Telemedicine support system for assisting in selecting and implementing rehabilitation programs for orthopedic patients

Abstract

We provide rehabilitation programs for orthopedic patients through a remote medical consultation system using smart devices. [Solution] A rehabilitation index is calculated that quantitatively evaluates the patient's recovery state on a numerical scale based on a recovery evaluation score calculated from a questionnaire using a health-related QOL assessment scale. A rehabilitation program of a grade appropriate for the patient is selected based on the calculated rehabilitation index. Then, the patient's exercise bio-information is measured and collected using a wearable sensor device as they perform the exercise program of the selected rehabilitation program. The grade of the selected rehabilitation program is updated to a program of a grade that imposes a load more appropriate for the patient by determining whether the measured and collected data meets the exercise target values ​​set for the rehabilitation program of that grade.

Description

[Technical Field]

[0001] The present invention relates to a remote medical support system using smart devices to support the selection and implementation of rehabilitation programs for orthopedic patients who are able to move independently. [Background technology]

[0002] Orthopedic patients with musculoskeletal diseases and disorders have reduced mobility even after treatment is complete, so they require a certain period of rehabilitation to return to their pre-illness state. Rehabilitation is performed with the goal of restoring the patient's motor function after treatment is complete.

[0003] Rehabilitation guidance for orthopedic patients who are able to move independently is provided by a doctor who examines the patient and provides exercise guidance tailored to the patient's condition as determined by the examination. Rehabilitation usually takes several months or more, depending on the type and severity of the disease being treated, and because the patient's condition fluctuates during the recovery process, patients must regularly visit medical institutions for examinations during the rehabilitation period to monitor their condition at any given time and update the rehabilitation program to one that is appropriate for that condition. As a result, patients are forced to make regular visits to medical institutions for examinations over a long period of time, and hospitals are constantly overwhelmed with outpatients.

[0004] Recently, the use of a remote medical treatment system using a computer network system for providing rehabilitation guidance to patients has been proposed. By delivering video to patients via a computer network, patients can receive rehabilitation guidance easily and effectively without having to visit a hospital.

[0005] In a telemedicine system, doctors cannot meet with patients face-to-face and perform physical examinations, so they can use a medical questionnaire for the examination. The medical questionnaire asks patients to answer a number of questions prepared in advance, and the doctor understands the patient's condition based on the patient's answers to the questions. However, no matter how well-designed the questions are, medical interviews rely on the patient's self-reporting, and for the results of the interview to be accurate, the patient must have the ability to accurately understand the content of the questions and must be accurately aware of their own condition in relation to the matters asked. In cases where the patient is elderly and suffering from dementia, it is difficult to obtain answers to numerous questions. Therefore, although the use of medical interviews is useful, it naturally has its limitations.

[0006] Furthermore, a patient's recovery status changes depending on factors such as the progress of rehabilitation, and in order for the load of an initially appropriately selected rehabilitation program to match the patient's subsequent condition, it is necessary to update the assessment of the patient's recovery status at any given time and to update the rehabilitation program prescribed to the patient based on the updated assessment.

[0007] The inventors of the present invention have proposed a remote medical support system in which a doctor or physical therapist can quantitatively evaluate a patient's recovery status using a questionnaire, prescribe a rehabilitation program selected based on the results of that quantitative evaluation, update the evaluation of the patient's recovery status at any given time as the patient performs the independent exercises instructed in the prescribed rehabilitation program, and update the rehabilitation program prescribed to the patient based on the updated evaluation (WO2023 / 219056 Patent No. 7344622). Summary of the Invention [Problem to be solved by the invention]

[0008] WO2023 / 219056 connects a dedicated wearable electronic terminal to a medical institution's system server to input patient data and measure and collect exercise biometric information, but in today's world where the use of smart devices such as smartphones and tablets is commonplace, it would be cost-effective and efficient to be able to use commercially available smart devices. Also, while WO2023 / 219056 primarily considers walking exercise as rehabilitation exercise, the symptoms and conditions of individual patients vary, and it is desirable for the remote medical care support system to be able to accommodate various types and contents of rehabilitation exercise tailored to the condition of each individual patient. [Means for solving the problem]

[0009] Under the circumstances described above, the inventors of the present invention have conducted intensive research to solve the above problems, and have come up with a remote medical care support system for supporting the selection and execution of a rehabilitation program for an orthopedic patient who is able to exercise independently, which includes: The system includes a smart device and a PC (personal computer) wirelessly connected to the smart device via an Internet line, and a wearable sensor device is connected to the smart device wirelessly or via a wired connection; The wearable sensor device is configured to be wearable on a patient's body; a means for measuring exercise biometric information from the patient's body; means for transmitting the measured exercise biological information of the patient to the smart device; It is The smart device is a remote medical support system application software. Both devices have health management application software installed. The health management application software is used to measure the patient's exercise biometric information. a means of collecting the data; a means for receiving exercise bio-information transmitted from the wearable sensor device; The wearable sensor device and / or the health management application software The patient's health status measured and collected by a smart device with the installed software means for transmitting exercise biological information to the PC; The PC has the application software for the remote medical support system installed. and installed in medical institutions so that the patient's doctor or physical therapist can access it. is set to A means of accepting input of patient identification number, profile, and type of disease treated and, Calculated based on answers to questions in a questionnaire using a health-related quality of life (HQOL) scale. A means for receiving input of a recovery assessment score that quantitatively evaluates the recovery state of a patient. and, means for receiving the patient's exercise bio-information transmitted from the smart device; and, a storage device, The storage device stores a plurality of rehabilitation programs corresponding to post-surgery for a predetermined type of disease. Each rehabilitation program consists of multiple exercise programs. And, Each of the rehabilitation programs involves carrying out the exercise program prescribed by the rehabilitation program. There are several grades depending on the load on the body. Each grade of the rehabilitation program has a specific exercise program for that grade. Rehabilitation guidance for patients who are in a recovery state suitable for the load on their body by performing The number is registered, Each grade of each rehabilitation program further includes the exercises prescribed by that grade. Target values ​​of exercise bio-information expected to be measured from the patient when the program is executed (exercise goal value) is registered, and the exercise goal value is the value that is used to execute the exercise program. It is set according to the patient profile, the system determines a rehabilitation index based on the patient's recovery assessment score, the rehabilitation index assessing the patient's recovery status on a numerical scale; selecting a rehabilitation program and its grade to be prescribed for the patient from a plurality of rehabilitation programs stored in a storage device of the PC based on the type of disease treated by the patient and the rehabilitation index; determining, based on the patient's profile, motor goals that are expected to be measured when the patient performs the independent movements prescribed by the rehabilitation program of the selected grade; comparing the measured values ​​of the exercise bio-information measured from the patient who has performed the rehabilitation program of the selected grade with the exercise target value of the patient; The measured value of the exercise bio-information is calculated from the exercise target value by a predetermined rule. If the patient is deemed to be within the scope of the prescribed rehabilitation program, the patient shall maintain the prescribed rehabilitation program. Propose that The measured value of the exercise bio-information is calculated from the exercise target value by a predetermined rule. If it is determined that the upper limit of the above will be exceeded, the patient will be advised to take the above prescribed rehabilitation program. We proposed a change to a rehabilitation program that would be one level less demanding on the patient. The measured value of the exercise bio-information is calculated from the exercise target value by a predetermined rule. If the patient is judged to be below the lower limit of the above, the patient will be given a rehabilitation program rather than the one prescribed above. We propose a change to a rehabilitation program that places a higher level of strain on the patient. Ru, The inventors have arrived at an invention of a remote medical care support system for supporting the selection and implementation of a rehabilitation program for orthopedic patients who are able to move independently.

[0010] Preferably, the smart device further comprises means for accepting input of a recovery assessment score that quantitatively evaluates the patient's recovery status calculated based on answers to questions in a questionnaire using a health-related QOL assessment scale, and the PC further comprises means for receiving the recovery assessment score transmitted from the smart device.

[0011] Preferably, the predetermined disease types include musculoskeletal diseases including lower back pain (post-surgery for lumbar degenerative disease), scoliosis, post-knee joint surgery, post-hip joint surgery, and chronic lower back pain.

[0012] Preferably, the exercise bio-information is the measured values ​​of a plurality of measurement items, and if it is determined that any one of the measured values ​​of the plurality of measurement items measured from the patient exceeds a predetermined range from the patient's exercise target value, it is determined that the load of the rehabilitation program of the selected grade is excessive or insufficient for the patient, and a rehabilitation program of a grade one level lower or higher in load than the prescribed rehabilitation program is proposed.

[0013] Preferably, the measurement items of the exercise bio-information are the patient's calorie expenditure and heart rate, and if either the calorie expenditure or heart rate measured from the patient exceeds the upper limit of the patient's exercise target value, it is determined that the load of the selected grade of rehabilitation program is excessive for the patient, and a rehabilitation program of a grade one level lower in load than the prescribed rehabilitation program is suggested.

[0014] Preferably, the measurement items of the exercise bio-information are the patient's calorie expenditure and heart rate, and if either the calorie expenditure or heart rate measured from the patient is below the lower limit of the patient's exercise target value, it is determined that the load of the selected grade of rehabilitation program is too low for the patient, and a rehabilitation program of a grade one level higher in load than the prescribed rehabilitation program is suggested.

[0015] Preferably, the calorie expenditure of the patient of the exercise bio-information is calculated based on the exercise intensity (METs value) and exercise time of the independent exercise prescribed by the exercise program of the rehabilitation program prescribed for the patient, and the patient's weight.

[0016] Preferably, the patient's recovery assessment score is calculated based on the scores assigned to the answers to the questions regarding the patient's profile and the sum of the disease-nonspecific score and the disease-specific score.

[0017] Preferably, the exercise bio-information includes all or some of the measurements of the patient's calories burned, heart rate, walking distance, walking speed, and number of steps.

[0018] Preferably, the health management application software installed on the smart device includes a home electrocardiogram program or a home heart rate monitor program.

[0019] Preferably, the PC further comprises means for receiving input of an identification number of a medical institution that prescribes a rehabilitation program for the patient. [Effects of the Invention]

[0020] In one preferred embodiment of the system of the present invention, both the PC and the smart device are provided with means for inputting a recovery assessment score that quantitatively evaluates the patient's recovery state, calculated based on answers to questions in a medical questionnaire using a health-related QOL assessment scale. Therefore, the recovery assessment score based on the medical interview can be input at a medical institution, or the patient can input it themselves using their smart device.

[0021] One preferred embodiment of the system of the present invention involves installing and using commercially available health management application software for measuring a patient's exercise biometric information (e.g., number of steps, walking distance, walking speed, etc.) on a commercially available smart device (mobile phone, tablet) along with the application software for the remote medical care support system of the present invention. This is extremely convenient for users, inexpensive, and commercially viable.

[0022] One preferred embodiment of the system of the present invention uses a simple wearable sensor device connected to a smart device (mobile phone, tablet), so that the patient's exercise bio-information such as heart rate and calories burned can be measured by the simple wearable sensor device and sent to the smart device, which can then send it to the PC of the attending doctor or physical therapist.

[0023] One preferred embodiment of the system of the present invention is capable of setting exercise target values ​​for each grade of a rehabilitation program according to the patient's profile, and determining whether the measured values ​​of exercise bio-information measured and collected from the patient's body are within a certain range of the exercise target values ​​set for that patient, thereby determining whether the rehabilitation program can be updated.

[0024] One preferred embodiment of the system of the present invention evaluates the exercise bio-information measured from the patient's body based on the measurement values ​​of multiple measurement items and determines whether the measured exercise bio-information is within the range of exercise target values ​​set according to the patient's profile, which is more reliable than determining it from the measurement value of a single measurement item.

[0025] One preferred embodiment of the system of the present invention registers the exercise intensity (METs value) of the exercise prescribed by the rehabilitation program, and uses the calories burned calculated based on the METs value, exercise time, and the patient's profile (body weight) as exercise bio-information, making it applicable to all rehabilitation programs regardless of the type and content of the rehabilitation exercise.

[0026] One preferred embodiment of the system of the present invention can be configured to link and register a patient's profile and the type of disease treated with the patient's ID, so that the patient's profile and the type of disease treated can be called up when the patient's ID is entered.

[0027] In one preferred embodiment of the system of the present invention, the medical institution's PC includes a means for accepting input of the patient's identification number along with the identification number of the medical institution that prescribes the rehabilitation program to the patient, so that the remote medical support system of the present invention can be used at multiple medical institutions. [Brief explanation of the drawings]

[0028] [Figure 1] FIG. 1 shows a conceptual diagram of a network of a system according to one embodiment of the present invention. [Figure 2] FIG. 2 shows the configuration of a PC used in a system according to one embodiment of the present invention. [Figure 3] FIG. 3 shows the configuration of a smart device / wearable sensor device used in a system according to one embodiment of the present invention. [Figure 4] FIG. 4 shows a display screen of a smart device used in a system according to one embodiment of the present invention. [Figure 5] 5(A) and (B) show a wearable sensor device used in a system according to one embodiment of the present invention. [Figure 6] FIG. 6 shows the SF-36 questionnaire used in the system of one embodiment of the present invention. [Figure 7] FIG. 7 shows the RMDQ questionnaire used in the system of one embodiment of the present invention. [Figure 8] FIG. 8 shows the question items of a medical questionnaire used in a system according to one embodiment of the present invention. [Figure 9] FIG. 9 shows the relationship between recovery evaluation scores, rehabilitation indices, and rehabilitation programs (for patients with lower back pain) in one example of a system according to one embodiment of the present invention. [Figure 10]Figure 10 shows the target heart rate and target calorie expenditure (for a patient with lower back pain) for a patient who has completed one rehabilitation unit (15 minutes of exercise) in one embodiment of the present invention. Figure 10(A) shows the case for a male patient, and Figure 10(B) shows the case for a female patient. [Figure 11] FIG. 11 shows an example of the selection and updating of a rehabilitation program (for a patient with lower back pain) in an embodiment of the present invention. [Figure 12] FIG. 12 shows the relationship between the type of patient's disease, the prescribed rehabilitation program, and the rehabilitation index in one embodiment of the present invention. [Figure 13] FIG. 13 shows a method for determining exercise target values ​​for each measurement item in one embodiment of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0029] <Definition>

[0030] <Independent exercise> In the present invention, "independent exercise" refers to exercise that a patient can perform by themselves under the guidance of a doctor or physical therapist, and includes exercise to strengthen muscle strength, exercise to strengthen muscle endurance, exercise to strengthen cardiopulmonary capacity (exercise to strengthen whole body endurance), exercise to improve flexibility, exercise to improve dexterity, exercise to improve coordination, and exercise to improve running ability. Walking exercise corresponds to exercise to strengthen muscle strength, exercise to strengthen muscle endurance, and exercise to strengthen cardiopulmonary capacity, and exercise to stand up from a chair corresponds to exercise to strengthen muscle strength and exercise to strengthen muscle endurance.

[0031] <Health-related QOL assessment scale> In one preferred embodiment of the system of the present invention, "health-related QOL" refers to a concept that quantifies the impact of a disease or treatment on a patient's subjective sense of health (mental health, vitality, pain, etc.) and their daily work, housework, and social activities. "Health-related QOL assessment scale" refers to a scale used to objectively assess health-related QOL, and disease-nonspecific scales (e.g., SF-36) and disease-specific scales (e.g., RDQ) are used. In a preferred embodiment of the present invention, questions created in accordance with the health-related QOL assessment scale are used as questions in the questionnaire, and the patient's recovery assessment score is calculated based on the sum of the scores assigned to the answers to those questions.

[0032] The question items of the questionnaire used in one preferred embodiment of the system of the present invention are created according to a health-related QOL scale, and the question items created according to a health-related QOL scale include question items created according to a disease-nonspecific scale (e.g., SF-36) that is not related to the specific disease of the patient, and question items created according to a disease-specific scale (e.g., RDQ, JOABPEQ) that is related to the specific disease of the patient. In the questionnaire used in one preferred embodiment of the present invention, question items based on a disease-nonspecific scale and question items based on a disease-specific scale are combined, and question items based on a health-related QOL assessment scale are used to evaluate the degree of recovery of the patient's motor function.

[0033] In one preferred embodiment of the present invention, the SF-36, RDQ, and JOABPEQ are used as health-related QOL scales. The SF-36 is a disease-nonspecific scale used to quantitatively evaluate health-related QOL (HRQOL). The RDQ (Roland Morris Disability Questionnaire) is a scale that allows patients to quantitatively evaluate the impairments in daily life caused by low back pain. The JOABPEQ (Japanese Orthopaedic Association Low Back Pain Questionnaire) is a scale used to calculate five severity scores: pain-related disability, lumbar dysfunction, walking dysfunction, social life disability, and psychological disability. These scales consist of numerous questions, and the patient's condition is quantitatively evaluated based on the answers to the questions by the total score assigned to each question. Quantitative assessment of a patient's health status based on these scales is internationally recognized and highly reliable.

[0034] <Recovery assessment score> In one preferred embodiment of the system of the present invention, the "recovery assessment score" refers to the sum of scores assigned to each patient's answers to multiple questions in the questionnaire used in the present invention, and the patient's state of recovery of motor function is evaluated based on the sum of the scores. In the present invention, the recovery assessment score is used as the basis for calculating a rehabilitation index. In a preferred embodiment of the present invention, the questionnaire includes non-disease-specific questions and / or disease-specific questions, and the patient's state of recovery is evaluated in the form of a quantitative score based on the patient's answers to these questions. Furthermore, by including questions regarding the patient's profile in the questions in the questionnaire, the recovery assessment score can be calculated as a value that takes into account the patient's gender, age, height, weight, etc.

[0035] <Disease-nonspecific score> In one preferred embodiment of the system of the present invention, the "disease-nonspecific score" is a score calculated as the sum of scores assigned to answers to multiple questions based on a health-related QOL assessment scale, regardless of the specific disease the patient has. The SF-36 is the most widely used self-report health status questionnaire in the world, and is designed to measure a comprehensive health concept in eight areas, rather than health conditions specific to a specific disease or symptom (see Figure 6).

[0036] <Disease-specific score> In a preferred embodiment of the system of the present invention, the "disease-specific score" is a score calculated in relation to a specific disease suffered by the patient, and is calculated as the sum of scores assigned to answers to multiple questions based on a disease-specific QOL scale. The RDQ (Roland Morris Disability Questionnaire) is a questionnaire that allows patients to quantitatively evaluate the impairment of daily life caused by low back pain (see Figure 7), and the JOABPEQ (Japanese Orthopaedic Association Low Back Pain Questionnaire) is a questionnaire used to calculate five severity scores: pain-related disability, lumbar dysfunction, walking dysfunction, social life disability, and psychological disability.

[0037] <Rehabilitation Index> In a preferred embodiment of the system of the present invention, the "rehabilitation index" refers to a value that evaluates the recovery state of a patient's motor function on a numerical scale based on the recovery assessment score. In a preferred embodiment of the present invention, the rehabilitation index is registered along with the exercise target value for each grade of the rehabilitation program stored in the storage device of a PC. In a preferred embodiment of the system of the present invention, when the SF-36 is used as the questionnaire, the evaluation score from the SF questionnaire is divided into 10 levels, with 1 to 10 being rehabilitation index 1, 11 to 20 being rehabilitation index 2, 21 to 30 being rehabilitation index 3, 31 to 40 being rehabilitation index 4, 41 to 50 being rehabilitation index 5, 51 to 60 being rehabilitation index 6, 61 to 70 being rehabilitation index 7, 71 to 80 being rehabilitation index 8, 81 to 90 being rehabilitation index 9, and 91 to 100 being rehabilitation index 10 (see Figures 9 and 12). For example, if a patient's total score after the SF-36 questionnaire is 43, the rehabilitation index for that patient is 5. When using a non-disease-specific score (SF-36) and a disease-specific score (RMDQ) in the interview, if the average value obtained by adding the SF-36 evaluation score and the RMDQ evaluation score and dividing it by 2 is 25, the patient's rehabilitation index will be 3 (see Figure 11).

[0038] In many cases, diseases such as lower back pain are caused by not only disease-specific factors with clear causes but also non-disease-specific factors with unclear causes. When selecting a rehabilitation program for lower back pain, the RDQ is an evaluation criterion related to the patient's lower back disease. However, lower back pain may be caused by factors other than the lower back disease, and therefore, it is necessary to evaluate these factors using a non-disease-specific scale. In this invention, orthopedic patients who have completed treatment for a disease are interviewed using both questionnaire items based on the disease-specific scale and the non-disease-specific scale, a rehabilitation index is calculated based on the results of both questionnaire items, and a rehabilitation program for the patient who has completed treatment for the disease is selected based on the rehabilitation index thus calculated.

[0039] In addition to the interview score using SF-36, RMDQ, JOABPEQ, etc., a doctor or physical therapist can ultimately determine the rehabilitation index by taking into account other characteristics or profiles of the patient that are not evaluated by such interviews. For example, if a patient is elderly and heavy for their height, it is desirable that the rehabilitation program prescribed has a lighter load, so the rehabilitation index can be smaller than that calculated from the interview score.

[0040] Since the system of the present invention is not intended to treat a disease but to prescribe an appropriate rehabilitation program for the recovery of a patient's motor function after treatment of the disease, the rehabilitation program prescribed to the patient is selected based on the recovery of the patient's motor function after treatment of the disease, not on the patient's disease. Therefore, even if the type of disease is different, if the patient's expected condition after treatment is the same, rehabilitation programs including the same exercise program may be selected.

[0041] <Smart devices> In a preferred embodiment of the system of the present invention, a "smart device" refers to an electronic device carried by a patient that can measure and collect the patient's exercise biometric information by installing health management application software. Figure 3 shows the configuration of a device capable of executing the system of the present invention. The smart device is wirelessly connected to a medical institution's PC via an internet line (see Figure 1). In an embodiment of the present invention, a commercially available smartphone (mobile phone) or tablet can be used as the smart device. While a smart device may not be equipped with the functionality to measure heart rate or calories burned on its own, connecting a simple wearable sensor device that can be worn around the patient's body or arm to measure the patient's heart rate to the smart device makes it possible to easily measure heart rate, calories burned, and other parameters. In an embodiment of the system of the present invention, the smart device is used for measuring, collecting, and transmitting a patient's exercise bio-information, and data such as the patient's identification number and profile are input into a PC. However, by providing an input unit on the smart device (see Figure 3), it is possible to optionally input the patient's recovery assessment score based on the medical interview into the smart device and transmit the patient's recovery assessment score from the smart device to the PC. A patient's recovery assessment score based on the medical interview can be entered into a PC when the patient visits a medical institution. However, if the patient can calculate the recovery assessment score themselves based on their answers to the questions on the medical interview sheet, it would be more convenient for the patient to enter the recovery assessment score themselves into their own smart device, which would also reduce the burden on the medical institution.

[0042] <Wearable sensor device> In one preferred embodiment of the system of the present invention, a "wearable sensor device" refers to a device that is worn by wrapping around the patient's arm or body and is capable of measuring the patient's exercise bio-information such as heart rate and calories burned. In one preferred embodiment of the present invention, the wearable sensor device is equipped with a belt that can be wrapped around the patient's arm (see Figure 5). The exercise bio-information such as the patient's heart rate measured by the wearable sensor device is transmitted to a smart device. The required function of the wearable sensor device is to measure the patient's exercise bio-information such as heart rate and transmit it to the smart device; no other functions are required, so a device with a simple configuration will suffice.

[0043] <Personal Computer (PC)> In one preferred embodiment of the system of the present invention, a "personal computer (PC)" refers to a device that is connected to a smart device and has the function of executing the system of the present invention (see Figure 2). The PC is connected to the smart device via an internet line (see Figure 1). The PC is used by installing application software for the remote medical care support system of the present invention. The PC's storage device stores multiple rehabilitation programs prescribed for patients and related data, as well as programs for operating the system of the present invention. The PC is equipped with a communication unit that receives transmissions from the smart device and an input unit (see Figure 2), and is used to input patient data such as the patient's ID, profile, and type of disease being treated.

[0044] <Exercise bio-information> In a preferred embodiment of the system of the present invention, "exercise bio-information" refers to data measured and collected from a patient performing exercises prescribed in a rehabilitation program. In an embodiment of the present invention, the exercise bio-information is measured and collected by a smart device and / or a wearable sensor device on which health management application software is installed. The exercise bio-information may include all or some of the following data: calories burned, heart rate, walking distance, walking speed, and number of steps.

[0045] <Exercise goal value> In one preferred embodiment of the system of the present invention, the "exercise target value" refers to the target value expected to be measured from the patient's body after performing the exercises prescribed in the rehabilitation program, and is registered in the PC's storage device along with the rehabilitation index for each grade of the rehabilitation program. The exercise target value is set for each measurement item according to the patient's profile. The exercise target value determined by the rehabilitation index of the patient performing the rehabilitation program and the patient's profile input from the input unit is compared with the exercise bio-information measured and collected from the patient's body.

[0046] In one preferred embodiment of the present invention, the exercise biometric information measured from a patient for a specific measurement item is determined to be within a ±10% range of the exercise target value. In this case, the percentage range above and below the exercise target value is determined by a clinical doctor or physical therapist at a medical institution. The exercise target values ​​(target heart rate, target calories burned, target walking distance, target number of steps, target walking speed) are not the same for all patients performing the same exercise; even when performing the same exercise, they vary depending on the individual patient's profile (age, gender, weight, height). Therefore, they are set according to the patient's profile. In the system of the present invention, the correspondence between the rehabilitation program, patient profile, and exercise target value is stored in the PC storage device and is used to calculate the exercise target value for each patient who performs the rehabilitation program. Figure 10 shows an example of the correspondence between the patient profile, target heart rate, and target calories burned in a rehabilitation program for a patient with lower back pain.

[0047] <Target calorie consumption> In a preferred embodiment of the system of the present invention, the "target calorie expenditure" is one of the exercise target values, and refers to the calories a patient is expected to expend when performing the exercise prescribed in the rehabilitation program. In a preferred embodiment of the present invention, it is determined whether the patient's measured calorie expenditure is within a range of 10% above or below the value registered as the target calorie expenditure. The amount of energy consumed in a single exercise session is determined by the patient's physique (weight), exercise intensity, and exercise duration. Since the amount of energy (calories consumed) a patient expends when performing the prescribed exercise varies depending on the weight, etc. of each individual patient, in the present invention, the target calorie expenditure is set according to the patient's profile. In a preferred embodiment of the present invention, if the measured calorie expenditure measured and collected from the patient's body performing the exercise prescribed in the prescribed rehabilitation program is above or below a predetermined range above or below the target calorie expenditure, the exercise is determined to be too high / low load for the patient.

[0048] <Exercise intensity, METs value> In a preferred embodiment of the system of the present invention, exercise intensity refers to the load or strain placed on a patient when performing the exercise prescribed in the rehabilitation program. METs is a unit of exercise intensity that indicates how many times the energy consumed by a particular exercise, assuming a resting oxygen intake of 3.5 ml / kg is 1. For example, sitting while watching television or riding in a car is 1.9 METs, sitting while talking, eating, or doing desk work is 1.5 METs, and walking around the house is 2.0 METs. The exercises in the rehabilitation program of the present invention include Nordic walking (4.3 METs), back stretching of the lower limbs (2.3 METs), exercises for strength and balance (2.3 METs), exercises for strengthening lower limb muscles (4.3 METs), calf exercises (4.0 METs), exercises for improving balance (2.3 METs), exercises for strengthening core muscles (4.0 METs), and physical strength training (4.1 METs). In one preferred embodiment of the present invention, the METs value of exercise is registered in each rehabilitation program stored in a PC, thereby enabling the calorie expenditure associated with the patient performing the exercises in the prescribed rehabilitation program to be calculated.

[0049] <Target heart rate> In a preferred embodiment of the system of the present invention, the "target heart rate" is one of the exercise target values, and refers to the heart rate that a patient is expected to exhibit when performing the exercise prescribed in a rehabilitation program. Generally, a patient's heart rate increases when the load imposed by the exercise is heavy, and decreases when the load is light. Since the load imposed on a patient by performing the prescribed exercise varies depending on the gender, age, height, weight, etc. of each patient, the target heart rate in the present invention is set according to the patient's gender, age, height, weight, etc. In a preferred embodiment of the present invention, if the heart rate measurement collected from the patient's body performing the walking exercise prescribed in the prescribed rehabilitation program exceeds a predetermined upper limit from the target heart rate, the exercise is determined to be too demanding for the patient.

[0050] <Target walking distance> In a preferred embodiment of the system of the present invention, the "target walking distance" is one of the exercise target values, and refers to the distance a patient is expected to walk within a predetermined time period after performing the walking exercise prescribed in a rehabilitation program. In a preferred embodiment of the present invention, if the measured walking distance measured and collected by the health management application software from a patient performing the walking exercise prescribed in a prescribed rehabilitation program falls below a predetermined lower limit of the target walking distance, the exercise is determined to be too strenuous for the patient.

[0051] <Target walking speed> In a preferred embodiment of the system of the present invention, the "target walking speed" is one of the exercise target values, and refers to the walking speed that a patient who performs the walking exercise prescribed in a rehabilitation program is expected to walk within a predetermined time. In a preferred embodiment of the system of the present invention, if the measured walking speed measured and collected by health management application software from a patient who performs the walking exercise prescribed in a prescribed rehabilitation program is lower / higher than a predetermined range from the target walking speed, the exercise is determined to be too high / low load for the patient.

[0052] <Embodiment> 1 shows the network configuration of a system according to one embodiment of the present invention. A doctor's PC (personal computer) 10 is connected via an internet line to smart devices 21, 22, and 23 carried by patients 1, 2, and 3, respectively. The smart devices 21, 22, and 23 are connected to wearable sensor devices 31, 32, and 33, respectively.

[0053] 2 shows the configuration of a PC (personal computer) used in the present invention. The CPU of the PC processes data received from the smart devices 21, 22, and 23 via the communication unit, and outputs the results to the display unit.

[0054] Figure 3 shows the configuration of a smart device and a wearable sensor device used in one embodiment of the present invention. The smart device includes an input unit that can be used to input a recovery assessment score based on a medical interview, an exercise biometric information measurement and collection unit that measures and collects the patient's exercise biometric information, and a communication unit that transmits the patient's exercise biometric information to a PC. The wearable sensor device is connected to the smart device wirelessly or via a cable, and includes a heart rate measurement unit that measures the patient's heart rate, and a communication unit that transmits the measured data to the smart device.

[0055] FIG. 4 shows an example of a display screen of a smart device used in the present invention.

[0056] 5(A) and (B) show an example of the configuration of a wearable sensor device used in the present invention. The device is configured to measure the heart rate while the belt is wrapped around the patient's arm.

[0057] Figure 6 shows a sample of the SF-36 questionnaire used in one embodiment of the present invention, Figure 7 shows a sample of the RDQ questionnaire used in one embodiment of the present invention, and Figure 8 shows sample questions of the questionnaire used in one embodiment of the present invention.

[0058] The following table shows one example of a method for determining whether the exercise program load of a rehabilitation program in this invention is excessive or insufficient. In the example table below, the calorie expenditure, heart rate, walking distance, number of steps, and walking speed of a patient undergoing a rehabilitation program including Nordic walking are measured, and the measured values ​​for each measurement item are compared with the exercise target values ​​(target calorie expenditure, target heart rate, target walking distance, target number of steps, and target walking speed). If the measured calorie expenditure is less than ±20 points of the target calorie expenditure, 1 point is assigned. If the measured calorie expenditure is more than ±20 points of the target calorie expenditure, 100 points are assigned. If the measured calorie expenditure is within ±20 points of the target calorie expenditure, 10 points are assigned. Similar calculations are performed for heart rate, walking distance, number of steps, and walking speed. If the total score is 40 points or less, the exercise program load of the prescribed rehabilitation program is determined to be insufficient. If the total score is 200 points or more, the exercise program load of the prescribed rehabilitation program is determined to be excessive for the patient. (table) TIFF0007805046000002.tif68151 [Example]

[0059] Hereinafter, an embodiment of the present invention will be described with reference to the drawings.

[0060] Example 1 A 65-year-old man visited the clinic with lower back pain. At the time of his outpatient visit, his height and weight were recorded as 170 cm and 85 kg, respectively. His SF-36 PCS score was 48, his RDQ score was 38, and the sum of these scores divided by 2 yielded an assessment score of 43, resulting in a rehabilitation index of 5 (see Figure 9). A rehabilitation program (15-minute units) was selected for the rehabilitation index of 5, including Nordic walking (4.3 METs), lower back stretching (2.3 METs), back stretching (2.3 METs), strength and balance exercises (2.3 METs), core muscle strengthening exercises (4.3 METs), back stretching exercises (3.5 METs), and balance improvement exercises (2.3 METs). Based on the patient's registered height (normal) and weight (overweight), a target heart rate of 150 beats per minute and a target calorie expenditure of 148 kcal were set (see Figures 9 and 10). At the end of the rehabilitation exercises, the patient's heart rate was measured at 160 beats per minute and his calorie expenditure was 160 kcal. Since the patient's measured heart rate of 160 beats per minute and calorie expenditure of 160 kcal were both within a ±10% range of the target heart rate (150% per minute) and target calorie expenditure (148 kcal) set in the rehabilitation program, it was suggested that the rehabilitation program grade be maintained without any changes (see Figure 11).

[0061] Example 2 A 60-year-old woman visited the clinic with lower back pain. At the time of her outpatient visit, her height was 150 cm and her weight was 60 kg. Her SF-36 PCS score was 26, her RDQ score was 24, and her combined score divided by 2 resulted in an assessment score of 25, resulting in a calculated rehabilitation index of 3 (see Figure 9). A rehabilitation program (15-minute units) was selected for her rehabilitation index of 3, including Nordic walking (4.3 METs), lower back stretching (2.3 METs), back stretching (2.3 METs), strength and balance exercises (2.3 METs), core muscle strengthening exercises (4.3 METs), back stretching exercises (3.5 METs), and balance improvement exercises (2.3 METs). Based on the patient's normal height and excess weight, the target heart rate and calorie expenditure for the selected rehabilitation program were set at 155 beats per minute and 148 kcal, respectively (see Figures 9 and 10). The patient's measured heart rate at the end of the rehabilitation exercise was 165 beats per minute, and the calorie expenditure was 110 kcal. Because the heart rate (165 beats per minute) was within ±10% of the target heart rate (160 beats per minute), and the calorie expenditure (110 kcal) was below the lower limit of ±10% of the target calorie expenditure (148 kcal), the patient was deemed to be able to tolerate the prescribed program, and it was suggested that the patient be moved up to a program with a rehabilitation index of one level higher, 4 (see Figure 11).

[0062] Example 3 A 45-year-old man visited the clinic with lower back pain. At the time of his outpatient visit, his height and weight were recorded as 160 cm and 75 kg, respectively. His SF-36 PCS score was 60, and his RDQ score was 62. The sum of these scores divided by 2 yielded an assessment score of 61, resulting in a rehabilitation index of 7. A program with a grade corresponding to a rehabilitation index of 7 was selected, including Nordic walking (4.3 METs), lower back stretching (2.3 METs), back stretching (2.3 METs), strength and balance exercises (2.3 METs), core muscle strengthening exercises (4.3 METs), back stretching exercises (3.5 METs), and balance improvement exercises (2.3 METs). Based on the patient's normal height and excess weight, the target heart rate and calorie expenditure for the selected rehabilitation program were set at 140 beats per minute and 132 kcal, respectively (see Figures 9 and 10). At the end of the rehabilitation exercise, the patient's heart rate was measured at 150 / min and the calories burned were 150 kcal. The patient's heart rate of 150 / min was within the range of ±10% of the target heart rate, but the calories burned of 150 kcal exceeded the upper limit of the ±10% range of the target calorie burn of 132 kcal. Therefore, it was suggested that the rehabilitation program be downgraded to a rehabilitation index of 6 (see Figure 11).

[0063] Example 4 A 60-year-old woman presented to the clinic with knee osteoarthritis. Her height and weight were recorded as 156 cm and 52 kg, respectively, at the time of her outpatient visit. Her SF-36 PCS score was 43 and her WOMAC score was 46. The sum of these scores, divided by 2, resulted in an assessment score of 44.5, resulting in a rehabilitation index of 5. A program was selected, corresponding to a rehabilitation index of 5: chair-to-sit exercises, 30 repetitions (10 repetitions x 3 sets), for 10 minutes, three times a week. Based on the patient's normal height and excess weight, a target heart rate of 155 beats per minute and a target calorie expenditure of 148 kcal were set. At the end of the rehabilitation exercises, the patient's heart rate was measured at 160 beats per minute, and calorie expenditure was 120 kcal. Because the patient's calorie expenditure was below the ±10% range of the rehabilitation program's target, the program was deemed to be within the patient's tolerance, and it was suggested that the rehabilitation program be upgraded by one level.

[0064] Although the embodiments of the present invention have been described above with reference to the drawings, the present invention is not limited to these embodiments and can be modified and implemented in various embodiments within the scope of the present invention. [Explanation of symbols]

[0065] 10 PCs (personal computers) 21 Smart Device 1 22 Smart Devices 2 23 Smart Devices 3 31 Wearable Sensor Device 1 32 Wearable Sensor Devices 2 33 Wearable Sensor Devices 3

Claims

1. A remote medical care support system for supporting the selection and implementation of a rehabilitation program for an orthopedic patient who is capable of independent movement, comprising: The system includes a smart device and a PC (personal computer) wirelessly connected to the smart device via an Internet line, The smart device is carried by the patient and has application software of a remote medical care support system installed thereon; Calculated based on responses to questions in a questionnaire using a health-related quality of life scale A means for receiving an input of a recovery evaluation score that quantitatively evaluates the recovery state of a patient; means for transmitting the recovery assessment score to the PC; The PC has the application software for the remote medical support system installed. It is installed in medical institutions and set up so that the patient's doctor or physical therapist can access it. the law of nature, Accepts input of patient identification number, profile, and type of disease treated Means and Calculated based on responses to questions in a questionnaire using a health-related quality of life scale A means for receiving an input of a recovery evaluation score that quantitatively evaluates the recovery state of a patient; receiving the recovery assessment score of the patient transmitted from the smart device; and a storage device, The storage device stores a plurality of rehabilitation programs corresponding to post-surgery for a predetermined type of disease. Each rehabilitation program can be stored in memory, and multiple exercise programs can be stored in memory. Each rehabilitation program is composed of a rehabilitation program. The amount of strain on the body caused by carrying out the exercise program prescribed by There are multiple grades according to the level of rehabilitation, and each grade of each rehabilitation program Grades are designed to improve your body by performing an exercise program for that grade. The rehabilitation index of patients with a recovery state suitable for such load is registered, The system determines a rehabilitation index that evaluates the recovery status of the patient on a numerical scale based on the recovery assessment score of the patient input from the smart device or the PC; selecting a rehabilitation program and its grade to be prescribed for the patient from a plurality of rehabilitation programs stored in a storage device of the PC based on the type of disease treated by the patient and the rehabilitation index; A remote medical support system for supporting the selection and implementation of a rehabilitation program for orthopedic patients who are able to move independently.

2. A wearable sensor device is connected to the smart device wirelessly or by wire, and the wearable sensor device is configured to be wearable on the patient's body, and includes a means for measuring exercise bio-information from the patient's body and a means for transmitting the measured exercise bio-information of the patient to the PC; The system is configured to be able to change the grade of the selected rehabilitation program based on exercise bio-information measured by the wearable sensor device attached to the patient's body. The remote medical care support system according to claim 1.

3. For each grade of each rehabilitation program, a target value (exercise target value) of exercise bio-information that is expected to be measured from the patient when the exercise program indicated by that grade is performed is registered, and the exercise target value is set according to the profile of the patient performing the exercise program; The system determines, based on the patient's profile, motor goals that the patient is expected to measure when performing the independent movements prescribed by the selected grade of rehabilitation program; comparing the measured values ​​of the exercise bio-information measured from the patient who has performed the rehabilitation program of the selected grade with the exercise target value of the patient, and when it is determined that the measured values ​​of the exercise bio-information are within a predetermined range from the exercise target value according to a predetermined rule, suggesting that the prescribed rehabilitation program be maintained; When it is determined that the measured value of the exercise bio-information exceeds a predetermined upper limit from the exercise target value according to a predetermined rule, a change to a rehabilitation program of a grade one step lower in burden on the patient than the prescribed rehabilitation program is suggested; when it is determined that the measured value of the exercise bio-information falls below a predetermined lower limit of the exercise target value according to a predetermined rule, a change to a rehabilitation program of a grade one level higher than the prescribed rehabilitation program is suggested, which places a burden on the patient. The remote medical care support system according to claim 2.

4. The remote medical support system of claim 2 or 3, wherein the exercise bio-information is the measured value of a plurality of measurement items, and if it is determined that any one of the measured values ​​of the plurality of measurement items measured from the patient exceeds a predetermined range from the patient's exercise target value, it is determined that the load of the rehabilitation program of the selected grade is excessive or insufficient for the patient, and a rehabilitation program of a grade one level lower or higher in load than the prescribed rehabilitation program is proposed.

5. Application software for a remote medical care support system, The application software is installed and used on a smart device and a PC (personal computer) wirelessly connected to the smart device via an Internet line; the smart device is carried by the patient and includes: means for receiving an input of a recovery assessment score that quantitatively evaluates the recovery state of the patient, the recovery assessment score being calculated based on answers to questions in a questionnaire using a health-related QOL assessment scale; and means for transmitting the recovery assessment score to the PC; The PC is installed in a medical institution and set so as to be accessible by the patient's doctor or physical therapist, and is equipped with a means for accepting input of the patient's identification number, profile, and type of disease treated, and a storage device, the storage device stores a plurality of rehabilitation programs corresponding to post-operative periods for a predetermined type of disease, each rehabilitation program being composed of a plurality of exercise programs, each rehabilitation program having a plurality of grades according to the magnitude of the load placed on the body by executing the exercise program instructed by the rehabilitation program, and each grade of each rehabilitation program has registered therein a rehabilitation index for a patient whose recovery state is appropriate for the load placed on the body by executing the exercise program of that grade, The application software comprises: determining a rehabilitation index that evaluates the recovery status of the patient on a numerical scale based on the recovery assessment score of the patient transmitted from the smart device to the PC; and selecting a rehabilitation program and its grade to be prescribed for the patient from among a plurality of rehabilitation programs stored in a storage device of the PC based on the patient profile, the type of disease being treated, and the rehabilitation index input from the PC. Application software for the remote medical care support system.

6. A wearable sensor device is connected to the smart device wirelessly or by wire, and the wearable sensor device is configured to be wearable on the patient's body, and includes a means for measuring exercise bio-information from the patient's body and a means for transmitting the measured exercise bio-information of the patient to the PC; The application software is configured to change the grade of the selected rehabilitation program based on the exercise bio-information measured by the wearable sensor device attached to the patient. Application software for the remote medical care support system according to claim 5.

7. Each grade of each rehabilitation program further includes registered target values ​​(exercise target values) of exercise bio-information that are expected to be measured from the patient when the exercise program indicated by that grade is performed, and the exercise target values ​​are set according to the profile of the patient performing the exercise program; the application software determines, based on the patient profile, motor goals that the patient is expected to measure when performing the independent movements prescribed by the selected grade of rehabilitation program; comparing the measured values ​​of the exercise bio-information measured from the patient who has performed the rehabilitation program of the selected grade with the exercise target value of the patient, and when it is determined that the measured values ​​of the exercise bio-information are within a predetermined range from the exercise target value according to a predetermined rule, suggesting that the prescribed rehabilitation program be maintained; When it is determined that the measured value of the exercise bio-information exceeds a predetermined upper limit from the exercise target value according to a predetermined rule, a change to a rehabilitation program of a grade one step lower in burden on the patient than the prescribed rehabilitation program is suggested; and when it is determined that the measured value of the exercise bio-information falls below a predetermined lower limit of the exercise target value according to a predetermined rule, the program proposes a change to a rehabilitation program of a grade one level higher in load on the patient than the prescribed rehabilitation program.

7. Application software for the remote medical care support system according to claim 5 or 6.

8. 7. The application software of the remote medical care support system of claim 6, wherein the exercise bio-information is the measured values ​​of a plurality of measurement items, and the application software is configured to, when it is determined that any one of the measured values ​​of the plurality of measurement items measured from the patient exceeds a predetermined range from the patient's exercise target value, determine that the load of the selected grade of rehabilitation program is excessive or insufficient for the patient, and propose a rehabilitation program of a grade one level lower or higher in load than the prescribed rehabilitation program.

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