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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 547 -553. doi: 10.3877/cma.j.issn.1674-134X.2021.05.005

临床论著

手机应用程序康复指导对全膝关节置换术后患者的影响
李文昌1, 宋康平2, 黄天雯1, 陈晓玲1, 刘巧梨1, 赵龙1, 林阳阳2, 廖威明1, 邬培慧1,†()   
  1. 1. 510075　广州，中山大学附属第一医院关节外科
    2. 510655　广州，中山大学附属第六医院康复科
  • 收稿日期:2020-09-06 出版日期:2021-10-01
  • 通信作者: 邬培慧
  • 基金资助:
    中山大学青年教师培育项目基金(20ykpy69); 广东省科技计划项目基金(2017B020227005); 广东省自然科学基金(2019A141401002)

Effect of mobile application rehabilitation guidance on patients after total knee arthroplasty

Wenchang Li1, Kangping Song2, Tianwen Huang1, Xiaoling Chen1, Qiaoli Liu1, Long Zhao1, Yangyang Lin2, Weiming Liao1, Peihui Wu1,†()   

  1. 1. Department of joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510075, China
    2. Department of Rehabilitation Medicine, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
  • Received:2020-09-06 Published:2021-10-01
  • Corresponding author: Peihui Wu
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引用本文：

李文昌, 宋康平, 黄天雯, 陈晓玲, 刘巧梨, 赵龙, 林阳阳, 廖威明, 邬培慧. 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(05): 547-553.

Wenchang Li, Kangping Song, Tianwen Huang, Xiaoling Chen, Qiaoli Liu, Long Zhao, Yangyang Lin, Weiming Liao, Peihui Wu. Effect of mobile application rehabilitation guidance on patients after total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(05): 547-553.

目的

研究基于手机应用程序(APP)进行远程术后康复指导和随访对全膝关节置换术后患者下肢疼痛、日常活动功能及运动功能表现的影响，为行全膝关节置换术患者建立一种科学、积极有效的康复管理方案提供参考。

方法

纳入中山大学附属第一医院关节外科自2019年3月至2019年10月收治的膝骨关节炎行全膝关节置换术患者，排除继发性关节炎及并发严重基础或精神等疾病患者。随机数字法分为两组，干预组出院后利用手机APP接受术后居家康复指导，对照组嘱患者遵医嘱进行居家康复训练，随访6个月后，比较两组疼痛视觉模拟评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、起立行走测试(TUG)、单腿站立测试(SLS)及依从性评分。采用t检验和秩和检验进行统计分析。

结果

共分析患者资料60例，每组各30例。干预组患者的VAS评分和WOMAC总分、TUG和SLS测试时间及依从性评分均优于对照组且有统计学意义(t＝2.37，P<0.05；t＝2.566, P<0.05 ；Z＝-3.507, P<0.05；t＝-2.632，P<0.05)。其中，随访6个月后干预组及对照组VAS评分分别为(1.7±1.1)分和(2.5±1.3)分；WOMAC总分分别为(15.4±8.4)分和(21.2±8.9)分；TUG测试时间分别为8.8(8.0，12.3)s和12.0(10.0，15.0)s；SLS测试时间分别为(13.9±8.8)s和(8.4±4.4)s；依从性评分分别为(40.3±6.1)分和(30.9±9.6)分。而WOMAC量表疼痛条目和日常功能活动条目评分两组比较差别有统计学意义(t＝2.472, P<0.05; t＝2.327，P<0.05)。

结论

基于手机APP进行家庭康复训练指导及随访使患者具有更高的锻炼依从性且术后早期功能康复的效果更好，具有良好的临床应用价值。

关键词: 关节成形术，置换，膝, 手机应用, 运动疗法, 病人依从
Objective

To study the impact of remote postoperative rehabilitation guidance and follow-up based on the smartphone application (APP) on lower extremity pain, physical function and motor function performance in patients undergoing total knee arthroplasty.

Methods

The patients who underwent total knee arthroplasty due to knee osteoarthritis were recruited from the Joint Surgery Department of the First Affiliated Hospital of Sun Yat-sen University between March 2019 to October 2019. The patients with secondary arthritis and severe underlying disease or mental diseases were excluded. The patients were randomly divided into two groups by random number table. During the follow-up, the intervention group conducted rehabilitation guidance and follow-up through the smartphone APP after discharge while the control group underwent traditional home rehabilitation training instructed by doctors. After six months of follow-up, visual analog scale (VAS) of pain, Western Ontario and McMaster university osteoarthritis index scale (WOMAC), Time-up-and-go test(TUG), single leg stance test (SLS) and adherence scores were compared. The t test and rank sum test were used for statistical analysis.

Results

A total of 60 patients were analyzed with 30 in each group. The VAS score and total WOMAC score, TUG and SLS test time and adherence score of the intervention group were better than those of the control group (t=2.37, P<0.05; t=2.566, P<0.05 ; Z=-3.507, P<0.05; t=-2.632, P<0.05). Among them, after six months of follow-up, the VAS scores in the intervention group and the control group were (1.7±1.1) points and (2.5±1.3) points; WOMAC total scores were (15.4±8.4) and (21.2±8.9) points; TUG test time were 8.8 (8.0, 12.3) seconds and 12.00(10.0, 15.0) seconds; SLS test time were (13.9±8.8) seconds and (8.4±4.4) seconds respectively; adherence scores were (40.3±6.1) points and (30.9±9.6) points, respectively. However, the difference between the scores of pain items and physical function items of the WOMAC scale were statistically significant (t=2.472, P<0.05; t=2.327, P<0.05).

Conclusions

Based on the smartphone APP for home rehabilitation training guidance and follow-up, patients have higher exercise adherence and better recovery effects. In the future, technological products continue to introduce and it has broad application prospects and is worthy of further promotion.

Key words: Arthroplasty, replacement, knee, Mobile applications, Exercise therapy, Patient compliance
表1 患者基线资料比较
基本资料 干预组 对照组 统计值 P值
例数 30 30    
性别(例)        
  男 7 5 t＝0.417 >0.05
  女 23 25
年龄[岁，(±s)] 66.2±6.7 67.3±8.0 t＝-0.594 >0.05
身高[cm，(±s)] 158.5±6.0 157.3±7.0 t＝0.734 >0.05
体重[kg，(±s)] 64.8±9.7 61.8±10.1 t＝1.208 >0.05
BMI [kg/m2，(±s)] 25.8±3.3 24.9±2.9 t＝1.145 >0.05
手术时间[min，(±s)] 107.3±7.1 108.8±7.3 t＝-0.838 >0.05
出血量[ml，(±s)] 318.8±73.8 316.1±58.3 t＝0.156 >0.05
手术侧(例)     χ2＝0.069 >0.05
左 12 13 χ2＝0.069 >0.05
右 18 17
图1 试验流程图
表2 两组患者VAS评分比较(±s)
组别 例数 术前 干预后 t值 P值
干预组 30 6.1±1.0 1.7±1.1 17.07 <0.001
对照组 30 6.6±1.3 2.5±1.3 11.76 <0.001
t值   1.69 2.37    
P值   >0.05 0.021    
表3 两组患者WOMAC评分比较
组别 例数 WOMAC总分(±s) 疼痛评分(±s) 僵硬评分M(P25，P75) 日常功能活动评分M(P25，P75)
术前 干预后 术前 干预后 术前 干预后 术前 干预后
干预组 30 56.9±10.9 15.4±8.4 12.9±2.6 3.3±2.0 2.0(1.0，2.0) 1.0(0，2.0) 41.0(34.0，51.3) 9.0(7.0，14.3)
对照组 30 59.5±12.4 21.2±8.9 13.9±3.0 4.8±2.8 2.0(1.0，2.0) 1.0(0.8，2.0) 43.5(34.0，51.8) 13.0(9.0，20.0)
统计值   t＝0.872 t＝2.566 t＝1.341 t＝2.472 Z＝-0.440 Z＝-0.529 Z＝-0.548 Z＝-2.327
P值   >0.05 0.013 >0.05 0.016 >0.05 >0.05 >0.05 0.020
表4 运动功能测试结果比较
组别 例数 起立行走计时[s，M(P25，P75)] 单腿站立计时[s，(±s)]
术前 干预后 术前 干预后
干预组 30 13(11，14) 9(8，12) 10±5 14±9
对照组 30 14(11，16) 12(10，15) 8±3 8±4
统计值   Z＝-1.427 Z＝-3.507 t＝-1.583 t＝-2.632
P值   >0.05 <0.001 >0.05 <0.01
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