基于家庭的数字健康干预对老年髋部骨折术后患者功能结局的特征和影响：系统评价和荟萃分析。

BACKGROUND: Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. OBJECTIVE: This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. METHODS: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS: Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=-7.89; 95% CI -10.34 to -5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95% CI 5.73-10.24; P<.001). CONCLUSIONS: Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population.

背景：数字健康干预（DHIs）已被用于改善老年髋部骨折患者的术后功能能力。然而，关于基于家庭的 DHIs 的特征的信息有限，并且关于它们对该人群功能结局的影响存在争议。

目的：本研究旨在提供关于基于家庭的 DHIs 对手术后老年髋部骨折患者功能结局的特征和影响的概述。

方法：我们按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统评价和荟萃分析。检索了五个电子医学数据库（PubMed、Embase、Cochrane、ProQuest 和 CINAHL），截至 2023 年 1 月 3 日。我们纳入了英文的临床试验或随机对照试验（RCT），涉及手术后老年髋部骨折患者的基于家庭的 DHIs 用于术后护理。排除了涉及未住院、未出院回家、未直接使用 DHIs 或无法获取全文的患者的研究。PROSPERO 注册号为 CRD42022370550。两名独立的审查员进行了筛选和提取数据（SP 和 NB）。通过讨论和与第三位作者（KP）达成一致来解决分歧。基于家庭的 DHIs 的特征在于目的和内容、交付模式和医疗保健提供者。评估的功能结局包括计时起立行走测试（TUG）、简短身体表现电池（SPPB）和功能独立性测量（FIM）。使用具有 95%置信区间的均数差计算汇总措施。使用风险偏倚 2 评估工具评估 RCT 的风险偏倚和非 RCT 的 ROBINS-I。使用 GRADE（推荐评估、制定和评估的分级）评估证据质量。

结果：在 2125 项确定的研究中，有 16 项研究被纳入系统评价，涉及 1467 名参与者。六项研究纳入荟萃分析（4 项用于 TUG，4 项用于 SPPB，2 项用于 FIM）。基于家庭的 DHIs 主要涉及沟通和反馈、教育和远程康复。电话是最常见的交付模式，其次是基于网络的软件和移动应用程序。物理治疗师是主要的医疗保健提供者。荟萃分析显示，与常规护理相比，基于家庭的 DHIs 改善了功能结局，TUG 评分降低（平均差异=-7.89；95%CI -10.34 至-5.45；P<.001），SPPB 评分显著增加（平均差异=1.11；95%CI 0.51 至 1.72；P<.001），FIM 评分增加（平均差异=7.98；95%CI 5.73 至 10.24；P<.001）。

结论：整合沟通和反馈、教育和远程康复的基于家庭的 DHIs 已被证明可有效提高髋部骨折手术后老年患者的功能结局。这些干预措施通常由物理治疗师实施，他们在促进和指导康复过程中发挥着关键作用。然而，尽管现有证据支持这些干预措施的有效性，但仍需要进一步研究以增强我们对基于家庭的 DHIs 的理解并优化其在该特定人群中的实施。