基于ICF冠心病患者远程康复的Scoping综述

doi:10.3969/j.issn.1006-9771.2023.04.009

Abstract

Abstract:

Objective To analyze the application of telerehabilitation in patients with coronary heart disease (CHD) based on the theories and methods of the International Classification of Functioning, Disability and Health (ICF).
Methods Literatures on the application of telerehabilitation in patients with CHD from databases of PubMed, Web of Science, CNKI, and Wanfang data were retrieved from establishment to May 5th, 2022. Scoping review methods were used to analyze the intervention measures, evaluation methods and indicators, rehabilitation outcomes, and influencing factors on patients with CHD based on ICF.
Results A total of 4 172 literatures were retrieved, and 15 of them from five countries were enrolled. They were almost published in journals on medical and public health, from 2015 to 2022. The main elements of telerehabilitation included nine items: the establishment of telerehabilitation group, the establishment of personal health profiles, physical activity, exercise monitoring, provision of relevant knowledge, communication and guidance from professionals, provision of psychological support, self-report and supervision and reminder of medical staff. According to the ICF framework, telerehabilitation promoted the function of patients with CHD mainly in body function (including b1 mental functions, b4 function of the cardiovascular, hematological, immunological and respiratory systems, b5 functions of the digestive, metabolic and endocrine systems, and b7 neuromusculoskeletal and movement-related functions) and activity and participation (including d2 general tasks and demands, d4 mobility, d7 interpersonal interactions and relationships, d8 major life areas, and d9 community, social and civic life). The factors affecting the activity and participation of patients with CHD contained environmental factors and personal factors, mainly including e1 products and technology, e3 support and relationships, e4 attitudes, and e5 service, systems and policies.
Conclusion This paper summarized nine items of telerehabilitation for patients with CHD, and analyzed the effects and related influencing factors of telerehabilitation on patients with CHD based on ICF.

Key words: International Classification of Functioning, Disability and Health, coronary heart disease, telerehabilitation, scoping review

CLC Number:

R541

CAO Yuhan, LI Jin, HE Min, WANG Dan, CHEN Wei. Telerehabilitation for patients with coronary heart disease based on ICF: a scoping review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 433-442.

Figures/Tables 2

纳入文献	国家	研究对象	n(T/C)	评价指标及工具	干预方法		干预时间	干预媒介	康复结果	影响因素
纳入文献	国家	研究对象	n(T/C)	评价指标及工具	T	C	干预时间	干预媒介	康复结果	影响因素
Avila等^[5](2020)	比利时	冠状动脉疾病患者	30/30/30（T/C1/C2）	心肺适能、身体活动水平、肌肉力量、传统心血管危险因素、SF-36	③④⑥⑧	C1：以中心为基础的延续康复C2：常规康复 (宣教+随访)	12周	网站信息平台+电话/邮件	心血管、血液、免疫和呼吸系统功能(b4)；神经肌肉骨骼和运动有关的功能(b7)；消化、代谢和内分泌系统功能(b5)；活动(d4)；社区、社会和公民生活(d9)：VO_2peak、心血管危险因素等指标及生活质量改善效果相似	用品和技术(e1)；服务、体制和政策(e5)
田云等^[8](2020)	中国	PCI术后患者	53/53	SF-12、疾病家庭负担量表、LVEF、运动耐力(包括6MWT步行距离、无氧阈、VO_2peak)	①③④⑤⑥⑦⑧	常规康复	3个月	移动应用程序+电话	精神功能(b1)；活动(d4)；人际交往和人际关系(d7)：生活质量提高；心血管、血液、免疫和呼吸系统功能(b4)：6MWT距离、无氧阈及VO_2peak提高	支持和相互联系(e3)：医务人员；态度(e4)
Su等^[10](2021)	中国	冠心病患者	73/73	IPAQ、健康促进生活方式量表、吸烟状况、自我效能感量表、生活质量问卷、心理状态、心血管危险因素(包括血压、BMI、腰围)	④⑤⑥⑦⑧⑨	常规护理	12周	网站信息平台	精神功能(b1)；活动(d4)；社区、社会和公民生活(d9)：对身体活动水平、健康生活方式、自我效能有积极作用	未涉及
Chow等^[13] (2015)	澳大利亚	冠心病患者	352/358	LDL-C水平、心血管危险因素(包括血压、BMI)、吸烟状况、全球体力活动问卷、其他心血管危险因素	⑤⑨	常规治疗	6个月	短信	心血管、血液、免疫和呼吸系统功能(b4)；消化、代谢和内分泌系统功能(b5)：BMI、LDL-C降低、控制血压；社区、社会和公民生活(d9)：定期锻炼，总活动量增加；精神功能(b1)：吸烟状况略有改善	未涉及
Avila等^[14] (2018)	比利时	冠状动脉疾病患者	30/30/30（T/C1/C2）	峰值运动能力、通气阈、呼吸交换率、峰值心率、身体活动水平、肌肉力量、传统心血管危险因素、空腹血生化参数、SF-36	③④⑥⑧⑨	C1：以中心为基础的康复 C2：常规康复(宣教+随访)	12周	网站信息平台+电话/邮件	心血管、血液、免疫和呼吸系统功能(b4)：第一、二通气阈改善；活动(d4)：久坐时间减少；神经肌肉骨骼和运动有关的功能(b7)；消化、代谢和内分泌系统功能(b5)；活动(d4)；社区、社会和公民生活(d9)：肌力、耐力、心血管危险因等指标及生活质量的改善效果与中心基础的康复相似	个人因素：年龄
Duan等^[15] (2018)	中国	冠心病患者	60/54	行为的内部与外部指标、身体活动量、果蔬摄入量、BMI、生活质量、流行病学研究中心抑郁症量表	③⑦⑧⑨	等待干预	8周	网站信息平台+电话	精神功能(b1)；一般任务和要求(d2)：更高的自我效能感与具体的计划；活动(d4)；社区、社会和公民生活(d9)：生活质量提高	态度(e4)：社会支持
Maddison等^[16](2019)	澳大利亚	稳定性冠心病患者	82/80	VO_2max、空腹血脂、人体成分测量、血压、体力活动、运动相关动机、运动依从性、不良事件发生率、EQ-5D-3L	③④⑤⑥⑦	以中心为基础的康复	12周	网站信息平台(医)+运动应用程序(患)+短信	心血管、血液、免疫和呼吸系统功能(b4)；一般任务和要求(d2)；活动(d4)；社区、社会和公民生活(d9)	支持和相互联系(e3)；服务、体制和政策(e5)
轩玉宏等^[17](2019)	中国	稳定性冠心病患者	80/80	SAQ、冠心病自我管理量表、自制问卷	①⑤⑥⑧⑨	常规健康教育	8个月	移动应用程序(微信群)	活动(d4)；心血管、血液、免疫和呼吸系统功能(b4)；一般任务和要求(d2)：自我管理能力提高	用品和技术(e1)：通信方式；服务、体制和政策(e5)：医疗水平
Song等^[18](2020)	中国	稳定性冠心病患者	53/53	VO_2peak及其他心肺运动试验参数、运动习惯、血检指标、超声心动图参数、血糖、血脂控制率、不良事件发生率	③④⑤⑥	常规管理	6个月	移动应用程序+短信/邮件	心血管、血液、免疫和呼吸系统功能(b4)：提高运动耐量及心肺功能；一般任务和要求(d2)：提高运动依从性，促进运动习惯的保持和发展	用品和技术(e1)；服务、体制和政策(e5)；个人因素：使用应用程序的熟练程度
陈旭红等^[19](2020)	中国	冠心病患者	60/60	SF-36、治疗依从性调查问卷、主要心脏不良事件发生率	①②③⑤⑥⑨	常规护理	3个月	网站信息平台	精神功能(b1)；活动(d4)；社区、社会和公民生活(d9)：改善生活质量；心血管、血液、免疫和呼吸系统功能(b4)：心脏不良事件发生率降低	未涉及
袁丽霞等^[20](2020)	中国	PCI术后患者	60/60	心功能、SAQ、血压、血脂、Morisky服药依从性量表、SAS、SDS、一般自我效能感量表	②③⑤⑥⑨	常规健康教育+随访	12个月	移动应用程序	心血管、血液、免疫和呼吸系统功能(b4)：心功能指标、血压、与心血管和呼吸功能相关的感觉改善；消化、代谢和内分泌系统功能(b5)；精神功能(b1)：改善情绪状态；一般任务和要求(d2)：自我管理能力提高	用品和技术(e1)
Brouwers等^[21](2021)	荷兰	冠心病患者	150/150	身体活动水平、生活质量调查问卷	③④⑥⑦⑧	中心心脏康复	12个月	网站信息平台+视频	活动(d4)；社区、社会和公民生活(d9)：身体活动水平、生活质量持续提高，但组间无差异	未涉及
Snoek等^[22](2021)	荷兰	急性冠状动脉综合征(ACS)、PCI或CABG后患者	61/61	VO_2peak、IPAQ、生活质量问卷、心血管危险因素(BMI、腰围、总胆固醇)、主要心血管不良事件、情感及社交功能(患者健康问卷、PHQ-9、HADS、多维感知社会支持量表)	③④⑥⑦	电话随访	12个月	网站信息平台+电话	精神功能(b1)；心血管、血液、免疫和呼吸系统功能(b4)；活动(d4)；社区、社会和公民生活(d9)：VO_2peak、运动能力等指标组间改善效果相似	支持和相互联系(e3)：卫生专业人员；服务、体制和政策(e5)
肖春红等^[23](2021)	中国	冠心病患者	54/54	心理状态(SAS、SDS)、中国心血管病人生活质量评分问卷、健康行为依从率、满意度、不良事件发生率	②③⑤⑦⑧⑨	常规护理及健康教育	3个月	网站信息平台	精神功能(b1)：改善心理状态等；一般任务和要求(d2)：遵医服药、定期复查率等均增高；社区、社会和公民生活(d9)：社会心理、一般生活评分改善等；心血管、血液、免疫和呼吸系统功能(b4)：心血管不良事件发生率降低	未涉及
Dalli Peydró等^[24](2022)	西班牙	急性冠状动脉综合征患者	33/34	IPAQ、VO_2max、其他心肺功能运动试验参数、血液指标、人体测量参数(体重、内脏脂肪)、HADS、地中海饮食问卷、EQ‐5D‐5L、吸烟状况	③④⑤⑥⑧	中心心脏康复	10个月	网站信息平台+移动应用程序	精神功能(b1)：改善焦虑、抑郁；心血管、血液、免疫和呼吸系统功能(b4)：改善脂质谱；活动(d4)：身体活动增加；主要生活领域(d8)：恢复工作时间缩短	个人因素：性别、年龄

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Telerehabilitation for patients with coronary heart disease based on ICF: a scoping review

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