三思而后行：针对脑卒中后患者的基于远程医疗的负重或站立位活动的干预措施——范围综述。
Look Before You Leap: Interventions Supervised via Telehealth Involving Activities in Weight-Bearing or Standing Positions for People After Stroke-A Scoping Review.
机构信息
School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia.
Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Australia.
出版信息
Phys Ther. 2021 Jun 1;101(6). doi: 10.1093/ptj/pzab073.
OBJECTIVE
The COVID-19 pandemic has seen a rapid shift to telehealth-delivered physical therapy services. Common impairments after stroke create unique challenges when providing rehabilitation via telehealth, particularly when it involves activities undertaken in weight-bearing or standing positions, including walking training. Our scoping review maps the evidence regarding safety, efficacy, and feasibility of remotely supervised telehealth interventions involving activities undertaken in weight-bearing or standing positions for people after stroke.
METHODS
Searches of relevant databases for primary research studies were conducted using keywords relating to exercise and telehealth. Studies of stroke survivors undertaking interventions involving activities in weight-bearing or standing positions, supervised in real-time via telehealth were included. Two reviewers independently appraised all studies. Data were charted by one reviewer, checked by another, and results synthesized narratively.
RESULTS
Seven studies (2 randomized trials, 1 mixed-methods, and 4 pre-post studies) were included, involving 179 participants. Some studies included stroke survivors with cognitive impairment, and 2 (29%) studies included only participants who walked independently. Adherence (reported in 3 studies) and satisfaction (reported in 4 studies) were good, and no serious adverse events (data from 4 studies) related to interventions were reported. Strategies to overcome technological barriers were used to optimize intervention safety and feasibility, along with physiological monitoring, caregiver assistance, and in-person exercise prescription. However, there is limited high-quality evidence of efficacy.
CONCLUSIONS
We identified strategies used in research to date that can support current practice. However, urgent research is needed to ensure that stroke survivors are receiving evidence-based, effective services.
IMPACT
The COVID-19 pandemic has necessitated a rapid shift to telerehabilitation services for people with stroke, but there is little evidence to guide best practice. Our review provides practical guidance and strategies to overcome barriers and optimize safety and adherence for telehealth interventions involving activities in weight-bearing or standing positions.
目的
新冠疫情期间，远程医疗已迅速成为提供物理治疗服务的主要手段。脑卒中后常见的功能障碍给远程康复带来了独特的挑战，特别是涉及到需要负重或站立完成的活动，如行走训练。本研究旨在对涉及负重或站立位活动的远程监督远程康复干预措施的安全性、有效性和可行性相关证据进行系统综述。
方法
使用与运动和远程医疗相关的关键词对相关数据库进行了初步研究检索。研究对象为脑卒中幸存者，在实时远程监督下接受涉及负重或站立位活动的干预措施。两位评审员独立评估所有研究。由一位评审员记录数据，另一位评审员核对，并进行综述。
结果
共纳入 7 项研究（2 项随机对照试验、1 项混合方法研究和 4 项前后对照研究），涉及 179 名参与者。部分研究纳入了伴有认知障碍的脑卒中幸存者，有 2 项研究（29%）仅纳入了独立行走的参与者。在 3 项研究中报告了依从性，在 4 项研究中报告了满意度，均较好，并且没有报告与干预相关的严重不良事件（来自 4 项研究的数据）。为了优化干预的安全性和可行性，研究中使用了一些策略，包括克服技术障碍、生理监测、照顾者协助和面对面的运动处方。但是，目前缺乏疗效的高质量证据。
结论
我们确定了迄今为止在研究中使用的策略，这些策略可以为当前的实践提供支持。然而，迫切需要开展研究以确保脑卒中幸存者获得基于证据的有效服务。
意义
新冠疫情大流行促使人们迅速转向远程康复服务，但目前针对脑卒中患者的远程康复服务的实践缺乏证据支持。本综述为涉及负重或站立位活动的远程康复干预措施提供了实用的指导和策略，有助于克服障碍，提高安全性和依从性。
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