Michaelchuk Wade, Oliveira Ana, Marzolini Susan, Nonoyama Mika, Maybank Aline, Goldstein Roger, Brooks Dina
Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Canada; Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada.
Westpark Healthcare Centre, Respiratory Medicine, Toronto, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Canada; Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; IBiMED - Institute of Biomedicine, University of Aveiro, Aveiro, Portugal.
Int J Med Inform. 2022 Mar 31;162:104754. doi: 10.1016/j.ijmedinf.2022.104754.
Home-based telehealth pulmonary rehabilitation (HTPR) for chronic obstructive pulmonary disease (COPD) is increasingly common partly due to the COVID-19 pandemic. However, optimal HTPR programming has not been described. This review provides a comprehensive overview of the design, delivery, and effects of HTPR for people with COPD.
Relevant databases were searched to July 2021 for studies on adults with COPD utilizing information or communication technology to monitor or deliver HTPR. A meta-analysis was performed on a subset of randomized controlled trials.
Of 3124 records retrieved, 38 studies evaluating 1993 individuals with stable COPD (age 54-75 and FEV 31-92% predicted) were included. Program components included exercise and education (n = 17) or exercise alone (n = 15) with in-clinic baseline assessments commonly conducted (n = 26). Few trials (n = 7) featured synchronous virtual exercise supervision. Aerobic exercise commonly involved walking (n = 14) and cycling (n = 11) and most programs included resistance training (n = 25). Exercise progressions and emergency action plans were inconsistently reported. Meta-analysis demonstrated HTPR was comparable to outpatient PR and had a greater effect than usual care for the modified Medical Research Council dyspnea scale (mean difference [95 %CI]: -0.49 [-0.77, -0.22], p < 0.01) and COPD Assessment Test score (-4.90 [-7.13, -2.67], p < 0.01). Neither HTPR nor outpatient PR impacted sedentary time or step count. Only 6% of studies reported race and no studies reported participant ethnicity.
This review revealed the heterogeneity of HTPR program designs in COPD. HTPR programs had similar effects to outpatient PR programs and greater effects than usual care for people with COPD.
由于2019冠状病毒病大流行，基于家庭的远程医疗肺康复（HTPR）用于慢性阻塞性肺疾病（COPD）越来越普遍。然而，尚未描述最佳的HTPR方案。本综述全面概述了COPD患者HTPR的设计、实施和效果。
检索相关数据库至2021年7月，以查找利用信息或通信技术监测或实施HTPR的COPD成人研究。对一部分随机对照试验进行了荟萃分析。
在检索到的3124条记录中，纳入了38项研究，评估了1993例稳定期COPD患者（年龄54 - 75岁，FEV为预测值的31% - 92%）。方案组成部分包括运动和教育（n = 17）或仅运动（n = 15），通常进行门诊基线评估（n = 26）。很少有试验（n = 7）采用同步虚拟运动监督。有氧运动通常包括步行（n = 14）和骑自行车（n = 11），大多数方案包括阻力训练（n = 25）。运动进展和应急行动计划的报告不一致。荟萃分析表明，HTPR与门诊肺康复相当，对改良医学研究理事会呼吸困难量表（平均差[95%CI]：-0.49[-0.77，-0.22]，p < 0.01）和慢性阻塞性肺疾病评估测试评分（-4.90[-7.13，-2.67]，p < 0.01）的效果优于常规护理。HTPR和门诊肺康复均未影响久坐时间或步数。只有6%的研究报告了种族，没有研究报告参与者的种族。
本综述揭示了COPD中HTPR方案设计的异质性。HTPR方案对COPD患者的效果与门诊肺康复方案相似，且优于常规护理。
