Efficacy and Safety of Hybrid Comprehensive Telerehabilitation (HCTR) for Cardiac Rehabilitation in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Zheming Yang, Xiaodong Jia, Jiayin Li, Zhu Mei, Lin Yang, Chenghui Yan, Yaling Han
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Abstract
Backgrounds: Cardiovascular disease (CVD) is a serious condition that poses threats to patients' quality of life and life expectancy. Cardiac rehabilitation is a crucial treatment option that can improve outcomes for CVD patients. Hybrid comprehensive telerehabilitation (HCTR) is a relatively new approach. In the context of pandemics, HCTR can minimize the risk of cluster infections by reducing hospital visits while delivering effective rehabilitation care. This study is aimed at assessing the efficacy and safety of HCTR as a secondary prevention measure for CVD patients compared to usual rehabilitation care.
Methods: We searched PubMed, Embase, The Web of Science, The Cochrane Library, and PsychINFO for all related studies up to January 20, 2023. Two reviewers independently screened the titles and abstracts of potentially eligible articles based on the predefined search criteria. Data were analyzed using a comprehensive meta-analysis software (RevMan5.3).
Results: Eight trials, involving 1578 participants, were included. HCTR and usual rehabilitation care provide similar effects on readmission rates (odds ratio (OR) = 0.90 (95% CI 0.69-1.17), P = 0.43) and mortality (odds ratio (OR) = 1.06 (95% CI 0.72-1.57), P = 0.76). Effects on Short Form-36 Health Status Questionnaire (SF-36) score were also similar (SMD: 1.32 (95% CI-0.48-3.11), P = 0.15). Compared with usual rehabilitation care, HCTR can improve peak oxygen uptake (VO2 peak) (SMD: 0.99 (95% CI 0.23-1.74), P = 0.01) and 6-minute walking test (6MWT) (SMD: 10.02 (95% CI 5.44-14.60), P < 0.001) of patients.
Conclusions: Our findings indicate that HCTR is as effective as traditional rehabilitation care in reducing readmission rates and mortality and improving quality of life in patients with CVD. However, HCTR offers the added advantage of improving VO2 peak and 6MWT, measurements of cardiorespiratory fitness and functional capacity, respectively. These results suggest that HCTR can be a safe and effective alternative to traditional rehabilitation care, offering numerous benefits for CVD patients. Clinical Study Registration Number. This trial is registered with NCT02523560 and NCT02796404.
背景:心血管疾病(CVD)是一种严重威胁患者生活质量和预期寿命的疾病。心脏康复是一种关键的治疗选择，可以改善心血管疾病患者的预后。混合综合远程康复(HCTR)是一种较新的方法。在大流行的背景下，HCTR可以通过减少医院就诊，同时提供有效的康复护理，最大限度地减少聚集性感染的风险。本研究旨在评估HCTR作为心血管疾病患者二级预防措施的有效性和安全性，并与常规康复护理进行比较。方法:我们检索PubMed、Embase、Web of Science、Cochrane Library和PsychINFO，检索截至2023年1月20日的所有相关研究。两位审稿人根据预定义的搜索标准独立筛选可能符合条件的文章的标题和摘要。数据采用综合meta分析软件RevMan5.3进行分析。结果:纳入8项试验，1578名受试者。HCTR和常规康复护理在再入院率(优势比(OR) = 0.90 (95% CI 0.69-1.17)， P = 0.43)和死亡率(优势比(OR) = 1.06 (95% CI 0.72-1.57)， P = 0.76)方面具有相似的效果。对SF-36健康状况问卷(SF-36)评分的影响也相似(SMD: 1.32 (95% CI-0.48-3.11)， P = 0.15)。与常规康复护理相比，HCTR可改善患者的峰值摄氧量(VO2峰值)(SMD: 0.99 (95% CI 0.23-1.74)， P = 0.01)和6分钟步行试验(6MWT) (SMD: 10.02 (95% CI 5.44-14.60)， P < 0.001)。结论:我们的研究结果表明，HCTR在降低心血管疾病患者的再入院率和死亡率以及改善生活质量方面与传统康复护理一样有效。然而，HCTR提供了额外的优势，提高VO2峰值和6MWT，分别测量心肺适应性和功能能力。这些结果表明，HCTR可以作为传统康复护理的一种安全有效的替代方案，为心血管疾病患者提供许多益处。临床研究注册号。本试验注册号为NCT02523560和NCT02796404。
期刊介绍：
Occupational Therapy International is a peer-reviewed journal, publishing manuscripts that reflect the practice of occupational therapy throughout the world. Research studies or original concept papers are considered for publication. Priority for publication will be given to research studies that provide recommendations for evidence-based practice and demonstrate the effectiveness of a specific treatment method. Single subject case studies evaluating treatment effectiveness are also encouraged. Other topics that are appropriate for the journal include reliability and validity of clinical instruments, assistive technology, community rehabilitation, cultural comparisons, health promotion and wellness.
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