Bui Tram, King Clayton, Llado Ana, Lee Darren, Leong Grace, Paraparum Anuka, Li Ingrid, Scrivener Katharine
1Royal Rehab, 235 Morrison Road, Ryde, NSW 2112 Australia.
MQ Health Physiotherapy, Suite 307, Level 3, 2 Technology Place, Macquarie Park, NSW 2109 Australia.
Pilot Feasibility Stud. 2019 Mar 16;5:47. doi: 10.1186/s40814-019-0430-9. eCollection 2019.
There is a known positive relationship between time in therapy and therapy outcomes. Effective rehabilitation should therefore include larger doses of therapy. However, individuals participating in inpatient rehabilitation have low levels of activity throughout the day. This level of inactivity may limit rehabilitation potential. New technologies which deliver personalised exercise programs and track time spent on exercises may lead to greater activity levels and therefore improve functional outcomes in rehabilitation. This pilot randomised control trial aimed to investigate whether an app-based supplemental exercise program in orthopaedic rehabilitation will be feasible and acceptable to participants, increase activity levels and improve functional outcomes.
Participants were randomised to receive supplemental exercise via an app (PTPal™) on a tablet device additional to usual care or usual care alone. Primary outcome measures were participant satisfaction with app-based supplemental exercise, total repetitions of each activity and time in supplemental exercise programs. Secondary measures were 10-m walk test (10MWT), 6-min walk test (6MWT), Timed Up and Go (TUG), Functional Independence Measure and length of stay assessed by a blinded assessor.
Twenty individuals admitted into an inpatient private general rehabilitation unit for orthopaedic rehabilitation over a 4-week duration were included in this study. High acceptance of the app-based supplemental exercise program was demonstrated. Those using the app completed an additional 549 exercise repetitions during their admission (694 supplemental app-based repetitions vs 146 supplemental paper-based repetitions in the control group, mean difference [MD] 549, 95% CI 95 to 1002, = 0.02) and an additional 157 min in supplemental exercise throughout their admission (195.3 min vs 38.7 min, MD 157 min, 95% CI 0.9-312.3 min, = 0.05). There was insufficient power to demonstrate statistical significance in functional outcomes, but a trend towards improved functional outcomes was observed in the intervention group.
An app-based exercise program increases activity levels, is feasible and is a safe intervention with the potential to improve functional outcomes. This pilot study should be followed with a larger study powered to demonstrate functional effects with more participants having greater impairment.
Australian New Zealand Clinical Trials Registry (ANZCTR); trial number ACTRN12617000817347. This study was retrospectively registered (registration date 05/06/2017).
治疗时长与治疗效果之间存在已知的正相关关系。因此，有效的康复治疗应包括更大剂量的治疗。然而，参与住院康复治疗的个体全天活动水平较低。这种不活动程度可能会限制康复潜力。提供个性化锻炼计划并追踪锻炼时间的新技术可能会带来更高的活动水平，从而改善康复治疗中的功能结局。这项初步随机对照试验旨在调查骨科康复中基于应用程序的补充锻炼计划对参与者是否可行且可接受，是否能提高活动水平并改善功能结局。
参与者被随机分为两组，一组在接受常规护理的基础上，通过平板电脑上的应用程序（PTPal™）接受补充锻炼，另一组仅接受常规护理。主要结局指标包括参与者对基于应用程序的补充锻炼的满意度、每项活动的总重复次数以及补充锻炼计划中的时间。次要指标包括10米步行测试（10MWT）、6分钟步行测试（6MWT）、起立行走测试（TUG）、功能独立性测量以及由盲法评估者评估的住院时间。
本研究纳入了20名在4周内入住私立综合住院康复单元进行骨科康复的患者。结果表明，基于应用程序的补充锻炼计划得到了高度认可。使用该应用程序的患者在住院期间额外完成了549次锻炼重复（基于应用程序的补充重复次数为694次，而对照组基于纸质的补充重复次数为146次，平均差异[MD]为549，95%置信区间为95至1002，P = 0.02），并且在住院期间的补充锻炼中额外花费了157分钟（195.3分钟对38.7分钟，MD为157分钟，95%置信区间为0.9 - 312.3分钟，P = （此处原文有误，根据前文推测应为0.05））。在功能结局方面，没有足够的统计学效力来证明差异具有统计学意义，但在干预组中观察到功能结局有改善的趋势。
基于应用程序的锻炼计划可提高活动水平，是可行的，并且是一种安全的干预措施，有可能改善功能结局。这项初步研究之后应开展更大规模的研究，以证明在更多功能障碍程度更高的参与者中该计划对功能的影响。
澳大利亚新西兰临床试验注册中心（ANZCTR）；试验编号ACTRN12617000817347。本研究为回顾性注册（注册日期：2017年6月5日）。
