移动远程康复解决方案对肥胖患者代谢健康结局和康复依从性的影响：随机对照试验。
Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial.
机构信息
PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France.
Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
出版信息
JMIR Mhealth Uhealth. 2021 Dec 6;9(12):e28242. doi: 10.2196/28242.
BACKGROUND
Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components.
OBJECTIVE
The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity.
METHODS
This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients' adhesion, and satisfaction.
RESULTS
A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: -0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: -1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good.
CONCLUSIONS
In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients' adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666.
背景
肥胖是一个主要的公共卫生问题。代谢康复（MR）中结合运动训练、营养和治疗教育推荐用于肥胖管理。然而，随机对照研究的证据不足。此外，MR 与较差的患者依从性有关。移动健康设备可改善对 MR 成分的获取。
目的
本研究旨在比较远程康复（TR）计划内 12 周内患者的身体成分、人体测量参数、运动能力和生活质量（QOL）的变化与肥胖患者常规护理的变化。
方法
这是一项平行设计的随机对照研究。共纳入 50 名肥胖患者（BMI>30kg/m²），分为远程康复组（TRG）或常规护理组（UCG），每组 25 名，进行 12 周的治疗。患者接受生物阻抗分析、代谢运动测试、活动计和 QOL 和满意度问卷。主要结局是从基线到 12 周时的脂肪量变化。次要结局是体重、代谢参数、运动能力、QOL、患者的依从性和满意度的变化。
结果
共有 49 名患者完成了研究。脂肪量在组间和时间上无显著交互作用（TRG：平均 1.7kg，SD 2.6kg；UCG：平均 1.2kg，SD 2.4kg；P=.48）。与 UCG 相比，TRG 患者的腰臀比（TRG：-0.01kg，SD 0.04；UCG：+0.01kg，SD 0.06；P=.07）和 QOL 物理影响（TRG：+21.8，SD 43.6；UCG：-1.2，SD 15.4；P=.005）有显著改善趋势。身体成分、6 分钟步行试验距离、运动代谢、久坐时间和 QOL 均有显著的时间效应。TRG 的依从性（95%）和满意度良好。
结论
在肥胖成年人中，TR 方案并不优于常规护理，无法改善身体成分。然而，TR 能够为肥胖患者提供全面的多学科康复，并改善一些健康结果。鉴于患者的依从性和满意度，务实的项目应考虑使用移动健康设备来改善对 MR 的获取。需要进一步的研究来进一步确定 TR 相对于常规护理的优势。
试验注册
ClinicalTrials.gov NCT03396666；http://clinicaltrials.gov/ct2/show/NCT03396666。
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