全髋置换术后远程居家康复和住院康复疗效比较

Comparison between home-based tele-rehabilitation and in-hospital rehabilitation for total hip arthroplasty patients

关键词:  髋关节骨折  全髋关节置换  居家远程康复  老年人

Key words:  hip fracture  total hip arthroplasty  home-based tele-rehabilitation  the elderly

摘要:

目的 比较远程居家康复和传统住院康复对老年全髋关节置换术患者的疗效。 方法 本试验于2021年1月—2022年12月于上海市第一康复医院进行，受试者均于上海交通大学医学院附属第六人民医院和同济大学附属第十人民医院完成全髋关节置换手术（手术时间为2021年1月—2022年6月），康复干预于上海市第一康复医院完成。共64例患者被纳入该项单盲、平行、非劣效性随机对照试验，受试者被随机分为远程居家康复组（远程组）和住院康复组（住院组）。试验组与对照组各32人，于术后1周入组。试验组（远程组）的康复干预包括为期4周（每周5次×45 min）的远程视频电话指导与移动APP康复训练跟练，在干预后接受每2周1次的电话随访直至12周随访结束，并使用APP继续居家训练直至12周随访结束；对照组（住院组）接受4周（每周5次×45 min）的常规线下物理治疗干预，此外不接受其他康复相关治疗（如针灸、理疗和作业治疗等），出院前物理治疗师布置训练作业并以纸质方式交付患者及家属，出院后接受电话随访，训练频率与远程组一致。本试验的评估数据采集分别在入组时、干预结束（入组4周）及随访结束（入组12周）进行，主要观察指标为随访结束时的髋关节功能障碍和骨性关节炎结局评分（HOOS）的生活质量亚量表（QOL）评分，次要结局指标为入组4周和12周时HOOS的其他亚量表评分、起立行走计时测试（TUG）、Berg平衡测试（BBS）和12项生活质量调查简表（SF-12）评分以及入组4周的HOOS评分。 结果 远程组与住院组在人口统计学与临床特征上无显著差异。在随访12周结束时的评估中，两组的HOOS各亚量表评分（经初始基线值调整后）差异无统计学意义（P＞0.05）；两组的TUG和BBS结果均有显著提升，但组间差异无显著性（P>0.05）；在各个随访时间点，两组在躯体和精神方面均没有差异（P>0.05）。 结论 远程居家康复有利于促进老年全髋关节置换术后的髋关节功能恢复，且疗效与住院康复无显著差异，这为全髋关节置换术后患者的康复提供了新的选择。

Abstract:

Objective To compare the efficacy of home-based tele-rehabilitation with hospitalization rehabilitation in elderly patients after total hip arthroplasty(THA). Methods This is a two-arm, single-blind, parallel, non-inferiority randomized controlled trial. Sixty four patients who underwent THA in the Shanghai Sixth Peoples Hospital Affiliated to Shanghai Jiao Tong University School of Medicine or Shanghai Tenth Peoples Hospital Affiliated to Tongji University, and received rehabilitation intervention at Shanghai First Rehabilitation Hospital from January 2021 to December 2022, were enrolled within one week after THA. Patients were randomly divided into tele-rehabilitation group(TELE group, n=32) and hospitalization rehabilitation group(ONSITE group, n=32). The rehabilitation intervention of the TETE group included remote video phone guidance and mobile APP rehabilitation training for 4 weeks(45 min, 5/week). After the intervention, they received phone follow-up every 2 weeks and continued home training using the APP until the end of the 12-week follow-up. The ONSITE group received routine physical therapy intervention for 4 weeks(45 min, 5/week). Training assignments were given before discharge, and telephone follow-up was conducted after discharge. The primary outcome was the Quality of Life (QOL) subscale of the Hip Disability and Osteoarthritis Outcome Score(HOOS) at the end of follow-up, the secondary outcome included the other subscales of HOOS, Short Form 12(SF12), Timed Up and Go (TUG) test, and Berg Balance Scale(BBS) at 4 and 12 weeks of enrollment, and HOOS scores at 4 weeks of enrollment. Results There were no significant differences with demographic and clinical characteristics between the TELE and ONSITE groups. At 12 weeks of follow-up assessment, the main differences between the two groups regarding the HOOS subscales gains adjusted for baseline values, were close to zero in both groups(P>0.05). The TUG and BBS results of both groups were significantly improved, and there was no significant difference between two groups(P>0.05). At each follow-up time point, there were no differences in physical and mental aspects between the two groups(P>0.05). There were no physical and mental differences between the two groups(P>0.05). Conclusion The results of the study demonstrate that home-based tele-rehabilitation is beneficial to promote the recovery of hip function after THA in elderly patients, and the efficacy is not inferior to hospitalization rehabilitation. The study indicates home-based tele-rehabilitation provides a alternative choice for the rehabilitation of patients after THA.