Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
School of Nursing, Sun Yat-Sen University, Guangzhou, China.
J Med Internet Res. 2022 Sep 7;24(9):e37618. doi: 10.2196/37618.
Pressure injury is a common complication after a spinal cord injury. Long-term multidisciplinary follow-up is difficult after such patients have been discharged. Telemedicine promises to provide convenient and effective support for the prevention and treatment of pressure injury, but previous attempts to demonstrate that have produced inconsistent results.
The aim of this study is to evaluate the effectiveness of telemedicine in preventing and treating pressure injury among community-dwelling patients with spinal cord injury, and determine which telemedicine form is more effective.
This systematic review was performed according to the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analysis) standards. Ten databases were searched to identify randomized controlled trials and quasi-experimental studies related to the effectiveness of telemedicine intervention in patients with spinal cord injury. Two researchers worked independently and blindly selected studies, extracted data, and assessed the risk of bias. The results were described as relative risk (RR) and weighted mean difference and 95% CI.
The 35 studies comprised 25 randomized controlled trials and 10 quasi-experimental studies involving 3131 patients. The results showed that telemedicine can significantly (P<.05) reduce the incidence of pressure injury (RR 0.24, 95% CI 0.14-0.41; P<.05; I=0%), promote faster healing (RR 0.73, 95% CI 0.62-0.85; P<.05; I=0%), and yield lower scores on the pressure ulcer scale of healing (weighted mean difference=-1.98, 95% CI -3.51 to -0.46; P<.05; I=0%). Cumulative ranking estimates showed that combining telemedicine with conventional intervention (93.5%) was the most effective approach.
Telemedicine is a feasible way to prevent pressure injury among patients with spinal cord injuries. It can decrease the incidence and severity of pressure injury and accelerate patients' healing without imposing economic burden. It is best used in tandem with other, more conventional interventions. Due to the limited quality and quantity of included studies, large-scale and well-designed randomized controlled trials are warranted.
压疮是脊髓损伤后的常见并发症。患者出院后，长期进行多学科随访较为困难。远程医疗有望为压疮的预防和治疗提供便捷有效的支持，但之前的尝试结果并不一致。
本研究旨在评估远程医疗在预防和治疗社区居住的脊髓损伤患者压疮中的有效性，并确定哪种远程医疗形式更有效。
本系统评价按照 PRISMA-NMA（系统评价和荟萃分析扩展的首选报告项目-网络荟萃分析）标准进行。检索了 10 个数据库，以确定与远程医疗干预对脊髓损伤患者有效性相关的随机对照试验和准实验研究。两名研究人员独立且盲法选择研究、提取数据并评估偏倚风险。结果以相对风险（RR）和加权均数差及 95%置信区间（CI）表示。
35 项研究包括 25 项随机对照试验和 10 项准实验研究，共涉及 3131 例患者。结果表明，远程医疗可显著（P<.05）降低压疮发生率（RR 0.24，95%CI 0.14-0.41；P<.05；I=0%），促进更快愈合（RR 0.73，95%CI 0.62-0.85；P<.05；I=0%），且压疮愈合量表评分较低（加权均数差=-1.98，95%CI -3.51 至-0.46；P<.05；I=0%）。累积排序估计表明，远程医疗联合常规干预（93.5%）是最有效的方法。
远程医疗是预防脊髓损伤患者压疮的一种可行方法。它可以降低压疮的发生率和严重程度，加速患者的愈合，且不会带来经济负担。它最好与其他更常规的干预措施联合使用。由于纳入研究的质量和数量有限，需要进行大规模、精心设计的随机对照试验。
