髋关节或膝关节置换术患者远程物理康复的有效性和安全性:一项前瞻性随机比较研究

G. Sheiko, N. N. Karyakin, Anna N. Belova, Vadim D. Daminov, William O. Sushin, M. A. Shabanova, Olga V. Vorobyova, Sergey S. Ananyev
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An assessment of the effectiveness and safety of rehabilitation measures was carried out, including an analysis of physical examination data, vital signs, as well as data from various scales, tests and questionnaires (the 10-point visual-analog scale (VAS), the Timed 25-Foot Walk (T25-FW), the \"Timed Up and Go Test\", the Berg Balance Scale (BBS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC)). \nRESULTS AND DISCUSSION. 14 patients were randomized to the remote physical rehabilitation group (49.6 ± 12.4 years) and 16 to the comparison group (57.8 ± 11.2 years). Participation in the study was completed by 10 patients from the RPR group and all 16 patients in the comparison group. 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引用次数: 0

摘要

引言医疗康复的一个紧迫问题是,由于康复过程的中断和病人出院后不在家中上课,导致在各个阶段取得的成果付之东流。在这方面,在医疗康复的第三阶段,远程(远程医疗)康复援助形式尤为重要,由于新信息技术的出现,医疗专业人员和病人之间可以进行积极的交流,因此这种形式具有广阔的发展前景。然而,对远程物理康复的有效性和安全性问题的研究仍然不足,因此有必要进行随机比较试验,并对长期结果进行分析。目的评估远程物理康复(RPR)模式对一组接受髋关节(HR)或膝关节(KR)置换术患者的有效性和安全性,研究患者的依从性,以及选择最有参考价值的评估工具。研究对象包括 30 名接受髋关节或膝关节置换术的患者,年龄在 30 岁至 75 岁之间。研究参与者通过信封法被分为在提供医疗康复的常规临床实践之外进行远程康复(RPR 组)或仅进行常规医疗康复(对比组)的两组,包括住院医疗康复期间掌握的每日在家独立体育锻炼、生活方式调整、服用非甾体类抗炎药以及疼痛综合征的发展。对康复措施的有效性和安全性进行了评估,包括对体格检查数据、生命体征以及各种量表、测试和调查问卷(10 点视觉模拟量表(VAS)、定时 25 英尺步行(T25-FW)、"定时起立行走测试"、伯格平衡量表(BBS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC))的数据进行分析。结果与讨论。14名患者被随机分配到远程物理康复组(49.6 ± 12.4 岁),16名患者被随机分配到对比组(57.8 ± 11.2 岁)。远程物理康复组的 10 名患者和对比组的所有 16 名患者都完成了研究。比较两组患者在参加研究 1 个月后的康复结果发现,RPR 组患者在 T25-FW(P 0.0001)、"定时起床和走动测试"(P = 0.0064)、Berg 平衡量表(P = 0.0008)和 WOMAC(P 0.0001)方面的功能改善在统计学上更为显著。根据所得结果,选择了 "定时起立行走测试"、视觉模拟量表和 WOMAC 进行进一步的实际工作。年龄较大(χ2 16.75,P 0.0001)、养老金领取者身份(χ2 11.75,P = 0.0006)和居住地区(χ2 11.75,P = 0.0006)是提前终止 RPR 的最重要预测因素。不良事件分析显示,RPR 组有 4 名患者和对比组有 6 名患者的手术肢体疼痛综合征出现周期性加重。结论。研究结果表明,对接受髋关节或膝关节置换术的患者进行康复训练在恢复功能活动度、降低跌倒风险和疼痛综合征严重程度方面是安全有效的,并能提高患者对体育锻炼的依从性。远程物理康复在实际应用中的主要局限性与高速互联网的可用性和互联网门户网站的使用技巧有关。
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Efficacy and Safety of Remote Physical Rehabilitation in Patients with Hip or Knee Replacement: a Prospective Randomized Comparative Study
INTRODUCTION. An urgent problem of medical rehabilitation is the loss of results that were achieved at various stages due to the interruption of the recovery process and the absence of patients' classes at home after discharge from a medical institution. In this regard, at the third stage of medical rehabilitation, the remote (telemedicine) form of rehabilitation assistance is of particular importance, which has broad prospects for development due to the emergence of new information technologies that allow for active communication between a medical professional and a patient. Nevertheless, the issues of the effectiveness and safety of remote physical rehabilitation remain insufficiently studied, and therefore it is necessary to conduct randomized comparative trials with the analysis of long-term results. AIM. Evaluation of the effectiveness and safety of the remote physical rehabilitation (RPR) model for a group of patients who have undergone hip (HR) or knee (KR) replacement, the study of patient adherence, as well as the selection of the most informative evaluation tools. MATERIALS AND METHODS. The study included 30 patients aged 30 to 75 years who underwent HR or KR. The study participants were distributed by the envelope method into groups for remote rehabilitation in addition to routine clinical practice of providing medical rehabilitation (RPR group) or conducting only routine medical rehabilitation (comparison group), including daily independent physical exercises at home, mastered during inpatient medical rehabilitation, lifestyle modification, taking nonsteroidal anti-inflammatory drugs with the development of pain syndrome. An assessment of the effectiveness and safety of rehabilitation measures was carried out, including an analysis of physical examination data, vital signs, as well as data from various scales, tests and questionnaires (the 10-point visual-analog scale (VAS), the Timed 25-Foot Walk (T25-FW), the "Timed Up and Go Test", the Berg Balance Scale (BBS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC)). RESULTS AND DISCUSSION. 14 patients were randomized to the remote physical rehabilitation group (49.6 ± 12.4 years) and 16 to the comparison group (57.8 ± 11.2 years). Participation in the study was completed by 10 patients from the RPR group and all 16 patients in the comparison group. Comparing the results of rehabilitation between the groups 1 month after the inclusion of participants in the study revealed a more pronounced statistically significant improvement in the functional profile of the patient on the T25-FW (p 0.0001), the "Timed Up and Go Test" (p = 0.0064), the Berg Balance Scale (p = 0.0008) and WOMAC (p 0.0001) in group of RPR. The "Timed Up and Go Test", the visual analog scale and the WOMAC were selected based on the results obtained for further practical work. The most significant predictors of premature termination of RPR were older age (χ2 16.75, p 0.0001), pensioner status (χ2 11.75, p = 0.0006) and residence in the region (χ2 11.75, p = 0.0006). The analysis of adverse events showed that 4 patients in the RPR group and 6 in the comparison group had a periodic increase in pain syndrome in the operated limb. CONCLUSION. The results obtained demonstrate that of patients who have undergone hip or knee replacement is safe and effective in restoring functional mobility, reducing the risk of falls and the severity of pain syndrome, and increases adherence to physical exercises. The main limitations in the practical use of remote physical rehabilitation are related to the availability of high-speed Internet and the skills of using Internet portals.
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