The Efficacy of Electronic Health-Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review.
The Efficacy of Electronic Health-Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review.
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DOI：
10.2196/jmir.9465
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发表时间：
2018-04-26
影响因子：
7.4
通讯作者：
Paelke V
中科院分区：
文献类型：
--
作者：
Schäfer AGM;Zalpour C;von Piekartz H;Hall TM;Paelke V
膝关节骨关节炎是老年人残疾和活动受限的最常见原因，具有相当大的个人痛苦和高的直接和间接疾病相关费用。非手术干预，如锻炼、加强身体活动和自我管理，对减轻疼痛、身体功能和生活质量（QoL）有有益的影响，但这些治疗方法的可及性可能有限。因此，强烈建议家庭治疗。然而，这些项目的坚持度很低。患者报告缺乏动力，反馈和个人互动是家庭治疗依从性的主要障碍。为了克服这些障碍，电子保健（eHealth）被视为一个有希望的机会。尽管已有文献显示电子健康干预对慢性疼痛、心血管疾病和糖尿病等其他慢性疾病的有益作用，但目前还没有关于电子健康干预对膝关节骨关节炎患者疗效的系统文献综述。本研究的目的是比较ehealth支持的家庭运动干预与无干预或其他干预对膝关节骨关节炎患者疼痛、身体功能和健康相关生活质量的影响。MEDLINE， CENTRAL， CINAHL和PEDro使用关键词骨关节炎膝关节，eHealth和运动进行系统搜索。对单项研究的标准化平均差异（SMDs）进行反方差随机效应荟萃分析。使用Cochrane工具评估单个研究的偏倚风险，并按照推荐、评估、发展和评估分级方法评估各研究的证据质量。文献检索共产生648个结果。在筛选了题目、摘要和全文后，纳入了7项随机对照试验。汇总单个研究的数据表明，短期（疼痛SMD= - 0.31, 95% CI - 0.58至- 0.04，低质量；生活质量SMD=0.24, 95% CI 0.05-0.43，中等质量）和长期效果（疼痛- 0.30,95% CI - 0.07至- 0.53，中等质量；身体功能0.41,95% CI 0.17-0.64，高质量；生活质量SMD=0.27, 95% CI 0.06-0.47，高质量）有益。与无干预或其他干预相比，ehealth支持的运动干预减少了疼痛，改善了身体功能，改善了与健康相关的生活质量；然而，这些改善很小（SMD<0.5），可能对个体患者没有意义。低依从性被视为电子卫生干预的一个限制因素。未来的研究应侧重于电子健康技术的参与式发展，将运动科学的循证原则与提高患者动机和依从性的方法结合起来。
Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality). eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence.
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