两种远程康复监督方案对中重度创伤性脑损伤患者身体活动、移动能力和平衡的影响：一项混合方法单病例设计
The Impact of Two Telerehabilitation Supervision Schedules on Physical Activity, Mobility, and Balance Among People with Moderate to Severe Traumatic Brain Injury: A Mixed-Method Single-Subject Design.
作者信息
O'Neil Jennifer, Egan Mary, Marshall Shawn, Bilodeau Martin, Pelletier Luc, Sveistrup Heidi
机构信息
From the: Schools of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Bruyère Research Institute, Ottawa, Ontario, Canada.
出版信息
Physiother Can. 2023 May 1;75(2):118-131. doi: 10.3138/ptc-2021-0040. eCollection 2023 May.
BACKGROUND
Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery.
OBJECTIVE
We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life.
METHODS
A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured.
RESULTS
Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule.
CONCLUSION
Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.
背景
许多经历中度或重度创伤性脑损伤（TBI）的个体在身体活动、平衡和移动能力方面存在长期缺陷，需要专门护理。正在研究新的服务模式，以进行干预，应对因生活在偏远社区、交通困难和/或身体距离要求带来的挑战。鉴于当前向远程医疗服务的转变，确定远程康复的有效性至关重要。
目的
我们研究了两种远程治疗监督计划在提供居家强化运动计划方面的有效性，该计划针对1）身体活动、移动能力、平衡、参与度，以及2）跌倒担忧和生活满意度。
方法
采用交替单病例设计（SSD）和访谈的混合方法。五名经历中度或重度TBI的个体完成了两项居家强化远程康复计划。计划仅在监督计划上有所不同——每日或每周。测量了对客观和患者报告结果的影响。
结果
四名个体在身体活动水平、平衡和移动能力方面表现出临床上显著的改善。一名个体在两种监督计划后对跌倒的担忧都有所减少，而另外两名个体在每周远程监督后呈现出该趋势。无论监督计划如何，家庭成员也察觉到并报告了重要的功能改善（即平衡改善和疲劳减轻）。
结论
尽管该研究存在局限性，但研究结果表明，通过远程康复提供的运动计划可以改善平衡和移动能力，并对该人群的跌倒担忧和身体活动水平产生积极影响。两种远程康复监督计划之间未观察到明显差异。
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