The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR.
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR.
Int J Nurs Stud. 2021 Dec;124:104087. doi: 10.1016/j.ijnurstu.2021.104087. Epub 2021 Sep 5.
The objectives of this review were to identify different technology-assisted interventions in cardiac rehabilitation, to explore and examine the effectiveness of technology-assisted cardiac rehabilitation.
A systematic review and meta-analysis.
A systematic search was performed on six electronic databases: CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO to identify randomised controlled trials from 2010 to 2020. Selection of studies was performed by screening the titles, abstracts and full texts, and two reviewers independently and critically appraised the included studies using the revised Cochrane risk of bias tool for randomized trials (RoB 2).
Nine randomised controlled trials met the inclusion criteria; five studies with some bias concerns related to allocation concealment (n = 2) and measurement of outcome (n = 4), and four studies were of low risk of bias. The pooled effect size showed comparable effectiveness between technology-assisted cardiac rehabilitation and conventional/centre-based cardiac rehabilitation on modifiable coronary risk factors (systolic and diastolic blood pressure, total cholesterol, p>0.05), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.62, p = 0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p = 0.47). Narrative synthesis was performed for adherence to prescribed exercise sessions in cardiac rehabilitation. No significant adverse events occurred. The adverse events that did occur were self-reported, mostly unrelated to the interventions with technology and the number of events was comparable between both groups. Inconsistent results were found across the studies. This review revealed lack of self-efficacy and behaviour change theories/strategies, and educational emphasis among studies.
The results in the meta-analysis have indicated that technology-assisted cardiac rehabilitation demonstrated comparable results to conventional/centre-based cardiac rehabilitation. Technology-assisted cardiac rehabilitation is a potential alternative not only to remove cardiac rehabilitation barriers but also in the midst of current prolonged pandemic. Future studies on technology-assisted cardiac rehabilitation with the emphasis behavior change theories/strategies and education are required.
本综述的目的是确定心脏康复中不同的技术辅助干预措施，并探讨和检验技术辅助心脏康复的效果。
系统综述和荟萃分析。
对六个电子数据库进行系统检索：CINALH Complete、Cochrane 图书馆、PubMed、通过 OvidSP 的 MEDLINE、英国护理索引和 PsycINFO，以确定 2010 年至 2020 年的随机对照试验。通过筛选标题、摘要和全文，由两名评审员独立进行研究选择，并使用修订后的 Cochrane 随机试验偏倚风险工具（RoB 2）对纳入的研究进行批判性评价。
符合纳入标准的随机对照试验有 9 项；其中 5 项研究存在与分配隐匿性（n=2）和结局测量（n=4）相关的偏倚问题，4 项研究的偏倚风险较低。汇总效应大小表明，技术辅助心脏康复与常规/中心基础心脏康复在可改变的冠状动脉风险因素（收缩压和舒张压、总胆固醇，p>0.05）和心理结局（焦虑：SMD 0.25，95%CI-0.11 至 0.62，p=0.17 和抑郁：SMD 0.09，95%CI-0.16 至 0.35，p=0.47）方面具有相当的效果。对心脏康复中遵医嘱进行运动的依从性进行了叙述性综合分析。未发生显著不良事件。发生的不良事件均为自我报告，与技术干预大多无关，且两组之间的事件数量相当。研究结果不一致。本综述揭示了研究中缺乏自我效能和行为改变理论/策略以及教育重点。
荟萃分析结果表明，技术辅助心脏康复与常规/中心基础心脏康复的效果相当。技术辅助心脏康复不仅是消除心脏康复障碍的一种潜在替代方法，也是当前大流行期间的一种选择。需要进行更多强调行为改变理论/策略和教育的技术辅助心脏康复的未来研究。
