基于家庭的远程康复在老年慢性阻塞性肺疾病和心力衰竭患者中的应用：一项随机对照试验。

Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial.

机构信息

Care Continuity Unit and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy.

Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Brescia, Italy.

出版信息

Age Ageing. 2018 Jan 1;47(1):82-88. doi: 10.1093/ageing/afx146.

DOI:10.1093/ageing/afx146

PMID:28985325

Abstract

BACKGROUND

chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) frequently coexist in older people, reducing patients' quality of life (QoL) and increasing morbidity and mortality.

OBJECTIVE

we studied the feasibility and efficacy of an integrated telerehabilitation home-based programme (Telereab-HBP), 4 months long, in patients with combined COPD and CHF. The primary outcome was exercise tolerance evaluated at the 6-min walk test (6MWT). Secondary outcomes were time-to-event (hospitalisation and death), dyspnoea (MRC), physical activity profile (PASE), disability (Barthel) and QoL (MLHFQ and CAT).

STUDY DESIGN

randomised, open, controlled, multicenter trial.

METHODS

the Telereab-HBP included remote monitoring of cardiorespiratory parameters, weekly phone-calls by the nurse, and exercise programme, monitored weekly by the physiotherapist. All outcomes were studied again after 2 months of a no-intervention period.

RESULTS

in total, 112 patients were randomised, 56 per group. Their mean (SD) age was 70 (9) years, and 92 (82.1%) were male. After 4 months, the IG were able to walk further than at baseline: mean (95% CI) Δ6MWT was 60 (22.2,97.8) m; the CG showed no significant improvement: -15 (-40.3,9.8) m; P = 0.0040 between groups. In IG, the media time to hospitalisation/death was 113.4 days compared with 104.7 in the CG (P = 0.0484, log-rank test). Other secondary outcomes: MRC (P = 0.0500), PASE (P = 0.0015), Barthel (P = 0.0006), MLHFQ (P = 0.0007) and CAT (P = 0.0000) were significantly improved in the IG compared with the CG at 4 months. IG maintained the benefits acquired at 6 months for outcomes.

CONCLUSIONS

this 4-month Telereab-HBP was feasible and effective in older patients with combined COPD and CHF.

摘要

背景

慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）常同时发生在老年人中，降低了患者的生活质量（QoL），并增加了发病率和死亡率。

目的

我们研究了一项为期 4 个月的基于家庭的远程康复综合计划（Telereab-HBP）在合并 COPD 和 CHF 的患者中的可行性和疗效。主要结局是 6 分钟步行试验（6MWT）评估的运动耐量。次要结局是时间事件（住院和死亡）、呼吸困难（MRC）、体力活动概况（PASE）、残疾（巴氏量表）和生活质量（MLHFQ 和 CAT）。

研究设计

随机、开放、对照、多中心试验。

方法

Telereab-HBP 包括远程监测心肺参数、护士每周电话联系和运动计划，由物理治疗师每周监测。所有结果在 2 个月的无干预期后再次进行研究。

结果

共纳入 112 名患者，每组 56 名。他们的平均（SD）年龄为 70（9）岁，92 名（82.1%）为男性。4 个月后，IG 能够比基线走得更远：平均（95%CI）Δ6MWT 为 60（22.2，97.8）m；CG 无明显改善：-15（-40.3，9.8）m；P=0.0040 组间。在 IG 中，中位住院/死亡时间为 113.4 天，而 CG 为 104.7 天（P=0.0484，对数秩检验）。其他次要结局：MRC（P=0.0500）、PASE（P=0.0015）、巴氏量表（P=0.0006）、MLHFQ（P=0.0007）和 CAT（P=0.0000）在 IG 中均显著改善，与 CG 相比，在 4 个月时。IG 在 6 个月时保持了获得的益处。