Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review.
Evidence of Benefit of Telerehabitation After Orthopedic Surgery: A Systematic Review.
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DOI：
10.2196/jmir.6836
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发表时间：
2017-04-28
影响因子：
7.4
通讯作者：
Estebanez-Perez, Maria Jose
中科院分区：
文献类型：
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作者：
Pastora-Bernal, Jose Manuel;Martin-Valero, Rocio;Estebanez-Perez, Maria Jose
背景：除了传统的物理治疗外，基于远程康复计划的研究已经公布了在一些神经、认知和肌肉骨骼疾病方面的有效性、有效性、非劣势和重要优势的结果，为确定新的社会政策和干预措施提供了机会。目的：本系统综述的目的是调查外科手术后远程康复对骨科状况的影响，描述干预措施的设计，并确定远程康复是否可与传统的交付方法相比较。方法：根据牛津循证医学中心的建议，使用物理疗法证据数据库(PEDRO)评分和推荐等级对研究质量进行评估。结果：我们发现了3项研究，Pedro评分在6到8之间，被认为是1级证据(良好；20%[3/15])，4项研究评分为5，被认为是2级证据(可接受；27%[4/15])，其余8项研究的得分为4或更低，被认为(差；53%[8/15])。在选定的研究中，共有1316名参与者接受了远程康复干预，其中膝关节和髋关节置换术占所有研究的75%。在膝关节和髋关节置换干预中发现了强烈和中等等级的证据(建议A-B级)。关于上肢的研究占研究的25%，但只有1项研究的证据等级为中等(建议B级)，其余的研究方法质量较差，证据较弱(建议C级)。结论：无论病理如何，均未获得骨科手术后远程康复治疗疗效的确凿证据。我们发现强有力的证据支持全膝关节和髋关节置换术后患者的远程康复，而上肢干预的证据有限(中等和微弱的证据)。未来的研究需要更广泛和更具说服力。据作者所知，这是第一次对矫形外科手术后远程康复干预研究的质量进行系统评价。临床信息和未来的研究建议被包括在审查中。
BACKGROUND: In addition to traditional physiotherapy, studies based on telerehabilitation programs have published the results of effectiveness, validity, noninferiority, and important advantages in some neurological, cognitive, and musculoskeletal disorders, providing an opportunity to define new social policies and interventions.OBJECTIVES: The aim of this systematic review is to investigate the effects of telerehabilitation after surgical procedures on orthopedic conditions as well as to describe how interventions are designed and to determine whether telerehabilitation is comparable with conventional methods of delivery. This systematic review summarizes the levels of evidence and grades of recommendation regarding telerehabilitation intervention (synchronous or asynchronous provided via the telerehabilitation medium, either in conjunction with, or in isolation of, other treatment interventions) after surgical procedures on orthopedic conditions.METHODS: Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scores and grade of recommendation following the recommendation of the Oxford Centre for Evidence-Based Medicine.RESULTS: We found 3 studies with PEDro scores between 6 and 8, which is considered as level 1 evidence (good; 20% [3/15]), 4 studies with a score of 5, which is considered as level 2 evidence (acceptable; 27% [4/15]), and the remaining 8 studies had scores of 4 or less, which is considered (poor; 53% [8/15]). A total of 1316 participants received telerehabilitation intervention in the selected studies, where knee and hip replacement were 75% of all the studies. Strong and moderate grades of evidence (grade of recommendation A-B) were found in knee and hip replacement interventions. Studies on the upper limb were 25% of the studies, but only 1 study presented a moderate grade of evidence (grade of recommendation B) and the rest were of poor methodological quality with weak evidence (grade of recommendation C).CONCLUSIONS: Conclusive evidence on the efficacy of telerehabilitation for treatment after an orthopedic surgery, regardless of pathology, was not obtained. We found strong evidence in favor of telerehabilitation in patients following total knee and hip arthroplasty and limited evidence in the upper limb interventions (moderate and weak evidence). Future research needs to be more extensive and conclusive. To the best of the authors' knowledge, this is the first attempt at evaluating the quality of telerehabilitation intervention research after surgical procedures on orthopedic conditions in a systematic review. Clinical messages and future research recommendations are included in the review.