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Ng JY, Masood M, Kathir S, Cramer H. Perceptions of complementary, alternative, and integrative medicine: A global cross-sectional survey of cardiology researchers and clinicians. PLoS One 2025; 20:e0322340. [PMID: 40327629 PMCID: PMC12054883 DOI: 10.1371/journal.pone.0322340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 03/21/2025] [Indexed: 05/08/2025] Open
Abstract
BACKGROUND Complementary, alternative, and integrative medicine (CAIM) has been increasing in popularity among patients with cardiovascular illnesses. However, little is known about perceptions of CAIM among cardiology researchers and clinicians. In response, this study aimed to assess the practices, perceptions, and attitudes towards CAIM among cardiology researchers and clinicians. METHODS An anonymous, digital cross-sectional survey was administered to researchers and clinicians who have published articles in cardiology journals indexed in OVID MEDLINE. The survey was sent to 37,915 researchers and clinicians and included 5-point Likert scales, multiple-choice questions, and open-ended questions. Basic descriptive statistics were drawn from quantitative data, and a thematic content analysis was conducted to analyze open-ended responses. RESULTS Among the 309 respondents, the majority (n = 173, 55.99%) identified themselves as both researchers and clinicians in the field of cardiology. While 45.78% (n = 114) of participants expressed agreement regarding the safety of CAIM therapies, 44.40% (n = 111) disagreed on their efficacy. Most respondents believed in the value of conducting research on CAIM therapies (79.2%, n = 198). Respondents perceived mind-body therapies (57.61%, n = 159) and biologically based practices (47.46%, n = 131) as the most promising interventions for the prevention and treatment of cardiovascular conditions. Biofield therapies were the least favoured for integration into mainstream medical practices (11.93%, n = 29). CONCLUSIONS While cardiology researchers and clinicians perceive CAIM therapies to have potential, many are hesitant about integrating such interventions into the current medical system due to a perceived lack of scientific evidence and standardized products. Insights from this study may help establish educational resources for healthcare practitioners.
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Affiliation(s)
- Jeremy Y. Ng
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Mehvish Masood
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Sivany Kathir
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
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2
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Ben-Tzur D, Sabovich S, Hutzler Y, Rimon J, Zach S, Epstein M, Vadasz B, Diniz CV, Nabutovsky I, Klempfner R, Eilat-Adar S, Gabizon I, Menachemi DM, Grosman-Rimon L. Advances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation. Cardiol Rev 2025; 33:160-165. [PMID: 37607080 DOI: 10.1097/crd.0000000000000599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Patient-centered health care (PCC) is a framework of clinical care focused on the patient's individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients' individual needs, increase access to health care, and implement aspects of PCC domains.
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Affiliation(s)
- Dana Ben-Tzur
- From the The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Solomon Sabovich
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Yeshayahu Hutzler
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
| | - Jordan Rimon
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sima Zach
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
| | - Maor Epstein
- Department of Cardiology, Soroka Medical Center, Ben-Gurion University, Negev, Beer Sheva, Israel
| | - Brian Vadasz
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago
| | - Camilla V Diniz
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Irene Nabutovsky
- Cardiac Prevention and Rehabilitation Institute, Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel, Faculty of Medicine, Tel Aviv University, Israel
| | - Robert Klempfner
- Cardiac Prevention and Rehabilitation Institute, Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel, Faculty of Medicine, Tel Aviv University, Israel
| | - Sigal Eilat-Adar
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
| | - Itzhak Gabizon
- Department of Cardiology, Soroka Medical Center, Ben-Gurion University, Negev, Beer Sheva, Israel
| | - Doron M Menachemi
- Internal Medicine and Heart Failure Services, Wolfson UMC Holon, Tel-Aviv University, Israel
| | - Liza Grosman-Rimon
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
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Kim C, Song JH, Kim SH. The Accessibility and Effect of Cardiac Rehabilitation in COVID-19 Pandemic Era. Ann Rehabil Med 2024; 48:249-258. [PMID: 39074836 PMCID: PMC11372283 DOI: 10.5535/arm.240021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVE To prospectively compare the efficacy of conventional center-based cardiac rehabilitation (CBCR) and home-based cardiac rehabilitation (HBCR) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Ninety Patients were divided into HBCR and CBCR groups based on cardiovascular risk stratification and individual preference. The CBCR group performed supervised in-hospital exercise training 2-3 times/week and subsequent self-exercise at home. The HBCR group performed self-exercise at home after one or two sessions of exercise education. The cardiopulmonary exercise test results at baseline and those at the 3-, 6-, and 12-month follow-ups were analyzed as primary outcome. RESULTS The peak oxygen consumption (peak VO2, mL/kg/min) in the CBCR group was 20.1 and 24.0 at baseline and 12 months, respectively, showing significant improvement (p=0.006). In the HBCR group, it only increased from 24.4 to 25.5, showing suboptimal improvement. A significant increase in the Korean activity scale/index was confirmed only in the CBCR group (p=0.04). The cardiovascular outcome did not differ between the two groups, nor did the dropout rate or demographic factors. CONCLUSION During the COVID-19 pandemic, only CBCR was associated with a significant improvement in peak VO2 and physical activity levels, a finding that differs from those of other studies and seems to be affected by COVID-19. Therefore, in situations where the importance of HBCR is emphasized, it is essential to introduce measures to monitor and enhance exercise adherence among participants.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Hyeong Song
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Seung Hyoun Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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4
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Taylor MA, Berkowitz JL, Chen K, DeAngelis J, Wu WC. Impact of Prior COVID-19 Infections on Cardiac Rehabilitation Completion Rates and Outcomes. J Cardiopulm Rehabil Prev 2024; 44:157-161. [PMID: 38669342 DOI: 10.1097/hcr.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
PURPOSE This is a retrospective cohort study designed to evaluate the impact of having a prior COVID-19 infection on cardiac rehabilitation (CR) completion rates and outcomes. METHODS Participants enrolled into the CR program from June 1, 2020, to March 30, 2022. They completed both physical and mental health assessments prior to enrollment and upon completion of the program. The cohort was divided into (-) COVID and (+) COVID based on whether they self-reported a prior COVID-19 infection. Outcome measures included General Anxiety Disorder-7, Patient Health Questionnaire-9, Mental Composite Score (Short Form Health Survey-36), Physical Composite Score (Short Form Health Survey-36), and exercise capacity (reported in METs). Program completion rates and outcome measures were compared between (-) COVID and (+) COVID cohorts. RESULTS A total of 806 participants were enrolled in the study. Program completion rates were 58.7% in the (-) COVID group and 67.2% in the (+) COVID group ( P = .072). African Americans ( P = .017), diabetics ( P = .017), and current smokers ( P = .003) were less likely to complete the program. Both (-) COVID and (+) COVID groups showed significant improvement in all outcome measures after completing the CR program. However, there was no difference in outcomes between groups. CONCLUSIONS Having a prior COVID-19 infection did not negatively impact the mental and physical health benefits obtained by completing the CR program, regardless of the American Association of Cardiovascular and Pulmonary Rehabilitation risk category.
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Affiliation(s)
- Matthew A Taylor
- Author Affiliations: Department of Medicine, Rhode Island Hospital, Providence (Drs Taylor and Berkowitz); The Warren Alpert Medical School, Brown University, Providence, Rhode Island (Drs Taylor, Berkowitz, and Wu and Mr Chen); Division of Cardiology, Department of Medicine, VA Medical Center, Providence, Rhode Island (Dr Wu); and Center for Cardiac Fitness, The Miriam Hospital, Providence, Rhode Island (Ms DeAngelis and Dr Wu)
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Iannetta D, Rouleau CR, Chirico D, Laddu D, Aggarwal S, Arena R, Murias JM. A successful home-based cardiac rehabilitation program in the early phase of the COVID-19 pandemic. Prog Cardiovasc Dis 2024; 83:124-125. [PMID: 37696444 DOI: 10.1016/j.pcad.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Danilo Iannetta
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| | - Codie R Rouleau
- TotalCardiology™ Research Network, Calgary, AB, Canada; Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Deepika Laddu
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Sandeep Aggarwal
- TotalCardiology™ Research Network, Calgary, AB, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Ross Arena
- TotalCardiology™ Research Network, Calgary, AB, Canada; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Geana MV, Liu P, Pei J, Anderson S, Ramaswamy M. "A Friendly Conversation." Developing an eHealth Intervention to Increase COVID-19 Testing and Vaccination Literacy Among Women with Criminal and Legal System Involvement. JOURNAL OF HEALTH COMMUNICATION 2024; 29:131-142. [PMID: 38111197 PMCID: PMC10842808 DOI: 10.1080/10810730.2023.2293094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Many women leaving jails are ill-prepared to follow recommended COVID-19 mitigation practices, including testing and vaccination. Low COVID-19-related health literacy, exposure to disinformation, and mistrust in authorities put women at increased risk. Research on this population has shown significant use of mobile devices for communication and web access and public Wi-fi for the internet. Using inductive (formative empirical research with the community) and deductive (theory-based) practices, we designed, developed, and pilot-tested a multimedia, culturally tailored web-based electronic health (eHealth) application to increase COVID-19-specific health literacy and promote testing and vaccination among women with criminal and legal system involvement (CLSI). The intervention included a serialized animated multimedia component and a telenovela-style series, complementing each other and addressing knowledge needs identified in the formative research phase of the project. The eHealth intervention was pilot-tested with 13 CLSI women by using online activity logs and semi-structured telephone interviews. Findings confirmed that eHealth interventions employing multimodal information delivery had increased chances of engaging audiences, especially when developed with input from the target population and are culturally tailored. In addition, using a web-based delivery optimized for mobile made the intervention accessible on various devices and decreased the risk of technical problems.
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Affiliation(s)
- Mugur V. Geana
- Center for Excellence in Health Communication to Underserved Populations, School of Journalism and Mass Communications, University of Kansas, Lawrence, Kansas, USA
| | - Pan Liu
- Department of Media, Design, and Communication, Marian University, Indianapolis, Indiana, USA
| | - Jun Pei
- Center for Excellence in Health Communication to Underserved Populations, School of Journalism and Mass Communications, University of Kansas, Lawrence, Kansas, USA
| | - Sherri Anderson
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Leo DG, Proietti R. A New Player in the Game: Can Exergame Be of Support in the Management of Atrial Fibrillation? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:172. [PMID: 38256432 PMCID: PMC10819072 DOI: 10.3390/medicina60010172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, currently affecting 2-3% of the world's population. Traditional exercise and physical activity interventions have been successfully implemented in the management of AF, with the aim of improving patients' quality of life and their exercise capacity, as well as reducing their mortality rate. Currently, new technology-mediated approaches to exercise, defined as exergame, have been shown to be successful in the delivery of exercise home-based interventions in patients with cardiovascular diseases. However, data on the effects of exergame on AF are not yet available. In this paper, we summarise the current literature on the role of traditional exercise in AF and how it affects the pathophysiology of this condition. We also review the current literature on exergame and its employment in cardiac rehabilitation and suggest its potential role in the management of AF patients. A review of the evidence suggests that traditional exercise (of light-to-moderate intensity) is beneficial in patients with AF. Additionally, exergame seems to be a promising approach for delivering exercise interventions in patients with cardiovascular diseases. Exergame may be a promising tool to improve the quality of life and exercise capacity in patients with AF, with the additional advantage of being remotely delivered, and the potential to increase patients' engagement. Proper guidelines are required to prescribe exergame interventions, considering the principles of traditional exercise prescription and applying them to this new e-health approach. Further studies are needed to validate the use of exergame in patients with AF.
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Affiliation(s)
- Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool L8 7TX, UK
| | - Riccardo Proietti
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK
- Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool L8 7TX, UK
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Ciucă-Pană MA, Șerbănoiu LI, Cojocaru V, Olteanu G, Andronic O, Lăcraru A, Ion A, Andrei C, Sinescu C, Suceveanu MC, Mandu M, Onose G, Pedretti R, Niebauer J, Busnatu ȘS. Assessment of on-site and remote cardiac rehabilitation in Romania. BALNEO AND PRM RESEARCH JOURNAL 2023; 14:621. [DOI: 10.12680/balneo.2023.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
Abstract
: Introduction: It is well known that cardiovascular diseases are the leading cause of death worldwide. In Romania in 2015, cardiovascular diseases led to 153.953 deaths, representing 59.3% of deaths from all causes. Most people in Romania today have an unhealthy lifestyle, characterised mainly by a poor nutritious diet, low physical activity and a lack of medical screening.
Purpose: Considering these deficits of secondary prevention in the treatment line of the Romanian cardiovascular patient, we aimed through this study to assess the current access of the Romanian population to on-site and remote cardiac rehabilitation programs as well as their opinion regarding the telemedicine for future cardiovascular care modelling.
Methods: It was a prospective observational study, which was carried out by means of an online questionnaire composed of 26 items. It was dispersed in the online environment, including Social Media platforms, where it was active for ten weeks.
Results: Our online evaluation questionnaire had 1115 participants, with a minimum age of 18 years old, a preponderance of female sex and a predominantly urban background. The study participants were from all educational levels, from low to superior. We observed that most participants have an internet connection at home and use at least one form of technology daily, but most have never used a telemedicine service.
Conclusions: In conclusion, the access of cardiovascular patients to on-site cardiac rehabilitation services is extremely low and for remote ones, it is almost non-existent. For a middle-income country like Romania with such a high incidence of cardiovascular disease, it is almost mandatory to provide publicly funded cardiac telerehabilitation services also for the future.
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Affiliation(s)
- Maria-Alexandra Ciucă-Pană
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Liviu Ionut Șerbănoiu
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Victor Cojocaru
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Gabriel Olteanu
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Octavian Andronic
- Hospital for Cardiovascular Rehabilitation „Dr.Benedek Geza” Covasna, Romania
| | - Andreea Lăcraru
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Alexandru Ion
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Cătălina Andrei
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Crina Sinescu
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | | | - Mihaela Mandu
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Gelu Onose
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
| | - Roberto Pedretti
- Cardiovascular Department, IRCCS MultiMedica Sesto San Giovanni , Milan, Italy
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Ștefan-Sebastian Busnatu
- Carol Davila University of Medicine and Pharmacy, Bagdasar Arseni Emergency Hospital, Bucharest, Romania
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Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, Kaihoi B, Kopecky S, Krogman A, Leth S, Malik S, Marsteller J, Mathews L, Scales R, Schulte P, Shultz A, Taylor B, Thomas R, Wong N, Olson T. Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial. J Am Heart Assoc 2023; 12:e030883. [PMID: 38014699 PMCID: PMC10727355 DOI: 10.1161/jaha.123.030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
- Center for Health Equity and Community Engagement ResearchMayo ClinicRochesterMN
| | - Helayna Abraham
- Department of Internal MedicineMayo Clinic College of MedicineRochesterMN
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Melvin Echols
- Department of Cardiovascular MedicineMorehouse School of MedicineAtlantaGA
| | - Michael Hall
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Karen Hodgman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Brian Kaihoi
- Global Products and ServicesMayo Clinic Center for InnovationRochesterMN
| | - Stephen Kopecky
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Ashton Krogman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shawn Leth
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shaista Malik
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Jill Marsteller
- Center for Health Services and Outcomes ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lena Mathews
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Robert Scales
- Department of Cardiovascular MedicineMayo Clinic College of MedicinePhoenixAZ
| | - Phillip Schulte
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Adam Shultz
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Bryan Taylor
- Department of Cardiovascular MedicineMayo Clinic College of MedicineJacksonvilleFL
| | - Randal Thomas
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Nathan Wong
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Thomas Olson
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
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Alexander H, D'Silva A, Tack C, Cowie A. A survey of digital access, digital confidence and rehabilitation delivery preferences of patients referred for CR. THE BRITISH JOURNAL OF CARDIOLOGY 2023; 30:31. [PMID: 39247412 PMCID: PMC11376258 DOI: 10.5837/bjc.2023.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Remote delivery of cardiovascular rehabilitation (CR) has been vital during the COVID pandemic when restrictions have been placed on face-to- face services. In the future, CR services are likely to offer alternatives to centre- based CR, including digital options. However, little is known about the digital access and confidence of CR service users, or their CR delivery preferences. A telephone survey was conducted of those referred for CR in the London boroughs of Lambeth and Southwark (n=60) in which questions were asked about digital access and confidence, as well as current and future delivery preferences for their CR. Between March and July 2021, 60 service-users met the inclusion criteria and were recruited for a telephone survey (mean age 60 ± 11.2 years). Of those, 82% had regular access to a smartphone, 60% to a computer or laptop and 43% to a tablet device. A high proportion of service users perceived themselves to be 'extremely' or 'somewhat' confident to use their devices. Thirty-nine (65%) service users would currently prefer a face-to- face assessment, rising to 82% once the perceived COVID-19 threat and restrictions are less. Preferences for accessing exercise were equally split between face-to-face and remotely supported independent exercise, with low interest in digital options. Delivery preferences for education, relaxation and peer support were more heterogeneous with interest in all delivery options. In conclusion, digital access and confidence in CR service users was good. Redesigning CR services to offer more rehabilitation delivery options, aligned with patient choice may increase uptake and further trials are needed to assess the impact.
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Affiliation(s)
- Helen Alexander
- Physiotherapy Manager and Rehabilitation Services Lead Nuffield Health at St. Bartholomew's Hospital, 38 Giltspur Street, London, EC1A 7BS
| | - Andrew D'Silva
- Consultant Cardiologist Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH
| | - Christopher Tack
- Principal Consultant in Digital Health Channel 3 Consulting, 180 Borough High Street, London, SE1 1LB
| | - Aynsley Cowie
- Consultant Physiotherapist Cardiac Rehabilitation and HARP, Lister Centre, University Hospital Crosshouse, NHS Ayrshire and Arran, KA2 0BE
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11
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Brewer LC, Abraham H, Kaihoi B, Leth S, Egginton J, Slusser J, Scott C, Penheiter S, Albertie M, Squires R, Thomas R, Scales R, Trejo-Gutierrez J, Kopecky S. A Community-Informed Virtual World-Based Cardiac Rehabilitation Program as an Extension of Center-Based Cardiac Rehabilitation: MIXED-METHODS ANALYSIS OF A MULTICENTER PILOT STUDY. J Cardiopulm Rehabil Prev 2023; 43:22-30. [PMID: 35881503 PMCID: PMC10340723 DOI: 10.1097/hcr.0000000000000705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Innovative methods for delivering cardiac rehabilitation (CR) that provide strategies to circumvent the mounting barriers to traditional CR have the potential to widen access to a well-established secondary prevention strategy. Our study assesses the feasibility and acceptability of a novel virtual world-based CR (VWCR) program, Destination Rehab , as an extension of a conventional center-based CR program. METHODS Adult cardiac patients hospitalized at Mayo Clinic hospitals with a diagnosis for CR and ≥1 modifiable, lifestyle risk factor target-sedentary lifestyle (<3 hr physical activity/wk), unhealthy diet (<5 servings fruits and vegetables/d), or current smoking (>1 yr)-were recruited. Patients participated in an 8-wk health education program using a virtual world (VW) platform from a prior proof-of-concept study and a post-intervention focus group. Primary outcome measures included feasibility and acceptability. Secondary outcome measures included changes from baseline to post-intervention in cardiovascular (CV) health behaviors and biometrics, CV health knowledge, and psychosocial factors. RESULTS Of the 30 enrolled patients (age 59.1 ± 9.7 yr; 50% women), 93% attended ≥1 session and 71% attended ≥75% of sessions. The overall VWCR experience received an 8 rating (scale 0-10) and had high acceptability. Clinically relevant trends were noted in CV health behaviors and biometrics, although not statistically significant. CONCLUSIONS The VWCR program is a feasible, highly acceptable, and innovative platform to potentially influence health behaviors and CV risk and may increase accessibility to disadvantaged populations with higher CV disease burdens.
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Affiliation(s)
- LaPrincess C Brewer
- Departments of Cardiovascular Medicine (Drs Brewer, Squires, Thomas, and Kopecky and Ms Leth) and Internal Medicine (Dr Abraham), Mayo Clinic College of Medicine, Rochester, Minnesota; Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota (Drs Brewer, and Penheiter); Global Products and Services, Mayo Clinic Center for Innovation, Rochester, Minnesota (Mr Kaihoi); Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, Minnesota (Mr Egginton); Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota (Messrs Slusser and Scott); Center for Health Equity and Community Engagement Research, Mayo Clinic, Jacksonville, Florida (Ms Albertie); Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona (Dr Scales); and Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida (Dr Trejo-Gutierrez)
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12
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Heidari M, Harandi PN, Moghaddasi J, Kheiri S, Azhari A. Effect of Home-Based Cardiac Rehabilitation Program on Self-Efficacy of Patients With Implantable Cardioverter Defibrillator. SAGE Open Nurs 2023; 9:23779608231166473. [PMID: 37124375 PMCID: PMC10134157 DOI: 10.1177/23779608231166473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/18/2023] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction For more effective control and treatment of cardiac dysrhythmias caused by diseases, ischemia, or other causes, an implantable cardioverter defibrillator (ICD) is used. One of the effective ways for secondary prevention is the home-based cardiac rehabilitation (HBCR) which nurses have an effective role in its implementation. Objective The study aimed to investigate the effect of implementing HBCR programs on the self-efficacy of patients with ICD. Methods This is a semi-experimental study conducted on 70 patients who received ICD in Shahid Chamran Heart Center of Isfahan University of Medical Sciences (IUMS) in 2021. The patients were randomly assigned to intervention and control groups and were introduced to the practical concepts of HBCR during four training sessions. In the following, 3-month follow-up and trainings were continued by home visits, telephone follow-up, and use of social messaging networks due to the conditions of coronavirus disease 2019 (COVID-19) pandemic. The data were analyzed with SPSS/21. Results The findings showed that performing HBCR programs was effective in improving the self-efficacy of patients with ICDs. A significant trend in the implementation of the HBCR programs in two groups was shown using chi-square test and independent t-test and variance with repeated measurements (p < .001). There was no significant difference in self-efficacy score in both groups at the beginning of the study (p < .056). Conclusion Considering the effectiveness of HBCR programs on improving the self-efficacy of patients with ICDs, it can be used in the educational care programs of healthcare workers and in the strategic policies of health care services.
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Affiliation(s)
- Mohammad Heidari
- Community-Oriented Nursing Midwifery
Research Center, Nursing and Midwifery School, Shahrekord University of Medical
Sciences, Shahrekord, Iran
| | - Parviz Nadimi Harandi
- School of Nursing and Midwifery, Shahrekord University of Medical
Sciences, Shahrekord, Iran
- Parviz Nadimi Harandi, School of Nursing
and Midwifery, Ayatollah Kashani Blvd, Shahrekord University of Medical
Sciences, Shahrekord, Iran.
| | - Jaefar Moghaddasi
- Department of Adults and Geriatric
Nursing, School of Nursing and Midwifery, Shahrekord University of Medical
Sciences, Shahrekord, Iran
| | - Soleiman Kheiri
- Department of Epidemiology and
Biostatistics, School of Health, Modeling in Health Research Center, Shahrekord University of Medical
Sciences, Shahrekord, Iran
| | - Amirhossein Azhari
- Department of Cardiology, School of
Medicine Chamran Hospital, Isfahan University of Medical
Sciences, Isfahan, Iran
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13
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Van Iterson EH, Laffin LJ, Cho L. National, regional, and urban-rural patterns in fixed-terrestrial broadband internet access and cardiac rehabilitation utilization in the United States. Am J Prev Cardiol 2022; 13:100454. [PMID: 36636124 PMCID: PMC9830103 DOI: 10.1016/j.ajpc.2022.100454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
Objective Sparse patterns in fixed-terrestrial broadband internet access are predominantly observed among older adults and low income areas, which are interrelated factors also associated with low center-based cardiac rehabilitation (CR) utilization in the United States (US). Telehealth CR is proposed to increase CR utilization under an assumption that fixed-terrestrial broadband internet access is readily available nationwide and parallels CR utilization demand. We aimed to characterize national, geographical, and urban-rural patterns in fixed-terrestrial broadband internet access, CR eligibility rates, and center-based utilization throughout the US. Methods Centers for Disease Control data were used to estimate CR eligibility rates and center-based utilization for 2017-2018 among Medicare fee-for-service beneficiaries aged ≥65 years. Census Bureau data for 2018 were used to estimate fixed-terrestrial broadband internet access among households of adults aged ≥65 years. Results Southern states exhibited the highest percentage of households without broadband internet [median (IQR): 32% (24-39)] coupled with the highest CR eligibility rates [per 1,000 beneficiaries, median (IQR): 18 (15-21)] and lowest participation rates [percentage completing ≥1 session, median (IQR): 25% (17-33)]. Compared with urban areas, rural areas demonstrated significantly higher eligibility rates [15.5 (13.2-18.4) vs. 17.4 (14.5-21.0)], participation rates [30.6% (22.0-39.4) vs. 34.6% (22.6-48.3)], and percentage of households without broadband internet [23.8% (18.1-29.2) vs. 31.6% (26.5-37.6)], respectively. Conclusion Overlapping patterns in fixed-terrestrial broadband internet access and CR eligibility rates and center-based utilization suggest telehealth CR policies need to account for the possibility that lack of broadband-quality internet access could be a barrier to accessing telehealth CR delivery models.
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Núñez-Cortés R, Flor-Rufino C, Martínez-Arnau FM, Arnal-Gómez A, Espinoza-Bravo C, Hernández-Guillén D, Cortés-Amador S. Feasibility of the 30 s Sit-to-Stand Test in the Telehealth Setting and Its Relationship to Persistent Symptoms in Non-Hospitalized Patients with Long COVID. Diagnostics (Basel) 2022; 13:24. [PMID: 36611316 PMCID: PMC9818883 DOI: 10.3390/diagnostics13010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Fatigue, dyspnea and pain are the main limitations of patients with long COVID. The aim of this study was to determine the feasibility of the 30 s sit-to-stand (30s-STS) test in the telehealth setting and its relationship to persistent symptoms in a sample of non-hospitalized patients with long COVID. A cross-sectional study was conducted in community patients with long COVID. Data collection and assessments were performed by videoconference and consisted of the fatigue assessment scale (FAS), London activity of daily living scale (LCADL), post-COVID-19 functional status (PCFS) and European quality of life questionnaire (EQ-5D-5L), including the pain/discomfort dimension. The 30s-STS test was performed using a standardized protocol adapted for remote use, and the modified Borg scale (0−10) was used to assess dyspnea and lower limb fatigue immediately after the test. The feasibility of the 30s-STS test was assessed by the proportion of eligible participants who were able to complete the test. Safety was assessed by the number of adverse events that occurred during the test. Seventy-nine participants were included (median age: 44 years, 86.1% women). Performance in the 30s-STS test was 11.5 ± 3.2 repetitions with 60.8% of the sample below reference values. All eligible participants were able to complete the test. No adverse events were reported during the evaluation. Participants with lower 30s-STS performance had more fatigue and dyspnea, worse quality of life, more severe pain/discomfort, and worse functional status (p < 0.05). A significant correlation was obtained between LCADL and dyspnea, reported on the Borg scale (0−10) post 30s-STS (r = 0.71; p < 0.001). In conclusion, the 30s-STS test proved to be a feasible test to implement in the telehealth setting and is related to fatigue, dyspnea, quality of life and pain in non-hospitalized patients with long COVID. Clinicians may use this test when assessment of the physical sequelae of COVID-19 in the face-to-face setting is not possible.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago 8240000, Chile
| | - Cristina Flor-Rufino
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Francisco Miguel Martínez-Arnau
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Anna Arnal-Gómez
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | - David Hernández-Guillén
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Group of Physiotherapy in the Aging Process: Social and Health Care Strategies (PT_AGE), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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McAlister FA, Parikh H, Lee DS, Wijeysundera HC. Health Care Implications of the COVID-19 Pandemic for the Cardiovascular Practitioner. Can J Cardiol 2022:S0828-282X(22)01051-0. [PMID: 36481398 PMCID: PMC9721374 DOI: 10.1016/j.cjca.2022.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
There has been substantial excess morbidity and mortality during the COVID-19 pandemic, not all of which was directly attributable to SARS-CoV-2 infection, and many non-COVID-19 deaths were cardiovascular. The indirect effects of the pandemic have been profound, resulting in a substantial increase in the burden of cardiovascular disease and cardiovascular risk factors, both in individuals who survived SARS-CoV-2 infection and in people never infected. In this report, we review the direct effect of SARS-CoV-2 infection on cardiovascular and cardiometabolic disease burden in COVID-19 survivors as well as the indirect effects of the COVID-19 pandemic on the cardiovascular health of people who were never infected with SARS-CoV-2. We also examine the pandemic effects on health care systems and particularly the care deficits caused (or exacerbated) by health care delayed or foregone during the COVID-19 pandemic. We review the consequences of: (1) deferred/delayed acute care for urgent conditions; (2) the shift to virtual provision of outpatient care; (3) shortages of drugs and devices, and reduced access to: (4) diagnostic testing, (5) cardiac rehabilitation, and (6) homecare services. We discuss the broader implications of the COVID-19 pandemic for cardiovascular health and cardiovascular practitioners as we move forward into the next phase of the pandemic.
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Affiliation(s)
- Finlay A. McAlister
- The Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,The Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Alberta, Canada,Corresponding author: Dr Finlay A. McAlister, 5-134C Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada. Tel.: +1-780-492-9824; fax: +1-780-492-7277
| | - Harsh Parikh
- Peter Munk Cardiac Center, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ontario, Canada
| | - Douglas S. Lee
- Peter Munk Cardiac Center, Ted Rogers Centre for Heart Research, University of Toronto, Toronto, Ontario, Canada,ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Harindra C. Wijeysundera
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Schulich Heart Program, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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16
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Hatcher S, Werier J, Edgar NE, Booth J, Cameron DWJ, Corrales-Medina V, Corsi D, Cowan J, Giguère P, Kaluzienski M, Marshall S, Mestre T, Mulligan B, Orpana H, Pontefract A, Stafford D, Thavorn K, Trudel G. Enhancing COVID Rehabilitation with Technology (ECORT): protocol for an open-label, single-site randomized controlled trial evaluating the effectiveness of electronic case management for individuals with persistent COVID-19 symptoms. Trials 2022; 23:728. [PMID: 36056372 PMCID: PMC9437413 DOI: 10.1186/s13063-022-06578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As of May 2022, Ontario has seen more than 1.3 million cases of COVID-19. While the majority of individuals will recover from infection within 4 weeks, a significant subset experience persistent and often debilitating symptoms, known as "post-COVID syndrome" or "Long COVID." Those with Long COVID experience a wide array of symptoms, with variable severity, including fatigue, cognitive impairment, and shortness of breath. Further, the prevalence and duration of Long COVID is not clear, nor is there evidence on the best course of rehabilitation for individuals to return to their desired level of function. Previous work with chronic conditions has suggested that the addition of electronic case management (ECM) may help to improve outcomes. These platforms provide enhanced connection with care providers, detailed symptom tracking and goal setting, and access to relevant resources. In this study, our primary aim is to determine if the addition of ECM with health coaching improves Long COVID outcomes at 3 months compared to health coaching alone. METHODS The trial is an open-label, single-site, randomized controlled trial of ECM with health coaching (ECM+) compared to health coaching alone (HC). Both groups will continue to receive usual care. Participants will be randomized equally to receive health coaching (± ECM) for a period of 8 weeks and a 12-week follow-up. Our primary outcome is the WHO Disability Assessment Scale (WHODAS), 36-item self-report total score. Participants will also complete measures of cognition, fatigue, breathlessness, and mental health. Participants and care providers will be asked to complete a brief qualitative interview at the end of the study to evaluate acceptability and implementation of the intervention. DISCUSSION There is currently little evidence about the optimal treatment of Long COVID patients or the use of digital health platforms in this population. The results of this trial could result in rapid, scalable, and personalized care for people with Long COVID which will decrease morbidity after an acute infection. Results from this study will also inform decision making in Long COVID and treatment guidelines at provincial and national levels. TRIAL REGISTRATION ClinicalTrials.gov NCT05019963. Registered on 25 August 2021.
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Affiliation(s)
- Simon Hatcher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Joel Werier
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- Ontario Workers Network, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Nicole E. Edgar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
| | | | - D. William J. Cameron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Division of Infectious Diseases, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
| | - Vicente Corrales-Medina
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
| | - Daniel Corsi
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Juthaporn Cowan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON Canada
- Centre of Infection, Immunity, and Inflammation, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
| | - Pierre Giguère
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Pharmacy, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- School of Pharmaceutical Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, 5457-1145 Carling Avenue, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Shawn Marshall
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Division of Physical Medicine and Rehabilitation, University of Ottawa, 505 Smyth Road, Ottawa, ON Canada
- Bruyère Research Institute, 85 Primrose Avenue, Ottawa, ON Canada
| | - Tiago Mestre
- Parkinson’s Disease and Movement Disorders Center, Division of Neurology, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON Canada
- Neuroscience Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
- University of Ottawa Brain and Mind Research Institute, 451 Smyth Road, Ottawa, ON Canada
| | - Bryce Mulligan
- Department of Psychology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Private, Ottawa, ON Canada
| | - Heather Orpana
- Public Health Agency of Canada, 130 Colonnade Road, Ottawa, ON Canada
| | - Amanda Pontefract
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1919 Riverside Drive, Suite 406, Ottawa, ON Canada
- Department of Psychology, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Darlene Stafford
- Ontario Workers Network, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Guy Trudel
- Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON Canada
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Stefanakis M, Batalik L, Antoniou V, Pepera G. Safety of home-based cardiac rehabilitation: A systematic review. Heart Lung 2022; 55:117-126. [PMID: 35533492 DOI: 10.1016/j.hrtlng.2022.04.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR. OBJECTIVES To examine the incidence and severity of adverse events of HBCR. METHODS The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome. RESULTS Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise. CONCLUSION The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly.
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Affiliation(s)
- Marios Stefanakis
- Physiotherapy Department, University of West Attica, Egaleo, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital, Jihlavska 20, Brno 62500, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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Sujarwoto S, Augia T, Dahlan H, Sahputri RAM, Holipah H, Maharani A. COVID-19 Mobile Health Apps: An Overview of Mobile Applications in Indonesia. Front Public Health 2022; 10:879695. [PMID: 35602145 PMCID: PMC9114306 DOI: 10.3389/fpubh.2022.879695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mobile health applications (mHealth apps) have been widely used for various purposes for mitigating the COVID-19 pandemic, such as self-assessment, contact tracing, disseminating information, minimizing exposure, and reducing face-to-face health consultation. The objective of this study is to systematically review COVID-19 related mHealth apps and highlight gaps to inform the development of future mHealth initiatives in Indonesia. Methods A systematic search strategy using a PRISMA flowchart was used to identify mHealth apps available in Google Play and Apple Play stores. We searched mHealth apps using certain specific terms related to COVID-19 outbreaks. The inclusion criteria were apps-based smartphone users related to COVID-19 using local language, free of cost, available in the Google Play and Apple Play Stores, and supported by the Indonesian government. We excluded games, apps on infectious diseases unrelated to COVID-19 specifically, and apps with non-Bahasa Indonesia (Indonesian language). The selected mHealth apps were assessed based on two measures: (1) the WHO guidelines on digital health intervention and (2) the four dimensions of the mHealth technology fit framework. In addition, user feedback from experienced and non-experienced users was conducted to evaluate four dimensions of the apps. Results A total of 339 mHealth apps were generated from the initial search, remaining seven selected apps that met inclusion criteria. The results highlighted that mHealth apps reviewed had still not been widely used by the general public. The applications were purposed to disseminate information, conduct a self-risk assessment, provide an online community forum, and telemedicine or teleconsultation regarding COVID-19. Data services, including data storage, aggregation, and data exchange, are available in most apps. The rarest function found was contact tracing and assisting health management and health workers, such as the availability of testing facilities, reporting test results, and prescribing medication. The main issues reported were the lack of data security and data privacy protection, integration and infrastructures, usability, and usefulness. Conclusion Our study highlighted the necessity to improve mHealth apps' functions related to assisting health workers and the function of digital contact tracing. An effort to increase public awareness regarding the use of mHealth is also necessary to streamline the function of this innovation. Policymakers must consider usefulness, usability, integration, and infrastructure issues to improve their mHealth function.
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Affiliation(s)
- Sujarwoto Sujarwoto
- Department of Public Administration, Brawijaya University, Malang, Indonesia
| | - Trisfa Augia
- Department of Public Health, Andalas University, Padang, Indonesia
| | - Hendery Dahlan
- Department of Mechanical Engineering, Andalas University, Padang, Indonesia
| | | | - Holipah Holipah
- Department of Public Health, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Asri Maharani
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Strengthening the Trialability for the Intention to Use of mHealth Apps Amidst Pandemic: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052752. [PMID: 35270445 PMCID: PMC8910131 DOI: 10.3390/ijerph19052752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/05/2022] [Indexed: 12/28/2022]
Abstract
Recent advancements in mHealth apps and services have played a vital role in strengthening healthcare services and enabling their accessibility to marginalized people. With the alarming rise in COVID-19 infection rates around the world, there appears to be an urgent call to modernize traditional medical practices to combat the pandemic. This study aims to investigate the key factors influencing the trialability of mHealth apps/services and behavioral intention to adopt mobile health applications. The study also examines the moderating effects of self-discipline motivation, knowledge, and attitude on the relationship between trialability and behavioral intention to use. The deductive reasoning approach was followed in a positivism paradigm. The study used convenience sampling and collected responses from 280 Generation Y participants in Bangladesh. Partial least square-based structural equation modeling was employed. The results revealed that relative advantage (β = 0.229, p < 0.05), compatibility (β = 0.232, p < 0.05), complexity (β = −0.411, p < 0.05), and observability (β = 0.235, p < 0.05) of mHealth apps influence the trialability of mHealth apps and services among users. Trialability compatibility (β = 0.425, p < 0.05) of mHealth was positively related to the behavioral intention to use these mobile apps. The study found no moderating effects of attitude (β = 0.043, p > 0.05) or self-discipline motivation (β = −0.007, p > 0.05) on the hypothesized relationships. The empirical findings of this study may facilitate the development, design process, and implementation of mHealth applications with improved features that can lead to high user acceptance among Generation Y during future health crises.
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Kondratova I, Fournier H. Virtual Cardiac Rehabilitation in a Pandemic Scenario: A Review of HCI Design Features, User Acceptance and Barriers. LECTURE NOTES IN COMPUTER SCIENCE 2022:485-499. [DOI: 10.1007/978-3-031-05581-2_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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21
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Vilela EM, Ladeiras-Lopes R, Joao A, Braga J, Torres S, Viamonte S, Ribeiro J, Teixeira M, Nunes JP, Fontes-Carvalho R. Current role and future perspectives of cardiac rehabilitation in coronary heart disease. World J Cardiol 2021; 13:695-709. [PMID: 35070112 PMCID: PMC8716974 DOI: 10.4330/wjc.v13.i12.695] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/08/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.
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Affiliation(s)
- Eduardo M Vilela
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ana Joao
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Joana Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Susana Torres
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Sofia Viamonte
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4405-565, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Madalena Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
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22
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Abstract
PURPOSE Cardiac rehabilitation (CR) has been shown to improve functional status, quality of life, and recurrent cardiovascular disease (CVD) events. Despite its demonstrated compelling benefits and guideline recommendation, CR is underutilized, and there are significant disparities in CR utilization particularly by race, ethnicity, sex, and socioeconomic status. The purpose of this review is to summarize the evidence and drivers of these disparities and recommend potential solutions. METHODS In this review, key studies documenting disparities in CR referrals, enrollment, and completion are discussed. Additionally, potential mechanisms for these disparities are summarized and strategies are reviewed for addressing them. SUMMARY There is a wealth of literature demonstrating disparities among racial and ethnic minorities, women, those with lower income and education attainment, and those living in rural and dense urban areas. However, there was minimal focus on how the social determinants of health contribute to the observed disparities in CR utilization in many of the studies reviewed. Interventions such as automatic referrals, inpatient liaisons, mitigation of economic barriers, novel delivery mechanisms, community partnerships, and health equity metrics to incentivize health care organizations to reduce care disparities are potential solutions.
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Affiliation(s)
- Lena Mathews
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota
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23
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Abstract
PURPOSE OF REVIEW This review aims to assess the global impact of the COVID-19 pandemic on the cardiovascular diseases (CVDs), trying to assess the possible future trajectory of the CVDs and their management. RECENT FINDINGS The COVID-19 pandemic has had a deleterious impact on the CV risk factors, with an increase in both sedentary and unhealthy food habits. The fear of contagion has decreased the access to the emergency systems with an increase in out-of-hospital-cardiac-arrests and late presentation of acute myocardial infarctions. The closure of the non-urgent services has delayed cardiac rehabilitation programmes and chronic clinical care. As a result of the COVID-19 pandemic impact on the population habits and on the management of CVDs, we will probably face an increase in CVD and heart failure cases. It is crucial to use all the non-traditional approaches, such as telemonitoring systems, in order to overcome the difficulties raised by the pandemic.
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Affiliation(s)
- Alessandra Pina
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, piazzale Brescia 20, 20149 Milan, Italy
| | - Silvia Castelletti
- IRCCS Istituto Auxologico Italiano, Cardiomyopathy Unit and Center for the Cardiac Arrhythmias of Genetic Origin, Department of Cardiovascular, Neural and Metabolic Sciences, piazzale Brescia 20, 20149 Milan, Italy
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24
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Passantino A, Dalla Vecchia LA, Corrà U, Scalvini S, Pistono M, Bussotti M, Gambarin FI, Scrutinio D, La Rovere MT. The Future of Exercise-Based Cardiac Rehabilitation for Patients With Heart Failure. Front Cardiovasc Med 2021; 8:709898. [PMID: 34422933 PMCID: PMC8371325 DOI: 10.3389/fcvm.2021.709898] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023] Open
Abstract
Cardiac rehabilitation (CR) is a comprehensive program that includes exercise training, titration of medical therapy, lifestyle modification, educational support, and psychosocial assessment. All these components are safe and beneficial resulting in significant improvements in quality of life, functional capacity, mortality, and hospital readmission. Current guidelines support its use in a broad spectrum of cardiac disease. This review focuses on exercise-based CR for heart failure (HF) patients in whom CR is a recommended treatment. Exercise should be prescribed according to a personalized approach, optimizing, and tailoring the rehabilitative program to the patient's characteristics. Specific CR programs are dedicated to older patients, those with HF and preserved ejection fraction, and recipients of cardiac implantable electronic devices or left ventricular assistance device. Telemedicine may increase CR participation and overcome some of the barriers that limit its utilization.
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Affiliation(s)
- Andrea Passantino
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Bari, Italy
| | | | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Veruno, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Division of Cardiac Rehabilitation, Lumezzane, Italy
| | - Massimo Pistono
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Veruno, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Milan, Italy
| | - Fabiana Isabella Gambarin
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Veruno, Italy
| | - Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Bari, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri Spa SB, Division of Cardiac Rehabilitation, Montescano, Italy
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