度更高。很少有研究针对患者的心理健康/问题和自我效能作为结果指标。

结论

全关节置换术后，基于互联网的远程康复似乎对患者有效并为患者所接受。远程康复可以由护士与物理治疗师和外科医生作为一个团队合作进行。该移动应用程序是用于远程康复的可获得且灵活的传递媒体。必须进行可靠的随机对照试验，以提高基于移动应用的远程康复和护士提供的程序的有效性的证据质量。建议在未来的研究中纳入定性成分，并测量心理指标。

 

 

Background

Total joint arthroplasty is one of the most commonly performed orthopaedic procedures globally. Telerehabilitation has recently been used as a supplement or an alternative to face-to-face rehabilitation services among patients after total joint arthroplasty.

Objectives

To synthesise the evidence on the effectiveness of internet-based telerehabilitation regarding pain relief, range of motion, physical function, health-related quality of life, self-efficacy, psychological well-being/problems, and satisfaction among patients after total joint arthroplasty.

Methods

An integrative review was conducted using defined search periods, databases, and search terms. This review adopted a five-stage approach: problem identification, literature search, data evaluation, data analysis and presentation. Studies published in English and Chinese were included. The Mixed Methods Appraisal Tool was used to assess the quality of included studies.

Results

Twenty-two eligible studies with 1,179 participants were included in this review. Nineteen of them were conducted in North America, Europe and Australia, and three in China. There were 20 quantitative and two qualitative studies. Synchronous mode using videoconferencing (n = 11) was predominant in the studies between 2003 and 2017, while asynchronous mode using mobile apps (n = 7) has become the main mode since 2017. Internet-based telerehabilitation was delivered by physiotherapists in 17 studies and by nurses in three. Most of the included studies reported that, compared to face-to-face rehabilitation, internet-based telerehabilitation showed a comparable improvement in pain relief, range of motion, physical function, and health-related quality of life. Patients had a high satisfaction level. Very few studies addressed the patients’ psychological well-being/problems and self-efficacy as the outcome measures.

Conclusions

Internet-based telerehabilitation appears to be effective for and accepted by patients after total joint arthroplasty. Telerehabilitation could be delivered by nurses in collaboration with physiotherapists and surgeons as a team. The mobile app is an accessible and flexible delivery medium for telerehabilitation. Robust randomised controlled trials are warranted to enhance the quality of evidence on the effectiveness of mobile app-based telerehabilitation and nurse-delivered program. Qualitative components are suggested to be included in future research. Psychological outcomes should also be measured.

原文链接：

https://www.sciencedirect.com/science/article/pii/S0020748920303369

 

 

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