Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Block MD 11, 10 Medical Drive, Singapore 117597, Singapore.
Cardiac Rehabilitation, Department of Cardiology, National University Heart Centre, Singapore, Singapore.
Eur J Prev Cardiol. 2022 May 25;29(7):1017-1043. doi: 10.1093/eurjpc/zwab106.
The onset of the COVID-19 pandemic saw the suspension of centre-based cardiac rehabilitation (CBCR) and has underscored the need for home-based cardiac telerehabilitation (HBCTR) as a feasible alternative rehabilitation delivery model. Yet, the effectiveness of HBCTR as an alternative to Phase 2 CBCR is unknown. We aimed to conduct a meta-analysis to quantitatively appraise the effectiveness of HBCTR.
PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and PsycINFO were searched from inception to January 2021. We included randomized controlled trials (RCTs) comparing HBCTR to Phase 2 CBCR or usual care in patients with coronary heart disease (CHD). Out of 1588 studies, 14 RCTs involving 2869 CHD patients were included in this review. When compared with usual care, participation in HBCTR showed significant improvement in functional capacity {6-min walking test distance [mean difference (MD) 25.58 m, 95% confidence interval (CI) 14.74-36.42]}; daily step count (MD 1.05 K, 95% CI 0.36-1.75) and exercise habits [odds ratio (OR) 2.28, 95% CI 1.30-4.00)]; depression scores (standardized MD -0.16, 95% CI -0.32 to 0.01) and quality of life [Short-Form mental component summary (MD 2.63, 95% CI 0.06-5.20) and physical component summary (MD 1.99, 95% CI 0.83-3.16)]. Effects on medication adherence were synthesized narratively. HBCTR and CBCR were comparably effective.
In patients with CHD, HBCTR was associated with an increase in functional capacity, physical activity (PA) behaviour, and depression when compared with UC. When HBCTR was compared to CBCR, an equivalent effect on functional capacity, PA behaviour, QoL, medication adherence, smoking behaviour, physiological risk factors, depression, and cardiac-related hospitalization was observed.
COVID-19 大流行的爆发导致中心型心脏康复（CBCR）暂停，凸显了家庭心脏远程康复（HBCTR）作为一种可行的替代康复提供模式的必要性。然而，HBCTR 作为第二阶段 CBCR 的替代方案的有效性尚不清楚。我们旨在进行荟萃分析，定量评估 HBCTR 的有效性。
从开始到 2021 年 1 月，在 PubMed、EMBASE、CENTRAL、CINAHL、Scopus 和 PsycINFO 上进行了搜索。我们纳入了比较 HBCTR 与第二阶段 CBCR 或冠心病（CHD）患者常规护理的随机对照试验（RCT）。在 1588 项研究中，有 14 项 RCT 纳入了 2869 例 CHD 患者。与常规护理相比，参与 HBCTR 可显著改善功能能力[6 分钟步行试验距离（MD 25.58m，95%CI 14.74-36.42）]；每日步数（MD 1.05K，95%CI 0.36-1.75）和运动习惯[比值比（OR）2.28，95%CI 1.30-4.00)]；抑郁评分（标准化 MD-0.16，95%CI-0.32 至 0.01）和生活质量[短式心理成分综合评分（MD 2.63，95%CI 0.06-5.20）和身体成分综合评分（MD 1.99，95%CI 0.83-3.16）]。药物依从性的影响以叙述方式综合。HBCTR 和 CBCR 同样有效。
在 CHD 患者中，与 UC 相比，HBCTR 可增加功能能力、身体活动（PA）行为和抑郁。当 HBCTR 与 CBCR 进行比较时，在功能能力、PA 行为、生活质量、药物依从性、吸烟行为、生理危险因素、抑郁和与心脏相关的住院方面观察到等效的效果。
