基于移动医疗APP的健康管理在老年髋部骨折患者社区康复中的应用研究

Application of health management based on mobile medical APP in community rehabilitation of elderly patients with hip fractures

目的探讨远程医疗解决方案(使用平板电脑或智能手机上的APP应用程序)是否可以帮助老年髋部骨折患者在出院后居家期间的功能康复,并满足个人学习和自我保健的需求。方法选取2021年1月至12月在滕州市中心人民医院创伤骨科治疗的100例股骨粗隆间骨折患者进行前瞻性研究。依据随机数字法将患者分为观察组和对照组。观察组50例,男13例,女37例,年龄(82.00±10.68)岁,出院后采用移动医疗APP进行健康管理;对照组50例,男19例,女31例,年龄(81.24±8.29)岁,仅出院时向患者提供口头和书面的后续康复锻炼方案,出院后1、2、3个月门诊或电话随访。对两组患者的基线资料进行比较,同时分析两组患者术后1、2、3个月3个时间点的功能康复指标。统计学方法采用t检验、重复测量方差分析、χ^(2)检验或Freeman-Halton检验。结果两组患者进行随访,在随访过程中无失访或死亡病例出现。观察组患者在术后1、2、3个月3个时间点的功能独立性量表(FIM)评分、简易体能状况量表(SPPB)评分均大于对照组[(63.38±3.78)分比(56.50±4.47)分、(76.44±3.41)分比(65.72±4.13)分、(98.68±8.89)分比(89.20±8.22)分,(4.32±0.59)分比(2.84±0.62)分、(7.10±0.58)分比(4.90±0.51)分、(9.38±0.70)分比(7.40±0.67)],随着时间的推移两组患者的FIM评分和SPPB评分均逐渐提高,差异均有统计学意义(F_(组间)=135.585、484.430,F_(时间)=904.260、2011.030,均P<0.05);观察组患者在术后3个时间点的定时起跑(TUG)测试时间、医院焦虑和抑郁量表(HADS)评分、视觉模拟量表(VAS)评分均小于对照组[(66.70±5.41)s比(97.84±3.99)s、(39.92±4.24)s比(63.24±6.28)s、(12.58±3.05)s比(23.78±4.23)s,(8.18±0.87)分比(10.70±1.43)分、(4.66±0.82)分比(7.70±0.99)分、(1.24±0.87)分比(4.74±0.78)分,(3.44±0.54)分比(4.48±0.50)分、(1.42±0.50)分比(2.54±0.50)分、(1.40±0.49)分比(1.56±0.73)分],随着时间的推移两组患者的TUG测试时间、HADS评分、VAS评分均逐渐降低,差异均有统计学意义(F_(组间)=1599.893、503.140、177.898,F_(时间)=4836.303、1060.010、943.972,均P<0.05)。时间和组别对TUG测试、SPPB评分、HADS评分的交互效应差异均有统计学意义(F_(交互)=118.780、11.830、6.060,均P<0.05)。结论基于移动医疗APP应用程序的远程康复干预为老年髋部骨折患者提供了一种新的可行的、有效的居家康复选择,大大提高了患者出院后社区康复的效果,值得临床上推广应用。

Objective To investigate whether a telemedicine solution(using an APP on a pad or a smartphone)can help elderly patients with hip fractures taking functional recovery at home after hospital discharge and meet the needs of individual learning and self-care.Methods A prospective study was conducted on 100 patients with intertrochanteric fracture of femur who received traumatic orthopedic treatment in Tengzhou Central People's Hospital from January to December 2021.According to the random number method,the patients were divided into an observation group and a control group,with 50 cases in each group.There were 13 males and 37 females in the observation group;they are(82.00±10.68)years old.There were 19 males and 31 females in the control group;they were(81.24±8.29)years old.The observation group used the mobile medical APP for health management after discharge.The control group were treated with oral and written follow-up rehabilitation exercise programs only at the time of discharge,and took outpatient or telephone follow-up 1,2,and 3 months after discharge.The baseline data of the two groups were compared.The functional rehabilitation indicators of the two groups were analyzed 1,2,and 3 months after the surgery.t test,repeated measure analysis of variance,χ^(2) test,or Freeman-Halton test were applied.Results All the patients in both groups were followed up;no one missed the follow up or died.One,two,and three months after the surgery,the scores of Function Independent Measure(FIM)and Short Physical Performance Battery(SPPB)in the observation group were lower than those in the control group[(63.38±3.78)vs.(56.50±4.47),(76.44±3.41)vs.(65.72±4.13),(98.68±8.89)vs.(89.20±8.22),(4.32±0.59)vs.(2.84±0.62),(7.10±0.58)vs.(4.90±0.51),and(9.38±0.70)vs.(7.40±0.67)];the scores of FIM and SPPB of the two groups gradually improved with time;there were statistical differences(F_(between groups)=135.585 and 484.430;F_(time)=904.260 and 2011.030;all P<0.05).One,two,and three months after the surgery,the TUG test times and scores of Hospital Anxiety and Depression Scale(HADS)and Visual Analogue Scale(VAS)in the observation group were lower than those in the control group[(66.70±5.41)s vs.(97.84±3.99)s,(39.92±4.24)s vs.(63.24±6.28)s,(12.58±3.05)s vs.(23.78±4.23)s,(8.18±0.87)vs.(10.70±1.43),(4.66±0.82)vs.(7.70±0.99),(1.24±0.87)vs.(4.74±0.78),(3.44±0.54)vs.(4.48±0.50),(1.42±0.50)vs.(2.54±0.50),and(1.40±0.49)vs.(1.56±0.73)];the TUG test times and scores of HADS and VAS of the two groups gradually decreased with time;there were statistical differences(F_(between groups)=1599.893,503.140,and 177.898;F_(time)=4836.303,1060.010,and 943.972;all P<0.05).The interaction effect of time and group on TUG test and scores of SPPB and HADS were statistically significant(F_(interaction)=118.780,11.830,and 6.060;all P<0.05).Conclusions Tele-rehabilitation intervention based on mobile medical APP application provides a new feasible and effective home rehabilitation option for elderly patients with hip fractures,and greatly improves the effect of community rehabilitation after discharge,so it is worthy of clinical application.