Alternative models of cardiac rehabilitation: A systematic review
Alternative models of cardiac rehabilitation: A systematic review
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DOI：
10.1177/2047487313501093
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发表时间：
2015-01-01
影响因子：
8.3
通讯作者：
Tideman, Phillip
中科院分区：
文献类型：
--
作者：
Clark, Robyn A.;Conway, Aaron;Tideman, Phillip
传统的以医院为基础的心脏康复模式面临着巨大的挑战，如成本和可及性。近年来，这些挑战导致了心脏康复替代模型的发展。本研究的目的是识别和批评这些替代模型有效性的证据。共检索了22个数据库，以确定关于心脏康复替代模型有效性的定量研究或定量研究的系统综述。使用关键评估技能计划工具和国家卫生和医学研究委员会指定的证据水平对纳入的研究进行评估。83篇纳入的文章描述了以下大类替代护理模式的干预措施：多因素个性化远程保健、基于互联网的远程保健、注重锻炼的远程保健、注重康复的远程保健、以社区或家庭为基础的远程保健以及补充疗法。多因素个体化远程保健和以社区或家庭为基础的心脏康复是有效的心脏康复替代模式，因为与以医院为基础的方案相比，它们在减少心血管疾病风险因素方面效果相似。虽然需要进一步的研究来解决关于农村、偏远地区以及文化和语言不同人群的心脏康复替代模式有效性的可用数据的缺乏，但我们的综述表明，没有必要仅仅依赖以医院为基础的策略来提供有效的心脏康复。地方卫生保健系统应努力整合心脏康复的替代模式，例如根据个人风险因素概况以及社区或家庭规划量身定制的简短远程卫生干预，以确保患者有最适合其需求、风险因素概况和偏好的选择。
The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.