Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial
Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial
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DOI：
10.1001/jamaneurol.2019.1604
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发表时间：
2019-09-01
期刊：
影响因子：
29
通讯作者：
Sheehy, Christiana
中科院分区：
文献类型：
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作者：
Cramer, Steven C.;Dodakian, Lucy;Sheehy, Christiana
关键点：针对中风后手臂运动的6周强化家庭远程医疗课程是否提供与剂量匹配的传统诊所康复治疗相当的康复益处？结果在这项随机、评估者盲法、非劣效性临床试验中，124名中风后的成年人接受了远程康复治疗，在改善运动状态（Fugl-Meyer手臂运动量表）和提高患者对中风的认识方面，远程康复治疗显示出与传统的临床康复治疗相当的疗效。MeaningTelehealth是一种有效的手段，提供康复治疗和改善中风后患者的结果，并可能有助于改善获得康复therapy.ImportanceMany患者接受次优的康复治疗剂量中风后，由于有限的治疗师和交通困难，他们对中风的知识往往是有限的。远程保健有可能解决这些问题。目的确定通过家庭远程康复（TR）系统提供的针对手臂运动的治疗是否与传统诊所（IC）环境中提供的剂量匹配、强度匹配的治疗具有可比的疗效，并检查该系统是否具有提供卒中教育的可比疗效。设计、设置和实验对象在美国11个研究中心进行的随机、评估者设盲、非劣效性试验中，124例患者在4 - 36周前发生过卒中，并有手臂运动障碍。（Fugl-Meyer [FM]评分，22-56/66）在2015年9月18日至2017年12月28日期间入组，在家中接受远程康复治疗（TR组）或在门诊康复治疗诊所接受治疗（IC组）。主要疗效分析使用意向治疗人群。干预参与者接受了36次手臂运动疗法（每次70分钟）加中风教育，治疗强度，持续时间和频率在各组之间匹配。主要结果和测量FM评分从基线到治疗结束后4周的变化和卒中知识从基线到治疗结束的变化。结果共有124名参与者（34名女性和90名男性），平均（SD）年龄为61（14）岁，平均（SD）基线FM评分为43（8）分，平均（SD）为18.7（8.9）周后，经历了中风。在接受治疗的患者中，IC组患者依从36次治疗中的33.6次（93.3%），TR组患者依从36次分配治疗中的35.4次（98.3%）。IC组患者从基线至治疗后30天的平均（SD）FM评分变化为8.36（7.04）分（P
Key PointsQuestionDoes a 6-week course of intensive home-based telehealth targeting arm movements after stroke provide rehabilitation benefits that are comparable with those derived from dose-matched traditional in-clinic rehabilitation therapy? FindingsIn this randomized, assessor-blinded, noninferiority clinical trial of 124 adults following stroke, telerehabilitation showed comparable efficacy to traditional in-clinic rehabilitation for improving motor status (Fugl-Meyer arm motor scale) and for improving patient knowledge about stroke. MeaningTelehealth is an effective means to provide rehabilitation therapy and improve patient outcomes after stroke and may be useful for improving access to rehabilitation therapy.ImportanceMany patients receive suboptimal rehabilitation therapy doses after stroke owing to limited access to therapists and difficulty with transportation, and their knowledge about stroke is often limited. Telehealth can potentially address these issues. ObjectivesTo determine whether treatment targeting arm movement delivered via a home-based telerehabilitation (TR) system has comparable efficacy with dose-matched, intensity-matched therapy delivered in a traditional in-clinic (IC) setting, and to examine whether this system has comparable efficacy for providing stroke education. Design, Setting, and ParticipantsIn this randomized, assessor-blinded, noninferiority trial across 11 US sites, 124 patients who had experienced stroke 4 to 36 weeks prior and had arm motor deficits (Fugl-Meyer [FM] score, 22-56 of 66) were enrolled between September 18, 2015, and December 28, 2017, to receive telerehabilitation therapy in the home (TR group) or therapy at an outpatient rehabilitation therapy clinic (IC group). Primary efficacy analysis used the intent-to-treat population. InterventionsParticipants received 36 sessions (70 minutes each) of arm motor therapy plus stroke education, with therapy intensity, duration, and frequency matched across groups. Main Outcomes and MeasuresChange in FM score from baseline to 4 weeks after end of therapy and change in stroke knowledge from baseline to end of therapy. ResultsA total of 124 participants (34 women and 90 men) had a mean (SD) age of 61 (14) years, a mean (SD) baseline FM score of 43 (8) points, and were enrolled a mean (SD) of 18.7 (8.9) weeks after experiencing a stroke. Among those treated, patients in the IC group were adherent to 33.6 of the 36 therapy sessions (93.3%) and patients in the TR group were adherent to 35.4 of the 36 assigned therapy sessions (98.3%). Patients in the IC group had a mean (SD) FM score change of 8.36 (7.04) points from baseline to 30 days after therapy (P