Kairy Dahlia, Lehoux Pascale, Vincent Claude, Visintin Martha
Department of Health Administration, University of Montreal, Canada.
Disabil Rehabil. 2009;31(6):427-47. doi: 10.1080/09638280802062553.
To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities.
Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale.
Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, rehabilitation for speech-language impairments, and rehabilitation for varied clienteles. Clinical outcomes were generally improved following a telerehabilitation intervention and were at least similar to or better than an alternative intervention. Clinical process outcomes, such as attendance and compliance, were high with telerehabilitation although few comparisons are made to alternative interventions. Consultation time tended to be longer with telerehabilitation. Satisfaction with telerehabilitation was consistently high, although it was higher for patients than therapists. Few studies examined healthcare utilization measures and those that did reported mixed findings with respect to adverse events, use of emergency rooms and doctor visits. Only five of the studies examined costs. There is some preliminary evidence of potential cost savings for the healthcare facility.
While evidence is mounting concerning the efficacy and effectiveness of telerehabilitation, high-quality evidence regarding impact on resource allocation and costs is still needed to support clinical and policy decision-making.
确定与肢体残疾者远程康复相关的临床结局、临床过程、医疗保健利用情况及成本。
检索相关数据库，查找截至2007年2月发表的关于远程康复的文章。查阅参考文献列表，并手工检索主要期刊。纳入分析的研究包括针对肢体功能障碍者的远程康复研究，且采用了实验性或观察性研究设计，无论具体的服务对象或服务地点如何。使用一种表格提取数据，以记录与临床、过程、医疗保健利用及成本结局相关的方法学方面和结果。使用PEDro评分量表评估随机临床试验的研究质量。
共分析了约28篇文章。这些文章涉及社区个体康复、神经康复、心脏康复、脊髓损伤个体的随访、言语语言障碍康复以及针对不同服务对象的康复。远程康复干预后，临床结局总体得到改善，且至少与替代干预相似或更好。远程康复的临床过程结局，如出勤率和依从性较高，尽管与替代干预的比较较少。远程康复的咨询时间往往更长。对远程康复的满意度一直很高，不过患者的满意度高于治疗师。很少有研究考察医疗保健利用指标，那些考察的研究在不良事件、急诊室使用和医生就诊方面报告了不一致的结果。只有五项研究考察了成本。有一些初步证据表明医疗保健机构可能节省成本。
虽然关于远程康复的疗效和有效性的证据越来越多，但仍需要高质量的证据来支持临床和政策决策，这些证据涉及对资源分配和成本的影响。
