熟练使用智能手机有助于冠心病患者接受基于家庭的远程心脏康复
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摘要
目的研究智能手机应用等因素对冠心病患者基于家庭的远程心脏康复(home-based telemonitored cardiac rehabilitation,HTCR)接受情况的影响。方法对北京地区多家三甲医院及社区医院的冠心病患者进行问卷调查,并采用单因素分析和多因素分析探讨影响冠心病患者对HTCR接受程度的因素。结果有效调查冠心病患者1121例,其中使用智能手机980例(87.42%)。使用智能手机的冠心病患者对HTCR的接受率为46.84%(459/980),智能手机使用较为流利的冠心病患者HTCR接受率较高(使用非常流利:OR=3.159,95%CI:2.070～4.819,P <0.001),高中以上学历(OR=1.570,95%CI:1.166～2.114,P=0.003)、有一定运动习惯(规律锻炼:OR=2.764,95%CI:1.861～4.105,P <0.001)及就诊于社区医院(OR=2.163,95%CI:1.522～3.074,P <0.001)均对冠心病患者HTCR接受情况具有积极影响。结论冠心病患者HTCR接受程度受智能手机应用情况等多种因素的影响,医护人员需针对不同特征患者采取不同的干预措施,从而改善患者预后。
Objective To study the influence of smartphone using and other factors on the acceptance of home-based telemonitored cardiac rehabilitation(HTCR) in patients with coronary heart disease(CHD). Method A questionnaire survey was conducted among patients with CHD in several Third Grade& Class A hospitals and community hospitals in Beijing. Univariate and multivariate analysis were used to explore the factors affecting the acceptance of HTCR in patients with CHD. Result A total of 1121 patients were effectively investigated, of whom 980 cases(87.42%) used smartphones. The acceptance rate of the smartphone users was 46.84%(459/980). Patients using smart phones fluently had higher acceptance rate of HTCR(OR = 3.159, 95%CI: 2.070 ～ 4.819, P < 0.001). Having an education above high school graduate(OR = 1.570, 95%CI: 1.166 ～ 2.114, P = 0.003), having exercise habits(exercising regularly: OR = 2.764, 95%CI: 1.861 ～ 4.105, P < 0.001) and visiting community hospitals(OR = 2.163, 95%CI: 1.522 ～ 3.074, P < 0.001) had a positive effect on the acceptance of HTCR in patients with CHD. Conclusion The acceptance of HTCR in patients with CHD is affected by many factors, such as fluency in using smartphone. Medical staffs should take different interventions for patients with different characteristics, so as to improve the prognosis of patients.
Objective To study the influence of smartphone using and other factors on the acceptance of home-based telemonitored cardiac rehabilitation(HTCR) in patients with coronary heart disease(CHD). Method A questionnaire survey was conducted among patients with CHD in several Third Grade& Class A hospitals and community hospitals in Beijing. Univariate and multivariate analysis were used to explore the factors affecting the acceptance of HTCR in patients with CHD. Result A total of 1121 patients were effectively investigated, of whom 980 cases(87.42%) used smartphones. The acceptance rate of the smartphone users was 46.84%(459/980). Patients using smart phones fluently had higher acceptance rate of HTCR(OR = 3.159, 95%CI: 2.070 ～ 4.819, P < 0.001). Having an education above high school graduate(OR = 1.570, 95%CI: 1.166 ～ 2.114, P = 0.003), having exercise habits(exercising regularly: OR = 2.764, 95%CI: 1.861 ～ 4.105, P < 0.001) and visiting community hospitals(OR = 2.163, 95%CI: 1.522 ～ 3.074, P < 0.001) had a positive effect on the acceptance of HTCR in patients with CHD. Conclusion The acceptance of HTCR in patients with CHD is affected by many factors, such as fluency in using smartphone. Medical staffs should take different interventions for patients with different characteristics, so as to improve the prognosis of patients.
引文
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[25]Treskes RW,van der Velde ET,Barendse R,et al.Mobile health in cardiology:a review of currently available medical apps and equipment for remote monitoring[J].Expert Rev Med Devices,2016,13(9):823-830.
[2]Boyde M,Rankin J,Whitty JA,et al.Patient preferences for the delivery of cardiac rehabilitation[J].Patient Educ Couns,2018,101(12):2162-2169.
[3]Anderson L,Oldridge N,Thompson DR,et al.Exercise-based cardiac rehabilitation for coronary heart disease:Cochrane Systematic Review and Meta-Analysis[J].J Am Coll Cardiol,2016,67(1):1-12.
[4]高炜,徐顺霖.基于运动的治疗性训练是心脏康复的发展之路[J].中国医学前沿杂志(电子版),2016,8(8):1-2.
[5]Kotseva K,Wood D,De Backer G,et al.Use and effects of cardiac rehabilitation in patients with coronary heart disease:Results from the EUROASPIRE III survey[J].Eur J Prev Cardiol,2013,20(5):817-826.
[6]Poushter J,Bishop C,Chwe H.Social Media Use Continues to Rise in Developing Countries but Plateaus Across Developed Ones[R/OL].(2018-06-19)[2019-03-15].http://www.pewglobal.org/2018/06/19/social-media-use-continues-to-rise-indeveloping-countries-but-plateaus-across-developed-ones/.
[7]Frederix I,Van DN,Hansen D,et al.Increasing the mediumterm clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients[J].Eur J Prev Cardiol,2015,22(2):150-158.
[8]Tousignant M,Mampuya WM.Telerehabilitation for patients with heart failure[J].Cardiovasc Diagn Ther,2015,5(1):74-78.
[9]Hwang R,Bruning J,Morris NR,et al.Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure:a randomised trial[J].J Physiother,2017,63(2):101-107.
[10]Piotrowicz E,Orzechowski P,Jasionowska A,et al.Effects of hybrid comprehensive cardiac telerehabilitation conducted under the pention preventive program of the social insurance institution[J].Med Pr,2017,68(1):61-74.
[11]Riebe D,Ehrman JK,Liguori G,et al.ACSM's Guidelines for Exercise Testing and Prescription[M].10th Edition.USA:American College of Sports Medicine,2018:147-151.
[12]Piotrowicz E,Korzeniowska-Kubacka I,Chrapowicka A,et al.Feasibility of home-based cardiac telerehabilitation:Results of Tele Inter Med study[J].Cardiol J,2014,21(5):539-546.
[13]高永祥,张晋昕.Logistic回归分析的样本量确定[J].循证医学,2018,18(2):122-124.
[14]Melholt C,Joensson K,Spindler H,et al.Cardiac patients'experiences with a telerehabilitation web portal:Implications for e Health literacy[J].Patient Educ Couns,2018,101(5):854-861.
[15]Dankner R,Drory Y,Geulayov G,et al.A controlled intervention to increase participation in cardiac rehabilitation[J].Eur J Prev Cardiol,2015,22(9):1121-1128.
[16]Fang JY,Li JL,Li ZH,et al.Attitudes towards acceptance of an innovative home-based and remote sensing rehabilitation protocol among cardiovascular patients in Shantou,China[J].JGeriatr Cardiol,2016,13(4):326-332.
[17]Anderson L,Sharp GA,Norton RJ,et al.Home-based versus centre-based cardiac rehabilitation[J].Cochrane Database Syst Rev,2017,6:CD007130.
[18]Maddison R,Stewart R,Doughty R,et al.Text4HeartⅡ-improving medication adherence in people with heart disease:a study protocol for a randomized controlled trial[J].Trials,2018,19(1):70.
[19]Avila A,Claes J,Goetschalckx K,et al.Home-Based Rehabilitation With Telemonitoring Guidance for Patients With Coronary Artery Disease(Short-Term Results of the TRi CHStudy):Randomized Controlled Trial[J].J Med Internet Res,2018,20(6):e225.
[20]Maddison R,Pfaeffli L,Whittaker R,et al.A mobile phone intervention increases physical activity in people with cardiovascular disease:Results from the HEART randomized controlled trial[J].Eur J Prev Cardiol,2015,22(6):701-709.
[21]Maddison R,Rawstorn JC,Stewart RAH,et al.Effects and costs of real-time cardiac telerehabilitation:randomised controlled non-inferiority trial[J].Heart,2018,105(2):122-129.
[22]Rawstorn JC,Gant N,Rolleston A,et al.End users want alternative intervention delivery models:usability and accepta bility of the REMOTE-CR exercise-based cardiac telerehab ilitation program[J].Arch Phys Med Rehabil,2018,99(11):2373-2377.
[23]Anton D,Berges I,Bermúdez J,et al.A Telerehabilitation System for the Selection,Evaluation and Remote Management of Therapies[J].Sensors(Basel),2018,18(5).pii:E1459.
[24]Frederix I,Solmi F,Piepoli MF,et al.Cardiac telerehabilitation:A novel cost-efficient care delivery strategy that can induce long-term health benefits[J].Eur J Prev Cardiol,2017,24(16):1708-1717.
[25]Treskes RW,van der Velde ET,Barendse R,et al.Mobile health in cardiology:a review of currently available medical apps and equipment for remote monitoring[J].Expert Rev Med Devices,2016,13(9):823-830.