Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
Front Public Health. 2022 Sep 28;10:954754. doi: 10.3389/fpubh.2022.954754. eCollection 2022.
Coronavirus disease 2019 (COVID-19) significantly impacts physical, psychological, and social functioning and reduces quality of life, which may persist for at least 6 months. Given the fact that COVID-19 is a highly infectious disease and therefore healthcare facilities may be sources of contagion, new methods avoiding face-to-face contact between healthcare workers and patients are urgently needed. Telerehabilitation is the provision of rehabilitation services to patients at a distance information and communication technologies. However, high-quality evidence of the efficacy of telerehabilitation for COVID-19 is still lacking. This meta-analysis aimed to investigate the efficacy of telerehabilitation for patients with and survivors of COVID-19.
We searched the Cochrane Library, EMBASE, Medline ( PubMed), PEDro, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform from January 1st, 2020 to April 30th, 2022 for randomized controlled trials published in English, which aimed to evaluate the efficacy of telerehabilitation vs. face-to-face rehabilitation, usual care, or no treatment for COVID-19. Methodological quality and overall evidence quality of the included studies were assessed. The statistical reliability of the data was quantified using the trial sequential analysis.
Seven randomized controlled trials with eight comparisons were included and all of them were used for meta-analysis. The meta-analyses of absolute values showed the superiority of telerehabilitation over no treatment or usual care for dyspnea (Borg scale: mean difference = -1.88, -2.37 to -1.39; Multidimensional dyspnea-12: mean difference = -3.70, -5.93 to -1.48), limb muscle strength (mean difference = 3.29; 2.12 to 4.47), ambulation capacity (standardized mean difference = 0.88; 0.62 to 1.14), and depression (mean difference = -5.68; -8.62 to -2.74). Significant improvement in these variables persisted in the meta-analyses of change scores. No significant difference was found in anxiety and quality of life. No severe adverse events were reported in any of the included studies.
Moderate- to very low-quality evidence demonstrates that telerehabilitation may be an effective and safe solution for patients with and survivors of COVID-19 in dyspnea, lower limb muscle strength, ambulation capacity, and depression. Further well-designed studies are required to evaluate the long-term effects, cost-effectiveness, and satisfaction in larger samples.
2019 年冠状病毒病（COVID-19）严重影响身体、心理和社会功能，降低生活质量，这种影响可能至少持续 6 个月。由于 COVID-19 是一种高度传染性疾病，因此医疗保健设施可能是传染源，因此迫切需要避免医护人员与患者之间面对面接触的新方法。远程康复是通过信息和通信技术向患者提供康复服务。然而，关于 COVID-19 远程康复的疗效仍缺乏高质量证据。本荟萃分析旨在研究远程康复对 COVID-19 患者和幸存者的疗效。
我们检索了 Cochrane 图书馆、EMBASE、Medline（PubMed）、PEDro、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台，从 2020 年 1 月 1 日至 2022 年 4 月 30 日，以获取发表在英文期刊上的评估远程康复与面对面康复、常规护理或不治疗 COVID-19 的疗效的随机对照试验。评估了纳入研究的方法学质量和总体证据质量。使用试验序贯分析量化数据的统计可靠性。
纳入了 7 项随机对照试验，共 8 项比较，均用于荟萃分析。绝对值的荟萃分析显示，远程康复优于不治疗或常规护理，可改善呼吸困难（Borg 量表：平均差值=-1.88，-2.37 至-1.39；多维呼吸困难 12 项量表：平均差值=-3.70，-5.93 至-1.48）、四肢肌肉力量（平均差值=3.29；2.12 至 4.47）、步行能力（标准化平均差值=0.88；0.62 至 1.14）和抑郁（平均差值=-5.68；-8.62 至-2.74）。变化分数的荟萃分析中，这些变量的显著改善仍然存在。焦虑和生活质量方面无显著差异。纳入的研究均未报告严重不良事件。
中等到极低质量证据表明，远程康复可能是 COVID-19 患者和幸存者呼吸困难、下肢肌肉力量、步行能力和抑郁的有效且安全的治疗方法。需要进一步设计良好的研究来评估更大样本量的长期效果、成本效益和满意度。
