慢性阻塞性肺疾病患者远程肺康复护理需求的质性研究

目的了解COPD患者对远程肺康复的护理需求, 为我国构建远程肺康复护理模式提供理论依据。方法采用质性研究中现象学研究法, 于2022年3—5月采用目的抽样法选择东南大学附属中大医院呼吸科的14例COPD患者进行半结构式访谈, 运用主题分析法对资料进行整理和分析。结果 COPD患者对远程肺康复护理需求可归纳为3个主题, 即自我保健的需求、社会支持的需求、信息系统的需求。结论 COPD患者对远程肺康复仍有很多需求未得到满足, 应根据患者的疾病特点和实际需求, 成立多学科肺康复团队, 提供个性化肺康复计划和持续监督管理, 构建有效的交流平台, 提供多角度社会支持, 开发简便、易操作的应用程序和智能远程监测系统, 以满足COPD患者肺康复需求, 进一步提高其居家康复质量。     

远程康复对脑卒中患者康复功能影响的meta分析

摘要 目的：比较远程康复和传统康复方法对脑卒中患者功能康复的影响,分析远程康复的效果。 方法：检索PubMed、Web of Science、The Cochrane Library、中国生物医学文献服务系统（SinoMed）、中国知网（CNKI）、万方数据知识服务平台、维普中文科技期刊数据库（VIP）等数据库,收集远程康复改善脑卒中康复功能的随机对照试验,检索时间均从建库至2018年8月。按照纳入标准由2名研究者独立筛选文献并提取有效数据,逐一评价纳入研究的质量,采用RevMan5.3软件进行meta分析。 结果：根据纳入和排除标准最终纳入14个随机对照试验,包括822例脑卒中患者,其中远程康复组412例,传统康复组410例。meta分析结果表明：基于视频会议的远程康复组与传统康复组相比较,在运动功能方面（WMD=12.46,95%CI：9.17—15.75,P＜0.05)、日常生活活动能力康复方面（SMD=1.76,95%CI：1.15—2.37,P＜0.05）具有更好的康复效果;在平衡功能康复方面（WMD=2.31,95%CI：-8.61—13.22,P＞0.05）两者无明显差异;基于虚拟现实、机器人等技术的远程康复组与传统康复组相比较,在上肢运动功能方面（WMD=3.73,95%CI：0.56—6.89,P＜0.05)具有更好的康复效果,在日常生活活动能力康复（SMD=0.71,95%CI：-0.47—1.88,P＞0.05）、平衡功能康复方面（WMD=0.35,95%CI：-0.98—1.67,P＞0.05）两者无明显差异。 结论：远程康复对脑卒中患者的运动功能和日常生活能力有促进效果,有助于脑卒中患者社区家庭康复的开展。     

脑神经网络综合康复治疗仪的研制

目的:开发一种新型的脑卒中康复治疗仪,能够对脑卒中患者脑神经网络重建、运动功能的恢复、脑神经的保护以及心理功能的康复起到积极的作用,从而为脑卒中患者的全面康复提供一种新的治疗平台.方法:治疗仪采用电路模块结合PC的上、下位机结构.下位机包括体表肌电采集电路、神经肌肉电刺激电路、小脑顶核电刺激电路三大部分,各个电路采用模块化设计方法;上位机(PC)的软件系统在Borland C Builder6.0下开发完成,软件系统主要负责视觉信号反馈,治疗参数控制、病历登记、信息查询等功能.结果:开发出了基于肌电生物反馈法与小脑顶核电刺激的脑神经网络综合康复仪,并通过相关部门的检测.结论:治疗仪能提供综合的脑卒中康复方法,而且具有安全、无创、便捷、人机交互能力强等特点.     

远程居家康复护理对脑卒中偏瘫患者康复的影响

目的:探讨远程康复护理在脑卒中恢复期偏瘫患者居家康复护理中的应用效果。方法:选取脑卒中瘫痪患者100例,随机分为远程康复组和对照组各50例。对照组患者常规出院护理指导,远程康复组患者在常规指导的基础上实施远程康复指导,分别在出院时、出院后3个月、出院后6个月对两组患者进行Barthel指数评分,并完成脑卒中相关护理知识问卷测试。结果:出院后3个月、出院后6个月两组患者日常生活能力有提高,远程康复组Barthel指数评分明显高于对照组(P0.05);出院后6个月远程康复组对知识掌握的提高水平明显高于对照组(P0.05)。结论:对脑卒中恢复期偏瘫患者进行远程康复护理指导,可以帮助患者进行健康行为自我管理,提高患者的日常生活能力。     

冠状动脉粥样硬化性心脏病患者远程康复长期护理需求调查

目的 调查冠状动脉粥样硬化性心脏病(简称“冠心病”)患者远程康复的长期护理需求,为构建冠心病远程康复长期护理方案提供参考依据。方法 采用便利抽样法选取2020年12月至2021年4月在中国中东西部3所三甲医院(湖南株洲市中心医院、西安唐都医院和南昌大学第一附属医院)心内科住院的650例冠心病患者作为研究对象,以问卷形式调查患者的远程护理需求。结果 650例患者中,有425例患者愿意接受远程护理,占比为65.38%。不同婚姻状况、医保类型患者的远程护理需求得分均有统计学差异(P均<0.05)。愿意接受远程护理患者的远程康复护理需求问卷平均总分为(43.27±10.02)分,其中,患者对用药指导和康复指导的需求高于对心理指导的需求。在接受远程护理患者选择护理提供的方式方面,医院专业远程护理APP(32.71%)、微信群/QQ群(24.47%)和电话交流(21.18%)居前3位。结论 冠心病患者对远程长期康复护理的需求大,医务工作者应该根据患者情况,对护理服务内容和方法制订合理的计划,为患者提供人性化的远程康复长期护理内容,提高其生存质量。     

远程心电监测在心肌梗死患者心脏康复中的应用进展

简要介绍远程心电监测系统及其开发状况,包括可穿戴技术。在心肌梗死患者心脏康复过程中,远程心电监测系统通过监测心率,计算心率恢复,可评定自主神经功能;通过计算心率-收缩压双乘积,可推测康复过程患者的乳酸无氧阈,确定有氧运动强度。最后探讨患者康复发生意外的法律责任问题和与物联网结合等创新意义。     

脑卒中远程康复与传统专业康复效果比较的循证分析

目的:利用循证方法将远程康复与传统专业康复在脑卒中患者中应用效果进行比较,明确远程康复的优势与劣势,为今后在脑卒中患者中实施远程康复提供有效证据。方法:检索Web of Science、Pub Med、Cochrane Library、中国生物医学文献服务系统(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、万方科技期刊全文数据库。英文检索词为(telerehabilitation OR telemedicine)AND(stroke OR poststroke OR Cerebro--vascular accident);中文检索词为(远程康复OR远程医疗)AND(脑卒中OR脑出血OR脑梗塞),收集远程康复在脑卒中患者中应用的随机对照试验,根据纳入和排除标准选取文献,提取资料并评价试验质量,采用Rev Man5软件进行Meta分析。结果:筛选出11篇随机对照研究文献,其中有9篇可纳入meta分析,其余采用描述性分析。共505例研究对象,均为轻中度脑卒中患者,其中远程康复组259例,传统专业康复组246例。Meta分析结果显示:远程康复组与传统专业康复组相比较,患者在日常生活活动能力[MD=-0.24,95%CI(-3.11,2.63)]、平衡功能(MD=0.03,95%CI[-2.29,2.36)]、运动功能[MD=-0.24,95%CI(-1.84,1.36))]上肢运动功能[MD=1.59,95%CI(-1.03,4.2)]方面无显著性差异,描述性分析结果提示患者满意度、自我效能与自我照顾能力方面无显著性差异,但在成本效益方面,远程康复组低于传统专业康复组。结论:远程康复或许作为一种有效的康复方式补充到轻中度脑卒中患者的家庭长期康复中,但是在远程康复的技术和训练方式上尚有待进一步发展,建议今后在构建远程康复网络及其应用效果方面进行更深入研究。     

龙氏日常生活自理能力评定量表在远程康复中的应用

远程康复是一项新兴的康复技术,利用互联网技术为偏远地区或无法获得康复的功能障碍者提供康复服务。龙氏日常生活自理能力评定量表,是基于中国人的生活习俗制定的,具有评估内容可清晰反映服务对象的需求、评估结果可直接反映服务对象的功能等级等优势,借助移动互联网可在线使用,并已积累一定规模的大数据,这对远程康复中康复治疗的调整、护理指导的连续性以及确保功能障碍者获得足够的社会支持和残疾福利有重要意义。该文就龙氏日常生活自理能力评定量表在远程康复中的应用进行了阐述。     

远程家庭康复指导对脑梗死患者日常生活活动能力和运动功能的影响

目的探讨远程家庭康复指导对脑梗死患者的日常生活活动能力和运动功能的影响。方法脑梗死恢复期患者101例,分为对照组50例和康复组51例,对康复组进行远程家庭康复指导治疗。治疗前和治疗后3个月分别对两组病例采用Barthel指数(BI)和简化Fugl-Meyer运动功能评分(FMA)进行评定。结果两组患者治疗前BI、FMA评分无显著性差异,治疗后康复组优于对照组(P<0.05)。结论远程家庭康复指导对脑梗死偏瘫患者的日常生活能力和运动功能有促进效果。     

基于HTR平台的远程康复护理在脑卒中出院患者中的应用

目的:探讨基于家庭远程康复(HTR)平台的远程康复护理在脑卒中出院患者中的应用效果。方法:选取2018年9月1日~2020年10月1日收治的80例脑卒中出院患者为研究对象,按照随机数字表法分为对照组和观察组各40例,对照组给予常规护理,观察组实施基于HTR平台的远程康复护理。比较两组干预前后Barthel指数量表(BI)、生存质量[采用脑卒中专用生命质量量表(SS-QOL)]、遵医行为、心理状况[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)],比较两组护理满意度。结果:干预3、6个月后,观察组BI评分和SS-QOL评分均优于对照组(P<0.01);干预后,观察组遵医行为评分高于对照组(P<0.01);干预后,观察组SAS、SDS评分低于对照组(P<0.01);观察组护理沟通、健康教育方面护理满意度评分高于对照组(P<0.01)。结论:基于HTR平台的远程康复护理应用于脑卒中出院患者,可提升患者的BI评分和生存质量,强化其遵医行为,还可改善其心理状况,提高护理满意度。     

脑卒中患者远程康复体验质性研究的Meta整合

目的 系统评价脑卒中患者远程康复体验的质性研究,为临床应用及改善远程康复技术提供参考依据。方法 计算机检索PubMed、Web of Science、PsycINFO、CINAHL、Cochrane Library、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库、Scopus、中国知网、中国生物医学文献数据库、万方等中英文数据库,搜索关于脑卒中患者远程康复的质性研究,检索时限从建库至2020年6月。根据澳大利亚JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,运用Meta整合方法对研究结果进行整合。 结果 共纳入13篇研究,提炼出43个明确的研究结果,将相似的研究结果归纳形成13个新类别,综合出4个整合结果：脑卒中患者对信息与通讯技术设备的使用态度;脑卒中患者远程康复感知益处;脑卒中患者远程康复感知障碍;脑卒中患者长期远程康复需求。 结论 远程康复作为传统康复的可替代方式,其效果受到多数脑卒中患者的肯定,但未来研究应注意加强远程康复设备及技术支持工作,构建脑卒中患者远程康复全程同伴支持系统,并丰富脑卒中患者远程康复内容及形式,以进一步提高远程康复的接受度。     

Assessing dysphagia via telerehabilitation: Patient perceptions and satisfaction

Abstract

To gain insight into factors which may influence future acceptance of dysphagia management via telerehabilitation, patients’ perceptions were examined before and after a telerehabilitation assessment session. Forty adult patients with dysphagia (M =66 years, SD =16.25) completed pre- and post-session questionnaires which consisted of 14 matched questions worded to suit pre- and post-conditions. Questions explored comfort with the use of telerehabilitation, satisfaction with audio and video quality, benefits of telerehabilitation assessments and patients’ preferred assessment modality. Questions were rated on a 5-point scale (1 = strongly disagree, 3 = unsure, 5 = strongly agree). Patients’ comfort with assessment via telerehabilitation was high in over 80% of the group both pre- and post-assessment. Pre-assessment, patients were unsure what to expect with the auditory and visual aspects of the videoconference, however there were significant positive changes reported post-experience. In relation to perceived benefits of telerehabilitation services in general, most patients believed in the value of telerehabilitation and post-assessment this increased to 90–100% agreement. Although 92% felt they would be comfortable receiving services via telerehabilitation, 45% of patients indicated ultimate preference for a traditional face-to-face assessment. The data highlight that patients are interested in and willing to receive services via telerehabilitation; however, any concerns should be addressed pre-assessment.     

A systematic review of clinical outcomes,clinical process,healthcare utilization and costs associated with telerehabilitation

Purpose. To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities.

Method. Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale.

Results. Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, rehabilitation for speech-language impairments, and rehabilitation for varied clienteles. Clinical outcomes were generally improved following a telerehabilitation intervention and were at least similar to or better than an alternative intervention. Clinical process outcomes, such as attendance and compliance, were high with telerehabilitation although few comparisons are made to alternative interventions. Consultation time tended to be longer with telerehabilitation. Satisfaction with telerehabilitation was consistently high, although it was higher for patients than therapists. Few studies examined healthcare utilization measures and those that did reported mixed findings with respect to adverse events, use of emergency rooms and doctor visits. Only five of the studies examined costs. There is some preliminary evidence of potential cost savings for the healthcare facility.

Conclusions. While evidence is mounting concerning the efficacy and effectiveness of telerehabilitation, high-quality evidence regarding impact on resource allocation and costs is still needed to support clinical and policy decision-making.     

Formal verification of software-based medical devices considering medical guidelines

Objective

    Software-based devices have increasingly become an important part of several clinical scenarios. Due to their critical impact on human life, medical devices have very strict safety requirements. It is therefore necessary to apply verification methods to ensure that the safety requirements are met. Verification of software-based devices is commonly limited to the verification of their internal elements without considering the interaction that these elements have with other devices as well as the application environment in which they are used. Medical guidelines define clinical procedures, which contain the necessary information to completely verify medical devices. The objective of this work was to incorporate medical guidelines into the verification process in order to increase the reliability of the software-based medical devices.

Materials and  methods

   Medical devices are developed using the model-driven method deterministic models for signal processing of embedded systems (DMOSES). This method uses unified modeling language (UML) models as a basis for the development of medical devices. The UML activity diagram is used to describe medical guidelines as workflows. The functionality of the medical devices is abstracted as a set of actions that is modeled within these workflows. In this paper, the UML models are verified using the UPPAAL model-checker. For this purpose, a formalization approach for the UML models using timed automaton (TA) is presented.

Results

    A set of requirements is verified by the proposed approach for the navigation-guided biopsy. This shows the capability for identifying errors or optimization points both in the workflow and in the system design of the navigation device. In addition to the above, an open source eclipse plug-in was developed for the automated transformation of UML models into TA models that are automatically verified using UPPAAL.

Conclusions

    The proposed method enables developers to model medical devices and their clinical environment using clinical workflows as one UML diagram. Additionally, the system design can be formally verified automatically.     

Use of a modified treatment-based classification system for subgrouping patients with low back pain: Agreement between telerehabilitation and face-to-face assessments

ABSTRACT

Objective: To examine the agreement between telerehabilitation and face-to-face assessments of patients with acute and subacute low back pain (LBP) using a modified treatment-based classification (TBC) system. A secondary aim was to evaluate patient satisfaction with the telerehabilitation assessment. Methods: Patients with LBP of less than 90 days’ duration underwent both telerehabilitation and face-to-face assessments. After physical examination, patients were classified into one of three intervention groups (mobilization/manipulation, specific exercise, and stabilization). The assessment order and clinicians were randomized, and the clinicians were blinded to each other’s classification decision. Results: Forty-seven patients participated (mean [SD] age, 48.6 [15.0] years; 70% female). The overall rate of percentage agreement was 68.1% (κ = 0.52; 95% confidence interval, 0.32–0.72). There was no difference in classification distributions between assessments (χ² = 2.14, p = 0.54). The percentage agreement was 48.9%–59.6% for the modified TBC algorithm variables except for straight leg raise greater than 91°, which was markedly lower at 35.1%. This was the only variable that was significantly different between the telerehabilitation and face-to-face scenarios. The overall satisfaction with the telerehabilitation assessment was good. Conclusions: The results suggest that a telerehabilitation assessment using the modified TBC system may be able to direct treatment of patients with acute and subacute LBP. However, challenges still remain in applying this approach to clinical practice.     

Physical therapists and public perceptions of telerehabilitation: An online open survey on acceptability,preferences, and needs

BackgroundDuring the COVID-19 pandemic, telerehabilitation allowed the continuation of physical therapy care in parallel with public health measures to prevent the virus spread. However, in low- and middle-income countries including Brazil, telerehabilitation was unfamiliar to most of the population.ObjectiveTo investigate acceptability, preferences, and needs in telerehabilitation by Brazilian physical therapists and the general population.MethodsWe conducted an observational cross-sectional study with an online survey consisting of 13 multiple-choice items. Items were distributed among acceptability, preferences, and needs sections, and encompassed confidence in delivering or receiving telerehabilitation, its perceived efficacy and costs, and suitable content.ResultsA total of 1107 responses were registered, 717 from physical therapists. Half of them self-reported confidence in conducting telerehabilitation through the internet (synchronous or asynchronous). The same proportion disagreed that telerehabilitation is as effective as in-person interventions. Physical therapists agreed telerehabilitation should contain educational, self-management strategies, and exercises information, but the general population endorsed the provision of technical advice on exercise execution. The general population mostly reported that telerehabilitation could help their specific health condition (86%), but only 14% of respondents would pay the same as they pay for in-person consultations. Participants reported an overall preference for synchronous communication and concern about the lack of a hands-on approach.ConclusionPhysical therapists and the general population appear to demonstrate apprehension towards telerehabilitation. Insufficient preparation or inadequate knowledge might influence participants’ acceptance, preferences, and needs.     

Staff perspectives on the key elements to successful rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments

Background and purpose

During the COVID-19 pandemic, hospital physiotherapy departments transitioned to telerehabilitation to ensure continuity of care for patients. The purpose of this study is to determine the key elements to successful, rapid uptake of telerehabilitation in medium-sized public hospital physiotherapy departments in response to COVID-19.

Methods

This study used a qualitative design. Physiotherapists who delivered telerehabilitation consultations during the COVID-19 restriction period in two Brisbane public hospital physiotherapy departments were eligible to participate in semi-structured interviews. Data were analysed thematically.

Results

Twenty-five physiotherapists (22–60 years of age; 68% female) with 1–40 years of clinical experience provided insights into their perceptions of the rapid uptake of telerehabilitation in the provision of clinical care. Physiotherapists worked across musculoskeletal outpatient (72%), inpatient, community, paediatrics and pelvic health departments. Qualitative analyses in relation to the physiotherapist perceptions of the key elements of rapid transition to telerehabilitation, revealed four key themes underpinning success: (1) ‘it requires a whole team approach’, (2) ‘technology issues will be encountered and can be overcome’, (3) ‘optimise the situation while understanding the differences’ and (4) ‘modifying your approach doesn't imply inferior quality of care’.

Conclusion

Rapid implementation of telerehabilitation in a hospital setting is possible, and is facilitated by organisational, administrative and management support, willingness of physiotherapists to adopt, shared learning experience, quality software and connection, availability of equipment and space and optimised systems and processes. Key factors facilitating successful telerehabilitation consultations include effective communication, demonstration, involving a third party to help, and clients who are well prepared and willing to engage.

     

Telerehabilitation mediated physiotherapy assessment of ankle disorders

Background and Purpose. Musculoskeletal injuries are the most common source of chronic pain and disability. The ankle joint is the most common of these injuries and without adequate rehabilitation function can be severely impaired. Access to physiotherapy rehabilitation services can be limited due to geographical remoteness and a shortage of services in rural and remote areas. Telerehabilitation is a potential solution to bridge this service delivery gap. The aim of this study was to determine the criterion validity and reliability of conducting a remote musculoskeletal assessment of the ankle joint complex using telerehabilitation technologies compared with a face‐to‐face assessment. Methods. This study utilized a repeated measures design to assess 15 subjects (mean age 24.5, SD 10.8 years) presenting with ankle pain. Conventional face‐to‐face assessments were compared with assessments performed via a telerehabilitation system. Results. A similar agreement of 93.3% in patho‐anatomical diagnosis and an 80% exact agreement (χ² = 4.267; p < 0.04) in primary systems diagnosis was found between face‐to‐face and telerehabilitation assessments. Clinical observations were found to have very strong agreement (k = 0.92) for categorical data and significant agreement (93.3% agreement; χ² = 234.4; p < 0.001) for binary data. A high level of inter‐ and intrarater reliability was found for the telerehabilitation assessments. Conclusions. This study demonstrates the criterion validity and reliability of remote musculoskeletal assessments of the ankle joint complex using telerehabilitation. Copyright © 2010 John Wiley & Sons, Ltd.     

Telerehabilitation Wheeled Mobility and Seating Assessments Compared With In Person

Schein RM, Schmeler MR, Holm MB, Saptono A, Brienza DM. Telerehabilitation wheeled mobility and seating assessments compared with in person.

Objective

To evaluate the equivalency of wheeled mobility and seating assessments delivered under 2 conditions: in person (IP) at a local clinic and via Telerehabilitation at remotely located clinics.

Design

The study used a prospective, multicenter controlled nonrandomized design to investigate wheeled mobility and seating assessments.

Setting

Five wheelchair clinics in Western Pennsylvania.

Participants

Participants (N=98) in need of new wheeled mobility and seating were recruited and consented for IP assessments at the Center for Assistive Technology (n=50) and Telerehabilitation (n=48) assessments at remotely located clinics.

Interventions

The telerehabilitation condition used a custom videoconferencing system to connect a wheeled mobility and seating expert at the University of Pittsburgh's Rehabilitation Engineering Research Center on Telerehabilitation to a remote clinic.

Main Outcome Measures

Study findings were based on the level of function the participants showed with their new wheeled mobility and seating devices as measured by using the Functioning Everyday with a Wheelchair (FEW) outcome tool.

Results

The results revealed no significant differences between the FEW pretest average or item scores for the 2 conditions or the FEW posttest average or item scores except for the FEW transportation item. The average FEW and FEW item scores reached the established clinically relevant pretest-posttest difference of 1.85, and the change scores were significantly different. The difference between FEW means based on posttest confidence intervals indicated that telerehabilitation was equally effective as IP rehabilitation.

Conclusions

An expert practitioner located at least 125 miles away from each of the remote sites used a secured videoconferencing system to consult from a geographic distance on wheeled mobility and seating evaluations via telerehabilitation. Compared with participants receiving standard IP care, the telerehabilitation treatment condition was equally effective on all but 1 outcome.