远程医疗支持的膝关节骨关节炎运动或体育活动方案：系统评价和荟萃分析。
Telehealth-Supported Exercise or Physical Activity Programs for Knee Osteoarthritis: Systematic Review and Meta-Analysis.
机构信息
Rehabilitation Medicine Center and Institute 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.
出版信息
J Med Internet Res. 2024 Aug 2;26:e54876. doi: 10.2196/54876.
BACKGROUND
The integration of telehealth-supported programs in chronic disease management has become increasingly common. However, its effectiveness for individuals with knee osteoarthritis (KOA) remains unclear.
OBJECTIVE
This study aimed to assess the effectiveness of telehealth-supported exercise or physical activity programs for individuals with KOA.
METHODS
A comprehensive literature search encompassing Embase, MEDLINE, CENTRAL, Web of Science, PubMed, Scopus, PEDro, GreyNet, and medRxiv from inception to September 2023 was conducted to identify randomized controlled trials comparing telehealth-supported exercise or physical activity programs to a control condition for KOA. Data were extracted and qualitatively synthesized across eligible studies, and a meta-analysis was performed to evaluate the effects. The study was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020.
RESULTS
In total, 23 studies met eligibility criteria, with 20 included in the meta-analysis. Results showed that telehealth-supported exercise or physical activity programs reduced pain (g=-0.39; 95% CI -0.67 to -0.11; P<.001), improved physical activity (g=0.13; 95% CI 0.03-0.23; P=.01), and enhanced physical function (g=-0.51; 95% CI -0.98 to -0.05; P=.03). Moreover, significant improvements in quality of life (g=0.25; 95% CI 0.14-0.36; P<.001), self-efficacy for pain (g=0.72; 95% CI 0.53-0.91; P<.001), and global improvement (odds ratio 2.69, 95% CI 1.41-5.15; P<.001) were observed. However, self-efficacy for physical function (g=0.14; 95% CI -0.26 to 0.53; P=.50) showed insignificant improvements. Subgroup analyses based on the World Health Organization classification of digital health (pain: χ=6.5; P=.04 and physical function: χ=6.4; P=.04), the type of teletechnology in the intervention group (pain: χ=4.8; P=.31 and function: χ=13.0; P=.01), and active or inactive controls (pain: χ=5.3; P=.02 and physical function: χ=3.4; P=.07) showed significant subgroup differences.
CONCLUSIONS
Telehealth-supported exercise or physical activity programs might reduce knee pain and improve physical activity, physical function, quality of life, self-efficacy, and global improvement in individuals with KOA. Future research should consider longer implementation durations and assess the feasibility of incorporating wearables and standardized components into large-scale interventions to evaluate the effects.
TRIAL REGISTRATION
PROSPERO CRD42022359658; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359658.
背景
远程医疗支持的项目已在慢性病管理中得到广泛应用。然而，其对膝骨关节炎（KOA）患者的有效性尚不清楚。
目的
本研究旨在评估远程医疗支持的运动或体育活动方案对 KOA 患者的有效性。
方法
从建库至 2023 年 9 月，通过全面检索 Embase、MEDLINE、CENTRAL、Web of Science、PubMed、Scopus、PEDro、GreyNet 和 medRxiv，以识别比较远程医疗支持的运动或体育活动方案与对照条件对 KOA 影响的随机对照试验。对合格研究进行数据提取和定性综合分析，并进行荟萃分析以评估效果。本研究按照 PRISMA（系统评价和荟萃分析的首选报告项目）2020 进行报告。
结果
共有 23 项研究符合纳入标准，其中 20 项纳入荟萃分析。结果显示，远程医疗支持的运动或体育活动方案可减轻疼痛（g=-0.39；95%CI-0.67 至-0.11；P<.001），提高身体活动（g=0.13；95%CI0.03-0.23；P=.01），并改善身体功能（g=-0.51；95%CI-0.98 至-0.05；P=.03）。此外，生活质量（g=0.25；95%CI0.14-0.36；P<.001）、疼痛自我效能感（g=0.72；95%CI0.53-0.91；P<.001）和总体改善（比值比 2.69，95%CI1.41-5.15；P<.001）均有显著改善。但身体功能自我效能感（g=0.14；95%CI-0.26 至 0.53；P=.50）无显著改善。基于世界卫生组织数字健康分类（疼痛：χ=6.5；P=.04 和身体功能：χ=6.4；P=.04）、干预组远程医疗技术类型（疼痛：χ=4.8；P=.31 和功能：χ=13.0；P=.01）和主动或非主动对照（疼痛：χ=5.3；P=.02 和身体功能：χ=3.4；P=.07）的亚组分析显示，存在显著的亚组差异。
结论
远程医疗支持的运动或体育活动方案可能会减轻 KOA 患者的膝关节疼痛，改善身体活动、身体功能、生活质量、自我效能感和总体改善。未来的研究应考虑更长的实施时间，并评估将可穿戴设备和标准化组件纳入大规模干预措施的可行性，以评估其效果。
试验注册
PROSPERO CRD42022359658；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359658.
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