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重度获得性脑损伤患者的远程康复:基本原理、研究设计与方法

Telerehabilitation in individuals with severe acquired brain injury: Rationale, study design, and methodology.

作者信息

Calabrò Rocco Salvatore, Bramanti Alessia, Garzon Martina, Celesti Antonio, Russo Margherita, Portaro Simona, Naro Antonino, Manuli Alfredo, Tonin Paolo, Bramanti Placido

机构信息

IRCCS Centro Neurolesi Bonino Pulejo.

IRCCS San Camillo Hospital Foundation, Venice.

出版信息

Medicine (Baltimore). 2018 Dec;97(50):e13292. doi: 10.1097/MD.0000000000013292.

Abstract

BACKGROUND

Severe acquired brain injury (SABI) rehabilitation should be as intensive and long as to allow the patients get the best independence and quality of life (QoL), but facing with the rehabilitation socioeconomic burden. Telerehabilitation (TR) could supply frail subjects requiring long-term rehabilitation.

METHODS

A multicenter, prospective, parallel design, single-blind trial will be conducted at the IRCCS Neurolesi Bonino Pulejo (Messina, Italy) and IRCCS Hospital San Camillo (Venice, Italy) involving patients suffering from SABI and requiring home motor and cognitive rehabilitation. We will investigate the use of TR, based on advanced Information and Communication Technology (ICT) solutions, taking into account that the supervision of rehabilitation at home will be enriched with the counseling and vital parameters monitoring. The enrolled patients will be balanced for pathology, and randomized in 2 groups, performing TR (G1) or standard rehabilitation training (G2), respectively, according to a pc-generated random assignment. TR will be delivered by means of an advanced video-conferencing system, whereas the patient will be provided with low-cost monitoring devices, able to collect data about his/her health status and QoL. In both the groups each treatment (either cognitive or motor, or both as per patient functional status) will last about 1 hour a day, 5 days/week, for 12 weeks. Two structured telephone interviews will be administered to the patients (when possible) and/or their caregivers, and to all the healthcare professionals involved in the patient management, 1 week after the beginning and at the end of the TR. All the patients will undergo a complete neurological and cognitive examination performed by skilled physicians and psychologists, blindly. Clinical evaluations will be administered blindly, before and after the treatments.

RESULTS

the data of this study should demonstrate that TR is at least non-inferior in comparison with the same amount of usual territorial rehabilitative physical treatments, taking into account patients' functional recovery, psychological well-being, caregiver burden, and healthcare costs.

CONCLUSION

data coming from this study could demonstrate the usefulness of TR in facing the rehabilitation socioeconomic burden of managing patients with SABI, so to allow the patients get the best independence and quality of life (QoL).

摘要

背景

重度获得性脑损伤(SABI)康复应尽可能强化且持续足够长的时间,以使患者获得最佳的独立性和生活质量(QoL),但面临康复的社会经济负担。远程康复(TR)可为需要长期康复的虚弱患者提供帮助。

方法

一项多中心、前瞻性、平行设计、单盲试验将在意大利梅西纳的IRCCS Neurolesi Bonino Pulejo和意大利威尼斯的IRCCS圣卡米洛医院进行,纳入患有SABI且需要家庭运动和认知康复的患者。我们将基于先进的信息通信技术(ICT)解决方案研究TR的应用,同时考虑到在家康复的监督将通过咨询和生命体征参数监测得到加强。入选患者将根据病情进行均衡分组,并通过计算机生成的随机分配分别随机分为两组,一组接受TR(G1),另一组接受标准康复训练(G2)。TR将通过先进的视频会议系统进行,同时为患者提供低成本的监测设备,以收集其健康状况和生活质量的数据。两组中,每种治疗(根据患者功能状态进行认知或运动治疗,或两者皆有)每天持续约1小时,每周5天,共12周。在TR开始后1周和结束时,将对患者(如有可能)及其护理人员以及所有参与患者管理的医护人员进行两次结构化电话访谈。所有患者将由熟练的医生和心理学家进行盲法的全面神经和认知检查。治疗前后将进行盲法临床评估。

结果

本研究的数据应表明,考虑到患者的功能恢复、心理健康、护理人员负担和医疗成本,TR与相同数量的常规区域康复物理治疗相比至少不逊色。

结论

本研究的数据可证明TR在应对管理SABI患者的康复社会经济负担方面的有效性,从而使患者获得最佳的独立性和生活质量(QoL)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6253/6320067/06e8bc596bd5/medi-97-e13292-g001.jpg

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