智能手机在监测腰椎术后患者远程康复训练依从性中的应用
|
摘要
目的评价智能手机对腰椎术后患者远程康复训练依从性的判断效力。方法选取28例腰椎手术3个月以上的异地患者,患者在有视频监控的康复室中通过智能手机客户端进行远程康复训练。康复计划由15个小节组成,每小节训练完成后患者需点击相应按钮进行反馈,两次点击之间的时间为患者单节训练的实际时间(Ta),视频时长为单节训练的理论时间(Tt),计算二者的时间差Td(Ta–Tt)及时差比Tr([Ta–Tt)/Tt]。同期康复医生通过查阅监控视频对每节患者的依从性进行评判,然后评价智能手机Td和Tr值对患者依从性的判断效力。结果共收集420小节有效信息,其中依从组327个小节、非依从组93个小节。非依从组Td、Tr值显著高于依从组(P <0.05)。其中Td值可以更好地判断患者的依从性(P <0.05),AUROC值为0.976(95%CI,0.955～0.997);当诊断界值为7 s时,敏感度为0.964(95%CI,0.932～0.981),特异度为0.981(95%CI,0.921～1.000)。40岁以下、40岁及以上两个年龄亚组Td值比较,差异无统计学意义(P>0.05)。结论智能手机可用于监测腰椎术后患者远程康复训练依从性,应用Td可取得良好的判断效力,且其不受年龄因素影响。
Objective To evaluate the effectiveness of judgement on e-health, a smartphone-based rehabilitation system in monitoring patient compliance of remote-distance rehabilitation training after lumbar surgery. Methods A total of 28 nonlocal patients treated by lumbar surgery for more than 3 months were enrolled in the study. They were invited into a rehabilitation monitored wards, and were trained following the rehabilitation software through the client of the smartphone. The rehabilitation schedule comprised of 15 sections,for each section, patients' actual exercise time(Ta) and theoretical time(Tt) were recorded by the system, after that, time difference(Td) and relative time difference(Tr) were calculated as follows: Td = Ta – Tt, Tr =(Ta –Tt)/Tt. The rehabilitation doctors judged the compliance of each patient by consulting the surveillance video at the same period. Results Valid information of 420 sections was collected, 327 of which were complied and 93 were non-complied. The Td and Tr values were significantly higher in non-complied sections than complied sections(both P <0.05), in which Td value was found significantly better in evaluating the compliance of patients(P <0.05), with AUROC value of 0.976(95% CI, 0.955-0.997). When the cutoff value for Td was set as 7 s, the sensitivity and specificity was 0.964(95% CI, 0.932-0.981) and 0.981(95% CI, 0.921-1.000) respectively. There was no statistic difference of Td value between patients younger than 40 and older than or equal to 40(P >0.05).Conclusions The smartpone can be used to predict patient compliance of remote-distance rehabilitation training after lumbar surgery; application of Td value has good efficacy of judgement which is not to be influenced by age factor.
Objective To evaluate the effectiveness of judgement on e-health, a smartphone-based rehabilitation system in monitoring patient compliance of remote-distance rehabilitation training after lumbar surgery. Methods A total of 28 nonlocal patients treated by lumbar surgery for more than 3 months were enrolled in the study. They were invited into a rehabilitation monitored wards, and were trained following the rehabilitation software through the client of the smartphone. The rehabilitation schedule comprised of 15 sections,for each section, patients' actual exercise time(Ta) and theoretical time(Tt) were recorded by the system, after that, time difference(Td) and relative time difference(Tr) were calculated as follows: Td = Ta – Tt, Tr =(Ta –Tt)/Tt. The rehabilitation doctors judged the compliance of each patient by consulting the surveillance video at the same period. Results Valid information of 420 sections was collected, 327 of which were complied and 93 were non-complied. The Td and Tr values were significantly higher in non-complied sections than complied sections(both P <0.05), in which Td value was found significantly better in evaluating the compliance of patients(P <0.05), with AUROC value of 0.976(95% CI, 0.955-0.997). When the cutoff value for Td was set as 7 s, the sensitivity and specificity was 0.964(95% CI, 0.932-0.981) and 0.981(95% CI, 0.921-1.000) respectively. There was no statistic difference of Td value between patients younger than 40 and older than or equal to 40(P >0.05).Conclusions The smartpone can be used to predict patient compliance of remote-distance rehabilitation training after lumbar surgery; application of Td value has good efficacy of judgement which is not to be influenced by age factor.
引文
[1]Oosterhuis T,Costa LO,Maher CG,et al.Rehabilitation after lumbar disc surgery[J].Cochrane Database Syst Rev,2014(3):CD003007.
[2]Abbott AD,Tyni-Lenne R,Hedlund R.Early rehabilitation targeting cognition,behavior,and motor function after lumbar fusion:a randomized controlled trial[J].Spine,2010,35(8)848-857.
[3]van Erp RMA,Jelsma J,Huijnen IPJ,et al.Spinal surgeons opinions on pre-and postoperative rehabilitation in patients undergoing lumbar spinal fusion surgery:a survey-based study in the Netherlands and Sweden[J].Spine,2018,43(10):713-719.
[4]McGregor AH,DoréCJ,Morris TP,et al.Function after spinal treatment,exercise and rehabilitation(FASTER)improving the functional outcome of spinal surgery[J].BMCMusculoskelet Disord,2010,11:17.
[5]Mannion AF,Denzler R,Dvorak J,et al.A randomised controlled trial of post-operative rehabilitation after surgica decompression of the lumbar spine[J].Eur Spine J,2007,16(8):1101-1117.
[6]Aalto TJ,Leinonen V,Herno A,et al.Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis:a prospective study with 2-year postoperative follow-up[J].Eur Spine J,2011,20(8):1331-40.
[7]van der Weegen S,Verwey R,Spreeuwenberg M,et al.The development of a mobile monitoring and feedback tool to stimulate physical activity of people with a chronic disease in primary care:a user-centered design[J].JMIR Mhealth Uhealth,2013,1(2):e8.
[8]Hou J,Ke Y.Addressing the shortage of health professionals in rural China:issues and progress comment on"have health human resources become more equal between rural and urban areas after the new reform?"[J].Int J Health Policy Manag2015,4(5):327-328.
[9]Zhang X,Dupre ME,Qiu L,et al.Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China[J].BMC Geriatr,2017,17(1):151.
[10]Liu WT,Wang CH,Lin HC,et al.Efficacy of a cell phonebased exercise programme for COPD[J].Eur Respir J,2008,32(3):651-659.
[11]Whitehead L,Seaton P.The effectiveness of self-management mobile phone and tablet apps in long-term condition management:a systematic review[J].J Med Internet Res,2016,18(5):e97.
[12]Cristancho-Lacroix V,Wrobel J,Cantegreil-Kallen I,et al.Aweb-based psychoeducational program for informal caregivers of patients with Alzheimer's disease:a pilot randomized controlled trial[J].J Med Internet Res,2015,17(5):e117.
[13]Mcgregor AH,Dore CJ,Morris TP,et al.ISSLS prize winner:Function After Spinal Treatment,Exercise,and Rehabilitation(FASTER):a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved[J].Spine,2011,36(21):1711-1720.
[14]Sherman KJ,Cherkin DC,Erro J,et al.Comparing yoga,exercise,and a self-care book for chronic low back pain:a randomized,controlled trial[J].Ann Intern Med,2005,143(12):849-856.
[15]Soegaard R,Christensen F B,Lauerberg I,et al.Lumbar spinal fusion patients'demands to the primary health sector:evaluation of three rehabilitation protocols:a prospective randomized study[J].Eur Spine J,2006,15(5):648-656.
[16]Demir S,Dulgeroglu D,Cakci A.Effects of dynamic lumbar stabilization exercises following lumbar microdiscectomy on pain,mobility and return to work:randomized controlled trial[J].Eur J Phys Rehabil Med,2014,50(6):627-640.
[2]Abbott AD,Tyni-Lenne R,Hedlund R.Early rehabilitation targeting cognition,behavior,and motor function after lumbar fusion:a randomized controlled trial[J].Spine,2010,35(8)848-857.
[3]van Erp RMA,Jelsma J,Huijnen IPJ,et al.Spinal surgeons opinions on pre-and postoperative rehabilitation in patients undergoing lumbar spinal fusion surgery:a survey-based study in the Netherlands and Sweden[J].Spine,2018,43(10):713-719.
[4]McGregor AH,DoréCJ,Morris TP,et al.Function after spinal treatment,exercise and rehabilitation(FASTER)improving the functional outcome of spinal surgery[J].BMCMusculoskelet Disord,2010,11:17.
[5]Mannion AF,Denzler R,Dvorak J,et al.A randomised controlled trial of post-operative rehabilitation after surgica decompression of the lumbar spine[J].Eur Spine J,2007,16(8):1101-1117.
[6]Aalto TJ,Leinonen V,Herno A,et al.Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis:a prospective study with 2-year postoperative follow-up[J].Eur Spine J,2011,20(8):1331-40.
[7]van der Weegen S,Verwey R,Spreeuwenberg M,et al.The development of a mobile monitoring and feedback tool to stimulate physical activity of people with a chronic disease in primary care:a user-centered design[J].JMIR Mhealth Uhealth,2013,1(2):e8.
[8]Hou J,Ke Y.Addressing the shortage of health professionals in rural China:issues and progress comment on"have health human resources become more equal between rural and urban areas after the new reform?"[J].Int J Health Policy Manag2015,4(5):327-328.
[9]Zhang X,Dupre ME,Qiu L,et al.Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China[J].BMC Geriatr,2017,17(1):151.
[10]Liu WT,Wang CH,Lin HC,et al.Efficacy of a cell phonebased exercise programme for COPD[J].Eur Respir J,2008,32(3):651-659.
[11]Whitehead L,Seaton P.The effectiveness of self-management mobile phone and tablet apps in long-term condition management:a systematic review[J].J Med Internet Res,2016,18(5):e97.
[12]Cristancho-Lacroix V,Wrobel J,Cantegreil-Kallen I,et al.Aweb-based psychoeducational program for informal caregivers of patients with Alzheimer's disease:a pilot randomized controlled trial[J].J Med Internet Res,2015,17(5):e117.
[13]Mcgregor AH,Dore CJ,Morris TP,et al.ISSLS prize winner:Function After Spinal Treatment,Exercise,and Rehabilitation(FASTER):a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved[J].Spine,2011,36(21):1711-1720.
[14]Sherman KJ,Cherkin DC,Erro J,et al.Comparing yoga,exercise,and a self-care book for chronic low back pain:a randomized,controlled trial[J].Ann Intern Med,2005,143(12):849-856.
[15]Soegaard R,Christensen F B,Lauerberg I,et al.Lumbar spinal fusion patients'demands to the primary health sector:evaluation of three rehabilitation protocols:a prospective randomized study[J].Eur Spine J,2006,15(5):648-656.
[16]Demir S,Dulgeroglu D,Cakci A.Effects of dynamic lumbar stabilization exercises following lumbar microdiscectomy on pain,mobility and return to work:randomized controlled trial[J].Eur J Phys Rehabil Med,2014,50(6):627-640.