慢性阻塞性肺疾病患者网络远程运动康复有效性及安全性的系统评价

The effectiveness and safety of internet-based tele-exercise rehabilitation in COPD patients:a systematic review

目的系统评价网络远程运动康复在COPD患者中应用的有效性及安全性。方法计算机检索Cochrane Library、PubMed、Web of Science、EBSCO等12个中英文数据库和临床试验注册平台并辅以手工检索,检索建库至2022年12月发表的相关文献。由2名研究者独立进行文献筛选、提取资料及文献质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入25篇文献,包括2359例患者。Meta分析结果显示,与传统运动康复相比,网络远程运动康复有助于增加COPD患者6 min步行距离[MD=42.80,95%CI(29.53,56.07),P<0.001]、降低COPD评估测试评分[MD=-2.22,95%CI(-3.68,-0.76),P=0.003]。与无网络技术参与的远程康复相比,网络远程运动康复可增加患者6 min步行距离[MD=21.07,95%CI(13.29,28.84),P<0.001],但其长期效果尚不确定;提高患者运动行为水平,如每日行走步数[MD=805.83,95%CI(435.08,1176.58),P<0.001]、日常运动时间[MD=5.61,95%CI(3.11,8.10),P<0.001]、中高强度运动时间[MD=2.32,95%CI(0.77,3.87),P=0.003];降低患者圣乔治呼吸问卷评分[MD=-3.12,95%CI(-5.87,-0.36),P=0.030]、提高慢性呼吸系统疾病问卷评分[MD=9.18,95%CI(0.97,17.40),P=0.030]。在安全性方面,网络远程运动康复未增加COPD急性加重率,但具有较高的不良事件发生率。结论实施网络远程运动康复有助于改善COPD患者的运动功能、提高运动行为水平和生活质量,但结局评价指标的规范性有待改进,康复的长期效果及安全性仍需大量高质量研究验证。

Objective To systematically evaluate the effectiveness and safety of internet-based tele-exercise rehabilitation in COPD patients.Methods 12 electronic databases,such as Cochrane Library,PubMed,Web of Science,EBSCO etc,and clinical trials registry platforms were searched from their inception to December 2022,by computer and manual search.Literature search,study selection,data extraction and methodological quality evaluation were conducted by 2 researchers independently.Meta-analysis was performed by RevMan 5.4.Results 25 studies involving 2359 patients were included.Meta-analysis indicated that compared to traditional exercise rehabilitation,internet-based tele-exercise rehabilitation contributed to an increase in 6MWD[MD=42.80,95%CI(29.53,56.07),P<0.001]and a decrease in COPD assessment test score[MD=-2.22,95%CI(-3.68,-0.76),P=0.003];compared to remote rehabilitation without internet-based technology,internet-based tele-exercise rehabilitation increased patients 6MWD[MD=21.07,95%CI(13.29,28.84),P<0.001],but its long-term maintenance effect was uncertain;it improved the level of exercise behavior,including daily walking steps[MD=805.83,95%CI(435.08,1176.58),P<0.001],daily exercise time[MD=5.61,95%CI(3.11,8.10),P<0.001],and moderate to high intensity exercise time[MD=2.32,95%CI(0.77,3.87),P=0.003];internet-based tele-exercise rehabilitation also improved quality of life,by St.George’s Respiratory Questionnaire[MD=-3.12,95%CI(-5.87,-0.36),P=0.030]and Chronic Respiratory Disease Questionnaire[MD=9.18,95%CI(0.97,17.40),P=0.030].In terms of safety,there was no significant difference in acute exacer-bations of COPD compared to the control group,but there was a higher risk of adverse events.Conclusion The implementation of internet-based tele-exercise rehabilitation can help improve motor function,exercise behavior level and quality of life in COPD patients,but the outcome evaluation indexes need to be standardized,and the long-term effects and safety of rehabilitation still need to be verified by numerous high-quality studies.