BACKGROUND:To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS:Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N = 2188) in post-TKR rehabilitation and 4 studies (N = 783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): - 0.25; 95% confidence interval (CI): - 0.48, - 0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: - 11.18, - 2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION:There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

译文

背景:为了评估全髋/膝关节置换术(THR / TKR)后技术辅助康复的有效性和安全性。
方法:检索了六个没有语言或时间限制的电子数据库以进行相关研究:MEDLINE,EMBASE,Cochrane图书馆,CINAHL,SPORTDiscus,物理治疗证据数据库(PEDro);从成立到2018年11月7日。两名评价者独立地应用纳入标准,选择符合条件的随机对照试验(RCT),以研究基于技术的干预措施与常规护理或不接受THR / TKR干预的患者相比的有效性。两名审稿人独立提取了试验的详细信息(例如,患者档案,干预,结果,磨损和不良事件)。研究方法学质量使用PEDro量表进行评估。使用建议分级,评估,制定和评估方法对证据质量进行严格评估。
结果:我们确定了21项评估远程康复,基于游戏或基于网络的疗法的合格研究。在TKR术后康复中有17项研究(N = 2188),在THR术后康复中有4项研究(N = 783)。与常规护理相比,基于技术的干预在减轻疼痛方面更有效(平均差异(MD):-0.25; 95%置信区间(CI):-0.48,-0.02;适度证据)并改善随时间推移而测得的功能-在接受TKR的人群中进行了一次走动测试(MD:-7.03; 95%CI:-11.18,-2.88)。在这些研究中,没有观察到住院再入院率或与治疗相关的不良事件(AE)的组间差异。
结论:有中等质量的证据表明,技术辅助的康复,尤其是远程康复,可使疼痛得到统计学上的显着改善。以及关于TKR患者功能性流动性改善的证据不足。但是,效果太小,不足以具有临床意义。对于THR,仅有非常有限的低质量证据显示没有明显影响。

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