원격재활이 뇌졸중 환자의 일상생활활동과 삶의 질에 미치는 영향: 메타분석 = The Effect of Tele-Rehabilitation on Activities of Daily Living and Quality of Life in Individuals With Stroke: Meta-Analysis

다국어 초록 (Multilingual Abstract)

Objective: The purpose of this study is to investigate the effects of remote rehabilitation on activities of daily living and quality of life in stroke patients.
Methods: This study analyzed articles published between January 2000 and January 2022 among randomized controlled trials that verified the effectiveness of using tele-rehabilitation in stroke patients. Embase, MEDLINE, PubMed, and RISS were used as the databases. The quality of the study was evaluated based on the PEDro scale. A meta-analysis was conducted using statistics such as the number of samples, averages, and standard deviations.
Results: The final 10 randomized controlled trials were selected, and the total number of participants was 343 in the experimental group and 332 in the control group. The effect size was calculated based on Cohen’s d-value and a random effect model. An analysis showed no significant difference at 0.22 (95% Confidence Interval [CI]: -0.02 – 0.46; p = 0.07) in improving daily life activities in stroke patients, whereas interventions involving activities of daily living training in tele-rehabilitation programs showed a moderate effect size of 0.48 (95% CI: 0.15 – 0.81; p = 0.004). In addition, there was no significant change in the quality of life improvement of stroke patients at 0.68 (95% CI: -1.24 – 2.59; p = 0.49).
Conclusion: Through this study, it was found that the inclusion of activities of daily living (ADL) training in a tele-rehabilitation program was effective for stroke patients. In addition, although tele-rehabilitation showed no significant difference in improving the quality of life of stroke patients, it is meaningful that this study comprehensively analyzed the literature on the ADL and quality of life provided to such patients.

국문 초록 (Abstract)

목적:본 연구는 뇌졸중 환자에게 원격재활이 일상생활활동과 삶의 질에 미치는 효과를 알아보고자 하였다.
연구방법:뇌졸중 환자들을 대상으로 원격재활 중재를 사용하여 효과성을 검증한 국내외 무작위 실험연구 중, 2000년 1월에서 2022년 1월 사이에 출판된 논문들로 분석하였다. 검색을 위한 학술 데이터베이스로는 Embase, MEDLINE, PubMed, RISS를 사용하였고, PEDro 척도를 사용하여 연구의 질을 평가하였다. 메타분석은 샘플 수, 평균, 표준 편차와 같이 통계학적 수치를 사용하여 분석을 시행하였다.
결과:검색 결과 최종 10편의 무작위 대조 임상시험 연구가 선정되었고, PEDro 척도를 이용하여 연구의 질을 평가한 결과 6점 이상에 해당되었다. 참여대상자의 총 인원은 실험군이 343명, 대조군이 332명이었다. 효과크기는 Cohen의 d값과 램덤효과 모델로 산출하였다. 분석 결과, 원격재활이 뇌졸중 환자의 일상생활활동에 향상에는 0.22 (95% Confidence Interval[CI]: -0.02 – 0.46; p = 0.07)로 유의한 차이를 보이지 않았으나, 원격재활 프로그램에 일상생활활동 훈련이 포함된 중재들은 뇌졸중 환자의 일상생활활동에 0.48 (95% CI: 0.15 – 0.81; p = 0.004)로 중간 효과크기가 있는 것으로 나타났다. 그리고 뇌졸중 환자의 삶의 질 향상에는 0.68(95% CI: -1.24 – 2.59; p = 0.49)로 유의한 변화를 보이지 않았다.
결론:본 연구를 통해 원격재활 프로그램에 일상생활활동 훈련이 포함된 경우, 뇌졸중 환자의 일상생활활동에 효과가 있는 걸 알 수 있었다. 또한 원격재활이 뇌졸중 환자의 삶의 질 향상에는 유의한 차이를 보이지 않았지만 본 연구를 통해 뇌졸중 환자에게 제공되는 원격재활의 일상생활활동과 삶의 질에 대한 문헌들을 종합적으로 분석하여 효과를 알아보았다는데 의미가 있다.

참고문헌 (Reference)

1 박성순 ; 김수경 ; 유두한 ; 김희, "원격재활 기반 작업치료가 뇌졸중 환자의 실행기능, 일상생활수행, 작업수행에 미치는 영향" 대한신경계작업치료학회 10 (10): 115-127, 2021

2 이병관 ; 손영곤, "메타분석 결과에서 통계적 오류의 영향: 헤지스·올킨 방법과 헌터·슈미트 방법의 비교 분석" 한국헬스커뮤니케이션학회 (15) : 47-97, 2016

3 임영명 ; 이지용 ; 조성준 ; 안예슬 ; 유두한, "뇌졸중 환자를 위한 가상현실 기반의 원격재활 효과에 관한 체계적 고찰" 대한지역사회작업치료학회 7 (7): 59-70, 2017

4 Center for Connected Health Policy, "What is Telehealth?"

5 Eric B. Larson, "Virtual reality and cognitive rehabilitation: A review of current outcome research" IOS Press 34 (34): 759-772, 2014

6 Fred S. Sarfo, "Trends in stroke admission and mortality rates from 1983 to 2013 in central Ghana" Elsevier BV 357 (357): 240-245, 2015

7 Alessandro Peretti, "Telerehabilitation: Review of the State-of-the-Art and Areas of Application" JMIR Publications Inc. 4 (4): e7-, 2017

8 Kate E Laver, "Telerehabilitation services for stroke" Wiley 2020 (2020): 2020

9 Joseph H. Ricker, "Telerehabilitation needs: A survey of persons with acquired brain injury" Ovid Technologies (Wolters Kluwer Health) 17 (17): 242-250, 2002

10 Huidi Tchero, "Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis" JMIR Publications Inc. 20 (20): e10867-, 2018

11 Jing Chen, "Telerehabilitation Approaches for Stroke Patients: Systematic Review and Meta-analysis of Randomized Controlled Trials" Elsevier BV 24 (24): 2660-2668, 2015

12 Nicola L. Saywell, "Telerehabilitation After Stroke Using Readily Available Technology: A Randomized Controlled Trial" SAGE Publications 35 (35): 88-97, 2020

13 Zampolini, M., "Tele-rehabilitation : Present and future" 44 (44): 125-134, 2008

14 Fred S. Sarfo, "Tele-Rehabilitation after Stroke: An Updated Systematic Review of the Literature" Elsevier BV 27 (27): 2306-2318, 2018

15 Kim, J. Y., "Stroke statistics in Korea, 2018" 12 (12): 1845-1860, 2018

16 Craig Anderson, "Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care" Springer Science and Business Media LLC 20 (20): 537-552, 2002

17 Jacob Cohen, "Statistical Power Analysis" SAGE Publications 1 (1): 98-101, 1992

18 Gerald Choon-Huat Koh, "Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial: protocol of a randomized clinical trial on tele-rehabilitation for stroke patients" Springer Science and Business Media LLC 15 (15): 2015

19 Marcus J. Fuhrer, "SUBJECTIVE WELL-BEING: IMPLICATIONS FOR MEDICAL REHABILITATION OUTCOMES AND MODELS OF DISABLEMENT" Ovid Technologies (Wolters Kluwer Health) 73 (73): 358-364, 1994

20 Grigore C. Burdea, "Robotics and Gaming to Improve Ankle Strength, Motor Control, and Function in Children With Cerebral Palsy—A Case Study Series" Institute of Electrical and Electronics Engineers (IEEE) 21 (21): 165-173, 2013

21 Christopher G Maher, "Reliability of the PEDro Scale for Rating Quality of Randomized Controlled Trials" Oxford University Press (OUP) 83 (83): 713-721, 2003

22 Schipper, H., "Quality of life assessments in clinical trials" Definitions and Conceptual Issues, B. Spilker 11-24, 1990

23 Jeffrey A. Kleim, "Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage" American Speech Language Hearing Association 51 (51): 2008

24 Jozef Opara, "Outcome Measure Post-Stroke: Effectiveness of Rehabilitation Post-Stroke and Quality of Life" Begell House 21 (21): 275-293, 2009

25 Laura H Schopp, "Multidimensional telecare strategies for rural residents with brain injury" SAGE Publications 6 (6): 146-149, 2000

26 Marcia A. Testa, "Methods for Quality-Of-Life Studies" Annual Reviews 15 (15): 535-559, 1994

27 Wolf, F. M., "Meta-analysis : Quantitative for research synthesis" SAGE 1986

28 Elliot J. Roth, "Medical Complications Encountered in Stroke Rehabilitation" Elsevier BV 2 (2): 563-578, 1991

29 SHARON B. ARNOLD, "Measurement of Quality of Life in the Frail Elderly" Elsevier 50-73, 1991

30 Emily A Keshner, "Introduction to the special issue from the proceedings of the 2006 International Workshop on Virtual Reality in Rehabilitation" Springer Science and Business Media LLC 4 (4): 2007

31 C Mathewson, "Initial experiences with telerehabilitation and contingency management programs for the prevention and management of pressure ulceration in patients with spinal cord injuries" Elsevier BV 27 (27): 269-271, 2000

32 Montserrat Grau-Pellicer, "Impact of mHealth technology on adherence to healthy PA after stroke: a randomized study" Informa UK Limited 27 (27): 354-368, 2019

33 Lewis, C. H., "Human factors consideration in clinical applications of virtual reality" 44 : 35-56, 1997

34 Valery L Feigin, "Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013" Elsevier BV 15 (15): 913-924, 2016

35 Barbara CH Huijgen, "Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis" SAGE Publications 14 (14): 249-256, 2008

36 L Piron, "Exercises for paretic upper limb after stroke: A combined virtual-reality and telemedicine approach" Medical Journals Sweden AB 41 (41): 1016-102, 2009

37 Ita Daryanti Saragih, "Effects of telehealth interventions on performing activities of daily living and maintaining balance in stroke survivors: A systematic review and meta‐analysis of randomised controlled studies" Wiley 31 (31): 2678-2690, 2021

38 Neale R. Chumbler, "Effects of Telerehabilitation on Physical Function and Disability for Stroke Patients" Ovid Technologies (Wolters Kluwer Health) 43 (43): 2168-2174, 2012

39 Jing Chen, "Effects of Home-based Telesupervising Rehabilitation on Physical Function for Stroke Survivors with Hemiplegia" Ovid Technologies (Wolters Kluwer Health) 96 (96): 152-160, 2017

40 Roberto Lloréns, "Effectiveness, Usability, and Cost-Benefit of a Virtual Reality–Based Telerehabilitation Program for Balance Recovery After Stroke: A Randomized Controlled Trial" Elsevier BV 96 (96): 418-425.e2, 2015

41 Maayken van den Berg, "Early Supported Discharge by Caregiver-Mediated Exercises and e-Health Support After Stroke" Ovid Technologies (Wolters Kluwer Health) 47 (47): 1885-1892, 2016

42 Michael J. Ackerman, "Developing Next-Generation Telehealth Tools and Technologies: Patients, Systems, and Data Perspectives" Mary Ann Liebert Inc 16 (16): 93-95, 2010

43 Amanda Egner, "Depression, fatigue, and health-related quality of life among people with advanced multiple sclerosis: Results from an exploratory telerehabilitation study" IOS Press 18 (18): 125-133, 2003

44 ELSIE E. GULICK, "Correlates of Quality of Life Among Persons With Multiple Sclerosis" Ovid Technologies (Wolters Kluwer Health) 46 (46): 305-311, 1997

45 Robert V Kenyon, "Considerations for the future development of virtual technology as a rehabilitation tool" Springer Science and Business Media LLC 1 (1): 13-, 2004

46 Joseph Kvedar, "Connected Health: A Review Of Technologies And Strategies To Improve Patient Care With Telemedicine And Telehealth" Health Affairs (Project Hope) 33 (33): 194-199, 2014

47 Carey, J. R., "Comparison of finger tracking versus simple movement training via telerehabilitation to alter hand function and cortical reorganization after stroke" 21 (21): 216-232, 2007

48 Robert Rosenthal, "Comparing effect sizes of independent studies" American Psychological Association (APA) 92 (92): 500-504, 1982

49 Zhishui Wu, "Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China: A Randomized Controlled Trial" Elsevier BV 29 (29): 105328-, 2020

50 Judith D. M. Vloothuis, "Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): A randomized controlled trial" Public Library of Science (PLoS) 14 (14): e0214241-, 2019

51 N. E. Mayo, "Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke" Oxford University Press (OUP) 37 (37): 32-38, 2007

52 Lin, K. H., "Bidirectional and multi-user telerehabilitation system : Clinical effect on balance, functional activity, and satisfaction in patients with chronic stroke living in long-term care facilities" 14 (14): 12451-12466, 2014

53 Korean Statistical Information Service (KOSIS), "Annual report on the cause of death statistics"

54 Neil Vaughan, "An overview of self-adaptive technologies within virtual reality training" Elsevier BV 22 : 65-87, 2016

55 National Center for Interaction and Telemedicine, "Advanced informatics in medicine"

56 V.G. Popescu, "A virtual-reality-based telerehabilitation system with force feedback" Institute of Electrical and Electronics Engineers (IEEE) 4 (4): 45-51, 2000

57 T. M. Gill, "A critical appraisal of the quality of quality-of-life measurements" American Medical Association (AMA) 272 (272): 619-626, 1994