Telemedicine Service, Fondazione Salvatore Maugeri, Institute for Care and Scientific Research (IRCCS), Via Giuseppe Mazzini, 129-25065 Lumezzane, Brescia, Italy.
Phys Ther. 2013 Aug;93(8):1073-83. doi: 10.2522/ptj.20120212. Epub 2013 Apr 18.
Exercise rehabilitation after cardiac surgery has beneficial effects, especially on a long-term basis. Rehabilitative programs with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home.
The purpose of this study was to compare exercise capacity after home-based cardiac rehabilitation (HBCR) or in-hospital rehabilitation in patients at low to medium risk for early mortality (EuroSCORE 0-5) following cardiac surgery.
A quasi-experimental study was conducted.
At hospital discharge, patients were given the option to decide whether to enroll in the HBCR program. Clinical examinations (electrocardiography, cardiac echo color Doppler, chest radiography, blood samples) of patients in the HBCR group were collected during 4 weeks of rehabilitation, and exercise capacity (assessed using the Six-Minute Walk Test [6MWT]) was assessed before and after rehabilitation. A group of patients admitted to the in-hospital rehabilitation program was used as a comparison group. Patients in the HBCR group were supervised at home by a medical doctor and telemonitored daily by a nurse and physical therapist by video conference. Periodic home visits by health staff also were performed.
One hundred patients were recruited into the HBCR group. An equal number of patients was selected for the comparison group. At the end of the 4-week study, the 2 groups showed improvement from their respective baseline values only in the 6MWT. No difference was found in time × group interaction.
Because patients self-selected to enroll in the HBCR program and because they were enrolled from a single clinical center, the results of the study cannot be generalized.
In patients who self-selected HBCR, the program was found to be effective and comparable to the standard in-hospital rehabilitative approach, indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service.
心脏手术后的运动康复具有有益的效果，尤其是从长期来看。结合适当技术的康复计划与远程医疗相结合，可能满足在家中进行康复的需求。
本研究旨在比较心脏手术后低至中度早期死亡率（EuroSCORE 0-5）患者进行家庭心脏康复（HBCR）或住院康复后的运动能力。
准实验研究。
在出院时，患者可以选择是否参加 HBCR 计划。HBCR 组患者在康复的 4 周内接受临床检查（心电图、心脏超声彩色多普勒、胸部 X 光、血液样本），并在康复前后评估运动能力（使用六分钟步行测试[6MWT]评估）。一组住院康复计划的患者被用作对照组。HBCR 组的患者在家中由医生监督，每天由护士和物理治疗师通过视频会议进行远程监测。卫生人员还定期上门家访。
100 名患者被纳入 HBCR 组。选择了相同数量的患者作为对照组。在 4 周的研究结束时，仅在 6MWT 中，2 组从各自的基线值开始都有所改善。未发现时间×组交互作用的差异。
由于患者自行选择参加 HBCR 计划，并且他们仅从单个临床中心招募，因此研究结果不能推广。
对于自行选择 HBCR 的患者，该方案被发现是有效且与标准住院康复方法相当的，表明当与综合远程医疗服务相结合时，心脏手术后的康复可以在家中有效实施。
