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比较数字与传统心脏康复实践的结果:系统评价与荟萃分析

Comparing the Outcomes of Digital and Traditional Cardiac Rehabilitation Practices: A Systematic Review and Meta-Analysis.

作者信息

Ansari Sumbul, Nadar Bhuvaneshwari G, Estêvão M Dulce, Aguiar Débora R, Ejeh Jude, Khan Zahid

机构信息

Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, IND.

Public Health Dentistry, Terna Dental College and Hospital, Mumbai, IND.

出版信息

Cureus. 2025 Jan 21;17(1):e77757. doi: 10.7759/cureus.77757. eCollection 2025 Jan.


DOI:10.7759/cureus.77757
PMID:39981488
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11840654/
Abstract

This systematic review and meta-analysis aimed to evaluate the effects of digital cardiac rehabilitation (DCR) encompassing application-based telehealth compared to traditional cardiac rehabilitation onmajor adverse cardiovascular events (MACE), rehospitalisation, costs, quality of life (QoL), and physical activity levels in patients with coronary artery disease (CAD). From 2014 to May 2024, a systematic search of the MEDLINE, PubMed, Web of Science, and Scopus databases was conducted using relevant keywords to identify randomised controlled trials (RCTs) or randomised cross-over trials. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale and risk of bias tool. The included articles were then subjected to qualitative synthesis and meta-analysis. Thirteen studies involving 1850 participants were included in the study. Meta-analysis revealed statistically significant improvements in QoL (mean deviation (MD) = 0.10, 95% CI: 0.05-0.15, p = 0.0002). DCR compared with centre-based rehabilitation (CBR). These improvements in QoL likely translated to enhanced daily functioning, such as the increased ability to perform activities of daily living. However, no significant differences were found for physical activity levels (MD = 1.69, 95% CI: 1.49-4.87, p = 0.30), rehospitalisation (relative risk (RR) = 0.86, 95% CI: 0.66-1.11, p = 0.25) or MACE (RR = 0.67, 95% CI: 0.42-1.07, p = 0.09). High heterogeneity was observed in QoL, likely due to variations in DCR modalities, study populations, and intervention content. The results of this study, therefore, must be interpreted with caution. DCR may offer significant benefits in terms of improving the QoL in patients with CAD. While promising trends were observed for rehospitalisation and MACE, further research is needed to confirm these findings. Potential reasons for the observed benefits of DCR over centre-based rehabilitation plausibly include improved accessibility, enhanced patient engagement, and greater flexibility. However, it is important to acknowledge the presence of heterogeneity among the included studies and potential gender imbalances within the study populations, which may have influenced the results. Future research should prioritize long-term outcomes, cost-effectiveness, real-world effectiveness in diverse populations, and the development of standardized DCR protocols.

摘要

本系统评价和荟萃分析旨在评估与传统心脏康复相比,包含基于应用程序的远程医疗的数字心脏康复(DCR)对冠状动脉疾病(CAD)患者主要不良心血管事件(MACE)、再住院、成本、生活质量(QoL)和身体活动水平的影响。2014年至2024年5月,使用相关关键词对MEDLINE、PubMed、科学网和Scopus数据库进行了系统检索,以识别随机对照试验(RCT)或随机交叉试验。使用物理治疗证据数据库(PEDro)量表和偏倚风险工具评估纳入研究的方法学质量。然后对纳入的文章进行定性综合和荟萃分析。该研究纳入了13项涉及1850名参与者的研究。荟萃分析显示,生活质量有统计学意义的改善(平均偏差(MD)=0.10,95%CI:0.05 - 0.15,p = 0.0002)。与基于中心的康复(CBR)相比,DCR有这些改善。生活质量的这些改善可能转化为日常功能的增强,例如进行日常生活活动能力的提高。然而,在身体活动水平(MD = 1.69,95%CI:1.49 - 4.87,p = 0.30)、再住院(相对风险(RR)= 0.86,95%CI:0.66 - 1.11,p = 0.25)或MACE(RR = 0.67,95%CI:0.42 - 1.07,p = 0.09)方面未发现显著差异。在生活质量方面观察到高度异质性,可能是由于DCR模式、研究人群和干预内容的差异。因此,本研究结果必须谨慎解释。DCR在改善CAD患者生活质量方面可能提供显著益处。虽然在再住院和MACE方面观察到了有前景的趋势,但需要进一步研究来证实这些发现。DCR相对于基于中心的康复所观察到的益处的潜在原因可能包括可及性提高、患者参与度增强和更大的灵活性。然而,必须认识到纳入研究中存在异质性以及研究人群中可能存在的性别不平衡,这可能影响了结果。未来的研究应优先关注长期结果、成本效益、在不同人群中的实际效果以及标准化DCR方案的制定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/511894458ffd/cureus-0017-00000077757-i14.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/c943ffbf4adb/cureus-0017-00000077757-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/ae245af7f572/cureus-0017-00000077757-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/719007d830a9/cureus-0017-00000077757-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/3aa0718a6786/cureus-0017-00000077757-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/9928c6d1005f/cureus-0017-00000077757-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/96e7295f65c8/cureus-0017-00000077757-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/3bd835d1fd63/cureus-0017-00000077757-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/aba674a550e8/cureus-0017-00000077757-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/66b2e6cca426/cureus-0017-00000077757-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/02ec285a346b/cureus-0017-00000077757-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/9fd23dc85e56/cureus-0017-00000077757-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/0433522d0561/cureus-0017-00000077757-i12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/62c8941db6e3/cureus-0017-00000077757-i13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/511894458ffd/cureus-0017-00000077757-i14.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/c943ffbf4adb/cureus-0017-00000077757-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/ae245af7f572/cureus-0017-00000077757-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/719007d830a9/cureus-0017-00000077757-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/3aa0718a6786/cureus-0017-00000077757-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/9928c6d1005f/cureus-0017-00000077757-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/96e7295f65c8/cureus-0017-00000077757-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/3bd835d1fd63/cureus-0017-00000077757-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/aba674a550e8/cureus-0017-00000077757-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/66b2e6cca426/cureus-0017-00000077757-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/02ec285a346b/cureus-0017-00000077757-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/9fd23dc85e56/cureus-0017-00000077757-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/0433522d0561/cureus-0017-00000077757-i12.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/62c8941db6e3/cureus-0017-00000077757-i13.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9752/11840654/511894458ffd/cureus-0017-00000077757-i14.jpg

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[3]
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Eur Heart J Digit Health. 2020-11-23

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