IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy.
J Telemed Telecare. 2020 Aug-Sep;26(7-8):385-399. doi: 10.1177/1357633X19850381. Epub 2019 May 27.
Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system and a major cause of disability in young adults. Recently, there has been a growing interest in the development of innovative ways to deliver rehabilitation care outside of a hospital setting. The aim was to conduct a systematic review and a meta-analysis of the efficacy of an integrated telerehabilitation approach (ITA) on motor, cognitive and participation outcomes delivered to people with MS (pwMS).
We systematically searched for original manuscripts regarding ITA in pwMS. Efficacy on motor, cognitive and participation outcomes was measured as the standardized mean difference (Hedges' g) of pre and post training.
Nine studies encompassing 716 pwMS diagnosis were included. The overall effect of ITA was: large for motor outcomes (g = 1.05; = 0.013); small for cognitive performance outcomes (g = 0.16; = 0.237); and small for participation outcomes (g = 0.15; = 0.259). Domain-specific results showed that the effect on motor disability was large ( = 1.18), while on gait and balance was medium ( = 0.32 and = 0.48, respectively). Moreover, all effects on single cognitive domains were small. Finally, among the single participation outcomes considered (depression, fatigue, daily functioning, quality of life and self-efficacy) only depression showed a nearly medium effect (g = 0.30).
PwMS can benefit from ITA in the treatment of motor symptoms according to the current model of continuity of care. However, the low efficacy of ITA on cognition and participation domains suggests the necessity to develop intervention models that include a broader spectrum of needs and objectives.
多发性硬化症（MS）是一种中枢神经系统的慢性免疫介导疾病，也是导致年轻人残疾的主要原因。最近，人们越来越关注在医院环境之外提供康复护理的创新方法。本研究旨在对针对多发性硬化症患者（pwMS）的远程综合康复治疗（ITA）的疗效进行系统评价和荟萃分析。
我们系统地搜索了关于 pwMS 的 ITA 原始文献。将训练前后的标准化均数差值（Hedges'g）作为运动、认知和参与结果的疗效测量指标。
共纳入 9 项研究，涵盖 716 例 pwMS 患者。ITA 的总体效果为：运动结局效果较大（g=1.05；=0.013）；认知表现结局效果较小（g=0.16；=0.237）；参与结局效果较小（g=0.15；=0.259）。特定领域的结果显示，对运动障碍的影响较大（=1.18），而对步态和平衡的影响为中等（=0.32 和=0.48）。此外，所有单一认知领域的效果都较小。最后，在所考虑的单一参与结局（抑郁、疲劳、日常功能、生活质量和自我效能）中，只有抑郁显示出接近中等的效果（g=0.30）。
根据当前的连续性护理模式，pwMS 可以从 ITA 治疗运动症状中受益。然而，ITA 对认知和参与领域的疗效较低表明，有必要开发干预模型，以满足更广泛的需求和目标。
