Shah Nirali, Costello Kerry, Mehta Akshat, Kumar Deepak
Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, United States.
JMIR Rehabil Assist Technol. 2022 Jun 8;9(2):e33489. doi: 10.2196/33489.
With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR).
This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR.
In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included.
Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively.
For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes.
随着老年人越来越多地采用高速互联网和移动技术，数字健康成为一种很有前景的方式，可用于改善膝关节骨关节炎（KOA）患者（包括接受膝关节置换术（KR）的患者）的临床护理。
本研究旨在总结数字健康在KOA和KR干预中的当前使用情况、成本效益以及患者和临床医生的观点。
在这项叙述性综述中，于2018年10月至2021年2月期间在PubMed和Embase数据库中使用了移动健康、智能手机、移动应用程序、移动技术、电子健康、短信、互联网、膝关节骨关节炎、全膝关节置换术和膝关节置换等搜索词。搜索仅限于过去10年内发表的英文原创文章。总共纳入了91项研究。
网站、移动应用程序、电话、短信、社交媒体、视频会议和定制多技术系统等数字健康技术已被用于对KOA和KR人群进行干预。总体而言，这些人群使用的数字健康类型和应用存在显著异质性。数字患者教育提高了与疾病相关的知识，尤其是在作为KOA和KR患者传统患者教育方法的辅助手段时。对于KOA和KR患者，包含个性化激励信息、生物反馈或患者监测的数字健康在改善身体活动方面比自我指导的数字干预更成功。许多数字运动干预被发现对KOA患者与面对面物理治疗一样有效。许多针对KR的数字运动干预结合了面对面和基于网络的治疗（混合形式）、与临床医生的沟通以及多技术系统，并成功改善了膝关节活动范围和自我报告的症状，缩短了住院时间。与未治疗或传统治疗相比，所有纳入认知行为疗法或类似心理干预的数字干预在KOA和KR患者的膝关节疼痛、功能和心理健康方面均显示出显著改善。尽管数量有限，但研究表明数字健康对这些人群可能具有成本效益，尤其是在考虑旅行成本时。最后，尽管KOA和KR患者以及临床医生对数字健康持积极看法，但患者和临床医生分别提出了与隐私和安全相关的担忧以及与后勤和培训相关的担忧。
对于KOA和KR患者，许多研究发现数字健康在患者教育、身体活动和运动干预方面与传统治疗一样有效。与未治疗或传统治疗相比，所有纳入认知行为疗法或类似心理治疗的数字干预均报告能使KOA和KR患者有显著改善。总体而言，融合了与临床医生沟通以及生物反馈或患者监测的技术显示出良好的效果。
