智能可穿戴设备BPMpathway在全膝关节置换术后患者居家康复中的应用效果

摘要/Abstract

摘要：

目的·评价基于智能可穿戴设备BPMpathway的居家康复方案在全膝关节置换（total knee arthroplasty，TKA）术后患者中的应用效果。方法·采用方便抽样法，选取苏州大学附属第四医院（苏州市独墅湖医院）和苏州大学附属第一医院骨科2021年4月—2022年12月收治的膝关节骨关节炎并接受TKA术的患者作为研究对象。按照患者入院顺序，将住院号尾数为奇数的患者纳入对照组，住院号尾数为偶数的患者纳入干预组。对照组患者给予常规居家康复训练方案，干预组在对照组的基础上实施基于BPMpathway的远程居家康复训练方案。分别于基线及术后1、3、6个月采用骨科患者功能锻炼依从性量表、美国特种外科医院膝关节评分表（Hospital for Special Surgery Scale，HSS）和36项简明健康状况调查表（36-item Short Form Health Survey，SF-36）对2组患者进行测评，同时测量患者的膝关节活动度。结果·最终纳入110例患者，其中对照组56例，干预组54例。2组患者的一般资料差异无统计学意义。2组患者基线时的膝关节活动度、HSS评分、SF-36评分差异均无统计学意义。重复测量方差分析结果显示：2组患者膝关节活动度、功能锻炼依从性评分、HSS评分及SF-36评分的组间效应、时间效应及交互效应均具有统计学意义（均P<0.05）。术后1、3、6个月干预组的膝关节活动度、功能锻炼依从性评分、HSS评分及SF-36评分均高于对照组（均P<0.05）。结论·医护人员基于智能可穿戴设备BPMpathway开展的远程康复训练方案，有助于提高TKA术后患者居家康复期间功能锻炼的依从性，改善膝关节活动度，促使膝关节功能恢复，提高其生存质量，对患者预后具有积极的作用。

关键词: 膝关节置换术, 骨关节炎, 可穿戴设备, BPMpathway, 远程康复

Abstract:

Objective ·To evaluate the effectiveness of the tele-rehabilitation program based on the smart wearable device BPMpathway in patients after total knee arthroplasty (TKA). Methods ·Convenience sampling method was used to select patients with knee osteoarthritis after TKA admitted to both the Department of Orthopedics in the Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital) and The First Affiliated Hospital of Soochow University, from April 2021 to December 2022, as the study population. According to the sequence of the patients′ admissions, patients with an odd hospitalization number were allocated to the control group while those with an even number to the intervention group. The control group received the routine home-based rehabilitation training program, while the intervention group was additionally subjected to the tele-rehabilitation program based on the BPMpathway. At baseline, and 1 month, 3 months and 6 months after TKA, the two groups of patients were evaluated by the compliance scale of functional exercise for orthopedic patients, the Hospital for Special Surgery Scale (HSS), and 36-item Short Form Health Survey (SF-36), while the knee joint motion of the patients was measured. Results ·One hundred and ten patients with knee osteoarthritis after TKA were finally enrolled, including 56 patients in the control group and 54 patients in the intervention group. There were no statistically significant differences in the general information between the two groups. The differences in knee range of motion, HSS score, and SF-36 score between the two groups at baseline were not statistically significant. Repeated measurement variance analysis showed that the between-group effect, time effect and interaction effect of knee range of motion, functional exercise compliance score, HSS score and SF-36 total score were statistically significant in both groups (all P<0.05). Meanwhile, knee range of motion, HSS score, functional exercise compliance score, and SF-36 score in the intervention group were significantly better than those in the control group at 1, 3, and 6 months after TKA (all P<0.05). Conclusion ·The tele-rehabilitation training program, conducted by healthcare providers using the smart wearable device BPMpathway, can enhance patients′ compliance with functional exercise during home rehabilitation after TKA. This leads to increased knee mobility, contributes to the recovery of knee function and improves quality of life of the patients. All of these factors have a positive effect on the patient prognosis.

Key words: total knee arthroplasty (TKA), osteoarthritis, BPMpathway, wearable device, tele-rehabilitation

中图分类号:

R473.6

洪洋, 王洁, 张霞芬, 赵丹, 程敏. 智能可穿戴设备BPMpathway在全膝关节置换术后患者居家康复中的应用效果[J]. 上海交通大学学报（医学版）.

HONG Yang, WANG Jie, ZHANG Xiafen, ZHAO Dan, CHENG Min. Efficacy of smart wearable device BPMpathway in home rehabilitation of patients after total knee arthroplasty[J]. Journal of Shanghai Jiao Tong University (Medical Science).

图/表 3

参考文献 33

1	李文昌, 宋康平, 黄天雯, 等. 手机应用程序康复指导对全膝关节置换术后患者的影响[J]. 中华关节外科杂志(电子版), 2021, 15(5): 547-553.
	LI W C, SONG K P, HUANG T W, et al. Effect of mobile application rehabilitation guidance on patients after total knee arthroplasty[J]. Chinese Journal of Joint Surgery (Electronic Edition), 2021, 15(5): 547-553.
2	周萌, 林川, 贾晶丽, 等. 膝关节置换术后患者出院随访的最佳证据总结[J]. 中华护理杂志, 2019, 54(12): 1877-1880.
	ZHOU M, LIN C, JIA J L, et al. Evidence summary for discharge follow-up of patients after knee arthroplasty[J]. Chinese Journal of Nursing, 2019, 54(12): 1877-1880.
3	北京医学会骨科专业委员会关节外科学组, 中华医学会骨科学分会关节外科学组. 中国全膝关节置换术围手术期疼痛管理指南(2022)[J]. 协和医学杂志, 2022, 13(6): 965-985.
	Joint Surgery Branch of Chinese Orthopaedic Association, Joint Surgery Branch of Beijing Orthopaedic Association. Guidelines for perioperative pain management in total knee arthroplasty in China (2022)[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 965-985.
4	陈迁, 施春香, 徐靖贻, 等. 可穿戴设备在全膝关节置换术中的应用进展[J]. 上海护理, 2023, 23(1): 27-30.
	CHEN Q, SHI C X, XU J Y, et al. Progress on the application of wearable devices in total knee arthroplasty[J]. Shanghai Nursing, 2023, 23(1): 27-30.
5	亓攀, 赵志昕, 贾斌, 等. 智能可穿戴康复系统在膝关节置换术后康复训练中的应用效果[J]. 中华解剖与临床杂志, 2019, 24(6): 567-570.
	QI P, ZHAO Z X, JIA B, et al. Effect of intelligent wearable rehabilitation system on rehabilitation training after knee joint replacement [J]. Chinese Journal of Anatomy and Clinics, 2019, 24(6): 567-570.
6	庄雅丽, 殷婷婷. 互联网+随访平台在全膝关节置换患者恐动症及功能锻炼依从性中的应用[J]. 广东医学, 2023, 44(4): 514-518.
	ZHUANG Y L, YIN T T. Application of Internet+follow-up platform in kinesiophobia and functional exercise compliance of total knee arthroplasty patients[J]. Guangdong Medical Journal, 2023, 44(4): 514-518.
7	FORTIER L M, ROCKOV Z A, CHEN A F, et al. Activity recommendations after total hip and total knee arthroplasty[J]. J Bone Joint Surg Am, 2021, 103(5): 446-455.
8	张瑶瑶. 基于IMB模型的全膝关节置换患者康复锻炼方案的构建与应用[D]. 青岛: 青岛大学, 2022.
	ZHANG Y Y. Construction and application of rehabilitation exercise mode for total knee arthroplasty patients based on IMB[D]. Qingdao: Qingdao University, 2022.
9	刘思雨, 戴付敏, 蒋梦蝶, 等. 老年全膝关节置换患者疾病感知与居家康复依从性的关系研究[J]. 护理管理杂志, 2021, 21(10): 721-725.
	LIU S Y, DAI F M, JIANG M D, et al. Study on the relationship between illness perception and home-based rehabilitation adherence in elderly patients with knee arthroplasty[J]. Journal of Nursing Administration, 2021, 21(10): 721-725.
10	傅利勤, 刘浩怡, 吴菁. 移动医疗技术在关节置换患者康复锻炼依从性干预中的研究进展[J]. 解放军护理杂志, 2021, 38(3): 57-60.
	FU L Q, LIU H Y, WU J. A study review: application of mobile medical technology in promoting the compliance of rehabilitation exercise among patients with joint replacement[J]. Military Nursing, 2021, 38(3): 57-60.
11	National Institute for Health and Care Excellence. BPMpathway for rehabilitation support in joint replacement surgery [EB/OL]. (2023-03-21)[2023-11-03]. https://www.nice.org.uk/advice/mib319/chapter/Expert-comments#general-comments.
12	INSALL J N, RANAWAT C S, AGLIETTI P, et al. A comparison of four models of total knee-replacement prostheses[J]. J Bone Joint Surg Am, 1976, 58(6): 754-765.
13	谭媛媛, 和晖, 杨秀贤, 等. 骨科患者功能锻炼依从性量表的编制及信度效度检验[J]. 中国护理管理, 2019, 19(11): 1626-1631.
	TAN Y Y, HE H, YANG X X, et al. Development and reliability and validity test of the Compliance Scale of Functional Exercise for Orthopedic Patients[J]. Chinese Nursing Management, 2019, 19(11): 1626-1631.
14	任敬, 巩航辉, 郑世成, 等. 单半径假体全膝关节置换术对重度膝关节骨性关节炎患者膝关节活动度和术后并发症的影响[J]. 陕西医学杂志, 2022, 51(10): 1249-1252.
	REN J, GONG H H, ZHENG S C, et al. Effect of total knee arthroplasty with single radius prosthesis on knee range of motion and postoperative complications in patients with severe knee osteoarthritis[J]. Shaanxi Medical Journal, 2022, 51(10): 1249-1252.
15	THEODOULOU A, BRAMWELL D C, SPITERI A C, et al. The use of scoring systems in knee arthroplasty: a systematic review of the literature[J]. J Arthroplasty, 2016, 31(10): 2364-2370.e8.
16	SZÖTS K, KONRADSEN H, SOLGAARD S, et al. Telephone follow-up by nurse after total kneearthroplasty: results of a randomized clinical trial[J]. Orthop Nurs, 2016, 35(6): 411-420.
17	陈天辉, 李鲁, JOERG M S, 等. 健康相关生命质量测量工具SF-36第二版和第一版的比较[J]. 中国社会医学杂志, 2006, 23(2): 111-114.
	CHEN T H, LI L, JOERG M S, et al. Comparison on the first version and the second version of SF-36[J]. Chinese Journal of Social Medicine, 2006, 23(2): 111-114.
18	薛源. 应用SF-36量表评价人工关节置换术对病人生命质量的影响[D]. 重庆: 第三军医大学, 2008.
	XUE Y. Evaluation of SF-36 health survey on influence of artificial joint replacement on patients′ quality of life[D]. Chongqing: Third Military Medical University, 2008.
19	赵改云, 许燕玲. 人工关节置换术后康复训练依从性影响因素研究现状[J]. 解放军护理杂志, 2018, 35(16): 41-45.
	ZHAO G Y, XU Y L. Research status of influencing factors of rehabilitation training compliance after artificial joint replacement[J]. Military Nursing, 2018, 35(16): 41-45.
20	尹慧珍, 山慈明. 老年关节置换术后早期活动依从性对关节恢复及深静脉血栓发生的影响[J]. 中国老年学杂志, 2017, 37(6): 1450-1452.
	YIN H Z, SHAN C M. Effect of early mobility compliance on joint recovery and deep vein thrombosis in elderly patients after joint replacement[J]. Chinese Journal of Gerontology, 2017, 37(6): 1450-1452.
21	曲倩倩, 杨亚婷, 张振. 人工关节置换病人术后功能锻炼依从性的干预策略研究进展[J]. 护理研究, 2022, 36(12): 2221-2224.
	QU Q Q, YANG Y T, ZHANG Z. Research progress on intervention strategies for functional exercise compliance of patients after artificial joint replacement[J]. Chinese Nursing Research, 2022, 36(12): 2221-2224.
22	刘思雨. 基于自我调节模型的护理干预对老年膝关节置换患者疾病感知的影响[D]. 郑州: 郑州大学, 2021.
	LIU S Y. The influence of nursing intervention based on self-regulatory model for illness perception in elderly patients with knee arthroplasty[D]. Zhengzhou: Zhengzhou University, 2021.
23	温雅婷, 郭霞, 孙国堃, 等. 骨科专科护士主导的“互联网+医疗健康” 干预在前交叉韧带重建病人中的应用效果[J]. 护理研究, 2023, 37(11): 2043-2048.
	WEN Y T, GUO X, SUN G K, et al. Application effect of orthopedic specialist nurse-led “Internet+ medical health” intervention in patients with anterior cruciate ligament reconstruction[J]. Chinese Nursing Research, 2023, 37(11): 2043-2048.
24	张启栋, 曹光磊, 何川, 等. 膝关节单髁置换术围手术期管理专家共识[J]. 中华骨与关节外科杂志, 2020, 13(4): 265-271.
	ZHANG Q D, CAO G L, HE C, et al. Interpretation of expert consensus on perioperative management of unicompartmental knee arthroplasty[J]. Chinese Journal of Bone and Joint Surgery, 2023, 13(4): 265-271.
25	王小泉, 刘超然, 王荣丽, 等. 人工全膝关节置换术后膝关节功能的影响因素研究进展[J]. 中国康复医学杂志, 2020, 35(7): 880-885.
	WANG X Q, LIU C R, WANG R L, et al. Progress on the study of factors affecting knee function after artificial total knee arthroplasty[J]. Chinese Journal of Rehabilitation Medicine, 2020, 35(7): 880-885.
26	尹正录, 孟兆祥, 林舜艳, 等. 全膝关节置换术后分阶段康复训练疗效观察[J]. 中华物理医学与康复杂志, 2013, 35(2): 138-139.
	YIN Z L, MENG Z X, LIN S Y, et al. Clinical observation of phased rehabilitation training after total knee arthroplasty[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2013, 35(2): 138-139.
27	韩文意, 唐储爱, 琚新梅, 等. 悬吊运动在全膝关节置换术后早期功能锻炼中的效果评价[J]. 护理学杂志, 2020, 35(22): 89-91, 95.
	HAN W Y, TANG C A, JU X M, et al. Effect of adding sling exercise therapy to early functional exercise after total knee arthroplasty[J]. Journal of Nursing Science, 2020, 35(22): 89-91, 95.
28	SHI H Y, MAU L W, CHANG J K, et al. Responsiveness of the Harris Hip Score and the SF-36: five years after total hip arthroplasty[J]. Qual Life Res, 2009, 18(8): 1053-1060.
29	潘科, 刘奕, 漆伟, 等. 老年髋部骨折术后病人的髋关节功能、步行能力对生存质量的影响及其相关性分析[J]. 蚌埠医学院学报, 2021, 46(10): 1393-1395, 1399.
	PAN K, LIU Y, QI W, et al. Effect of the hip function and walking ability on quality of life and their correlation in elderly patients with hip fracture after operation[J]. Journal of Bengbu Medical College, 2021, 46(10): 1393-1395, 1399.
30	李杨, 蔡宏, 张克. 膝关节置换术前患者及家属关注问题调查[J]. 中国骨与关节杂志, 2013, 2(8): 425-430.
	LI Y, CAI H, ZHANG K. An investigation of concerns of Chinese patients and their families before total knee arthroplasty[J]. Chinese Journal of Bone and Joint, 2013, 2(8): 425-430.
31	田瑞瑞. 膝关节置换患者结果期望及其与术后功能恢复和满意度的相关性研究[D]. 天津: 天津医科大学, 2016.
	TIAN R R. Patient outcome expectations of knee arthroplasty and the association with post-operative function and satisfaction[D]. Tianjin: Tianjin Medical University, 2016.
32	何明, 朱锦宇, 王仁, 等. 心理和精神因素对全膝关节置换术后功能恢复及生活质量的影响[J]. 中国骨与关节杂志, 2014, 3(6): 433-438.
	HE M, ZHU J Y, WANG R, et al. Effects of psychological and spiritual factors on functional recovery and life quality after total knee arthroplasty[J]. Chinese Journal of Bone and Joint, 2014, 3(6): 433-438.
33	于澄, 阎美英, 吴欣旎, 等. 老年人心理健康在听力障碍与生活质量间的中介效应[J]. 中华耳科学杂志, 2023, 21(2): 175-181.
	YU C, YAN M Y, WU X Y, et al. Mediating effects of mental health in the elderly between hearing impairment and quality of life[J]. Chinese Journal of Otology, 2023, 21(2): 175-181.

Characteristic variable	Intervention group (n=54)	Control group (n=56)	t/χ² value	P value
Gender/n(%)			0.292	0.589
Male	18 (33.33)	16 (28.57)
Female	36 (66.67)	40 (71.43)
Age/year	68.67±7.13	68.18±5.32	-0.408	0.684
Education/n(%)			0.678	0.712
Junior high and below	31 (57.41)	34 (60.71)
Senior high school/technical secondary school	17 (31.48)	14 (25.00)
Junior college and above	6 (11.11)	8 (14.29)
Work/n(%)			0.111	0.739
In service	17 (31.48)	16 (28.57)
Not in service	37 (68.52)	40 (71.43)
Marital status/n(%)			0.041	0.840
Married	47 (87.04)	48 (85.71)
Single and others	7 (12.96)	8 (14.29)
Chronic comorbidities/n(%)			0.151	0.698
Yes	29 (53.70)	28 (50.00)
No	25 (46.30)	28 (50.00)

Characteristic variable	Intervention group (n=54)	Control group (n=56)	t/χ² value	P value
Gender/n(%)			0.292	0.589
Male	18 (33.33)	16 (28.57)
Female	36 (66.67)	40 (71.43)
Age/year	68.67±7.13	68.18±5.32	-0.408	0.684
Education/n(%)			0.678	0.712
Junior high and below	31 (57.41)	34 (60.71)
Senior high school/technical secondary school	17 (31.48)	14 (25.00)
Junior college and above	6 (11.11)	8 (14.29)
Work/n(%)			0.111	0.739
In service	17 (31.48)	16 (28.57)
Not in service	37 (68.52)	40 (71.43)
Marital status/n(%)			0.041	0.840
Married	47 (87.04)	48 (85.71)
Single and others	7 (12.96)	8 (14.29)
Chronic comorbidities/n(%)			0.151	0.698
Yes	29 (53.70)	28 (50.00)
No	25 (46.30)	28 (50.00)

Time	Knee range of motion^①				HSS score^②				Function exercise compliance score^③
Time	Intervention group (n=54)	Control group (n=56)	t value	P value	Intervention group (n=54)	Control group (n=56)	t value	P value	Intervention group (n=54)	Control group (n=56)	t value	P value
Baseline	80.52±4.12	80.89±3.72	-0.493	0.623	55.81±10.00	54.63±9.31	0.646	0.519	‒	‒	‒	‒
Post-operation
1 month	103.51±4.94	98.03±4.84	5.876	0.000	70.37±5.34	63.52±8.10	5.220	0.000	62.57±9.46	56.48±8.53	3.549	0.001
3 months	113.86±4.95	106.42±5.08	7.779	0.000	83.02±6.50	73.41±7.16	7.361	0.000	58.06±7.89	51.18±6.27	5.071	0.000
6 months	124.10±3.91	115.76±5.19	9.494	0.000	92.46±5.77	84.32±5.36	7.667	0.000	54.26±6.66	45.88±5.56	7.180	0.000

Time	Knee range of motion^①				HSS score^②				Function exercise compliance score^③
Time	Intervention group (n=54)	Control group (n=56)	t value	P value	Intervention group (n=54)	Control group (n=56)	t value	P value	Intervention group (n=54)	Control group (n=56)	t value	P value
Baseline	80.52±4.12	80.89±3.72	-0.493	0.623	55.81±10.00	54.63±9.31	0.646	0.519	‒	‒	‒	‒
Post-operation
1 month	103.51±4.94	98.03±4.84	5.876	0.000	70.37±5.34	63.52±8.10	5.220	0.000	62.57±9.46	56.48±8.53	3.549	0.001
3 months	113.86±4.95	106.42±5.08	7.779	0.000	83.02±6.50	73.41±7.16	7.361	0.000	58.06±7.89	51.18±6.27	5.071	0.000
6 months	124.10±3.91	115.76±5.19	9.494	0.000	92.46±5.77	84.32±5.36	7.667	0.000	54.26±6.66	45.88±5.56	7.180	0.000

Time	Score of physical component summary^①				Score of mental component summary^②				SF-36 total score^③
Time	Intervention group (n=54)	Control group (n=56)	t value	P value	Intervention group (n=54)	Control group (n=56)	t value	P value	Intervention group (n=54)	Control group (n=56)	t value	P value
Baseline	44.29±10.37	45.12±11.41	-0.400	0.690	56.40±15.24	54.15±12.89	0.836	0.405	54.08±8.81	52.84±7.18	0.816	0.416
Post-operation
1 month	59.35±10.58	54.34±11.01	2.429	0.017	70.07±9.54	66.39±8.82	2.104	0.038	66.57±7.46	62.59±6.05	3.083	0.003
3 months	83.41±7.07	70.73±11.11	7.112	0.000	87.17±4.77	69.92±5.52	17.507	0.000	86.23±4.66	70.28±6.12	15.340	0.000
6 months	94.91±5.02	84.57±10.68	6.459	0.000	92.46±5.77	84.32±5.36	12.994	0.000	93.90±5.39	80.96±5.63	12.302	0.000