基于智能手机的家庭护理模式改善了心肌梗死后患者心脏康复的利用率：一项随机对照试验的结果
Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial.
作者信息
Varnfield Marlien, Karunanithi Mohanraj, Lee Chi-Keung, Honeyman Enone, Arnold Desre, Ding Hang, Smith Catherine, Walters Darren L
机构信息
Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
出版信息
Heart. 2014 Nov;100(22):1770-9. doi: 10.1136/heartjnl-2014-305783. Epub 2014 Jun 27.
OBJECTIVE
Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI). This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients.
METHODS
In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n=60; 55.7±10.4 years) and CAP-CR (n=60; 55.5±9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants' homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression.
RESULTS
CAP-CR had significantly higher uptake (80% vs 62%), adherence (94% vs 68%) and completion (80% vs 47%) rates than TCR (p<0.05). Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks (TCR: 537±86-584±99 m; CAP-CR: 510±77-570±80 m), which was maintained at 6 months. CAP-CR showed slight weight reduction (89±20-88±21 kg) and also demonstrated significant improvements in emotional state (K10: median (IQR) 14.6 (13.4-16.0) to 12.6 (11.5-13.8)), and quality of life (EQ5D-Index: median (IQR) 0.84 (0.8-0.9) to 0.92 (0.9-1.0)) at 6 weeks.
CONCLUSIONS
This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services.
TRIAL REGISTRATION NUMBER
ANZCTR12609000251224.
目的
心脏康复（CR）对于预防心肌梗死（MI）复发至关重要。本研究旨在探讨与传统的基于中心的项目（TCR）相比，基于智能手机的家庭服务提供的CR（护理评估平台-CR，CAP-CR）对MI后患者CR使用情况和健康结局的影响。
方法
在这项非盲随机对照试验中，MI后患者被随机分为TCR组（n = 60；年龄55.7±10.4岁）和CAP-CR组（n = 60；年龄55.5±9.6岁），进行为期6周的CR和6个月的自我维持期。在参与者家中提供的CAP-CR包括健康和运动监测、激励和教育材料发放以及每周的指导咨询。使用意向性分析将CAP-CR的采用率、依从率和完成率与TCR进行比较。使用线性混合模型回归比较两组内和两组间在基线、6周和6个月时临床结局（可改变的生活方式因素、生物医学危险因素和健康相关生活质量）的变化。
结果
CAP-CR的采用率（80%对62%）、依从率（94%对68%）和完成率（80%对47%）显著高于TCR（p<0.05）。两组从基线到6周的6分钟步行试验均有显著改善（TCR：537±86 - 584±99米；CAP-CR：510±77 - 570±80米），并在6个月时维持。CAP-CR显示体重略有减轻（89±20 - 88±21千克），并且在6周时情绪状态（K10：中位数（四分位间距）14.6（13.4 - 16.0）至12.6（11.5 - 13.8））和生活质量（EQ5D指数：中位数（四分位间距）0.84（0.8 - 0.9）至0.92（0.9 - 1.0））也有显著改善。
结论
这种基于智能手机的家庭护理CR项目提高了MI后CR的采用率、依从率和完成率。基于家庭的CR项目在改善生理和心理健康结局方面与传统CR一样有效。CAP-CR是优化CR服务使用的可行选择。
试验注册号
ANZCTR12609000251224。
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