基于互联网的远程医疗项目在髋或膝关节骨关节炎患者中的疗效：系统评价和荟萃分析。
Effectiveness of Internet-Based Telehealth Programs in Patients With Hip or Knee Osteoarthritis: Systematic Review and Meta-Analysis.
机构信息
Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
出版信息
J Med Internet Res. 2024 Sep 30;26:e55576. doi: 10.2196/55576.
BACKGROUND
Osteoarthritis (OA) is a chronic musculoskeletal disease that causes pain, functional disability, and an economic burden. Nonpharmacological treatments are at the core of OA management. However, limited access to these services due to uneven regional local availability has been highlighted. Internet-based telehealth (IBTH) programs, providing digital access to abundant health care resources, offer advantages, such as convenience and cost-effectiveness. These characteristics make them promising strategies for the management of patients with OA.
OBJECTIVE
This study aimed to evaluate the effectiveness of IBTH programs in the management of patients with hip or knee OA.
METHODS
We systematically searched 6 electronic databases to identify trials comparing IBTH programs with conventional interventions for hip and knee OA. Studies were selected based on inclusion and exclusion criteria, focusing on outcomes related to function, pain, and self-efficacy. Standardized mean differences (SMDs) with 95% CIs were calculated to compare outcome measures. Heterogeneity was assessed using I² and χ² tests. The methodological quality of the selected studies and the quality of evidence were also evaluated.
RESULTS
A total of 21 studies with low-to-high risk of bias were included in this meta-analysis. The pooled results showed that IBTH has a superior effect on increasing function (SMD 0.30, 95% CI 0.23-0.37, P<.001), relieving pain (SMD -0.27, 95% CI -0.34 to -0.19, P<.001), and improving self-efficacy for pain (SMD 0.21, 95% CI 0.08-0.34, P<.001) compared to the conventional intervention group. Subgroup analysis revealed that IBTH with exercise can significantly alleviate pain and improve function and self-efficacy, but IBTH with cognitive-behavioral therapy only had the effect of reducing pain.
CONCLUSIONS
The meta-analysis provides moderate-quality evidence that IBTH programs have a beneficial effect on improving function, relieving pain, and improving self-efficacy compared to conventional interventions in patients with hip or knee OA. Limited evidence suggests that the inclusion of exercise regimens in IBTH programs is recommended.
TRIAL REGISTRATION
PROSPERO CRD42024541111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=541111.
背景
骨关节炎（OA）是一种慢性肌肉骨骼疾病，会导致疼痛、功能障碍和经济负担。非药物治疗是 OA 管理的核心。然而，由于区域供应不均，这些服务的获取受到限制。基于互联网的远程医疗（IBTH）计划提供了数字访问丰富的医疗保健资源，具有便利性和成本效益等优势。这些特点使它们成为 OA 患者管理的有前途的策略。
目的
本研究旨在评估 IBTH 计划在髋或膝关节 OA 患者管理中的有效性。
方法
我们系统地搜索了 6 个电子数据库，以确定比较 IBTH 计划与髋和膝关节 OA 的常规干预措施的试验。研究根据纳入和排除标准进行选择，重点关注与功能、疼痛和自我效能相关的结果。使用标准化均数差（SMD）和 95%置信区间（CI）比较结局指标。使用 I² 和 χ²检验评估异质性。还评估了所选研究的方法学质量和证据质量。
结果
这项荟萃分析共纳入了 21 项低至高偏倚风险的研究。汇总结果表明，IBTH 在增加功能方面效果更好（SMD 0.30，95%CI 0.23-0.37，P<.001），缓解疼痛（SMD -0.27，95%CI -0.34 至 -0.19，P<.001）和改善疼痛自我效能（SMD 0.21，95%CI 0.08-0.34，P<.001）与常规干预组相比。亚组分析显示，IBTH 联合运动可以显著缓解疼痛，改善功能和自我效能，但 IBTH 联合认知行为疗法仅具有减轻疼痛的作用。
结论
荟萃分析提供了中等质量的证据，表明与常规干预相比，IBTH 计划在髋或膝关节 OA 患者中具有改善功能、缓解疼痛和提高自我效能的有益作用。有限的证据表明，建议在 IBTH 计划中纳入运动方案。
试验注册
PROSPERO CRD42024541111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=541111.
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