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基于互联网的远程医疗系统对乳腺癌幸存者功能能力和认知的影响:一项随机对照试验的二次分析

Effect of an Internet-based telehealth system on functional capacity and cognition in breast cancer survivors: a secondary analysis of a randomized controlled trial.

作者信息

Galiano-Castillo Noelia, Arroyo-Morales Manuel, Lozano-Lozano Mario, Fernández-Lao Carolina, Martín-Martín Lydia, Del-Moral-Ávila Rosario, Cantarero-Villanueva Irene

机构信息

Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.

Department of Physical Therapy, Health Science Faculty, University of Granada, Avda de la Ilustración 60, 18016, Granada, Spain.

出版信息

Support Care Cancer. 2017 Nov;25(11):3551-3559. doi: 10.1007/s00520-017-3782-9. Epub 2017 Jun 22.

Abstract

PURPOSE

This trial determines the effect of an Internet-based tailored exercise program compared to usual care control for improving functional capacity and cognition among breast cancer survivors.

METHODS

A two-arm, assessor-blinded, parallel, randomized controlled efficacy trial was conducted. Participants were recruited from the Oncology and Breast unit at the Virgen de las Nieves Hospital (Granada, Spain) between March 2012 to November 2013 and randomized to either the experimental group (an 8-week Internet-based tailored exercise program) or control group (usual care). The outcome measures were the 6-min walk test, Auditory Consonant Trigrams, and Trail Making Test. All were assessed at baseline, post-intervention, and 6-month follow-up.

RESULTS

After intervention, the telerehabilitation group had significantly improved distances (d = 0.92, P < 0.001) as well as percentage of predicted of the 6-min walk test (d = 0.93, P < 0.001) compared with the control group. Significant improvement was also observed favoring the telerehabilitation group for the number of consonants recalled in total compared with the control group (d = 0.47, P = 0.04). These findings were maintained after 6-month follow-up (d = 0.80, P = 0.001; d = 0.76, P = 0.002; and d = 0.57, P = 0.02, respectively). Analysis was based on intention-to-treat principle.

CONCLUSIONS

These findings support the effectiveness of a telehealth system based on an 8-week physical exercise to achieve improvements and maintain them after 6-month follow-up in terms of functional and cognitive performance in breast cancer survivors. This broad-reach modality could help the growing number of cancer survivors to face their disabling side effects.

摘要

目的

本试验旨在确定与常规护理对照相比,基于互联网的定制运动计划对提高乳腺癌幸存者的功能能力和认知能力的效果。

方法

进行了一项双臂、评估者盲法、平行、随机对照疗效试验。2012年3月至2013年11月期间,从西班牙格拉纳达市比维斯圣母医院的肿瘤科和乳腺科招募参与者,并随机分为实验组(为期8周的基于互联网的定制运动计划)或对照组(常规护理)。结果测量指标为6分钟步行试验、听觉辅音三联字和连线测验。所有指标均在基线、干预后和6个月随访时进行评估。

结果

干预后,与对照组相比,远程康复组在6分钟步行试验中的行走距离(d = 0.92,P < 0.001)以及预测百分比(d = 0.93,P < 0.001)均有显著改善。与对照组相比,远程康复组在总共回忆的辅音数量方面也观察到显著改善(d = 0.47,P = 0.04)。这些结果在6个月随访后得以维持(分别为d = 0.80,P = 0.001;d = 0.76,P = 0.002;d = 0.57,P = 0.02)。分析基于意向性治疗原则。

结论

这些发现支持了基于8周体育锻炼的远程医疗系统在改善乳腺癌幸存者的功能和认知表现方面的有效性,并在6个月随访后得以维持。这种广泛覆盖的模式可以帮助越来越多的癌症幸存者应对其致残的副作用。

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