技術輔助心臟康復的有效性:系統評價和薈萃分析

技術輔助的心臟康復是一種潛在的替代方案,不僅可以消除心臟康復障礙,而且可以在當前長期流行的情況下進行。

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Abstract

Objectives

The objectives of this review were to identify different technology-assisted interventions in cardiac rehabilitation, to explore and examine the effectiveness of technology-assisted cardiac rehabilitation.

Design

A systematic review and meta-analysis.

Methods

A systematic search was performed on six electronic databases: CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO to identify randomised controlled trials from 2010 to 2020. Selection of studies was performed by screening the titles, abstracts and full texts, and two reviewers independently and critically appraised the included studies using the revised Cochrane risk of bias tool for randomized trials (RoB 2).

Results

Nine randomised controlled trials met the inclusion criteria; five studies with some bias concerns related to allocation concealment (n = 2) and measurement of outcome (n = 4), and four studies were of low risk of bias. The pooled effect size showed comparable effectiveness between technology-assisted cardiac rehabilitation and conventional/centre-based cardiac rehabilitation on modifiable coronary risk factors (systolic and diastolic blood pressure, total cholesterol, p>0.05), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.62, p = 0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p = 0.47). Narrative synthesis was performed for adherence to prescribed exercise sessions in cardiac rehabilitation. No significant adverse events occurred. The adverse events that did occur were self-reported, mostly unrelated to the interventions with technology and the number of events was comparable between both groups. Inconsistent results were found across the studies. This review revealed lack of self-efficacy and behaviour change theories/strategies, and educational emphasis among studies.

Conclusions

The results in the meta-analysis have indicated that technology-assisted cardiac rehabilitation demonstrated comparable results to conventional/centre-based cardiac rehabilitation. Technology-assisted cardiac rehabilitation is a potential alternative not only to remove cardiac rehabilitation barriers but also in the midst of current prolonged pandemic. Future studies on technology-assisted cardiac rehabilitation with the emphasis behavior change theories/strategies and education are required.

摘要翻譯(僅供參考)

目標

本綜述的目的是確定心臟康復中不同的技術輔助干預措施,探索和檢驗技術輔助心臟康復的有效性。

設計

系統評價和薈萃分析。

方法

對六個電子數據庫進行了系統搜索:CINALH Complete、Cochrane Library 、PubMed、MEDLINE via OvidSP、British Nursing Index和PsycINFO,以確定 2010 年至 2020 年的隨機對照試驗。通過篩選標題、摘要和全文進行研究選擇文本,兩名審稿人使用經修訂的 Cochrane 隨機試驗偏倚風險工具(RoB 2)獨立和批判性地評估了納入的研究。

結果

9項隨機對照試驗符合納入標準;五項與分配隱藏相關的偏倚問題的研究(n = 2) 和測量結果 (n = 4),四項研究的偏倚風險較低。匯總效應大小顯示,技術輔助心臟康復和傳統/中心心臟康復對可改變的冠狀動脈危險因素(收縮壓和舒張壓、總膽固醇、p>0.05),心理結果(焦慮:SMD 0.25,95% CI -0.11 到 0.62, p = 0.17 和抑鬱:SMD 0.09,95% CI -0.16 到 0.35, p = 0.47)。進行敘述合成以堅持心臟康復中規定的鍛鍊課程。沒有發生顯著的不良事件。確實發生的不良事件是自我報告的,大多與技術干預無關,並且兩組之間的事件數量具有可比性。在所有研究中發現不一致的結果。該審查顯示缺乏自我效能和行為改變的理論/策略,以及研究之間的教育重點。

結論

薈萃分析的結果表明,技術輔助的心臟康復與傳統/以中心為基礎的心臟康復具有可比性。技術輔助的心臟康復是一種潛在的替代方案,不僅可以消除心臟康復障礙,而且可以在當前長期流行的情況下進行。未來需要對技術輔助心臟康復進行研究,重點是行為改變理論/策略和教育。

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