Hestetun-Mandrup Ann Marie, Toh Zheng An, Oh Hui Xian, He Hong-Gu, Martinsen Anne Catrine Trægde, Pikkarainen Minna
Oslomet -Oslo Metropolitan University, Oslo, Norway.
Sunnaas Rehabilitation Hospital, Norway.
Digit Health. 2024 Jun 3;10:20552076241256861. doi: 10.1177/20552076241256861. eCollection 2024 Jan-Dec.
Stroke survivors often experience residual impairments and motor decline post-discharge. While digital home rehabilitation combined with supervision could be a promising approach for reducing human resources, increasing motor ability, and supporting rehabilitation persistence there is a lack of reviews synthesizing the effects. Thus, this systematic review and meta-analysis aimed to synthesize the effect of digital home rehabilitation and supervision in improving motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function among stroke survivors.
Six electronic databases, grey literature, ongoing studies, and reference lists were searched for relevant studies. Two investigators independently reviewed titles, abstracts, screened full texts for eligibility and performed data extraction. Meta-analysis of 13 independent studies were grouped into four separate meta-analyses. The Grading of Recommendations, Assessments, Development and Evaluations (GRADE) tool was used for evaluating the overall quality of the evidence.
Meta-analyses showed no statistically significant difference between intervention (digital home rehabilitation) and control groups (home training/clinic-based) of all outcomes including motor ability of upper limb, static balance, stroke-related quality of life, and self-reported arm function. In the sub-group analysis digital home rehabilitation was associated with better quality of arm use (standardized mean difference = 0.68, 95% confidence interval: [0.27, 1.09], = 0.001).
This result indicated that digital home rehabilitation has similar effects and could potentially replace home training or clinic-based services. This review highlights better-targeted digital motor interventions to examine the effects of interventions further. The quality of evidence was moderate to high in motor and self-reported arm outcomes, and low for balance and quality of life.
中风幸存者出院后常伴有残留功能障碍和运动能力下降。虽然结合监督的数字家庭康复可能是一种减少人力资源、提高运动能力和支持康复持续性的有效方法，但目前缺乏对其效果进行综合分析的综述。因此，本系统综述和荟萃分析旨在综合评估数字家庭康复及监督对提高中风幸存者上肢运动能力、静态平衡、中风相关生活质量和自我报告的手臂功能的效果。
检索了六个电子数据库、灰色文献、正在进行的研究以及参考文献列表，以查找相关研究。两名研究人员独立审查标题、摘要，筛选全文以确定是否符合纳入标准，并进行数据提取。对13项独立研究进行荟萃分析，分为四个单独的荟萃分析。使用推荐分级、评估、制定与评价（GRADE）工具来评估证据的整体质量。
荟萃分析显示，在所有结果中，包括上肢运动能力、静态平衡、中风相关生活质量和自我报告的手臂功能，干预组（数字家庭康复）和对照组（家庭训练/基于诊所的训练）之间没有统计学上的显著差异。在亚组分析中，数字家庭康复与更好的手臂使用质量相关（标准化平均差 = 0.68，95%置信区间：[0.27, 1.09]，P = 0.001）。
该结果表明，数字家庭康复具有相似的效果，并且有可能取代家庭训练或基于诊所的服务。本综述强调了更具针对性的数字运动干预措施，以便进一步研究干预效果。在运动和自我报告的手臂功能结果方面，证据质量为中等到高，而在平衡和生活质量方面则较低。
