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Van Stee SK, Yang Q, Falcone M. Health Behavior Change Interventions Using Mobile Phones: A Meta-Analysis. HEALTH COMMUNICATION 2025; 40:1225-1247. [PMID: 39206617 DOI: 10.1080/10410236.2024.2393005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The technological capabilities of mobile phones have made them a useful tool for delivering interventions, but additional research is needed to determine the mechanisms underlying the comparative effectiveness of mobile health interventions. This meta-analysis analyzes the relative effectiveness of mobile phone-based health interventions relative to comparison/control groups (e.g., eHealth interventions, standard of care, etc.), the utility of the theory of planned behavior in mobile phone-based health interventions, and the roles of various moderators. One hundred eighteen studies met inclusion criteria and contributed to an overall effect size of d = 0.27 (95% CI [.22, .32]). Findings indicate that mobile phone-based health interventions are significantly more effective than comparison/control conditions at improving health behaviors. Additionally, perceived behavioral control was a significant moderator providing some support for the usefulness of theory of planned behavior in mobile phone-based health interventions.
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Affiliation(s)
| | - Qinghua Yang
- Department of Communication Studies, Texas Christian University
| | - Maureen Falcone
- Department of Patient Care Services, Veterans Administration St. Louis Health Care System
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2
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da Luz Goulart C, Alves ML, Medeiros FD, Borges RF, Milani M, D'Ávila LBO, Cristina Conde Holanda Sobra C, Cleides A, França B Cipriano G, Cipriano Junior G. E-Health rehabilitation on clinical, quality of life, and functional capacity in cardiovascular disease: preliminary results. BMC Sports Sci Med Rehabil 2025; 17:133. [PMID: 40437563 PMCID: PMC12117672 DOI: 10.1186/s13102-025-01087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 02/18/2025] [Indexed: 06/01/2025]
Abstract
This study aims to evaluate the preliminary effects of an e-health-based rehabilitation program delivered by a new technological solution, named eHeart, on functional capacity domains by assessing pre- and post-effects on cardiorespiratory fitness, quality of life, strength, and flexibility. The nine initial patients enrolled in this preliminary study were predominantly male (57%), elderly, with CVD, 4 of whom were diagnosed as HF, mostly with I and II NYHA functional class, and arterial hypertension (100%). Among the standard physical assessment domains changes pre and post-remote rehabilitation utilizing the eHeart technological platform, we observed a substantial increase in the cardiorespiratory capacity after rehabilitation in the number of 6MST steps (89 ± 47 versus 129 ± 48, p = 0.002), with a high D Cohen value (41.2) along with a substantial reduction on the resting rate (HR, bpm) (69 ± 10 versus 63 ± 10 bpm, p = 0.003) with a D Cohen of 25.4. Other variables (HR peak, SBP rest and peak, DBP rest and peak) did not present a significant difference following the remote protocol (p < 0.05). We observed a significant improvement after the rehabilitation in the isometric muscle strength of elbow flexion (13 ± 5 versus 18 ± 7, p = 0.04, D Cohen of 6.14) and in quality of life by the EQ-5D-5 L (0.57 ± 0.26 versus 0.71 ± 0.17, p = 0.04, D Cohen of 0.16). The conclusion of our study highlights the significant benefits of e-health in improving functional capacity, quality of life, and isometric muscle strength in individuals with CVD. Through 14 sessions, we observed marked improvements in these key health indicators, suggesting that e-health can be a valuable tool in the management of various health conditions.
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Affiliation(s)
- Cássia da Luz Goulart
- Health Sciences and Technologies Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil.
| | - Marcela Lopes Alves
- Rehabilitation Sciences Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Health Sciences and Technologies Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Robson Fernando Borges
- Rehabilitation Sciences Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Health Sciences and Technologies Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - Maurício Milani
- Rehabilitation Sciences Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | | | - Ana Cleides
- Human Movement and Rehabilitation Post Graduate Program, Evangelical University of Goiás - UniEVANGÉLICA, Anápolis, GO, Brazil
| | | | - Gerson Cipriano Junior
- Rehabilitation Sciences Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Health Sciences and Technologies Post Graduate Program, University of Brasilia (UnB), Brasilia, DF, Brazil
- Human Movement and Rehabilitation Post Graduate Program, Evangelical University of Goiás - UniEVANGÉLICA, Anápolis, GO, Brazil
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3
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Hamilton DE, Xie JX, Chang AL, Beatty AL, Golbus JR. Digital Technologies and Artificial Intelligence in Cardiac Rehabilitation: A Narrative Review. J Cardiopulm Rehabil Prev 2025; 45:169-180. [PMID: 40162809 DOI: 10.1097/hcr.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
PURPOSE This review explores the role and impact of digital technology in cardiac rehabilitation (CR), assessing its potential to enhance patient outcomes and address barriers to CR delivery. REVIEW METHODS A comprehensive literature search was conducted using curated search terms to target CR studies using digital technologies as an adjunct to in-person CR or as part of remote (ie, asynchronous) or virtual (ie, synchronous audiovisual communication) formats. The literature search focused on studies that evaluated the implementation and efficacy of using digital technologies within CR. SUMMARY Digital technology offers significant opportunities to improve CR by providing flexible and scalable solutions that can overcome traditional barriers to CR such as accessibility and capacity constraints. Remote or virtual CR delivery that incorporates digital technologies improves CR adherence and achieves similar improvements in exercise capacity when compared to in-person CR. While the majority of studies have focused on exercise, digital technologies are increasingly used to deliver comprehensive CR solutions as part of remote and virtual CR programs. However, challenges and gaps in the literature remain, such as the impact of digital literacy and promoting equitable CR access, particularly in high-risk and vulnerable populations. Further research needs to focus on longer term outcomes to evaluate the safety, efficacy, and cost-effectiveness of digital CR interventions. The potential of digital health to transform CR and reduce the burden of cardiovascular disease is substantial and warrants further investigation.
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Affiliation(s)
- David E Hamilton
- Author Affiliations: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (Drs Hamilton, Xie, and Golbus); Division of Cardiovascular Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Chang); Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Chang); Department of Epidemiology and Biostatistics, University of California, San Francisco, California (Dr Beatty); Division of Cardiology, Department of Medicine, University of California, San Francisco, California (Dr Beatty); and Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), University of Michigan, Ann Arbor, Michigan (Dr Golbus)
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Conte G, Magon A, Caruso R. The promise of truly interactive and real-time digital counselling in patients with coronary artery disease: a commentary. Eur J Cardiovasc Nurs 2025; 24:373-374. [PMID: 39760139 DOI: 10.1093/eurjcn/zvae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/05/2024] [Accepted: 12/05/2024] [Indexed: 01/07/2025]
Affiliation(s)
- Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
- Department of Biomedical Science for Health, University of Milan, Via Pascal 36, 20133 Milan, Italy
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Lahtinen M, Kaakinen P, Jansson MM, Paalimäki-Paakki K, Virtanen M, Kerimaa H, Kivelä K, Oikarinen A, Rajala M, Hylkilä K, Kääriäinen M. Effect of interactive digital counselling on risk factors and lifestyle in patients with coronary artery disease: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2025; 24:352-372. [PMID: 39743302 DOI: 10.1093/eurjcn/zvae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/18/2024] [Accepted: 10/28/2024] [Indexed: 01/04/2025]
Abstract
AIMS Digital counselling has gained paramount importance for coronary artery disease (CAD) patients' treatment in recent years. It has been shown to provide a multitude of benefits, including improved risk factors and enhanced lifestyles. No previous reviews have emphasized the interactiveness of digital counselling. Consequently, the aim of this review is to determine whether interactive two-way digital counselling can provide effective secondary prevention as alternative or adjunct care compared with usual care, where patients visit a cardiac clinic and obtain verbal information and written recommendations of the risk factors without a digital intervention. METHODS AND RESULTS Studies that implemented digital interventions in patient counselling among CAD patients were identified by searching 10 electronic databases at the end of August 2022 and updated on 15 December 2023. The Joanna Briggs Institution (JBI) protocol was used for screening, quality assessment, data extraction, and meta-analysis. In total, 15 papers were identified that reported the effect of interactive digital counselling on risk factors and lifestyle changes in CAD patients. The results of the meta-analyses had neutral pre-defined outcomes and did not show any effect on cardiovascular risk factors or lifestyle changes. CONCLUSION There is a need for better descriptions of the content and delivery of interactive digital interventions in studies. In the future, digital interventions should be designed not only to focus on patient, but to incorporate social support, peer groups, and interactive tools on a digital platform. Social support has proved to be important in terms of adherence to treatment. REGISTRATION PROSPERO CRD42021247315.
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Affiliation(s)
- Minna Lahtinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
| | - Pirjo Kaakinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
| | - Miia M Jansson
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
| | | | - Mari Virtanen
- Helsinki Metropolia University of Applied Sciences, Myllypurontie 1, 00920 Helsinki, Finland
| | - Heli Kerimaa
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
| | - Kirsi Kivelä
- The Wellbeing Services County of North Ostrobothnia, Kajaanintie 46 A, 90220 Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
| | - Mira Rajala
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
| | - Krista Hylkilä
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, University of Oulu, Aapistie 5 A, 90220 Oulu, Finland
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Yang Z, Jin D, Huang H, Zheng X, Liu S, Wang A. Nudging Health Behavior Change Among Home-Based Cardiac Rehabilitation Patients: A Scoping Review. J Multidiscip Healthc 2025; 18:1639-1653. [PMID: 40125302 PMCID: PMC11930280 DOI: 10.2147/jmdh.s515523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 03/08/2025] [Indexed: 03/25/2025] Open
Abstract
Background In home-based cardiac rehabilitation practices, nudging has emerged and was actively explored to promote health behavior change among patients with heart disease. The literature on nudging strategy is fragmented and lacks comprehensive reviews. Objective This study aimed to identify nudging interventions to promote health behavior change among patients undergoing home-based cardiac rehabilitation, focusing on the scope, characteristics and delivery. Methods A scoping review was conducted from July to September 2023, during which databases including PubMed, Web of Science, and OVID (Embase, Cochrane Library, JBI) were searched. Search terms were constructed based on population-concept-context mnemonics approach. Reviewers screened articles independently and reviewed the included articles to extract key information about each nudge intervention. Results In included 25 studies, the majority (n=21) with the nudging strategy had positive results. 14 nudge strategies were identified and coded with the primary objective of changing health behaviors. The most common nudging strategy was goal setting, followed by feedback, and reminders and alerts. To capture the heterogeneity of nudging strategies, two independent dimensions were introduced to further classify them into four quadrants (active vs passive and synchronous vs passive). For example, some nudging strategies usually occur when the target behavior must be performed (synchronization) and requires the immediate participation of the home-based cardiac rehabilitation patients (active). In addition, digital nudging technology with gamification elements may become the mainstream in future research. Conclusion These studies reflected different objectives and implement nudging strategies in different ways. Despite the multiple nudging strategies are widely adopted, identifying the contributing components remains challenging.
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Affiliation(s)
- Zhen Yang
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Dan Jin
- Department of Nursing, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Hao Huang
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Xutong Zheng
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Shu Liu
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Aiping Wang
- Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
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Pierucci A, de Almeida NS, Lemes ÍR, Milanez VF, Oliveira CB, Kretli Winkelströter L, de Abreu MAMM, Nakagaki WR, Toledo ACCG. M-health with cardiac rehabilitation improves functional capacity: A systematic review with meta-analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2025; 260:108551. [PMID: 39700688 DOI: 10.1016/j.cmpb.2024.108551] [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: 05/10/2024] [Revised: 11/21/2024] [Accepted: 12/02/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND AND OBJECTIVE In this systematic review and meta-analysis, we compared the effectiveness of the combined m-health and a cardiac rehabilitation program (CRP) and of CRP alone on functional capacity, adherence to CRP, and management of cardiovascular risk factors in cardiac patients. METHODS Medline, EMBASE, Central, PEDro, and SPORTDiscus were searched, from inception until July 2020, for randomized controlled trials (RCTs) comparing the m-health with CRP combination with CRP alone for adults with heart disease. The PEDro scale and GRADE approach was used to assess methodological and overall quality, respectively. Pooled estimates were calculated using a random-effects model to obtain the mean difference (MD) or standardized mean difference (SMD), and their respective 95 % confidence intervals (95 %CIs). RESULTS Twenty-two RCTs were eligible. The median risk-of-bias was 6.5/10. CRP with the m-Health intervention was more effective than CRP alone in improving VO2peak (MD: 1.02 95 %CI 0.50 -1.54) at short-term, and at medium-term follow-up (MD: 0.97, 95 %CI: 0.04 - 1.90. Similarly, CRP and m-Health were superior to CRP alone in increasing self-reported physical activity at short-term (SMD: 0.98, 95 %CI: 0.65 - 1.32] but not at medium-term follow-up (SMD: 0.18, 95 %CI:0.01 to 0.36). Furthermore, supervision of CRP with the m-Health intervention at short-term follow-up and M-Health and semi-supervised CRP - medium-term were more effective in improving VO2peak respectively (MD: 1.01, 95 %CI: 0.38‒1.64), (MD: 1.49, 95 %CI: 0.09, 2.89), and self-reported physical activity than supervised CRP at short-term (SMD: 0.98, 95 %CI: 0.65‒1.32) medium-term follow-ups (MD: 0.29 95 %CI: 0.12, 0.45]. CONCLUSION Our review found high-quality evidence that m-health interventions combined with CRP was more effective than CRP alone in improving cardiorespiratory fitness, at the short and medium terms follow-up.
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Affiliation(s)
- Alessandro Pierucci
- Curso de Pós-Graduação Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil; Departamento de Educação Física, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil
| | - Nathália Soares de Almeida
- Curso de Pós-Graduação Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil
| | - Ítalo Ribeiro Lemes
- Departamento de Fisioterapia, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP) Brazil; Departamento de Fisioterapia, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo , Brazil
| | - Vinicíus Flávio Milanez
- Departamento de Educação Física, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil
| | - Crystian Bitencourt Oliveira
- Curso de Pós-Graduação Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil; Departamento de Medicina, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil
| | - Lizziane Kretli Winkelströter
- Curso de Pós-Graduação Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil
| | | | - Wilson Romero Nakagaki
- Curso de Pós-Graduação Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil
| | - Ana Clara Campagnolo Gonçalves Toledo
- Curso de Pós-Graduação Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil; Departamento de Educação Física, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil; Departamento de Medicina, Universidade do Oeste Paulista, UNOESTE, Presidente Prudente, São Paulo, Brazil.
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Barber BV, Vallis M, Kephart G, Martin-Misener R, Rainham D. Leveraging context-specific behavioral economic principles to enable patients to change their physical activity patterns. J Health Psychol 2025:13591053251317320. [PMID: 39972659 DOI: 10.1177/13591053251317320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
This study explores how context-specific behavioral economic principles could be employed to tailor interventions to support patients' efforts to modify day-to-day routines. Using adapted geo-ethnography techniques, interviews collected in-depth descriptions about facilitators and barriers to physical activity (PA), and contexts influencing decisions about day-to-day activities. Data were analyzed using the COM-B model for behavior change and MINDSPACE behavioral economic principles as coding frameworks. Twenty-nine patients (19 men, 10 women) aged 50-79 participated. Findings indicate patients were motivated and capable of increasing PA but were challenged to identify opportunities to adapt day-to-day routines for increasing PA. Patients described disrupting default routines, increasing commitments, changing the messenger, and introducing incentives as potentially useful behavioral economic principles to improve day-to-day decisions about increasing PA. Patients had insight into potential behavioral economic principles, although they were not previously educated, and were valuable partners in developing research and clinic-based behavioral economic intervention strategies.
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Bertolín-Boronat C, Merenciano-González H, Marcos-Garcés V, Martínez-Mas ML, Climent Alberola JI, Pérez N, López-Bueno L, Esteban-Argente MC, Valls Reig M, Arizón Benito A, Payá Rubio A, Ríos-Navarro C, de Dios E, Gavara J, Sanchis J, Bodi V. Dynamics of HDL-Cholesterol Following a Post-Myocardial Infarction Cardiac Rehabilitation Program. Rev Cardiovasc Med 2025; 26:25399. [PMID: 39867202 PMCID: PMC11759968 DOI: 10.31083/rcm25399] [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: 06/26/2024] [Revised: 09/17/2024] [Accepted: 09/23/2024] [Indexed: 01/28/2025] Open
Abstract
Background Exercise-based cardiac rehabilitation programs (CRP) are recommended for patients following acute coronary syndrome to potentially improve high-density lipoprotein cholesterol (HDL-C) levels and prognosis. However, not all patients reach target HDL-C levels. Here we analyze the dynamics and predictors of HDL-C increase during CRP in patients following ST-segment elevation myocardial infarction or occlusion myocardial infarction. Methods We conducted a prospective study of myocardial infarction patients who completed exercise-based Phase 2 CRP. Data was collected on clinical variables, cardiovascular risk factors, treatment goals, pharmacological therapy, and health outcomes through questionnaires at the beginning and at the end of Phase 2 CRP. Lipid profile analysis was performed before discharge, 4 to 6 weeks after discharge, and at the end of Phase 2 CRP. Changes in lipid profiles were evaluated, and predictors of failure to increase HDL-C levels were identified by binary logistic regression analysis. Results Our cohort comprised 121 patients (mean age 61.67 ± 10.97 years, 86.8% male, and 47.9% smokers before admission). A significant decrease in total cholesterol, triglycerides, and low-density lipoprotein cholesterol (LDL-C) were noted, along with an increase in HDL-C (43.87 ± 9.18 vs. 39.8 ± 10.03 mg/dL, p < 0.001). Patients achieving normal HDL-C levels (>40 mg/dL in men and >50 mg/dL in women) significantly increased from 34.7% at admission to 52.9% the end of Phase 2. Multivariable analysis revealed smoking history (hazard ratio [HR] = 0.35, 95% confidence interval [CI], 0.11-0.96, p = 0.04), increased reduction in total cholesterol (HR = 0.94, 95% CI, 0.89-0.98, p = 0.004), and increased reduction in LDL-C (HR = 0.94, 95% CI, 0.89-0.99, p = 0.01) were inversely associated with failure to increase HDL-C levels. Conversely, higher HDL-C before CRP (HR = 1.15, 95% CI, 1.07-1.23, p < 0.001) and increased lipoprotein (a) (HR = 1.01, 95% CI, 1-1.02, p = 0.04) predicted failure to increase HDL-C levels. No significant correlations were found with Mediterranean diet adherence, weekly physical activity, training modalities, or physical fitness parameters. Conclusions Participation in an exercise-based Phase 2 CRP led to mild but significant increases in HDL-C. Smoking history and patients experiencing substantial reductions in total cholesterol and LDL-C were more likely to experience HDL-C increases, unlike those with higher HDL-C and lipoprotein (a) levels before CRP.
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Affiliation(s)
- Carlos Bertolín-Boronat
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Héctor Merenciano-González
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain
| | - Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain
| | - María Luz Martínez-Mas
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | | | - Nerea Pérez
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Laura López-Bueno
- Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | | | - María Valls Reig
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | | | - Alfonso Payá Rubio
- Department of Rehabilitation, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | | | - Elena de Dios
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain
| | - Jose Gavara
- Centre for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain
| | - Juan Sanchis
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Network Biomedical Research Center for Cardiovascular Diseases (CIBER-CV), 28029 Madrid, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
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Ansari S, Nadar BG, Estêvão MD, Aguiar DR, Ejeh J, Khan Z. Comparing the Outcomes of Digital and Traditional Cardiac Rehabilitation Practices: A Systematic Review and Meta-Analysis. Cureus 2025; 17:e77757. [PMID: 39981488 PMCID: PMC11840654 DOI: 10.7759/cureus.77757] [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] [Accepted: 01/20/2025] [Indexed: 02/22/2025] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the effects of digital cardiac rehabilitation (DCR) encompassing application-based telehealth compared to traditional cardiac rehabilitation onmajor adverse cardiovascular events (MACE), rehospitalisation, costs, quality of life (QoL), and physical activity levels in patients with coronary artery disease (CAD). From 2014 to May 2024, a systematic search of the MEDLINE, PubMed, Web of Science, and Scopus databases was conducted using relevant keywords to identify randomised controlled trials (RCTs) or randomised cross-over trials. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale and risk of bias tool. The included articles were then subjected to qualitative synthesis and meta-analysis. Thirteen studies involving 1850 participants were included in the study. Meta-analysis revealed statistically significant improvements in QoL (mean deviation (MD) = 0.10, 95% CI: 0.05-0.15, p = 0.0002). DCR compared with centre-based rehabilitation (CBR). These improvements in QoL likely translated to enhanced daily functioning, such as the increased ability to perform activities of daily living. However, no significant differences were found for physical activity levels (MD = 1.69, 95% CI: 1.49-4.87, p = 0.30), rehospitalisation (relative risk (RR) = 0.86, 95% CI: 0.66-1.11, p = 0.25) or MACE (RR = 0.67, 95% CI: 0.42-1.07, p = 0.09). High heterogeneity was observed in QoL, likely due to variations in DCR modalities, study populations, and intervention content. The results of this study, therefore, must be interpreted with caution. DCR may offer significant benefits in terms of improving the QoL in patients with CAD. While promising trends were observed for rehospitalisation and MACE, further research is needed to confirm these findings. Potential reasons for the observed benefits of DCR over centre-based rehabilitation plausibly include improved accessibility, enhanced patient engagement, and greater flexibility. However, it is important to acknowledge the presence of heterogeneity among the included studies and potential gender imbalances within the study populations, which may have influenced the results. Future research should prioritize long-term outcomes, cost-effectiveness, real-world effectiveness in diverse populations, and the development of standardized DCR protocols.
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Affiliation(s)
- Sumbul Ansari
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, IND
| | | | - M Dulce Estêvão
- School of Health, University of Algarve, Faro, PRT
- Algarve Biomedical Center Research Institute, University of Algarve, Faro, PRT
| | - Débora R Aguiar
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, BRA
| | - Jude Ejeh
- Faculty of Medicine, University of Geneva/Hôpital de la Tour, Geneva, CHE
| | - Zahid Khan
- Cardiology, University of South Wales, Pontypridd, GBR
- Cardiology, University of Buckingham, London, GBR
- Cardiology, Bart's Heart Centre, London, GBR
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Pong C, Tseng RMWW, Tham YC, Lum E. Current Implementation of Digital Health in Chronic Disease Management: Scoping Review. J Med Internet Res 2024; 26:e53576. [PMID: 39666972 PMCID: PMC11671791 DOI: 10.2196/53576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/26/2024] [Accepted: 10/28/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated. OBJECTIVE This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors. METHODS We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data. RESULTS A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were "obtain and use patient or consumer feedback" (196/252, 77.8%); "audit and provide feedback" (106/252, 42.1%); and piloting before implementation or "stage implementation scale-up" (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs. CONCLUSIONS This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them.
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Affiliation(s)
- Candelyn Pong
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Rachel Marjorie Wei Wen Tseng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Elaine Lum
- Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth, Singapore, Singapore
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12
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Li R, Wang M, Chen S, Zhang L. Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 158:104845. [PMID: 39032245 DOI: 10.1016/j.ijnurstu.2024.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation. OBJECTIVE To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation. DESIGN Systematic review and network meta-analysis. METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643). RESULTS This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence. CONCLUSIONS Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.
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Affiliation(s)
- Ruru Li
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Miao Wang
- The School of Nursing, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Shuoshuo Chen
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Liqing Zhang
- The Department of Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China.
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Homem F, Reveles A, Amaral A, Coutinho V, Gonçalves L. Improving transitional care after acute myocardial infarction: A scoping review. HEALTH CARE SCIENCE 2024; 3:312-328. [PMID: 39479273 PMCID: PMC11520247 DOI: 10.1002/hcs2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/18/2024] [Accepted: 08/05/2024] [Indexed: 11/02/2024]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality, posing a significant challenge to healthcare systems worldwide. Transitional care interventions, which ensure coordination and continuity of care as patients move between different levels of healthcare, have been shown to reduce unnecessary healthcare utilization and improve patient outcomes. While much attention has been given to transitional care in heart failure, this review aims to map the interventions implemented for patients following an acute myocardial infarction (AMI). A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with literature searches performed in the Cochrane, CINAHL, MEDLINE, JBI, and SciELO databases, focusing on publications from 2013 onwards in both Portuguese and English. Seventy-five studies were included, with most combining multiple interventions that contributed to improved cardiovascular health outcomes, including increased adherence to healthy lifestyle behaviors, enhanced medication compliance, and better healthcare self-management. These interventions were effective in reducing cardiovascular-related Emergency Department visits, unplanned 30-day readmissions, and mortality following a first-time myocardial infarction. Key strategies identified included discharge planning, digital health solutions, outpatient care, and healthcare coordination. The findings of this review underscore the need for developing methodologies that enhance the transition of care from hospital to primary care following an AMI. There is an urgent need to design and implement new healthcare programs that integrate discharge interventions, digital health, outpatient care, and healthcare coordination to ensure continuity of care and optimize patient outcomes post-discharge.
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Affiliation(s)
- Filipa Homem
- ULS Coimbra, Cardiologia CHUCCoimbraPortugal
- UICISA:E/ESEnfCCoimbra UniversityCoimbraPortugal
| | - Anaísa Reveles
- ULS Baixo Mondego, UIDRua HospitalFigueira da FozPortugal
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Bartos O, Trenner M. Wearable technology in vascular surgery: Current applications and future perspectives. Semin Vasc Surg 2024; 37:281-289. [PMID: 39277343 DOI: 10.1053/j.semvascsurg.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/17/2024]
Abstract
The COVID-19 pandemic exposed the vulnerabilities of global health care systems, underscoring the need for innovative solutions to meet the demands of an aging population, workforce shortages, and rising physician burnout. In recent years, wearable technology has helped segue various medical specialties into the digital era, yet its adoption in vascular surgery remains limited. This article explores the applications of wearable devices in vascular surgery and explores their potential outlets, such as enhancing primary and secondary prevention, optimizing perioperative care, and supporting surgical training. The integration of artificial intelligence and machine learning with wearable technology further expands its applications, enabling predictive analytics, personalized care, and remote monitoring. Despite the promising prospects, challenges such as regulatory complexities, data security, and interoperability must be addressed. As the digital health movement unfolds, wearable technology could play a pivotal role in reshaping vascular surgery while offering cost-effective, accessible, and patient-centered care.
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Affiliation(s)
- Oana Bartos
- Department of Vascular Medicine, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany
| | - Matthias Trenner
- Department of Vascular Medicine, St. Josefs-Hospital, Beethovenstraße 20, 65189 Wiesbaden, Germany; School of Medicine, Technical University of Munich, Munich, Germany.
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15
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van Mierlo RFR, Houben VJG, Rikken SAOF, Gómez-Doblas JJ, Lozano-Torres J, van ’t Hof AWJ. Cardiac (tele)rehabilitation in routine clinical practice for patients with coronary artery disease: protocol of the REHAB + trial. Front Cardiovasc Med 2024; 11:1387148. [PMID: 39224752 PMCID: PMC11367104 DOI: 10.3389/fcvm.2024.1387148] [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: 02/16/2024] [Accepted: 07/02/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Cardiac rehabilitation programs face the challenge of suboptimal participation, despite being a level Ia recommendation. Cardiac telerehabilitation, with its potential to engage patients who might otherwise not show interest, necessitates the adaption of existing center-based cardiac rehabilitation programs to facilitate rehabilitation at home. REHAB + is a mobile cardiac telerehabilitation program cocreated with patients and rehabilitation centers, aiming to future-proof cardiac rehabilitation and improve accessibility. The REHAB + application enables users to remotely communicate with their coach, receive on-demand feedback on health goal progression, and reduces the need for frequent in-person meetings at the cardiac rehabilitation center. The REHAB + study seeks to compare patient-related outcomes and characteristics of patients between those offered the option to participate in cardiac telerehabilitation and those attending center-based cardiac rehabilitation over a twelve-month period. Methods The REHAB + study is a multicenter, prospective, matched controlled, observational study that includes (N)STEMI patients eligible for cardiac rehabilitation. We aim to enroll 300 participants for cardiac telerehabilitation and 600 for center-based cardiac rehabilitation. Participants opting for cardiac telerehabilitation (REHAB+) will be matched with center-based cardiac rehabilitation participants. Additionally, characteristics of patients unwilling to participate in either center-based rehabilitation or telerehabilitation but are willing to share their demographics will be collected. The primary endpoint is quality of life measured with the SF-36 questionnaire at three and twelve months, with patient-related characteristics driving intervention choice as the most important secondary endpoint. Secondary endpoints include physical activity, modifiable risk factors, and digital health experience. The trial is registered at clinicaltrials.gov with registration number NCT05207072. Discussion The REHAB + trial is unique by offering patients freedom to choose between cardiac telerehabilitation and center-based rehabilitation. The integration of digital components into cardiac rehabilitation has the potential to complement behavioral change strategies for specific patient groups. Offering patients the option of cardiac telerehabilitation next to center-based rehabilitation could enhance overall cardiac rehabilitation participation rates.
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Affiliation(s)
- Rutger F. R. van Mierlo
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen and Geleen/Sittard, Netherlands
- Department of Radiation Oncology (Maastro), Research Institute for Oncology and Reproduction (GROW), Maastricht University, Maastricht, Netherlands
| | - Vitalis J. G. Houben
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen and Geleen/Sittard, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Sem A. O. F. Rikken
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Juan Jose Gómez-Doblas
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
| | - Jordi Lozano-Torres
- Department of Cardiology, Hospital Universitari Vall D’Hebron, Barcelona, Spain
| | - Arnoud W. J. van ’t Hof
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen and Geleen/Sittard, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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Paramita N, Santoso DIS, Nusdwinuringtyas N, Rasmin M, Kartinah NT, Jusman SWA, Abdullah M, Tinduh D, Widjanantie SC, Harini M, Sianipar IR, Nugraha B, Gutenbrunner C, Widaty S. The Delphi Method: Developing a Telerehabilitation Practice Guideline for Patients in Indonesia with Long COVID. Int J Telerehabil 2024; 16:e6610. [PMID: 39022434 PMCID: PMC11249837 DOI: 10.5195/ijt.2024.6610] [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] [Indexed: 07/20/2024] Open
Abstract
Telerehabilitation has the potential to help expand the reach of rehabilitation intervention. An online questionnaire-based Delphi method set out to develop a telerehabilitation guideline for patients in Indonesia with Long COVID. A Delphi panel comprised of 24 experts was selected from all relevant disciplines. Over two rounds of Delphi testing, panelists gave opinions and indicated their level of agreement with each recommendation. Key elements of consensus for a telerehabilitation guideline for patients with Long COVID includes: the benefit of telerehabilitation, types of rehabilitation intervention needed, methods of intervention, criteria for home-based self-exercise training, set-up of rehabilitation prescription, exercise monitoring, evaluation of rehabilitation intervention and duration of rehabilitation intervention. Further research is needed to determine the feasibility and effectiveness of this guideline.
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Affiliation(s)
- Nurul Paramita
- Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dewi Irawati Soeria Santoso
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nury Nusdwinuringtyas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Menaldi Rasmin
- Department of Pulmonology and Respiratory Medicine, Persahabatan National Respiratory Referral Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Neng Tine Kartinah
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Sri Widia A. Jusman
- Department of Biochemistry and Molecular Biology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Murdani Abdullah
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Damayanti Tinduh
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Department of Physical Medicine and Medical Rehabilitation, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Siti Chandra Widjanantie
- Department of Physical Medicine and Rehabilitation, Persahabatan National Respiratory Referral Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Melinda Harini
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Imelda Rosalyn Sianipar
- Department of Medical Physiology and Biophysics, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Boya Nugraha
- Department of Rehabilitation and Sport Medicine, Hannover Medical School, 30625 Hannover, Germany
- Hannover Rehabilitation Services & Science Consulting, 30627 Hannover, Germany
| | - Christoph Gutenbrunner
- Department of Rehabilitation and Sport Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Sandra Widaty
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Medical Education, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Ashley K, Tang MY, Flynn D, Cooper M, Errington L, Avery L. Identifying the active ingredients of training interventions for healthcare professionals to promote and support increased levels of physical activity in adults with heart failure: a systematic review. Health Psychol Rev 2024; 18:319-340. [PMID: 37530097 DOI: 10.1080/17437199.2023.2238811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 07/16/2023] [Indexed: 08/03/2023]
Abstract
Heart failure (HF) is characterised by breathlessness and fatigue that impacts negatively on patients' intentions to prioritise physical activity (PA). Healthcare professionals (HCPs) experience challenges when motivating patients to increase PA. It is essential to develop an understanding of how to support HCPs to deliver PA interventions. We aimed to identify active ingredients of HCP training interventions to enable delivery of PA interventions to HF patients. Nine databases were searched. Data were extracted on study characteristics, active ingredients, outcomes, and fidelity measures. Data were synthesised narratively, and a promise analysis was conducted on intervention features. Ten RCTs, which reported a training intervention for HCPs were included (N = 22 HCPs: N = 1,414 HF patients). Two studies reported the use of theory to develop HCP training. Seven behaviour change techniques (BCTs) were identified across the 10 training interventions. The most 'promising' BCTs were 'instruction on how to perform the behaviour' and 'problem solving'. Two studies reported that HCP training interventions had been formally evaluated. Fidelity domains including study design, monitoring and improving the delivery of treatment, intervention delivery, and provider training were infrequently reported. Future research should prioritise theory-informed development and robust evaluation of training interventions for HCPs to enable faithful and quality delivery of patient interventions.
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Affiliation(s)
- Kirsten Ashley
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Mei Yee Tang
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Matthew Cooper
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Linda Errington
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Leah Avery
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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18
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Gallegos-Rejas VM, Rawstorn JC, Gallagher R, Mahoney R, Thomas EE. Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:208-218. [PMID: 38774382 PMCID: PMC11104477 DOI: 10.1093/ehjdh/ztad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 05/24/2024]
Abstract
Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction and develop recommendations for future telehealth-delivered CR. The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE, and Cochrane Database) for randomized controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. We included 37 reports describing 26 randomized controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesized into four theories required to enhance participant outcomes and participation. These theories are as follows: (i) early and regular engagement; (ii) personalized interventions and shared goals; (iii) usable, accessible, and supported interventions; and (iv) exercise that is measured and monitored. Providing a personalized approach with frequent opportunities for bi-directional interaction was a critical feature for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, NSW 2050, Australia
| | - Ray Mahoney
- CSIRO Health & Biosecurity, Australian e-Health Research Centre, Surgical, Treatment and Rehabilitation Service—STARS Level 7, 296 Herston Rd, Herston 4029, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
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19
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Wu J, Olson JL, Brunke-Reese D, Lagoa CM, Conroy DE. Wearable device adherence among insufficiently-active young adults is independent of identity and motivation for physical activity. J Behav Med 2024; 47:197-206. [PMID: 37642938 PMCID: PMC10902189 DOI: 10.1007/s10865-023-00444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
Wearable devices are increasingly being integrated to improve prevention, chronic disease management and rehabilitation. Inferences about individual differences in device-measured physical activity depends on devices being worn long enough to obtain representative samples of behavior. Little is known about how psychological factors are associated with device wear time adherence. This study evaluated associations between identity, behavioral regulations, and device wear adherence during an ambulatory monitoring period. Young adults who reported insufficient physical activity (N = 271) were recruited for two studies before and after the SARS-COVID-19 pandemic declaration. Participants completed a baseline assessment and wore an Actigraph GT3X + accelerometer on their waist for seven consecutive days. Multiple linear regression indicated that wear time was positively associated with age, negatively associated with integrated regulation for physical activity, and greater after (versus before) the pandemic declaration. Overall, the model accounted for limited variance in device wear time. Exercise identity and exercise motivation were not associated with young adults' adherence to wearing the physical activity monitors. Researchers and clinicians can use wearable devices with young adults with minimal concern about systematic motivational biases impacting adherence to device wear.
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Affiliation(s)
- Jingchuan Wu
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, PA, USA
| | - Jenny L Olson
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA, USA
| | - Deborah Brunke-Reese
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, PA, USA
| | - Constantino M Lagoa
- School of Electrical Engineering & Computer Science, The Pennsylvania State University, University Park, Pennsylvania, PA, USA
| | - David E Conroy
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, PA, USA.
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Kenny E, Coyne R, McEvoy JW, McSharry J, Taylor RS, Byrne M. Behaviour change techniques and intervention characteristics in digital cardiac rehabilitation: a systematic review and meta-analysis of randomised controlled trials. Health Psychol Rev 2024; 18:189-228. [PMID: 36892523 DOI: 10.1080/17437199.2023.2185653] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023]
Abstract
Evidence suggests that digitally delivered cardiac rehabilitation (CR) is likely to be an effective alternative to centre-based CR. However, there is limited understanding of the behaviour change techniques (BCTs) and intervention characteristics included in digital CR programmes. This systematic review aimed to identify the BCTs and intervention characteristics that have been used in digital CR programmes, and to study those associated with effective programmes. Twenty-five randomised controlled trials were included in the review. Digital CR was associated with significant improvements in daily steps, light physical activity, medication adherence, functional capacity, and low-density lipoprotein-cholesterol when compared to usual care, and produced effects on these outcomes comparable to centre-based CR. The evidence for improved quality of life was mixed. Interventions that were effective at improving behavioural outcomes frequently employed BCTs relating to feedback and monitoring, goals and planning, natural consequences, and social support. Completeness of reporting on the TIDieR checklist across studies ranged from 42% to 92%, with intervention material descriptions being the most poorly reported item. Digital CR appears effective at improving outcomes for patients with cardiovascular disease. The integration of certain BCTs and intervention characteristics may lead to more effective interventions, however better intervention reporting is required.
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Affiliation(s)
- Eanna Kenny
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Rory Coyne
- School of Psychology, University of Galway, Galway, Republic of Ireland
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, School of Medicine, University of Galway, Galway, Republic of Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, University of Galway, Galway, Republic of Ireland
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21
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Hu Y, Ding K, Wu G, Li X, Li J, Shang Z. The Effect of Technology-Based Home Cardiac Rehabilitation on Risk Factor Modifications in Coronary Heart Disease Patients. A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2024; 25:59. [PMID: 39077346 PMCID: PMC11263160 DOI: 10.31083/j.rcm2502059] [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: 07/27/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 07/31/2024] Open
Abstract
Background The delivery channels and approaches related to cardiac rehabilitation (CR), such as eHealth, mHealth, and telehealth, are evolving. Several studies have identified their effects on patients with coronary heart disease, although no studies have focused on all the approaches collectively. Methods Randomized controlled trials have investigated lipid profiles, through systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Stata software was used for analysis, while Egger's linear regression test and Begg's funnel plot were also applied. Results Technology-based home CR revealed significantly lower total cholesterol (TC) levels (standardized mean difference (SMD) = -0.19; 95% confidence interval [CI]: [-0.27, -0.11]); triglyceride (TG) levels (SMD = -0.26; 95% CI: [-0.35, 0.17]); low-density lipoprotein (LDL) levels (SMD = -0.18; 95% CI: [ -0.25, -0.11]); SBP (SMD = -0.26; 95% CI: [-0.33, -0.19]); DBP (SMD = -0.24; 95% CI: [-0.32, -0.16]); BMI (SMD = -0.12; 95% CI: [-0.18, -0.05]), and improved high-density lipoprotein (HDL) levels (SMD = 0.22; 95% CI: [0.14, 0.31]). Conclusions Technology-based home CR can be used to lower TC, TG, and LDL levels, alongside the BMI, SBP, and DBP indexes, while also raising HDL levels; thus, its use should be widely promoted.
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Affiliation(s)
- Yemei Hu
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Kun Ding
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Gang Wu
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Xuedong Li
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Jun Li
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Zhuo Shang
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
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22
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Hamborg TG, Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Simonÿ C, Grøntved A, Brønd JC, Soja AMB, Tang LH. mHealth intervention including text messaging and behaviour change techniques to support maintenance of physical activity after cardiac rehabilitation: A single-arm feasibility study. Digit Health 2024; 10:20552076241239243. [PMID: 38495859 PMCID: PMC10943751 DOI: 10.1177/20552076241239243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To evaluate the feasibility of a mobile health-supported intervention in patients with cardiovascular diseases after completion of a cardiac rehabilitation programme. Methods The feasibility study was performed in two hospitals and one municipality in Region Zealand, Denmark. Eligible participants were ≥18 years old, participated in a supervised cardiac rehabilitation programme, had access to a mobile phone, and could walk 3 m independently. Participants received a 12-week intervention utilizing behaviour change techniques, consisting of action planning, text messages, and phone support. Feasibility was assessed using pre-defined progression criteria, which included recruitment (≥75%), retention (≥80%), accelerometer data completeness (≥80%), coordinator (phone support) time (≤30 min), the response rate on patient-reported outcomes (≥90%), adherence (≥75% respond to ≥75% of messages), and acceptability (≥75%). The secondary outcome of objective physical activity was assessed with accelerometers. Results Ten women and 30 men with cardiovascular diseases aged 63.5 (±9.8 SD) participated. The progression criteria for retention (90%), accelerometer data completeness (83%), coordinator time (9.9 min), adherence (83%), and acceptability (82%) were at acceptable levels, exceptions were progression criteria for recruitment (35%) being below acceptable levels for recruitment, and response rate on patient-reported outcomes (75%). High satisfaction (92.6%) with the intervention was found. All objectively measured physical activity levels remained unchanged from baseline to follow-up. No serious adverse events related to the intervention were reported. Conclusion Mobile health-supported maintenance of physical activity after cardiac rehabilitation completion was feasible, safe, and acceptable. Yet, changes to improve recruitment and response rate are needed before conducting a large-scale effect evaluation.
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Affiliation(s)
- Trine G Hamborg
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Rune M Andersen
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mikkel B Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Madalina Jäger
- Danish Center for Motivation and Behaviour Change, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan C Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne M B Soja
- Department of Medicine 1, Section of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Lars H Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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23
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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24
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Heimer M, Schmitz S, Teschler M, Schäfer H, Douma ER, Habibovic M, Kop WJ, Meyer T, Mooren FC, Schmitz B. eHealth for maintenance cardiovascular rehabilitation: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:1634-1651. [PMID: 37154363 DOI: 10.1093/eurjpc/zwad145] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
AIMS To provide a quantitative analysis of eHealth-supported interventions on health outcomes in cardiovascular rehabilitation (CR) maintenance (phase III) in patients with coronary artery disease (CAD) and to identify effective behavioural change techniques (BCTs). METHODS AND RESULTS A systematic review was conducted (PubMed, CINAHL, MEDLINE, and Web of Science) to summarize and synthesize the effects of eHealth in phase III maintenance on health outcomes including physical activity (PA) and exercise capacity, quality of life (QoL), mental health, self-efficacy, clinical variables, and events/rehospitalization. A meta-analysis following the Cochrane Collaboration guidelines using Review Manager (RevMan5.4) was performed. Analyses were conducted differentiating between short-term (≤6 months) and medium/long-term effects (>6 months). Effective behavioural change techniques were defined based on the described intervention and coded according to the BCT handbook. Fourteen eligible studies (1497 patients) were included. eHealth significantly promoted PA (SMD = 0.35; 95%CI 0.02-0.70; P = 0.04) and exercise capacity after 6 months (SMD = 0.29; 95%CI 0.05-0.52; P = 0.02) compared with usual care. Quality of life was higher with eHealth compared with care as usual (SMD = 0.17; 95%CI 0.02-0.32; P = 0.02). Systolic blood pressure decreased after 6 months with eHealth compared with care as usual (SMD = -0.20; 95%CI -0.40-0.00; P = 0.046). There was substantial heterogeneity in the adapted BCTs and type of intervention. Mapping of BCTs revealed that self-monitoring of behaviour and/or goal setting as well as feedback on behaviour were most frequently included. CONCLUSION eHealth in phase III CR is effective in stimulating PA and improving exercise capacity in patients with CAD while increasing QoL and decreasing systolic blood pressure. Currently, data of eHealth effects on morbidity, mortality, and clinical outcomes are scarce and should be investigated in future studies. REGISTRATION PROSPERO: CRD42020203578.
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Affiliation(s)
- Melina Heimer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Sandra Schmitz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Hendrik Schäfer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Emma R Douma
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Mirela Habibovic
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Willem J Kop
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Thorsten Meyer
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute for Rehabilitation Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank C Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
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25
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Hao L, Goetze S, Alessa T, Hawley MS. Effectiveness of Computer-Tailored Health Communication in Increasing Physical Activity in People With or at Risk of Long-Term Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46622. [PMID: 37792469 PMCID: PMC10585448 DOI: 10.2196/46622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 08/06/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Regular physical activity (PA) is beneficial for enhancing and sustaining both physical and mental well-being as well as for the management of preexisting conditions. Computer-tailored health communication (CTHC) has been shown to be effective in increasing PA and many other health behavior changes in the general population. However, individuals with or at risk of long-term conditions face unique barriers that may limit the applicability of CTHC interventions to this population. Few studies have focused on this cohort, providing limited evidence for the effectiveness of CTHC in promoting PA. OBJECTIVE This systematic review and meta-analysis aims to assess the effectiveness of CTHC in increasing PA in individuals with or at risk of long-term conditions. METHODS A systematic review and meta-analysis were conducted to evaluate the effect of CTHC in increasing PA in people with or at risk of long-term conditions. Hedges g was used to calculate the mean effect size. The total effect size was pooled and weighted using inverse variance. When possible, potential moderator variables were synthesized, and their effectiveness was evaluated by subgroups analysis with Q test for between-group heterogeneity Qb. Potential moderator variables included behavior change theories and models providing the fundamental logic for CTHC design, behavior change techniques and tailoring strategies to compose messages, and computer algorithms to achieve tailoring. Several methods were used to examine potential publication bias in the results, including the funnel plot, Egger test, Begg test, fail-safe N test, and trim-and-fill method. RESULTS In total, 24 studies were included in the systematic review for qualitative analysis and 18 studies were included in the meta-analysis. Significant small to medium effect size values were found when comparing CTHC to general health information (Hedges g=0.16; P<.001) and to no information sent to participants (Hedges g=0.29; P<.001). Half of the included studies had a low to moderate risk of bias, and the remaining studies had a moderate to high risk of bias. Although the results of the meta-analysis indicated no evidence of publication bias, caution is required when drawing definitive conclusions due to the limited number of studies in each subgroup (N≤10). Message-tailoring strategies, implementation strategies, behavior change theories and models, and behavior change techniques were synthesized from the 24 studies. No strong evidence was found from subgroup analyses on the effectiveness of using particular behavior change theories and models or from using particular message-tailoring and implementation strategies. CONCLUSIONS This study demonstrates that CTHC is effective in increasing PA for people with or at risk of long-term conditions, with significant small to medium effects compared with general health information or no information. Further studies are needed to guide design decisions for maximizing the effectiveness of CTHC.
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Affiliation(s)
- Longdan Hao
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Stefan Goetze
- Department of Computer Science, University of Sheffield, Sheffield, United Kingdom
| | - Tourkiah Alessa
- Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mark S Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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26
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Yang Z, Jia X, Li J, Mei Z, Yang L, Yan C, Han Y. Efficacy and Safety of Hybrid Comprehensive Telerehabilitation (HCTR) for Cardiac Rehabilitation in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Occup Ther Int 2023; 2023:5147805. [PMID: 37593110 PMCID: PMC10432031 DOI: 10.1155/2023/5147805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
Backgrounds Cardiovascular disease (CVD) is a serious condition that poses threats to patients' quality of life and life expectancy. Cardiac rehabilitation is a crucial treatment option that can improve outcomes for CVD patients. Hybrid comprehensive telerehabilitation (HCTR) is a relatively new approach. In the context of pandemics, HCTR can minimize the risk of cluster infections by reducing hospital visits while delivering effective rehabilitation care. This study is aimed at assessing the efficacy and safety of HCTR as a secondary prevention measure for CVD patients compared to usual rehabilitation care. Methods We searched PubMed, Embase, The Web of Science, The Cochrane Library, and PsychINFO for all related studies up to January 20, 2023. Two reviewers independently screened the titles and abstracts of potentially eligible articles based on the predefined search criteria. Data were analyzed using a comprehensive meta-analysis software (RevMan5.3). Results Eight trials, involving 1578 participants, were included. HCTR and usual rehabilitation care provide similar effects on readmission rates (odds ratio (OR) = 0.90 (95% CI 0.69-1.17), P = 0.43) and mortality (odds ratio (OR) = 1.06 (95% CI 0.72-1.57), P = 0.76). Effects on Short Form-36 Health Status Questionnaire (SF-36) score were also similar (SMD: 1.32 (95% CI-0.48-3.11), P = 0.15). Compared with usual rehabilitation care, HCTR can improve peak oxygen uptake (VO2 peak) (SMD: 0.99 (95% CI 0.23-1.74), P = 0.01) and 6-minute walking test (6MWT) (SMD: 10.02 (95% CI 5.44-14.60), P < 0.001) of patients. Conclusions Our findings indicate that HCTR is as effective as traditional rehabilitation care in reducing readmission rates and mortality and improving quality of life in patients with CVD. However, HCTR offers the added advantage of improving VO2 peak and 6MWT, measurements of cardiorespiratory fitness and functional capacity, respectively. These results suggest that HCTR can be a safe and effective alternative to traditional rehabilitation care, offering numerous benefits for CVD patients. Clinical Study Registration Number. This trial is registered with NCT02523560 and NCT02796404.
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Affiliation(s)
- Zheming Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Xiaodong Jia
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Jiayin Li
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Zhu Mei
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Lin Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Chenghui Yan
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Yaling Han
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, Liaoning 110167, China
- State Key Laboratory of Frigid Zone Cardiovascular Diseases (SKLFZCD), Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang 110016, China
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27
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Zhong W, Liu R, Cheng H, Xu L, Wang L, He C, Wei Q. Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2023; 11:e46359. [PMID: 37505803 PMCID: PMC10422170 DOI: 10.2196/46359] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. METHODS We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. RESULTS In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. CONCLUSIONS Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients.
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Affiliation(s)
- Wen Zhong
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Rui Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Hongxin Cheng
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lin Xu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Lu Wang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Chengqi He
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, China
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Heizmann AN, Chapelle C, Laporte S, Roche F, Hupin D, Le Hello C. Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e069966. [PMID: 37433730 DOI: 10.1136/bmjopen-2022-069966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE To systematically review randomised controlled trials (RCTs) using a wearable physical activity monitoring device as an intervention to increase daily walking activity and improve physical capacities in patients with cardiovascular disease (CVD). DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES PubMed, Embase and Web of Science from inception to June 2022. ELIGIBILITY CRITERIA Randomised controlled studies including patients with CVD over 18 years of age at the end of a cardiac rehabilitation programme comparing an intervention group using a wearable physical activity monitoring device with feedback with usual care or with a control group receiving no feedback on their physical activity and reporting a change in the daily number of steps and/or a change in the distance covered in the 6-minute walk test (6-MWT) or a change in peak oxygen uptake (V̇O2peak) as endpoints. RESULTS Sixteen RCTs were included. The intervention of wearing a physical activity monitoring device with feedback significantly improved daily number of steps compared with controls (standardised mean difference (SMD) 0.85; 95% CI (0.42; 1.27); p<0.01). The effect was greater when the duration of the intervention was less than 3 months (SMD 1.0; 95% CI (0.18; 1.82); p<0.01) than when the duration of the intervention was 3 months or longer (SMD 0.71; 95% CI (0.27; 1.16); p<0.01), but no significant interaction was found between subgroups (p=0.55). 6-MWT distance and V̇O2peak showed only small effects (SMD 0.34; 95% CI (-0.11; 0.80); p=0.02 and SMD 0.54; 95% CI (0.03; 1.03); p=0.07, respectively). CONCLUSION The use of wearable physical activity monitoring devices appears to help patients with CVD to increase their daily walking activity and thus their physical activity, particularly in the short term. PROSPERO REGISTRATION NUMBER CRD42022300423.
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Affiliation(s)
- Anne-Noëlle Heizmann
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
| | - Céline Chapelle
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Clinical Research Unit, Innovation, Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Silvy Laporte
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Clinical Research Unit, Innovation, Pharmacology, Saint-Etienne University Hospital, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
| | - Frederic Roche
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Physiology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - David Hupin
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Physiology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Claire Le Hello
- INSERM U1059-SAINBIOSE, Jean Monnet University, Mines Saint-Etienne, Saint-Etienne, France
- Campus Health and Innovation, Jean Monnet University, Saint-Etienne, France
- Department of Vascular and Therapeutic Medicine, Saint-Etienne University Hospital, Saint-Etienne, France
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Zangger G, Bricca A, Liaghat B, Juhl CB, Mortensen SR, Andersen RM, Damsted C, Hamborg TG, Ried-Larsen M, Tang LH, Thygesen LC, Skou ST. Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46439. [PMID: 37410534 PMCID: PMC10359919 DOI: 10.2196/46439] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Digital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear. OBJECTIVE This systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. METHODS We searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of 14,078 hits, 130 randomized controlled trials were included. Compared with usual care or minimal intervention, digital health interventions increased objectively measured physical activity (end of intervention: standardized mean difference [SMD] 0.29, 95% CI 0.21-0.37; follow-up: SMD 0.17, 95% CI 0.04-0.31) and physical function (end of intervention: SMD 0.36, 95% CI 0.12-0.59; follow-up: SMD 0.29, 95% CI 0.01-0.57). The secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life at the end of the intervention but only subjectively measured physical activity at follow-up. The risk of nonserious adverse events, but not serious adverse events, was higher in the digital health interventions at the end of the intervention, but no difference was seen at follow-up. CONCLUSIONS Digital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention. TRIAL REGISTRATION PROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028.
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Affiliation(s)
- Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Evidence-Based Orthopedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev and Gentofte, Denmark
| | - Sofie Rath Mortensen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Camma Damsted
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Trine Grønbek Hamborg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Jones AK, Yan CL, Rivera Rodriquez BP, Kaur S, Andrade-Bucknor S. Role of wearable devices in cardiac telerehabilitation: A scoping review. PLoS One 2023; 18:e0285801. [PMID: 37256878 PMCID: PMC10231816 DOI: 10.1371/journal.pone.0285801] [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: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based comprehensive program that includes exercise training, health education, physical activity promotion, and extensive counseling for the management of cardiovascular risk factors. Wearable devices monitor certain physiological functions, providing biometric data such as heart rate, movement, sleep, ECG analysis, blood pressure, energy expenditure, and numerous other parameters. Recent evidence supports wearable devices as a likely relevant component in cardiovascular risk assessment and disease prevention. The purpose of this scoping review is to better understand the role of wearable devices in home-based CR (HBCR) and to characterize the evidence regarding the incorporation of wearable devices in HBCR programs and cardiovascular outcomes. METHODS & FINDINGS We created a search strategy for multiple databases, including PubMed, Embase (Elsevier), CINAHL (Ebsco), Cochrane CENTRAL (Wiley), and Scopus (Elsevier). Studies were included if the patients were eligible for CR per Medicare guidelines and >18 years of age and if some type of wearable device was utilized during HBCR. Our search yielded 57 studies meeting all criteria. The studies were classified into 4 groups: patients with coronary heart disease (CHD) without heart failure (HF); patients with HF; patients with heart valve repair or replacement; and patients with exposure to center-based CR. In three groups, there was an upward trend toward improvement in quality of life (QOL) and peak VO2, less sedentary time, and an increase in daily step count in the intervention groups compared to control groups. CONCLUSIONS HBCR using wearable devices can be a comparable alternative or adjunct to center-based CR for patients with CHD and HF. More studies are needed to draw conclusions about the comparability of HBCR to center-based CR in patients with heart valve repair or replacement.
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Affiliation(s)
- Alexis K. Jones
- University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Crystal Lihong Yan
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | | | - Sukhpreet Kaur
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
| | - Sharon Andrade-Bucknor
- Department of Medicine, Division of Cardiovascular Disease, University of Miami/Jackson Memorial Hospital, Miami, FL, United States of America
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Bernardo Ferreira J, Cabral M, Santos R, Ferreira M, Fonseca-Pinto R, Antunes A, Januário F. Hybrid Cardiac Telerehabilitation After Acute Coronary Syndrome: Self-selection Predictors and Outcomes. Int J Telerehabil 2023; 15:e6475. [PMID: 38046554 PMCID: PMC10687976 DOI: 10.5195/ijt.2023.6475] [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] [Indexed: 12/05/2023] Open
Abstract
Aims To evaluate the effectiveness of a hybrid cardiac telerehabilitation (HCTR) program after acute coronary syndrome (ACS) on patient quality of life (QoL) and physical activity indices throughout phases 2-3 and establish predictors for hybrid program self-selection. Methodology This single-centre longitudinal retrospective study included patients who attended a cardiac rehabilitation program (CRP) between 2018-2021. Patients self-selected between two groups: Group 1 - conventional CRP (CCRP); Group 2 - HCTR. Baseline characteristics were registered. EuroQol-5D (EQ-5D) and International Physical Activity Questionnaire (IPAQ) were applied at three times: T0 - phase 2 onset; T1 - phase 3 onset; T2 - 3 months after T1. Results 59 patients participated (Group 1 - 27; Group 2 - 32). We found significant between-group differences regarding occupation (p=0.003). Diabetic patients were less likely to self-select into HCTR (OR=0.21; p<0.05). EQ-5D visual analogue scale and IPAQ result significantly improved between T0-T2 only for HCTR (p=0.001; p=0.021). Conclusions HCTR was superior to CCRP on physical activity indices and QoL of ACS patients.
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Affiliation(s)
- José Bernardo Ferreira
- Physical and Rehabilitation Medicine Department, Leiria Hospital Centre, Leiria, Portugal
| | | | - Rita Santos
- Physical and Rehabilitation Medicine Department, Leiria Hospital Centre, Leiria, Portugal
| | - Marta Ferreira
- Centro De Matemática, Universidade Do Minho, Braga, Portugal
| | - Rui Fonseca-Pinto
- CiTechcare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Alexandre Antunes
- Cardiology Department, Leiria Hospital Centre, Leiria, Portugal
- CiTechcare-Center for Innovative Care and Health Technology, Polytechnic of Leiria, Leiria, Portugal
| | - Filipa Januário
- Physical and Rehabilitation Medicine Department, Leiria Hospital Centre, Leiria, Portugal
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Popovici M, Ursoniu S, Feier H, Mocan M, Tomulescu OMG, Kundnani NR, Valcovici M, Dragan SR. Benefits of Using Smartphones and Other Digital Methods in Achieving Better Cardiac Rehabilitation Goals: A Systematic Review and Meta-Analysis. Med Sci Monit 2023; 29:e939132. [PMID: 37143317 PMCID: PMC10167866 DOI: 10.12659/msm.939132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The importance of introducing digital technology as an alternative to classical cardiac rehabilitation has been discussed in several reviews. The purpose of this systematic review and meta-analysis was to analyze the effectiveness of digital technology use in cardiac rehabilitation to determine whether digital methods like use of smartphones, compared to traditional rehabilitation methods, can improve the overall quality of life and exercise capacity of cardiac patients. MATERIAL AND METHODS PubMed, EMBASE, and ScienceDirect were systematically searched in a randomized manner, resulting in 11 randomized controlled trials (RCTs) that met all the inclusion criteria. The inclusion criteria were patients with coronary heart disease, valvular surgery, or post- myocardial revascularization that were in a technology-assisted cardiac rehabilitation program vs traditional standard physical follow-up protocol. RESULTS Seven eligible trials including a total of 802 participants examined the effect of interventions on VO2 peak. One of the studies comprised 2-stage analysis for this parameter. We found that VO₂ peak was significantly higher in the intervention group. Three studies analyzed the 6-minute walk test (6MWT) results; significant differences were reported, with better results in the interventional group. CONCLUSIONS The results of our meta-analysis support conducting further randomized trials, considering that the development of technology is on the rise. In the past decade there has been an immense increase in the use of smartphones, which can widely be used in healthcare, with promising benefits in having efficient home-based monitoring of the patients and in reducing financial burden.
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Affiliation(s)
- Miruna Popovici
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- Department of Functional Sciences, Discipline of Public Health, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Center for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Horea Feier
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Mihaela Mocan
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Nilima Rajpal Kundnani
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Mihaela Valcovici
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Simona Ruxanda Dragan
- Department VI Cardiology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Cardiology, Institute of Cardiovascular Diseases, Timisoara, Romania
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Yu T, Xu H, Sui X, Zhang X, Pang Y, Yu T, Lian X, Zeng T, Wu Y, Leng X, Li F. Effectiveness of eHealth Interventions on Moderate-to-Vigorous Intensity Physical Activity Among Patients in Cardiac Rehabilitation: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e42845. [PMID: 36989017 PMCID: PMC10131595 DOI: 10.2196/42845] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/27/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation is a class IA recommendation for patients with cardiovascular diseases. Physical activity is the core component and core competency of a cardiac rehabilitation program. However, many patients with cardiovascular diseases are failing to meet cardiac rehabilitation guidelines that recommend moderate-to-vigorous intensity physical activity. OBJECTIVE The major objective of this study was to review the evidence of the effectiveness of eHealth interventions in increasing moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. The secondary objective was to examine the effectiveness of eHealth interventions in improving cardiovascular-related outcomes, that is, cardiorespiratory fitness, waist circumference, and systolic blood pressure. METHODS A comprehensive search strategy was developed, and a systematic search of 4 electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) was conducted for papers published from the start of the creation of the database until November 27, 2022. Experimental studies reporting on eHealth interventions designed to increase moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation were included. Multiple unblinded reviewers determined the study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Collaboration Tool for randomized controlled trials and the Cochrane Effective Practice and Organization of Care group methods for nonrandomized controlled trials. A random-effect model was used to provide the summary measures of effect (ie, standardized mean difference and 95% CI). All statistical analyses were performed using Stata 17. RESULTS We screened 3636 studies, but only 29 studies were included in the final review, of which 18 were included in the meta-analysis. The meta-analysis demonstrated that eHealth interventions improved moderate-to-vigorous intensity physical activity (standardized mean difference=0.18, 95% CI 0.07-0.28; P=.001) and vigorous-intensity physical activity (standardized mean difference=0.2, 95% CI 0.00-0.39; P=.048) but did not improve moderate-intensity physical activity (standardized mean difference=0.19, 95% CI -0.12 to 0.51; P=.23). No changes were observed in the cardiovascular-related outcomes. Post hoc subgroup analyses identified that wearable-based, web-based, and communication-based eHealth intervention delivery methods were effective. CONCLUSIONS eHealth interventions are effective at increasing minutes per week of moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. There was no difference in the effectiveness of the major eHealth intervention delivery methods, thereby providing evidence that in the future, health care professionals and researchers can personalize convenient and affordable interventions tailored to patient characteristics and needs to eliminate the inconvenience of visiting center-based cardiac rehabilitation programs during the COVID-19 pandemic and to provide better support for home-based maintenance of cardiac rehabilitation. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021278029; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278029.
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Affiliation(s)
- Tianzhuo Yu
- School of Nursing, Jilin University, Changchun, China
| | - Haiyan Xu
- School of Nursing, Jilin University, Changchun, China
| | - Xin Sui
- School of Nursing, Jilin University, Changchun, China
| | - Xin Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Yue Pang
- School of Nursing, Jilin University, Changchun, China
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, China
| | - Xiaoqian Lian
- School of Nursing, Jilin University, Changchun, China
| | - Ting Zeng
- School of Nursing, Jilin University, Changchun, China
| | - Yuejin Wu
- School of Nursing, Jilin University, Changchun, China
| | - Xin Leng
- School of Nursing, Jilin University, Changchun, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, China
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Ebrahimi Sheikh-Shabani L, Aliakbari F, Khaledifar A, Deris F, Aein F. The Effect of Family-Centered Intervention via SMS on Life Expectancy and Self-Efficacy in Medication Regimen Compliance in Patients With Acute MI: A Randomized Clinical Trial. ARYA ATHEROSCLEROSIS 2023; 19:30-41. [PMID: 38883571 PMCID: PMC11066776 DOI: 10.48305/arya.2022.11809.2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/17/2022] [Indexed: 06/18/2024]
Abstract
BACKGROUND Myocardial infarction (MI) is a life-threatening condition affecting an individual's physical and social circumstances. Life expectancy and self-efficacy are required to determine the risk of cardiac complications associated with this disease. This study examined the effect of family-centered intervention via short message service (SMS) on patients with acute MI's life expectancy and self-efficacy in medication regimens. METHOD This study was a randomized, single-blind clinical trial. In 2018, 80 patients hospitalized with acute MI at educational centers affiliated with Shahrekord University were randomly assigned to the control and experimental groups. Routine intervention was performed in the control group. The experimental group was sent four educational text messages weekly for three months. Both groups' life expectancy and belief in their ability to adhere to their prescribed medication regimen were evaluated before and after the intervention. The data were analyzed using descriptive statistics, independent t, paired t, and chi-square tests via SPSS software. RESULTS The results showed that the mean difference score of total life expectancy change was significantly different between the experimental (12.23± 10.48) and the control group (0.06±7.16) (P < 0.001). The mean difference score of self-efficacy in the experimental group (21.94±12.76) was significantly higher than that in the control group (4.66±9.49) (P<0.001). CONCLUSIONS In patients with acute MI, using a text message intervention improved life expectancy and self-efficacy regarding medication regimens. Therefore, this intervention can be used as a low-cost and readily accessible tool to improve these patients' self-efficacy and life expectancy.
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Affiliation(s)
| | - Fatemeh Aliakbari
- Assistant Professor, Community-Oriented Nursing Midwifery Research Center, Nursing and Midwifery School, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Arsalan Khaledifar
- Associate Professor of Cardiovascular Surgery, Department of Cardiology, School of Medicine, Modeling in Health Research Center, Hajar Hospital, Shahrekord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Fatemeh Deris
- MSC, Department OF Epidemiology and Biostatistics, School of public health, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Fereshteh Aein
- Associate Professor, PhD, RN, Community-Oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahr-e-Kord, Iran
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Milewski K, Balsam P, Kachel M, Sitek B, Kolarczyk-Haczyk A, Skoczyński S, Hirnle P, Gawałko M, Kołtowski Ł, Główczynska R, Zając T, Małecki A, Nowak A, Kaźmierczak P, Piotrowicz E, Piotrowicz R, Jaguszewski M, Opolski G, Grabowski M. Actual status and future directions of cardiac telerehabilitation. Cardiol J 2023; 30:12-23. [PMID: 36385603 PMCID: PMC9987557 DOI: 10.5603/cj.a2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/03/2022] [Accepted: 05/22/2022] [Indexed: 11/18/2022] Open
Abstract
Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the recent COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions.
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Affiliation(s)
- Krzysztof Milewski
- American Heart of Poland SA, Katowice, Poland. .,University of Silesia, Faculty of Medicine, Katowice, Poland.
| | - Pawel Balsam
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Bronislaw Sitek
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Szymon Skoczyński
- Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Tomasz Zając
- The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - Andrzej Małecki
- The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | - Agata Nowak
- The Jerzy Kukuczka Academy of Physical Education in Katowice, Poland
| | | | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, National Institute of Cardiology, Warsaw, Poland.,College of Rehabilitation, National Institute of Cardiology, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
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Ghannem M, Boaouina MS, Ghannem L. [What imaging and what tools for modern cardiac rehabilitation ?]. Ann Cardiol Angeiol (Paris) 2022; 71:428-432. [PMID: 36272831 DOI: 10.1016/j.ancard.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Conventional Cardiovascular Rehabilitation (RCV) is a global approach; it integrates reconditioning with personalized effort, physical activity (PA), therapeutic education, dietary management, smoking cessation, medication compliance. It requires a multidisciplinary approach with interventions by cardiologists, paramedics, physiotherapists, teachers of adapted physical activity (APA), dieticians, addictologists, and a specialized technical platform for evaluation and reconditioning at the 'effort. The benefit of cardiovascular rehabilitation is supported by numerous studies, it is strongly recommended class IA [1], but the supply of care is insufficient. It is therefore necessary to develop a modality of care in RCV at home, subject to the same requirements as the programs in the center, thanks to the contributions of new technology and connected objects. Technological innovations have made it technically possible to treat and monitor patients remotely [14]. Telerehabilitation is an example of the application of technology-based care. It can be defined as the provision of Secondary Prevention at a distance. It consists of remote monitoring of patient physiological data, remote coaching, e-learning and social interaction [10]. From a theoretical point of view, cardiac telerehabilitation has the potential to go beyond traditional rehabilitation; it removes the barriers that prevent patients with ischemic heart disease from participating in rehabilitation programs in conventional centers. Several studies show that telerehabilitation represents an alternative, less expensive, effective, and profitable, it could, in addition to existing services, improve access to rehabilitation [15]. Increasing participation rates in cardiac rehabilitation can reduce disease burden. The study of the economic and social impact of increasing the use of cardiac rehabilitation and cardiac telerehabilitation shows that and the resulting benefits exceed its costs. Mots-clés: Réadaptation en centre; réadaptation à domicile; téléréadaptation.
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Affiliation(s)
- Mohamed Ghannem
- Université de Picardie Jules Verne UFR médecine. EA 3300 adaptation Physiologique à l'Exercice et Réadaptation cardiaque à l'Effort (APERE) 1, chemin du Thil- CS 52501 - 80025 Amiens cedex, France; Faculté de médecine de Sousse. Rue Mohamed Karoui, Sousse - 4002 Tunisie; Hôpital de Gonesse 2 boulevard du 19 mars 1962, Gonesse 95500 France
| | | | - Lotfi Ghannem
- Hôpital privé d'Antony. 1 Rue Velpeau, 92160 Antony France
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Gallagher R, Chow CK, Parker H, Neubeck L, Celermajer DS, Redfern J, Tofler G, Buckley T, Schumacher T, Hyun K, Boroumand F, Figtree G. The effect of a game-based mobile app 'MyHeartMate' to promote lifestyle change in coronary disease patients: a randomized controlled trial. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 4:33-42. [PMID: 36743873 PMCID: PMC9890079 DOI: 10.1093/ehjdh/ztac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/12/2022] [Indexed: 11/26/2022]
Abstract
Aims Secondary prevention reduces coronary heart disease (CHD) progression. Traditional prevention programs including cardiac rehabilitation are under-accessed, which smartphone apps may overcome. To evaluate the effect of a game-based mobile app intervention (MyHeartMate) to improve cardiovascular risk factors and lifestyle behaviours. Methods and results Single-blind randomized trial of CHD patients in Sydney, 2017-2021. Intervention group were provided the MyHeartMate app for 6 months. Co-designed features included an avatar of the patient's heart and tokens earned by risk factor work (tracking, challenges, and quizzes). The control group received usual care. Primary outcome was self-reported physical activity [metabolic equivalents (METs), Global Physical Activity Questionnaire] and secondary outcomes included lipid levels, blood pressure (BP), body mass index, and smoking. Pre-specified sample size was achieved (n = 390), age 61.2 ± 11.5 years; 82.5% men and 9.2% current smokers. At 6 months, adjusted for baseline levels, the intervention group achieved more physical activity than control (median difference 329 MET mins/wk), which was not statistically significant (95% CI -37.4, 696; P = 0.064). No differences occurred between groups on secondary outcomes except for lower triglyceride levels in the intervention [mean difference -0.3 (95% CI -0.5, -0.1 mmoL/L, P = 0.004)]. Acceptability was high: 94.8% of intervention participants engaged by tracking exercise or BP and completing missions; 26.8% continued to engage for ≥30 days. Participants (n = 14) reported the app supported tracking behaviours and risk factors, reinforcing and improving self-care confidence, and decreasing anxiety. Conclusion A game-based app proved highly acceptable for patients with CHD but did not improve risk factors or lifestyle behaviours other than triglyceride levels.
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Affiliation(s)
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, 176 Hawkesbury Road, Westmead, New South Wales 2006, Australia,Department of Cardiology, Westmead Hospital, 176 Hawkesbury Road, Westmead, New South Wales 2145, Australia
| | - Helen Parker
- Charles Perkins Centre, University of Sydney, Building D17 Johns Hopkins Drive, Sydney, New South Wales 2006, Australia,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, New South Wales 2006, Australia
| | - Lis Neubeck
- The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Close, Sighthill, EH11 4QD, UK
| | - David S Celermajer
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, John Hopkins Drive, Camperdown, New South Wales 2006, Australia,Department of Cardiology, Royal Prince Alfred Hospital, John Hopkins Drive, Camperdown, New South Wales 2050, Australia,Clinical Research Group, The Heart Research Institute, 7 Eliza Street, Newtown, New South Wales 2042, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, New South Wales 2006, Australia
| | - Geoffrey Tofler
- Department of Cardiology, Royal North Shore Hospital, Reserve Road St, Leonards, New South Wales 2065, Australia,Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Reserve Road St, Leonards, New South Wales 2006, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Building D17 Johns Hopkins Drive, Sydney, New South Wales 2006, Australia,Cardiovascular Discovery Group, Kolling Institute of Medical Research, Reserve Road St, Leonards, New South Wales 2065, Australia
| | - Tracy Schumacher
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Road, Callaghan, New South Wales 2308, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, New South Wales 2006, Australia
| | - Farzaneh Boroumand
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Building D17 Johns Hopkins Drive, Sydney, New South Wales 2006, Australia,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Susan Wakil Health Building, Western Ave, Camperdown, New South Wales 2006, Australia,School of Mathematical and Physical Sciences, Macquarie University, Herring Road, North Ryde, New South Wales 2109, Australia
| | - Gemma Figtree
- Department of Cardiology, Royal North Shore Hospital, Reserve Road St, Leonards, New South Wales 2065, Australia,Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Reserve Road St, Leonards, New South Wales 2006, Australia,Cardiovascular Discovery Group, Kolling Institute of Medical Research, Reserve Road St, Leonards, New South Wales 2065, Australia
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Alam S, Zhang M, Harris K, Fletcher LM, Reneker JC. The Impact of Consumer Wearable Devices on Physical Activity and Adherence to Physical Activity in Patients with Cardiovascular Disease: A Systematic Review of Systematic Reviews and Meta-Analyses. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sabrina Alam
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
| | - Mengna Zhang
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
| | - Kisa Harris
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
| | - Lauren M. Fletcher
- Rowland Medical Library; University of Mississippi Medical Center, Jackson, Mississippi, USA
- John D. Rockefeller Library, Brown University, Providence, Rhode Island, USA
| | - Jennifer C. Reneker
- Department of Population Health Science, John D. Bower School of Population Health; Jackson, Mississippi, USA
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Digitally enabled cardiac rehabilitation following coronary revascularization: results from a single centre feasibility study. Eur Heart J Suppl 2022; 24:H25-H31. [DOI: 10.1093/eurheartjsupp/suac054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Wearable activity monitors, together with smartphone-based health and fitness applications (apps), are becoming more accessible and their widespread use provides an additional opportunity for the recording of cardiovascular metrics in patients with cardiovascular disease. The use of selected metrics by cardiac rehabilitation (CR) programmes allows the facilitation of individualized and tailored positive lifestyle changes to patients and places the patient at the centre of their recovery programme. To investigate the role of such devices on outcomes with patients on a CR programme, a cohort/case–control study was conducted. Patients post-myocardial infarction who were treated with either percutaneous coronary intervention or surgical coronary revascularisation at a single centre were invited to use a physical activity monitor linked to a customized app at their initial assessment for the rehabilitation programme. Those who accepted were allocated to the treatment group. The control group was selected from a larger pool of 400 historical and concurrent patients. Propensity matching was used to associate each case with their closest control. The changes in self-reported physical activity were similar for both groups at the end of the CR programme (EOP). The digitally monitored group tended to achieve greater METS (metabolic equivalent of task - a measure of exercise intensity) at 12 weeks (P < 0.059); however, no difference was observed in the overall change in METS at EOP (P < 0.333). Although no difference was noted in diastolic blood pressure, a statistically significant drop in the systolic blood pressure in the digitally monitored group (P < 0.004) was detected. In this study, the innovative combination of technology and face-to-face CR showed promising results and assisted the individualization of delivered content. This intervention could easily be replicated and expanded. Challenges are the recruitment of the elderly population, those who may be less engaged with or have less access to technology, and the underrepresentation of women in the study sample.
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Arian M, Valinejadi A, Soleimani M. Quality of Life in Heart Patients Receiving Telerehabilitation: An Overview with Meta-Analyses. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2388-2403. [PMID: 36561264 PMCID: PMC9745418 DOI: 10.18502/ijph.v51i11.11157] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022]
Abstract
Background This overview is conducted to evaluate the effect of telerehabilitation on Health-Related Quality of Life (HRQOL) in patients with cardiovascular diseases (CVDs). Methods A comprehensive search was performed through the [MeSH] keywords (heart diseases, coronary disease, coronary artery disease, myocardial infarction, coronary artery bypass, heart failure, cardiac rehabilitation and telemedicine) until January 20, 2021 in databases of Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar and Cochrane library. Finally, 20 reviews were entered into the analysis. Results The results of meta-analyses showed that receiving telerehabilitation program by telemedicine method has a positive effect on the physical dimension and changing the mental status of patients following this intervention depends on age so that the use of these technologies in heart patients with younger ages promotes mental status. On the other hand, increasing the duration of the intervention 18 months or more affects the physical dimension and 12 months or more affects promoting overall HRQOL. Among the various types of Telemedicine methods, telephone support has a greater effect on promoting the physical dimension. Conclusion The ability to use virtual technology is less at older ages, so age conditions of patients should be considered in choosing this type of intervention. The living place of the people and the level of access to advanced care, seem to play an important role in changing outcomes and choosing this type of intervention because the main purpose of telerehabilitation is to provide treatment care in areas with low access levels.
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Affiliation(s)
- Mahdieh Arian
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Valinejadi
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohsen Soleimani
- Nursing Care Research Center, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran,Corresponding Author:
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Marques-Sule E, Sempere-Rubio N, Esparcia-Sánchez S, Deka P, Sentandreu-Mañó T, Sánchez-González JL, Klompstra L, Moreno-Segura N. Physical Therapy Programs in Older Adults with Coronary Artery Disease: Preferences to Technology-Based Cardiac Physical Therapy Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13130. [PMID: 36293707 PMCID: PMC9602975 DOI: 10.3390/ijerph192013130] [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: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Assessing preferences in technology-based cardiac physical therapy programs in older adults with coronary artery disease (CAD) is fundamental to promoting adherence to healthy lifestyles and healthy aging. This study aimed at analyzing preferences in technology-based cardiac physical therapy programs in older adults with CAD. Additionally, a comparison by sex was performed. (2) Methods: Cross-sectional study. 70 older adults with CAD (mean age 66.73 ± 0.77, 80% men) were evaluated. Technology use and preferences in technology-based cardiac physical therapy programs (Technology Usage Questionnaire) were assessed. (3) Results: 97.1% of the sample had Smartphones and 81.4% accessed the Internet every day, mostly with their Smartphones (75.5%). A total of 54.3% were interested in receiving rehabilitation via their Smartphone, and most of the sample considered ideas to manage stress (92.9%), healthy meal ideas and recipes (85.7%), exercise ideas (84.3%), exercise prompts (72.9%), setting goals (67.1%), exercise taught by a virtual therapist (65.7%), ideas to overcome cigarette cravings (62.9%), information on local exercise opportunities (60%), ideas to remember to take medications (57.1%), steps to achieve goals (54.3%) and eating tips for takeaways (51.7%) very useful. Additionally, men considered the technology-based advice about exercise prompts, healthy meal ideas and recipes, and ideas to manage stress more useful than women, and had more frequently a Smartphone, less frequently made phone calls, had more regular access to the Internet, and used the Internet more often. (4) Conclusions: Clinicians should encourage older adults to engage in cardiac technology-based physical therapy programs to provide meaningful exercise counselling, promote healthy lifestyle and healthy aging.
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Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Gasco Oliag 5, 46010 Valencia, Spain
| | - Nuria Sempere-Rubio
- Clinical Biomechanics Research Unit (UBIC), Department of Physiotherapy, Universitat de València, Gasco Oliag 5, 46010 Valencia, Spain
| | | | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | | | | | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, 58185 Linkoping, Sweden
| | - Noemí Moreno-Segura
- Department of Physiotherapy, University of Valencia, Gasco Oliag 5, 46010 Valencia, Spain
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Zhang X, Luo Z, Yang M, Huang W, Yu P. Efficacy and safety of digital therapeutics-based cardiac rehabilitation in heart failure patients: a systematic review. ESC Heart Fail 2022; 9:3751-3760. [PMID: 36085358 PMCID: PMC9773765 DOI: 10.1002/ehf2.14145] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 01/19/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, it has become difficult to provide centre-based cardiac rehabilitation for heart failure patients. Digital therapeutics is a novel concept proposed in recent years that refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. However, little is known about the use of this technology in heart failure patients. This study aims to explore the safety and efficacy of digital therapeutics-based cardiac rehabilitation in heart failure patients and to provide new insights into a new cardiac rehabilitation model during the COVID-19 era. To identify technologies related to digital therapeutics, such as the use of medical applications, wearable devices, and the Internet, all relevant studies published on PubMed, EMBASE, Cochrane database, and China National Knowledge Internet were searched from the time the database was established until October 2021. The PEDro was used to assess the quality of included studies. We ultimately identified five studies, which included 1119 patients. The mean age was 66.37, the mean BMI was 25.9, and the NYHA classification ranged from I to III (I = 232, II = 157, III = 209). The mean 6-min walk distance was 397.7 m. The PEDro scores included in the study ranged from 4 to 8, with a mean of 5.8. Exercise training was performed in four studies, and psychological interventions were conducted in three studies. No death or serious adverse events were observed. Adherence was reported in three studies, and all exceeded 85%. The results of most studies showed that digital therapeutics-based cardiac rehabilitation significantly increases exercise capacity and quality of life in heart failure patients. Overall, although this study suggests that digital therapeutics-based cardiac rehabilitation may be a viable intervention for heart failure patients during the COVID-19 era, the efficacy of this new model in routine clinical practice needs to be further validated in a large clinical trial.
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Affiliation(s)
- Xiu Zhang
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Zeruxin Luo
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Mengxuan Yang
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Wei Huang
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
| | - Pengming Yu
- Rehabilitation Medicine CenterWest China Hospital, Sichuan UniversityChengduSichuan ProvinceChina
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Quazi S, Malik JA. A Systematic Review of Personalized Health Applications through Human–Computer Interactions (HCI) on Cardiovascular Health Optimization. J Cardiovasc Dev Dis 2022; 9:jcdd9080273. [PMID: 36005437 PMCID: PMC9410340 DOI: 10.3390/jcdd9080273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: Currently, the deployment of human–computer interactive technologies to provide personalized care has grown and immensely taken shape in most healthcare settings. With the increasing growth of the internet and technology, personalized health interventions including smartphones, associated apps, and other interventions demonstrate prowess in various health fields, including cardiovascular management. This systematic review thus examines the effectiveness of various human–computer interactions technologies through telehealth (mainly eHealth) towards optimizing the outcomes in cardiovascular treatment. Methods: A comprehensive search of MEDLINE, EMBASE, and CINAHL databases using key terms was conducted from 2000 to November 2021 to identify suitable studies that explored the use of human–computer interaction technologies to provide a personalized care approach to facilitate bolstered outcomes for cardiovascular patients, including the elderly. The included studies were assessed for quality and risk of bias, and the authors undertook a data extraction task. Results: Ten studies describing the use of a mix of personalized health app (mHealth) interventions were identified and included in the study. Among the included studies, nine of them were randomized trials. All of the studies demonstrated the effectiveness of various personalized health interventions in maximizing the benefits of cardiovascular disease treatment. Conclusions: Personalized health application interventions through precision medicine has great potential to boost cardiovascular disease management outcomes, including rehabilitation. Fundamentally, since each intervention’s focus might differ based on the disease and outcome preference, it is recommended that more research be done to tailor the interventions to specific disease and patient outcome expectations.
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Affiliation(s)
- Sameer Quazi
- GenLab Biosolutions Private Limited, Bangalore 560043, Karnataka, India
- Department of Biomedical Sciences, School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Clinical Bioinformatics, School of Health Sciences, The University of Manchester, Manchester M13 9P, UK
- Correspondence: (S.Q.); (J.A.M.)
| | - Javid Ahmad Malik
- Department of Zoology, Guru Ghasidas University, Bilaspur 495009, Chhattisgarh, India
- Correspondence: (S.Q.); (J.A.M.)
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Chan NPT, Lai AYK, Choy HK, Cheung DYT, Wan ANT, Cheng VYH, Chan KY, Lau YK, Yung CY, Cheung GOC, Lam TH. Feasibility and Potential Effectiveness of a Smartphone Zero-Time Exercise Intervention for Promoting Physical Activity and Fitness in Patients With Coronary Heart Disease: A Pilot Randomized Controlled Trial. Front Public Health 2022; 10:865712. [PMID: 35910893 PMCID: PMC9330491 DOI: 10.3389/fpubh.2022.865712] [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: 01/30/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Zero-time Exercise (ZTEx), a simple strength- and stamina-enhancing physical activity (PA) requiring no extra equipment, can potentially increase PA and fitness. This pilot trial examined the feasibility and potential effectiveness of a smartphone ZTEx intervention to promote PA and fitness in patients with coronary heart disease (CHD). METHODS A parallel-group assessor-blinded pilot randomized controlled trial was conducted on Chinese patients with stable coronary heart disease (CHD) in three cardiology clinics. The experimental group received a 15-min brief individual face-to-face session and a 12-week ZTEx instant messaging with 28 picture e-messages and a smartphone ZTEx application (ZTExApp). The control group received the same duration of individual session and number and format of e-messages, but the content was healthy eating and breathing exercise. The feasibility was assessed based on: attrition rate, usage, response rate and perception of the intervention. The outcome evaluation included primary outcome (PA), fitness, exercise self-efficacy and intention, perceived happiness and health, and quality of life. A linear mixed model was used with intention-to-treat analysis adjusting for sex, age and baseline values. A semi-structured interview was conducted to collect feedback from the experiment group. RESULTS One hundred thirty-nine patients (mean age 59.8 ± 6.6; 71.2% male) were randomized to the experimental group (n = 70) or control group (n = 69), and 80% (56/70) and 82% (57/69) of patients completed the 12-week follow-up assessment, respectively. The attrition rate was 18.7%. The experimental group reported that ZTEx was feasible to integrate PA into their daily life and appreciated the picture e-messages, and 95% of them sent feedback to us, but only 19.6% (13/70) of the participants entered their PA information into the e-diary of the ZTExApp. The experimental group had a significantly greater increase in time spent walking [mean difference (95% CI): 155.3 (10.1, 300.4), P = 0.04, Cohen's d = 0.34] than the control group. CONCLUSIONS This pilot study showed using a brief ZTEx face-to-face session with picture e-messages empowered patients with CHD to integrate PA into daily life. Future definitive trials with a longer follow-up and a more user-friendly ZTExApp interface are necessary to determine the effectiveness of the smartphone ZTEx intervention in enhancing PA and related outcomes. TRIAL REGISTRATION The research protocol was registered at the Hong Kong University Clinical Trials Registry (HKUCTR) on 22 Jul 2016 (Study identifier: HKUCTR-2165) and was also retrospectively registered at the National Institutes of Health (identifier number: NCT03464331) on 14 March 2018.
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Affiliation(s)
- Noel P. T. Chan
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Agnes Y. K. Lai
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Hau K. Choy
- Faculty of Medicine, Poznon University of Medical Sciences, Poznan, Poland
| | - Derek Y. T. Cheung
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Alice N. T. Wan
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Aberdeen Kai Fong Welfare Association Services Centre, Aberdeen, Hong Kong SAR, China
| | - Victor Y. H. Cheng
- Division of Cardiology, Department of Medicine and Geriatrics, Pok Oi Hospital, New Territories, Hong Kong SAR, China
| | - Ka Y. Chan
- Intensive Care Unit, Hong Kong Sanatorium Hospital, Happy Valley, Hong Kong SAR, China
| | - Yuk K. Lau
- Private Practice, Hong Kong, Hong Kong SAR, China
| | - Chi Y. Yung
- Division of Cardiology, Department of Medicine, Ruttonjee and Tang Shiu Kin Hospitals, Wan Chai, Hong Kong SAR, China
| | - George O. C. Cheung
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - T. H. Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Antoniou V, Davos CH, Kapreli E, Batalik L, Panagiotakos DB, Pepera G. Effectiveness of Home-Based Cardiac Rehabilitation, Using Wearable Sensors, as a Multicomponent, Cutting-Edge Intervention: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:3772. [PMID: 35807055 PMCID: PMC9267864 DOI: 10.3390/jcm11133772] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 12/19/2022] Open
Abstract
Exercise-based cardiac rehabilitation is a highly recommended intervention towards the advancement of the cardiovascular disease (CVD) patients' health profile; though with low participation rates. Although home-based cardiac rehabilitation (HBCR) with the use of wearable sensors is proposed as a feasible alternative rehabilitation model, further investigation is needed. This systematic review and meta-analysis aimed to evaluate the effectiveness of wearable sensors-assisted HBCR in improving the CVD patients' cardiorespiratory fitness (CRF) and health profile. PubMed, Scopus, Cinahl, Cochrane Library, and PsycINFO were searched from 2010 to January 2022, using relevant keywords. A total of 14 randomized controlled trials, written in English, comparing wearable sensors-assisted HBCR to center-based cardiac rehabilitation (CBCR) or usual care (UC), were included. Wearable sensors-assisted HBCR significantly improved CRF when compared to CBCR (Hedges' g = 0.22, 95% CI 0.06, 0.39; I2 = 0%; p = 0.01), whilst comparison of HBCR to UC revealed a nonsignificant effect (Hedges' g = 0.87, 95% CI -0.87, 1.85; I2 = 96.41%; p = 0.08). Effects on physical activity, quality of life, depression levels, modification of cardiovascular risk factors/laboratory parameters, and adherence were synthesized narratively. No significant differences were noted. Technology tools are growing fast in the cardiac rehabilitation era and promote exercise-based interventions into a more home-based setting. Wearable-assisted HBCR presents the potential to act as an adjunct or an alternative to CBCR.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, 35100 Lamia, Greece; (V.A.); (E.K.)
| | - Constantinos H. Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece;
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, 35100 Lamia, Greece; (V.A.); (E.K.)
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic;
- Department of Public Health, Masaryk University Brno, Zerotinovo nam. 617/9, 601 77 Brno, Czech Republic
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 176 71 Kallithea, Greece;
- Faculty of Health, University of Canberra, Bruce 2617, Australia
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, 35100 Lamia, Greece; (V.A.); (E.K.)
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Krzowski B, Peller M, Boszko M, Hoffman P, Żurawska N, Jaruga K, Skoczylas K, Osak G, Kołtowski Ł, Grabowski M, Opolski G, Balsam P. Mobile app and digital system for patients after myocardial infarction (afterAMI): study protocol for a randomized controlled trial. Trials 2022; 23:522. [PMID: 35729626 PMCID: PMC9210045 DOI: 10.1186/s13063-022-06463-x] [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: 09/14/2021] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Treatment of acute myocardial infarction has been the subject of studies over the past years. However, the initial months after myocardial infarction are crucial from the perspective of the patient's prognosis. It is extremely important to take care of all cardiovascular risk factors and undergo a full rehabilitation program. Telemedical solutions are becoming more and more relevant in everyday practice. We describe a protocol of a study evaluating the use of the mobile application "afterAMI" in patients after myocardial infarction. The app offers an educational mode, calendar, vital signs diary, medication reminders, medical history card, and healthcare professional contact panel. It offers several solutions, which individually proved to be effective and improve a patient's prognosis. Despite general promising results from previous studies regarding telemedical tools, there is a paucity of evidence when it comes to prospective randomized trials. Our aim was to perform a comprehensive evaluation of a newly developed mobile application in the clinical setting. METHODS A group of 100 patients with myocardial infarction on admission at the 1st Chair and Department of Cardiology, Medical University of Warsaw, will be recruited into the study. The project aims to assess the impact of the application-supported model of care in comparison with standard rehabilitation. At the end of the study, cardiovascular risk factors will be analyzed, along with rehospitalizations, the patients' knowledge regarding cardiovascular risk factors, returning to work, and quality of life. In this prospective, open-label, randomized, single-center study, all 100 patients will be observed for 6 months after discharge from the hospital. Endpoints will be assessed during control visits 1 and 6 months after inclusion into the study. DISCUSSION This project is an example of a telemedical solution application embracing everyday clinical practices, conforming with multiple international cardiac societies' guidelines. Cardiac rehabilitation process enhancements are required to improve patients' prognosis. The evidence regarding the use of the mobile application in the described group of patients is limited and usually covers a small number of participants. The described study aims to discuss whether telemedicine use in this context is beneficial for the patients. TRIAL REGISTRATION ClinicalTrials.gov NCT04793425 . Registered on 11 March 2021.
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Affiliation(s)
- Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Michał Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Maria Boszko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paulina Hoffman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Natalia Żurawska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Karolina Jaruga
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Kamila Skoczylas
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Gabriela Osak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Łukasz Kołtowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
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Andersen RM, Skou ST, Clausen MB, Jäger M, Zangger G, Grøntved A, Brønd JC, Soja AMB, Tang LH. Maintenance of physical activity after cardiac rehabilitation (FAIR): study protocol for a feasibility trial. BMJ Open 2022; 12:e060157. [PMID: 35383088 PMCID: PMC8984013 DOI: 10.1136/bmjopen-2021-060157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To enhance health and prevent secondary consequences for patients with cardiovascular disease (CVD), maintenance of an active lifestyle following participation in cardiac rehabilitation (CR) is important. However, levels of physical activity often decrease after completion of a structured CR programme. Models that support long-term behaviour change with a sustained level of physical activity are imperative. The aim of this study is to evaluate the feasibility of a mobile health intervention based on the Health Action Process Approach theoretical model of behaviour change in patients with CVD for 3 months after completion of a CR programme. METHODS AND ANALYSIS In a feasibility trial design, we will recruit 40 participants from CR programmes at Slagelse Hospital, the City of Slagelse (municipality), or Holbæk Hospital. After completing the standard structured CR programme, each participant will create an action plan for physical activity together with a physiotherapist. Following that, participants are sent 2 weekly text messages for 3 months. The first text message prompts physical activity, and the second will check if the action plan has been followed. If requested by participants, a coordinator will call and guide the physical activities behaviour. The feasibility of this maintenance intervention is evaluated based on predefined progression criteria. Physical activity is measured with accelerometers at baseline and at 3 months follow-up. ETHICS AND DISSEMINATION Study approval was waived (EMN-2021-00020) by the Research Ethics Committee of Region Zealand, Denmark. Study results will be made public and findings disseminated to patients, health professionals, decision-makers, researchers and the public. TRIAL REGISTRATION NUMBER NCT05011994.
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Affiliation(s)
- Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Søren Thorgaard Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Christian Brønd
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Rochester CL. Does Telemedicine Promote Physical Activity? Life (Basel) 2022; 12:life12030425. [PMID: 35330176 PMCID: PMC8948765 DOI: 10.3390/life12030425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Exercise capacity and physical activity are different concepts: the former refers to what an individual is capable of performing, while the latter refers to what the individual does in daily life. Low levels of physical activity (PA), which are very common in individuals with COPD, are associated with poor health outcomes, including increased symptoms, a more rapid decline in lung function, increased health care utilization and increased mortality risk. Because of these pervasive negative outcomes, attempts have been made to increase physical activity in individuals with COPD, hoping that success in this area will mitigate the negative effects of inactivity. Based on its ability to increase exercise capacity and reduce dyspnea in COPD and other chronic respiratory diseases, pulmonary rehabilitation (PR) would be expected also increase physical activity in these patients. However, accessibility to pulmonary rehabilitation programs is problematic in some areas, and studies testing its effectiveness in this outcome area have had inconsistent results. Using telehealth interventions using technology to provide medical care conveniently over a distance would have the benefit of reaching a larger proportion of individuals with COPD. A systematic review of clinical trials testing telehealth to promote physical activity had mixed results and low-certainty evidence, resulting in the inability to recommend any single type of intervention. Thus, using telehealth interventions to promote physical activity for individuals with chronic respiratory diseases, while promising, remains an area where future investigations are needed to identify its optimal modalities and clarify its benefits.
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Affiliation(s)
- Carolyn L. Rochester
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; ; Tel.: +1-203-785-4163; Fax: +1-203-785-3627
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
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D'Amore C, Reid JC, Chan M, Fan S, Huang A, Louie J, Tran A, Chauvin S, Beauchamp MK. Title: Systematic review and meta-analysis of interventions including smart-technology compared to face-to-face physical activity interventions in older adults (Preprint). J Med Internet Res 2022; 24:e36134. [DOI: 10.2196/36134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/31/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
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Pogosova NV, Badtieva VA, Ovchinnikova AI, Sokolova OY. [New treatments and technologies in cardiac rehabilitation programs]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:50-57. [PMID: 35700376 DOI: 10.17116/kurort20229903150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article presents a review of literature data reflecting the relevance and modern views on the effectiveness and expediency of using various options for rehabilitation programs for cardiovascular diseases. The issues of the history of the development of cardiac rehabilitation both abroad and in Russia are consecrated. The article also presents alternative models for conducting cardiac rehabilitation, in particular, using remote and telemedicine technologies. The widespread use of smartphones and high-speed Internet access contributed to the further introduction and use of telemedicine technologies in cardiac rehabilitation. The article discusses the possibilities of telerehabilitation of cardiological patients and shows its comparable effectiveness with traditional cardiac rehabilitation.
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Affiliation(s)
- N V Pogosova
- National Medical Research Center of Cardiology, Moscow, Russia
| | - V A Badtieva
- Moscow Scientific-Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - A I Ovchinnikova
- Moscow Scientific-Practical Center of Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
| | - O Yu Sokolova
- National Medical Research Center of Cardiology, Moscow, Russia
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