뇌졸중 환자를 위한 가상현실 기반의 원격재활 효과에 관한 체계적 고찰

임영명,이지용,조성준,안예슬,유두한 대한지역사회작업치료학회 2017 대한지역사회작업치료학회지 Vol.7 No.1

목적 : 본 연구의 목적은 뇌졸중 환자를 대상으로 가상 현실 기반의 원격재활 효과를 체계적으로 고찰하여 그 효과와 국내 적용방법을 알아보고자 하였다. 연구방법 : 자료의 검색을 위해 EMBASE, CINAHL의 데이터베이스를 이용하였다. 주요 용어는 “Virtual Reality”, “Telerehabilitation”, “Stroke”으로 관련 연구를 검색하였다. 선정기준에 적합한 총 7편의 연구를 대상으로 질적 수준, 일반적 특성, PICO를 사용하여 연구 주제에 따른 자료를 분석하였다. 결과 : 선정된 7편의 연구는 가상현실 기반으로 한 원격재활 시스템으로 중재를 실시하였으며, 가상현실은 게임 프로그 램과 수동적인 팔 보조 그리고 Balance Trainer등을 활용하여 원격재활 중재를 실시하였다. 주된 결과 측정도구는 상지기능, 균형 및 보행, 일상생활 등을 평가하기 위한 도구가 사용되었다. 가상현실 기반의 원격재활 중재방법은 모든 연구에서 상지기능, 균형감각능력에서 효과를 보였으며, 일상생활 활동에서의 부분적인 효과를 확인하였다. 환경적 특이성을 보완하기 위한 원격재활 서비스는 클라이언트의 만족감을 향상시키고 기능의 유지를 위한 중재법 으로 그 효과를 확인할 수 있었다. 결론 : 가상현실 기반의 원격재활 시스템은 대부분 상지기능과 균형감각, 일상생활 활동을 위한 중재가 적용되었으며, 가정환경에서도 치료사의 중재, 감독, 교육 등을 통해 기능향상에 도움이 되는 것으로 나타났다. 본 연구는 가상현실 기반의 원격재활의 임상적 적용에 대한 근거와 가능성을 제시하고자 한다. 향후 연구에서 다양한 가상현실의 중재 방법과 원격재활을 활용한 재활 프로그램 개발과 같은 추가적인 연구가 필요할 것이다. Objective : The purpose of this study was to examine the effect of virtual reality-based remote rehabilitation on stroke patients systematically and to look for its effect and how to apply it domestically. Methods : In order to search data, EMBASE and CINAHL database were used. Relevant research used those terms of virtual reality, telerehabilitation, and stroke. A total of 10 studies satisfying the selection criteria was analyzed according to their qualitative level, general characteristics, and PICO method. Results : Based on the selected 10 studies, virtual reality-based telerehabilitation system was applied. Sensory and motor feedback was provided with inputting visual and auditory senses through a video in the home environment, and it stimulated changes in the client’s nervous system. Tools to measure the results were upper extremity function, balance and gait, activities of daily living, etc. Those virtual reality-based telerehabilitation method had an effect on upper extremity function and ability of sense of balance in all studies, and on the activities of daily living partially. Telerehabilitation service to make up environmental specificity improved satisfaction of client. That meaned the effect of the intervention to maintain the function. Conclusion : The virtual reality-based telerehabilitation system was applied to upper extremity function, sense of balance, and activities of daily living largely , and it showed that it helped to improve functions through intervention, supervision, and training of therapist in the home environment as well. This study suggests the basis and possibility of clinical application on virtual-reality based telerehabilitation. Additional research is needed to diverse virtual reality intervention methods and the effect of telerehabilitation in the future.

New Methods of Pulmonary Rehabilitation

( Seung-won Ra ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

The potential disadvantages of traditional center-based pulmonary rehabilitation (PR) include the availability of transportation system, limited access to PR services, and the difficulty of maintaining long-term adherence. The emergence of new methods of PR can complement traditional PR and provide a greater personalization of programs, making PR more accessible and acceptable to patients with chronic respiratory diseases. COVID-19 pandemic has greatly prompted a rapid transition to home-based or telerehabilitation. It has become more important than ever in this COVID-19 era to exploit digital technologies. The essential components of PR, however, should be delivered in these new models. Hybrid models combining in-person and virtual exercise training can be optimized to enhance the effect of PR while decreasing the risk of contagious infection. In this lecture, evidence-based benefits of telerehabilitation and home-based models using digital technologies will be reviewed and how they can be incorporated into clinical practice will be discussed. The highly advanced information technology and fast network in South Korea can be harnessed to have the new models of PR adopted rapidly.

뇌졸중 환자의 운동기능에 원격재활이 미치는 효과: 체계적 문헌고찰

신윤찬(Shin Yun-Chan),박지혁(Park Ji-Hyuk) 대한신경계작업치료학회 2018 재활치료과학 Vol.7 No.4

목적: 뇌졸중 환자에게 원격재활을 적용하고 운동기능의 변화를 알아본 연구들을 체계적으로 고찰하여 원격재활에서 사용한 원격감독 방법과 원격으로 제공된 중재의 효과를 알아보아 국내에서의 적용을 위한 기초자료를 제공하려 한다. 연구방법: 2000년부터 2018년 4월까지의 국외 문헌들을 PubMed, Embase 그리고 Cochrane을 통해 수집하였고 RISS를 통해 국내 문헌을 검색, 수집하였다. 국외 논문 검색어로는 Telerehabilitation, Telemedicine, Stroke을 사용하였고 국내 문헌은 원격재활, 뇌졸중, stroke, CVA, 뇌혈관질환 검색어를 사용하였다. 총 406개의 국외 문헌과 15개의 국내 문헌이 검색되었으며 결과적으로 총 7개의 문헌이 분석대상 문헌으로 선정되었다. 결과: 7편의 문헌 모두 원격재활을 적용받는 그룹에게 중재를 원격에서만 제공하였으며 전, 후 비교를 통해 운동기능에서 유의미한 효과를 확인하였다. 또한 원격재활 중재의 유의미한 효과를 전, 후 비교(n=7) 및 그룹간의 비교(n=4)를 통해 분석하여 운동기능에서의 긍정적인 효과를 확인하였다. 사용된 원격감독은 목적에 따라 중재로써의 감독(n=4)과 확인을 위한 감독(n=3)으로 분류할 수 있었다. 결론: 본 연구를 통해 전통적인 재활 서비스를 제공받는 것에 제한이 있는 뇌졸중 환자들에게 원격재활의 적용이 잠재적인 대체 방법이 될 수 있음을 제한적으로 확인하였다. 원격재활의 실질적인 국내적용을 위해서는 국내 실정에 맞는 비용효과에 대한 연구가 필요하며, 원격재활을 통해 제공되는 가장 효율적인 중재별 원격감독 방법을 확인해 볼 수 있는 연구가 이루어져야 할 것이다. Objective: The purpose of this study was to investigate the effects of telerehabilitation on stroke patients through remotely operated intervention and monitoring. Methods: Literature from 2000 to April 2018 was collected through PubMed, Embase, Cochrane, and RISS. We used telerehabilitation, telemedicine, and stroke as the search terms in regard to foreign literature, and the terms telerehabilitation, stroke, and CVA in regard to Korean literature. A total of 406 foreign and 15 Korean published studies were found. As a result, a total of seven documents was selected for the analysis. Results: As a result of the analysis, all the interventions applied through telerehabilitation were provided remotely, and significant effects were reported between pre-post assessments. In addition, the significant effects of telerehabilitation were reported through analyzing pre-post(n=7) and between groups(n=4) assessments. The monitoring used could be categorized according to purpose, that is, for checking (n=3) and as an intervention (n=4). Conclusions: This study confirmed, within limits, that the application of telerehabilitation could be a potential alternative for stroke patients with limited rehabilitation services. In order to apply telerehabilitation in Korea, it is necessary to study the cost effectiveness, according to the current domestic situation, and confirm the most effective monitoring method based on the intervention.

원격재활 운동프로그램이 무릎골관절염 환자의 근 기능과 삶의 질에 미치는 영향

김재윤 ( Jae-yun Kim ),이동우 ( Dong-woo Lee ),정모범 ( Mo-beom Jeong ) 대한물리의학회 2020 대한물리의학회지 Vol.15 No.1

PURPOSE: This study examined the effects of videoconferencing- based telerehabilitation exercise program on the gait, knee function, and quality of life of patients with knee osteoarthritis. METHODS: Forty-eight subjects, who were diagnosed with osteoarthritis of the knee by the radiologic findings, history, and a physical examination, were assigned randomly to a Control group, Experiment group I, and Experiment group Ⅱ. The control group did not perform any exercise program and were educated in understanding and managing the disease of knee osteoarthritis for only one hour. Experimental groups I and Ⅱ were provided with an exercise guidelines book for knee osteoarthritis, and the same exercise programs were conducted by face-to-face visits and non-face-to-face using telerehabilitation for eight weeks, respectively. To verify the effectiveness of each exercise program, the gait speed, knee disability index, and health related quality of life were measured. All assessments were conducted twice before and after the intervention. RESULTS: The participants who underwent both face-toface and telerehabilitation exercise programs showed an improved gait speed, knee function, and health-related quality of life. In particular, there was no significant difference between the telerehabilitation exercise group and the direct face-to-face exercise group in improving the knee joint function and health related quality of life. CONCLUSION: A these findings the telerehabilitation exercise program for patients with knee osteoarthritis can alternate or supplement the face-to-face exercise program. Therefore, the telerehabilitation exercise program should be used not only as a substitute supplement program but also as an intervention for various diseases.

Fast-track surgery and telerehabilitation protocol in unicompartmental knee arthroplasty leads to superior outcomes when compared with the standard protocol: a propensity-matched pilot study

( Luca De Berardinis ),( Marco Senarighi ),( Carlo Ciccullo ),( Fabiana Forte ),( Marco Spezia ),( Antonio Pompilio Gigante ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: Several strategies have been devised to reduce the length of stay after orthopedic surgery. Telerehabilitation has proved effective in functional outcomes after orthopedic procedures and is appreciated by patients. There is limited information on fast-track surgery and telerehabilitation protocols for unicompartmental knee arthroplasty (UKA). The purpose of this pilot study was to report and compare functional outcomes and satisfaction levels during first 12 months of recovery in patients who underwent UKA according to a fast-track and telerehabilitation protocol (G1) or standard surgery and rehabilitation program (G2). Methods: Data were retrospectively collected and reviewed for all elective UKAs from January 2018 to November 2019. A total of seven patients undergoing UKA according to the fast-track and telerehabilitation protocol were propensity score matched (1:3 ratio) to 21 patients undergoing standard surgery and rehabilitation. Patients were matched for age, sex, body mass index (BMI), and laterality. The Western Ontario and McMaster University (WOMAC) osteoarthritis index and range of motion (ROM) were collected pre- and postoperatively in both groups for 12 months. In addition, patient’ satisfaction was collected at 40 days. Results: The G1 group demonstrated significantly better outcomes in WOMAC index scores at 2, 15, and 40 days (p < 0.001, p < 0.001, p < 0.020, respectively) and a significantly greater knee ROM after surgery and at 2, 15, 40, and 12 months (p < 0.001, p < 0.001, p = 0.014, p < 0.001, p = 0.003, respectively). No patients in either group had postoperative complications. One patient was not completely satisfied in the G2, while no one in G1 reported not being completely satisfied (p = 1.000). Conclusions: This fast-track and telerehabilitation protocol after UKA can potentially be applied to patients as it is safe and effective. At 12-months follow-up, both groups reported favorable outcomes after UKA. However, the G1 score was better regarding WOMAC and ROM when compared with the propensity score-matched G2 program. A larger study is warranted to explore the role of fast-track and telerehabilitation in clinical and functional outcomes of UKA.

삼킴장애를 가진 파킨슨병 환자의 원격재활이 삼킴기능과 삶의 질에 미치는 영향: 예비연구

최현세,이두호 대한고령친화산업학회 2022 대한고령친화산업학회지 Vol.14 No.1

Objective : The purpose of this study is to investigate the effects of swallowing function and swallowing-related quality of life when telerehabilitation is conducted for patients with Parkinson's disease with swallowing disorder. Methods : In this study, telerehabilitation based on videoconferencing was conducted once for 30 minutes and twice a week for a total of 8 weeks for 10 people who were diagnosed with Parkinson's disease and had abnormal oropharyngeal function in a videofluoroscopy study. The SPSS 25.0 version program was used to confirm the swallowing function before and after intervention and the change in quality of life related to swallowing. Results : There was a statistically significant difference in swallowing function and swallowing-related quality of life after intervention (p<0.05). However, among the sub-items of swallowing-related quality of life, there was no statistically significant difference in the items of eating desire, food selection, mental health, and social function. Conclusion : There was a significant difference in swallowing function and improvement of swallowing-related quality of life during telerehabilitation in Parkinson's disease patients with swallowing disorders. Through this study, it is expected that telerehabilitation can be activated in patients with Parkinson's disease in the community to prevent swallowing disorders in patients.

원격재활 기반 작업치료가 뇌졸중 환자의 실행기능, 일상생활수행, 작업수행에 미치는 영향

박성순(Park, Seong-Sun),김수경(Kim, Su-kyung),유두한(Yoo, Doo-Han),김 희(Kim, Hee) 대한신경계작업치료학회 2021 재활치료과학 Vol.10 No.1

목적 : 본 연구는 원격재활에 기반 한 작업치료가 뇌졸중 환자의 실행기능, 일상생활수행, 작업수행에 영향을 미치는지 알아보고자 한다. 연구방법 : 지역사회에 거주하며, 재활병원에 외래로 통원하는 환자 30명을 실험군과 대조군에 각각 15명씩 무작위 할당하여 연구를 진행하였다. 실험군 집단과 실험군의 중재는 모두 주 3회 18회기로 실시하였다. 실험군 15명에게는 전통적 작업치료와 함께 더불어 가정에서의 원격재활 기반 프로토콜을 적용하였다. 대조군 15명은 전통적 작업치료만 실시하였다. 실험 참가자의 실행기능과 수단적 일상생활수행은 실행기능 수행평가 한국판(Executive Function Performance Test Korean version; EFPT-K)으로 측정하였고, 기본적 일상생활활동은 수정된 바델 지수(Modified Barthel Index; MBI), 작업수행은 클라이언트 중심의 과제수행을 측정하기 위해서 캐나다 작업수행 측정(Canadian Occupational Performance Measure; COPM)을 이용하였다. 결과 : 중재 후 실험군과 대조군은 모두 실행기능, 수단적 일상생활활동, 작업수행에서 유의한 변화가 있었으나(p<.05), 기본적 일상생활수행에서는 유의한 변화가 없었다. 집단 간 비교에서는 작업수행에서만 실험군이 대조군보다 유의하게 더 많은 증진이 나타났다. 결론 : 원격재활과 작업치료는 뇌졸중 환자의 실행기능, 수단적 일상생활수행, 작업수행의 향상에 긍정적인 영향을 미친다. 작업치료에 병행된 원격재활은 뇌졸중 환자의 작업수행에 추가적인 효과가 있음을 근거로써 제시한다. Objective : The purpose of this study was to investigate the effect of telerehabilitation on executive function, activities of daily living, instrumental activities of daily living, and occupational performance in stroke patients. Methods : The participants of this study were 30 outpatients with stroke residing in community. Both groups underwent the intervention 3 times a week for a total of 18 sessions. For the experimental group telerehabilitation was administered at home to only fifteen participants in the experimental group schedule, and it was supervised by the caregiver. Fifteen people in the control group underwent only the traditional occupational therapy. Executive function and instrumental activities of daily living were evaluated using the Korean version of the Executive Function Performance Test (EFPT-K). The basic daily activities of living were assessed using the Modified Barthel Index (MBI). The Canadian Occupational Performance Measure (COPM) was used to evaluate the client-centered occupational performance. Results : After the intervention, the experimental and control groups showed improvements in executive function, instrumental activities of daily living and occupational performance. Occupational performance improved more significantly in the experimental group than in the control group. Conclusion : Telerehabilitation and occupational therapy positively affect executive function, instrumental activities of daily living and occupational performance of patients with stroke. We suggest that telerehabilitation combined with occupational therapy is more effective in improving the occupational performance of stroke patients.

Need Assessment for Smartphone-Based Cardiac Telerehabilitation

김지수,윤도은,김현주,류호열,오재원,강석민 대한의료정보학회 2018 Healthcare Informatics Research Vol.24 No.4

Objectives: To identify the current status of smartphone usage and to describe the needs for smartphone-based cardiac telerehabilitation of cardiac patients. Methods: In 2016, a questionnaire survey was conducted in a supervised ambulatory cardiac rehabilitation (CR) program in a university affiliated hospital with the participation of heart failure or heart transplantation patients who were smartphone users. The questionnaire included questions regarding smartphone usage, demands for smartphone-based disease education, and home health monitoring systems. Results were described and analyzed according to principal diagnosis. Results: Ninety-six patients (66% male; mean age, 53 ± 11 years), including 56 heart failure and 40 heart transplantation patients, completed the survey (completion rate, 95%). The median daily smartphone usage time was 120 minutes (interquartile range, 60–300), and the most frequently used smartphone function was text messaging (61.5%). Of the patients, 26% stated that they searched for health-related information using their smartphones more than 1 time per week. The major source of health-related information was Internet browsing (50.0%), and the least sought source was the hospital’s website (3.1%). Patients with heart failure expressed significantly higher needs for disease education on treatment plan, home health monitoring of blood pressure, and body weight (χ2 = 5.79, 6.27, 4.50, p < 0.05). Heart transplantation patients expressed a significant need for home health monitoring of body temperature (χ2 = 5.25, p < 0.05). Conclusions: Heart failure and heart transplantation patients show high usage of and interest in mobile health technology. A smartphone-based cardiac telerehabilitation program should be developed based on high demand areas and modified to suit to each principal diagnosis.

원격재활을 활용한 물리치료 서비스의 현황과 전망

유경태 대한물리의학회 2024 대한물리의학회지 Vol.19 No.2

PURPOSE: This study examined the status and prospects of telerehabilitation to identify the challenges and propose strategies for its promotion both domestically and internationally. The study also focused on the preconditions and improvements required for adopting telerehabilitation, considering technological, institutional, and socio-cultural factors. METHODS: A thorough database search was conducted. The relevant research, papers, and reports were collected, and the literature was evaluated to summarize the findings. RESULTS: Tele-rehabilitation showed promise in enhancing the healthcare service quality and accessibility. However, addressing challenges requires a comprehensive analysis of its status, global research trends, and the formulation of adoption strategies. Research in this direction is expected to improve healthcare services. CONCLUSION: Tele-rehabilitation can enhance healthcare services by overcoming geographical limitations. On the other hand, addressing challenges through analysis and strategic planning is essential for its effective adoption and advancing healthcare quality and accessibility.

Reliability and Validity Inquiry for Tele-assessment Based on Video Conferencing

Suha Lee,Changho Song 물리치료재활과학회 2023 Physical therapy rehabilitation science Vol.12 No.2

Objective: The study examined the validity and reliability of tele-assessment of cervical range of motion (ROM) through video conferencing. Design: A cross-sectional studyMethods: The study included 22 healthy adults as subjects and 10 physical therapists as evaluators. The subjects underwent both face-to-face and tele-assessment of cervical ROM. The CROM (Cervical Range of Motion) device was used for reference measurements in the face-to-face assessment. The evaluators assessed the subjects' ROM through visual inspection (VI) and using a Universal Goniometer (UG) in the tele-assessment. Results: The results showed a significant correlation between the face-to-face and tele-assessment measurements for all ROM contents. The correlation coefficients ranged from r=0.54 to 0.71 (p<0.05), indicating concurrent validity. In terms of inter-rater reliability, the ICC values for both VI and UG assessments in the tele-assessment were high, with ICCs of 0.93 and 0.92, respectively. Additionally, the study investigated the usability of the tele-assessment method and environment. The satisfaction of the participants and evaluators was assessed using the Telehealth Usability Questionnaire (TUQ), which evaluates perceptions, usability, and satisfaction with telehealth services. Conclusions: In conclusion, tele-assessment of cervical range of motion using video conferencing was valid and reliable. Also, investigated participant and evaluator satisfaction and opinions, providing insights into the clinical value of tele-assessment. It is important to note that the study was conducted only healthy adults, and further research may be needed to validate the tele-assessment method in populations with cervical dysfunction or neck pain. These findings support the potential effectiveness of telerehabilitation services in assessing and managing musculoskeletal disorders.