心臟手術患者使用遠距居家復健的影響

背景與目的：心臟復健對於心臟術後患者是恢復的重要關鍵，可以加速術後的身體恢復，並提高生活品質、降低死亡率和再住院率，隨著科技的發展，遠距居家復健是另一種新型復健模式，解決交通、時間衝突和成本等問題，透過資訊與通訊技術結合居家復健似乎成為患者可接受的替代復健方案，其便利性和可行性有助於克服一些無法參與門診復健的患者，並提高心臟復健的依從性。方法：本研究為對照的兩組前後測設計，每組各12人，並遵照FITT處方進行漸進式的四個階段步行運動，為期8週的步行運動，並透過智能手機計步APP確認步數，且詳細記錄運動內容(含步數)於運動紀錄本，另外，實驗組之受試者需額外受到研究人員監督步行運動狀況，紀錄並透過通訊APP給予患者回饋及提醒等等。本研究使用的結果變量為心肺功能、握力、問卷、自律神經功能、活動量(步數)及運動依從性。結果：實驗組經由8週的監督下運動介入，可顯著提升心肺耐力(六分鐘行走測試, p = 0.017)與自律神經功能(SDNN, p = 0.022)，對於研究期間的活動量也有顯著差異(平均每日步數, p < 0.001)，運動依從性也有更好表現(中高運動依從性(人數比)，實: 69.2%；控: 25%)。結論：心臟術後患者透過資訊與通訊技術進行遠距居家復健，同時在監督下執行有氧運動，可能因此得到足夠的關注、提醒、關心及回饋等等，相較傳統居家復健有更好的心肺耐力及自律神經功能表現，同時提升研究期間的活動量(步數)及運動依從性。相較於傳統居家復健，此研究計畫為一種可行且有效的心臟復健，也為患者提供了另一種可替代性的新型復健模式，使心臟遠距居家復健的模型更加完整。

Background and purpose: Cardiac rehabilitation is an important key to recovery for patients after heart surgery. It can accelerate physical recovery after surgery, improve quality of life, and reduce mortality and re-hospitalization rates. With the development of technology, remote home rehabilitation is another new rehabilitation model that solves problems such as transportation, time conflicts and costs. Combining home rehabilitation with information and communication technology seems to be an acceptable alternative rehabilitation plan for patients. Its convenience and feasibility can help overcome the inability of some patients to participate in outpatient rehabilitation and improve compliance with cardiac rehabilitation.Methods: This study is a two-group randomized controlled pre- and post-test design, with 12 people in each group. They followed the FITT prescription to perform a progressive four-stage walking exercise for 8 weeks. The number of steps was confirmed through a smartphone pedometer APP, and the exercise content (including the number of steps) was recorded in detail in an exercise log book. In addition, the subjects in the experimental group were required to be supervised by the researchers for their walking exercise status, record it, and give feedback and reminders to the patients through the communication APP. The outcome variables used in this study were cardiopulmonary function, handgrip strength, questionnaires, autonomic function tests, activity level and exercise compliance.Results: After 8 weeks of supervised exercise intervention, the experimental group was able to significantly improve cardiopulmonary endurance (six-minute walk test, p = 0.017), and also significantly improved autonomic nervous function (SDNN, p = 0.022). There were also significant differences in activity volume (average daily steps, p < 0.001), and exercise compliance was better than that of the control group (medium-high exercise compliance (number of people), treatment: 69.2%; control: 25%).Conclusions: Patients after cardiac surgery can use information and communication technology to conduct remote home rehabilitation and perform aerobic exercise under supervision. They may receive sufficient attention, reminders, care and feedback, which can improve their cardiopulmonary endurance and autonomic nervous function, and increase their activity (number of steps) and exercise compliance during the study period. Compared with traditional home rehabilitation, this research project is a feasible and effective cardiac rehabilitation, and also provides patients with another alternative new rehabilitation model, making the model of remote home cardiac rehabilitation more complete.