Anandakumar Jeya, Ja Mai Htun, Bv Riblet Natalie, Waseem Hena
The Dartmouth Institute for Health Policy & Clinical Practices, Dartmouth College, Hanover, NH, USA.
The Dartmouth Institute for Health Policy & Clinical Practices, Dartmouth College, Hanover, NH, USA; Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Hanover, NH, USA.
J Clin Neurosci. 2024 Dec;130:110906. doi: 10.1016/j.jocn.2024.110906. Epub 2024 Nov 13.
The burden of stroke is higher in low- and middle-income countries (LMICs) than in high-income countries due to the lack of stroke care centers, stroke specialist, and rehabilitation access. One way to increase access to stroke care in LMICs is through the use of telehealth.
MATERIAL & METHOD: We performed a scoping review to summarize the evidence on telehealth in LMICs. We searched Medline, SCOPUS, and Web of Science through February 18th, 2022. Reviewers screened for studies reporting on health outcomes following telehealth interventions (imaging, thrombolysis, and rehabilitation) in LMICs. We included all study designs.
Out of 259 studies, 10 studies met the eligibility criteria. Nine reported on functional or disability measures, 6 reported on cerebral infarction or intracerebral hemorrhage, 5 reported on door-to-needle time to thrombolysis, and 6 reported on mortality rate. Out of 9 studies, 8 reported that the use of telehealth for stroke management and rehabilitation in LMICs has led to a decrease in the degree of post-stroke disability. However, the comparison group may have received no rehabilitation treatment at all in LMICs. All 5 studies that measured administration of thrombolytic therapy in respective telehealth interventions were within the recommended 3-hour time window. Studies with a comparison arm found that there was no significant difference in mortality and cerebral infarction/intracerebral hemorrhage rates between telehealth and control.
Evidence from this review suggests that telehealth may improve post-stroke disability and facilitate the timely administration of thrombolytics therapy within the 3-hour window by allowing remote access to distant tertiary stroke care center in situations where it would otherwise be delayed in LMICs due to logistical barriers such as an extended travel time. Further research using randomized and quasi-experimental studies are needed in LMICs to determine the overall effectiveness of telehealth intervention for stroke management and rehabilitation.
由于缺乏中风护理中心、中风专科医生以及康复服务，低收入和中等收入国家（LMICs）的中风负担高于高收入国家。在LMICs中增加中风护理可及性的一种方法是使用远程医疗。
我们进行了一项范围综述，以总结LMICs中远程医疗的证据。我们检索了截至2022年2月18日的Medline、SCOPUS和科学网。评审人员筛选了报告LMICs中远程医疗干预（成像、溶栓和康复）后健康结果的研究。我们纳入了所有研究设计。
在259项研究中，10项研究符合纳入标准。9项报告了功能或残疾指标，6项报告了脑梗死或脑出血，5项报告了溶栓的门到针时间，6项报告了死亡率。在9项研究中，8项报告称，在LMICs中使用远程医疗进行中风管理和康复可降低中风后残疾程度。然而，在LMICs中，对照组可能根本没有接受康复治疗。在各自的远程医疗干预中测量溶栓治疗给药情况的所有5项研究均在推荐的3小时时间窗内。有比较组的研究发现，远程医疗组和对照组在死亡率以及脑梗死/脑出血发生率方面没有显著差异。
本综述的证据表明，远程医疗可能改善中风后残疾状况，并通过在LMICs中因诸如旅行时间延长等后勤障碍而可能导致延迟的情况下，允许远程接入遥远的三级中风护理中心，从而促进在3小时时间窗内及时进行溶栓治疗。LMICs需要进一步开展随机和准实验研究，以确定远程医疗干预对中风管理和康复的总体有效性。
