Istituti Clinici Scientifici Maugeri IRCCS, a Care Continuity Unit and Telemedicine Service, Institute of Lumezzane, Brescia, Italy.
Cardiology Department of the Institute of Lumezzane, Brescia, Italy.
J Am Med Dir Assoc. 2019 Mar;20(3):340-346. doi: 10.1016/j.jamda.2018.09.003. Epub 2018 Oct 23.
The aim of this study was to determine the feasibility and efficacy of a 6-month tele-rehabilitation home-based program, designed to prevent falls in older adults with 1 or more chronic diseases (cardiac, respiratory, neuromuscular or neurologic) returning home after in-hospital rehabilitation for their chronic condition. Patients were eligible for selection if they had experienced a fall during the previous year or were at high risk of falling.
Randomized controlled trial. Tele-rehabilitation consisted of a falls prevention program run by the physiotherapist involving individual home exercise (strength, balance, and walking) and a weekly structured phone-call by the nurse inquiring about the disease status and symptoms and providing patient support.
Two hundred eighty-three patients (age 79 ± 6.6 years; F = 59%) with high risk of falls and discharged home after in-hospital rehabilitation were randomized to receive home-based program (intervention group, n = 141) or conventional care (control group, n = 142).
Incidence of falls at home in the 6-month period (primary outcome); time free to the first fall and proportion of patients sustaining ≥2 falls (secondary outcomes).
During the 6 months, 85 patients fell at least once: 29 (20.6%) in the Intervention Group versus 56 (39.4%) in the control group (P < .001). The risk of falls was significantly reduced in the intervention group (relative risk =0.60, 95% confidence interval: 0.44-0.83; P < .001). The mean ± standard deviation time to first fall was significantly longer in intervention group than control group (152 ± 58 vs 134 ± 62 days; P = .001). Significantly, fewer patients experienced ≥2 falls in the intervention group than in the control group: 11 (8%) versus 24 (17%), P = .020.
A 6-month tele-rehabilitation home-based program integrated with medical/nursing telesurveillance is feasible and effective in preventing falls in older chronic disease patients with a high risk of falling.
本研究旨在确定一项为期 6 个月的远程康复家庭计划的可行性和疗效，该计划旨在预防因慢性疾病（心脏、呼吸、神经肌肉或神经）住院康复后返回家中的 1 名或多名老年人跌倒。如果患者在过去一年中经历过跌倒或有跌倒高风险，则有资格入选。
随机对照试验。远程康复由物理治疗师进行，包括个人家庭锻炼（力量、平衡和行走）以及护士每周进行一次结构化电话询问疾病状况和症状，并提供患者支持。
283 名（年龄 79 ± 6.6 岁；F = 59%）有跌倒高风险且出院后在家中康复的患者被随机分为接受家庭计划（干预组，n = 141）或常规护理（对照组，n = 142）。
6 个月内在家中跌倒的发生率（主要结果）；首次跌倒的无跌倒时间和跌倒≥2 次的患者比例（次要结果）。
在 6 个月期间，85 名患者至少跌倒一次：干预组 29 名（20.6%），对照组 56 名（39.4%）（P <.001）。干预组跌倒风险显著降低（相对风险 = 0.60，95%置信区间：0.44-0.83；P <.001）。干预组首次跌倒的平均 ± 标准差时间明显长于对照组（152 ± 58 天对 134 ± 62 天；P =.001）。重要的是，干预组≥2 次跌倒的患者明显少于对照组：11 名（8%）对 24 名（17%），P =.020。
为期 6 个月的远程康复家庭计划与医疗/护理远程监测相结合，对于预防有跌倒高风险的老年慢性病患者跌倒是可行且有效的。
