1 Physiotherapy Department, Antonius Hospital, Sneek, The Netherlands.
2 Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands.
J Telemed Telecare. 2018 Sep;24(8):511-526. doi: 10.1177/1357633X17716576. Epub 2017 Jul 11.
Introduction The aim of this study was to systematically review the evidence on the effectiveness of exercise-based telemedicine in chronic pain. Methods We searched the Cochrane, PubMed, MEDLINE, EMBASE, CINAHL and PEDRO databases from 2000 to 2015 for randomised controlled trials, comparing exercise-based telemedicine intervention to no intervention or usual care in adults with chronic pain. Primary outcome data were pooled using random effect meta-analysis. Primary outcomes were pain, physical activity (PA), limitations in activities of daily living (ADL) and quality of life (QoL). Secondary outcomes were barriers, facilitators and usability of telemedicine. Results Sixteen studies were included. Meta-analyses were performed in three subgroups of studies with comparable control conditions. Telemedicine versus no intervention showed significantly lower pain scores (MD -0.57, 95% CI -0.81; -0.34), but not for telemedicine versus usual care (MD -0.08, 95% CI -0.41; 0.26) or in addition to usual care (MD -0.25, 95% CI -1.50; 1.00). Telemedicine compared to no intervention showed non-significant effects for PA (MD 19.93 min/week, 95% CI -5.20; 45.06) and significantly diminished ADL limitations (SMD -0.20, 95% CI -0.29; -0.12). No differences were found for telemedicine in addition to usual care for PA or for ADL (SMD 0.16, 95% CI -0.66; 0.34). Telemedicine versus usual care showed no differences for ADL (SMD 0.08, 95% CI -0.37; 0.53). No differences were found for telemedicine compared to the three control groups for QoL. Limited information was found on the secondary outcomes. Conclusions Exercise-based telemedicine interventions do not seem to have added value to usual care. As substitution of usual care, telemedicine might be applicable but due to limited quality of the evidence, further exploration is needed for the rapidly developing field of telemedicine.
介绍 本研究旨在系统地回顾基于运动的远程医疗在慢性疼痛中的有效性的证据。 方法 我们从 2000 年至 2015 年在 Cochrane、PubMed、MEDLINE、EMBASE、CINAHL 和 PEDRO 数据库中搜索了随机对照试验，比较了基于运动的远程医疗干预与慢性疼痛成人的无干预或常规护理。使用随机效应荟萃分析汇总主要结局数据。主要结局是疼痛、身体活动（PA）、日常生活活动（ADL）受限和生活质量（QoL）。次要结局是远程医疗的障碍、促进因素和可用性。 结果 纳入了 16 项研究。对具有可比对照条件的三组研究进行了荟萃分析。与无干预相比，远程医疗的疼痛评分显著降低（MD -0.57，95%CI -0.81；-0.34），但与常规护理（MD -0.08，95%CI -0.41；0.26）或常规护理加用（MD -0.25，95%CI -1.50；1.00）相比则不然。与无干预相比，远程医疗对 PA（MD 19.93 分钟/周，95%CI -5.20；45.06）的影响不显著，但显著降低了 ADL 受限（SMD -0.20，95%CI -0.29；-0.12）。在常规护理加用远程医疗方面，PA 或 ADL 方面，远程医疗没有差异（SMD 0.16，95%CI -0.66；0.34）。与常规护理相比，远程医疗对 ADL 没有差异（SMD 0.08，95%CI -0.37；0.53）。在 QoL 方面，与三个对照组相比，远程医疗没有差异。关于次要结局的信息有限。 结论 基于运动的远程医疗干预似乎对常规护理没有额外的价值。作为常规护理的替代方法，远程医疗可能适用，但由于证据质量有限，对于远程医疗这一快速发展的领域，需要进一步探索。
