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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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Pakrad F, Jahandideh S, Oshvandi K, Majidi L, Khazaei S, Pakrad B. Comparing the effect of the Model of Therapeutic Engagement in cardiac rehabilitation on the sense of coherence and adherence to treatment: a randomized clinical trial. Disabil Rehabil 2024; 46:3007-3016. [PMID: 37497869 DOI: 10.1080/09638288.2023.2239143] [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: 01/12/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The study aimed to compare the effectiveness of a traditional cardiac rehabilitation (CR) program with an enhanced program incorporating the model of therapeutic engagement (MTE) and extended remote support for patients undergoing coronary artery bypass graft (CABG) patients. MATERIALS AND METHODS In a randomized controlled trial, 88 CABG patients were assigned to experimental and control groups. The experimental group received integrated MTE cardiac rehabilitation, and assessments were conducted at three time points: pre-CR, one month later, and three months post-CR. The study measured medication adherence (MARS-5) and sense of coherence (SoC-13) scales. RESULTS The study found no significant differences in demographic factors between the experimental and control groups. However, significant differences were observed in MARS and individuals' SoC scores over time in the experimental group, with notable improvements (p < 0.001). The control group showed significant changes only up to one month. Group effects were evident, with consistent increases in the experimental group's outcomes at each assessment point. CONCLUSION Integrating the MTE into CR programs offers benefits in terms of medication adherence and individuals' sense of coherence, which warrants further investigation and clinical implementation.
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Affiliation(s)
- Fatemeh Pakrad
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sepideh Jahandideh
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Khodayar Oshvandi
- Department of Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Lobat Majidi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Centre for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Pakrad
- Department of exercise physiology, Farhangian University, Hamadan, Iran
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Zhou M, Xu Y, Zhang L, Yang Y, Zheng J. Effectiveness of smartphone-assisted cardiac rehabilitation: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:3256-3265. [PMID: 37559408 DOI: 10.1080/09638288.2023.2244883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To explore the effectiveness of smartphone-assisted home cardiac rehabilitation and whether it can be used as a remote detection method to promote home cardiac rehabilitation. METHODS Four databases were searched to collect randomized controlled trials (RCTs) about smartphone-assisted cardiac rehabilitation. The Cochrane risk-of-bias tool was used to assess the methodological quality of the included studies. Two independent investigators performed the literature screening, information extraction, and risk of bias assessment. Any disagreements were resolved by a third investigator. Meta-analysis and systematic review were performed. Sensitivity analysis and subgroup analysis were carried out to explore the sources of heterogeneity. RESULTS A total of 14 RCTs involving 1962 patients were included. Meta-analysis showed that compared with conventional cardiac rehabilitation/usual care, smartphone-assisted cardiac rehabilitation significantly improved VO2peak in patients with cardiovascular disease (WMD= 1.32, 95%CI:0.82 to 1.81, p > 0.05) and enhanced their treatment compliance (RR = 1.62, 95%CI:1.21 to 2.17, p > 0.05). There were no significant differences in six-minute walk distance (WMD = 12.88, 95%CI:-0.82 to 26.57, p > 0.05), body mass index (BMI) (WMD=-0.14, 95%CI:-0.34 to 0.06, p > 0.05), life quality, psychological status, and other cardiovascular risks. CONCLUSION Smartphone-assisted cardiac rehabilitation showed significant improvement in exercise capacity and treatment compliance in patients with cardiac rehabilitation but did not improve BMI, quality of life, psychological status, or reduce other cardiovascular risks. Smartphone-based cardiac rehabilitation is increasingly used as a remote detection method for cardiac rehabilitation in middle-income countries, which provides new insights into home cardiac rehabilitation.
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Affiliation(s)
- Meimei Zhou
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Youkang Xu
- Department of Osteoarthropathy Rehabilitation, The Second Rehabilitation Hospital of Shanghai, P.R. China
| | - Lili Zhang
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Yushan Yang
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
| | - Jiejiao Zheng
- Department of Rehabilitation, Huadong Hospital, Fudan University, Shanghai, P.R. China
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Kilfoy A, Chu C, Krisnagopal A, Mcatee E, Baek S, Zworth M, Hwang K, Park H, Jibb L. Nurse-led remote digital support for adults with chronic conditions: A systematic synthesis without meta-analysis. J Clin Nurs 2024. [PMID: 38894583 DOI: 10.1111/jocn.17226] [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: 11/28/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
AIM The systematic review aims to synthesize the literature examining the effectiveness of nurse-led remote digital support on health outcomes in adults with chronic conditions. BACKGROUND Adults with chronic diseases have increased rates of mortality and morbidity and use health care resources at a higher intensity than those without chronic conditions-placing strain on the patient, their caregivers and health systems. Nurse-led digital health disease self-management interventions have potential to improve outcomes for patients with chronic conditions by facilitating care in environments other that the hospital setting. DESIGN AND METHODS We searched PubMed/MEDLINE, Embase, PsycINFO and Cochrane Central databases from inception to 7 December 2022. We included randomized controlled trials assessing the impact of nurse-led remote digital support interventions compared to usual care on health-related outcomes in adults with chronic illness. The Cochrane risk-of-bias tool was used to assess bias in studies. Outcomes were organized into four categories: self-management, clinical outcomes, health care resource use and satisfaction with care. Results are presented narratively based on statistical significance. RESULTS Forty-four papers pertaining to 40 unique studies were included. Interventions most targeted diabetes (n = 11) and cardiovascular disease (n = 8). Websites (n = 10) and mobile applications (n = 10) were the most used digital modalities. Nurses supported patients either in response to incoming patient health data (n = 14), virtual appointment (n = 8), virtual health education (n = 5) or through a combination of these approaches (n = 13). Positive impacts of nurse-led digital chronic disease support were identified in each outcome category. Mobile applications were the most effective digital modality. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Results show that nurse-led remote digital support interventions significantly improve self-management capacity, clinical health outcomes, health care resource use and satisfaction with care. Such interventions have potential to support overall health for adults with chronic conditions in their home environments.
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Affiliation(s)
- Alicia Kilfoy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Charlene Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Archanaa Krisnagopal
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Enoch Mcatee
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Sunny Baek
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mallory Zworth
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kyobin Hwang
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hyun Park
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Lindsay Jibb
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
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Hou QL, Liu LY, Wu Y. The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2024; 26:e52341. [PMID: 38861710 PMCID: PMC11200038 DOI: 10.2196/52341] [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: 08/31/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. OBJECTIVE In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. METHODS We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. RESULTS The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD -0.46, 95% CI -0.83 to -0.08; Z=2.38; P=.02) and depression (SMD -0.34, 95% CI -0.56 to -0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ≥6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (≥90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). CONCLUSIONS On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. TRIAL REGISTRATION PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf.
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Affiliation(s)
- Qiao Ling Hou
- School of Nursing, Capital Medical University, Beijing, China
| | - Le Yang Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Chen SM, Wu MK, Chen C, Wang LY, Guo NW, Wei CL, Zheng YC, Hsiao HY, Wu PJ, Chen YL, Chen CJ, Hang CL. Benefit of cardiac rehabilitation in acute heart failure patients with cognitive impairment. Heliyon 2024; 10:e30493. [PMID: 38726193 PMCID: PMC11079101 DOI: 10.1016/j.heliyon.2024.e30493] [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: 04/27/2023] [Revised: 04/13/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
Aims This study aimed to evaluate the prevalence of cognitive impairment among patients with acute heart failure (AHF), its prognosis, and the effects of cardiac rehabilitation (CR) on these patients' outcomes. Methods Overall, 247 consecutive AHF patients (median age, 60 years; males, 78.5 %) were evaluated from March 2015 to May 2021. Patients received an AHF disease management program coordinated by an HF specialist nurse and underwent a Luria-Nebraska Neuropsychological battery-screening test (LNNB-S) assessment during admission. Cognitive impairment was defined as an LNNB-S score ≥10. Patients who underwent at least one session of phase II CR and continued with the home-based exercise program were considered to have received CR. The primary endpoint was composite all-cause mortality or readmission after a 3.30-year follow-up (interquartile range, 1.69-5.09 years). Results Cognitive impairment occurred in 53.0 % and was associated with significantly higher composite endpoint, all-cause mortality, and readmission rates (p=<0.001, 0.001, and 0.015, respectively). In the total cohort, 40.9 % of patients experienced the composite endpoint. Multivariate analysis showed that the peak VO2 was a significant predictor of the composite endpoint. After adjustment, CR significantly decreased the event rate of the composite endpoint and the all-cause mortality in patients with cognitive impairment (log-rank p = 0.024 and 0.009, respectively). However, CR did not have a significant benefit on the composite endpoint and the all-cause mortality in patients without cognitive impairment (log-rank p = 0.682 and 0.701, respectively). Conclusion Cognitive impairment is common in AHF patients and can lead to poor outcomes. CR is a standard treatment to improve prognosis.
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Affiliation(s)
- Shyh-Ming Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
- Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Ching Chen
- Clinical Psychologist, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Nai-Wen Guo
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Taiwan, Republic of China
| | - Chin-Ling Wei
- Department of Nursing, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - You-Cheng Zheng
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Hao-Yi Hsiao
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Po-Jui Wu
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Yung-Lung Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
- Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Chien-Jen Chen
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
| | - Chi-Ling Hang
- Section of Cardiology, Department of Internal Medicine, Heart Failure Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan, Republic of China
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Seron P, Oliveros MJ, Marzuca-Nassr GN, Morales G, Román C, Muñoz SR, Gálvez M, Latin G, Marileo T, Molina JP, Navarro R, Sepúlveda P, Lanas F, Saavedra N, Ulloa C, Grace SL. Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350301. [PMID: 38194236 PMCID: PMC10777264 DOI: 10.1001/jamanetworkopen.2023.50301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024] Open
Abstract
Importance While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. Objective To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. Design, Setting, and Participants This pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021. Interventions Participants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks. Main Outcomes and Measures The primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists. Results A total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, -11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, -0.35% [95% CI, -7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, -3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group). Conclusions and Relevance The results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation. Trial Registration ClinicalTrials.gov Identifier: NCT03881150.
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Affiliation(s)
- Pamela Seron
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Maria Jose Oliveros
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Gabriel Nasri Marzuca-Nassr
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
| | - Gladys Morales
- Facultad de Medicina, Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile
| | - Claudia Román
- Facultad de Medicina, Escuela de Kinesiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Raúl Muñoz
- Facultad de Medicina, Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile
| | - Manuel Gálvez
- Unidad de Kinesiología, Complejo Hospitalario San José, Santiago, Chile
| | - Gonzalo Latin
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico, Hospital San Borja Arriarán, Santiago, Chile
| | - Tania Marileo
- Unidad de Rehabilitación Cardiaca, Hospital Regional de Antofagasta, Antofagasta, Chile
| | - Juan Pablo Molina
- Servicio de Medicina Física y Rehabilitación, Hospital San Juan de Dios, Santiago, Chile
| | - Rocío Navarro
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Pablo Sepúlveda
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
| | - Fernando Lanas
- Facultad de Medicina, Departamento de Medicina Interna, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Nicolás Saavedra
- Facultad de Medicina, Departamento de Ciencias Básicas, Universidad de La Frontera, Temuco, Chile
| | - Constanza Ulloa
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
| | - Sherry L. Grace
- York University & University Health Network, University of Toronto, Toronto, Ontario, Canada
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de Moel-Mandel C, Lynch C, Issaka A, Braver J, Zisis G, Carrington MJ, Oldenburg B. Optimising the implementation of digital-supported interventions for the secondary prevention of heart disease: a systematic review using the RE-AIM planning and evaluation framework. BMC Health Serv Res 2023; 23:1347. [PMID: 38049862 PMCID: PMC10694952 DOI: 10.1186/s12913-023-10361-6] [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: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND mHealth technologies are now widely utilised to support the delivery of secondary prevention programs in heart disease. Interventions with mHealth included have shown a similar efficacy and safety to conventional programs with improvements in access and adherence. However, questions remain regarding the successful wider implementation of digital-supported programs. By applying the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to a systematic review and meta-analysis, this review aims to evaluate the extent to which these programs report on RE-AIM dimensions and associated indicators. METHODS This review extends our previous systematic review and meta-analysis that investigated the effectiveness of digital-supported programs for patients with coronary artery disease. Citation searches were performed on the 27 studies of the systematic review to identify linked publications that reported data for RE-AIM dimensions. All included studies and, where relevant, any additional publications, were coded using an adapted RE-AIM extraction tool. Discrepant codes were discussed amongst reviewers to gain consensus. Data were analysed to assess reporting on indicators related to each of the RE-AIM dimensions, and average overall reporting rates for each dimension were calculated. RESULTS Searches found an additional nine publications. Across 36 publications that were linked to the 27 studies, 24 (89%) of the studies were interventions solely delivered at home. The average reporting rates for RE-AIM dimensions were highest for effectiveness (75%) and reach (67%), followed by adoption (54%), implementation (36%) and maintenance (11%). Eleven (46%) studies did not describe relevant characteristics of their participants or of staff involved in the intervention; most studies did not describe unanticipated consequences of the intervention; the ongoing cost of intervention implementation and maintenance; information on intervention fidelity; long-term follow-up outcomes, or program adaptation in other settings. CONCLUSIONS Through the application of the RE-AIM framework to a systematic review we found most studies failed to report on key indicators. Failing to report these indicators inhibits the ability to address the enablers and barriers required to achieve optimal intervention implementation in wider settings and populations. Future studies should consider alternative hybrid trial designs to enable reporting of implementation indicators to improve the translation of research evidence into routine practice, with special consideration given to the long-term sustainability of program effects as well as corresponding ongoing costs. REGISTRATION PROSPERO-CRD42022343030.
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Affiliation(s)
| | - Chris Lynch
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia.
- Northern Health, Melbourne, VIC, Australia.
| | - Ayuba Issaka
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
| | - Justin Braver
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Western Health, Melbourne, VIC, Australia
| | - Brian Oldenburg
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
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9
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Mbau L, Mallya Prabhakar P, Khan Z. Effectiveness of Cardiac Rehabilitation Services in Low- and Middle-Income Countries: A Systematic Review. Cureus 2023; 15:e50953. [PMID: 38249190 PMCID: PMC10800146 DOI: 10.7759/cureus.50953] [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: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Cardiac rehabilitation (CR) is a cost-effective intervention that can reduce cardiovascular disease (CVD) morbidity and mortality by 20%. Despite the clear benefits of CR, it remains unavailable and underutilized. This study aimed to assess the effectiveness of different CR models in reducing CVD-related morbidity and mortality in low-and middle-income countries. We conducted a systematic review of studies conducted in low- and middle-income countries that assessed at least one of the three phases of CR (inpatient rehabilitation, outpatient rehabilitation in a hospital, or community setting and maintenance). The primary outcomes of interest were mortality (all-cause and CVD-specific), CVD-related morbidity, functional capacity, risk factor reduction, and quality of life (QoL). The electronic search retrieved 1,102 studies, of which 22 were retrieved and included in the review. These studies were conducted between 2011 and 2022 and the majority (18) were conducted in Asia. All studies except one were randomized controlled trials (RCTs), and all except one were conducted at a single site. The target population in most studies (16) included patients with coronary artery disease (CAD). Seven studies have incorporated digital technology. Only one study has reported a significant reduction in all-cause mortality. Thirteen studies reported data on functional capacity, and 16 on quality of life (QoL), showing statistically significant improvements. Data on risk factors, anxiety, and depression have shown mixed results. CR is effective in low- and middle-income countries, and strategies to scale it up using locally available resources tailored to the patient population should be adopted.
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Affiliation(s)
- Lilian Mbau
- Cardiology, Kenya Cardiac Society, Nairobi, KEN
| | | | - Zahid Khan
- Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend on Sea, GBR
- Cardiology, Bart's Heart Centre, London, GBR
- Cardiology and General Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, London, GBR
- Cardiology, Royal Free Hospital, London, GBR
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10
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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: 8] [Impact Index Per Article: 8.0] [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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11
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Braver J, Marwick TH, Oldenburg B, Issaka A, Carrington MJ. Digital Health Programs to Reduce Readmissions in Coronary Artery Disease: A Systematic Review and Meta-Analysis. JACC. ADVANCES 2023; 2:100591. [PMID: 38938339 PMCID: PMC11198697 DOI: 10.1016/j.jacadv.2023.100591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2024]
Abstract
Background The use of mobile health (mHealth, wireless communication devices, and/or software technologies) in health care delivery has increased rapidly in recent years. Their integration into disease management programs (DMPs) has tremendous potential to improve outcomes for patients with coronary artery disease (CAD), yet a more robust evaluation of the evidence is required. Objectives The purpose of this study was to undertake a systematic review and meta-analysis of mHealth-enabled DMPs to determine their effectiveness in reducing readmissions and mortality in patients with CAD. Methods We systematically searched English language studies from January 1, 2007, to August 3, 2021, in multiple databases. Studies comparing mHealth-enabled DMPs with standard DMPs without mHealth were included if they had a minimum 30-day follow-up for at least one of all-cause or cardiovascular-related mortality, readmissions, or major adverse cardiovascular events. Results Of the 3,411 references from our search, 155 full-text studies were assessed for eligibility, and data were extracted from 18 publications. Pooled findings for all-cause readmissions (10 studies, n = 1,514) and cardiac-related readmissions (9 studies, n = 1,009) indicated that mHealth-enabled DMPs reduced all-cause (RR: 0.68; 95% CI: 0.50-0.91) and cardiac-related hospitalizations (RR: 0.55; 95% CI: 0.44-0.68) and emergency department visits (RR: 0.37; 95% CI: 0.26-0.54) compared to DMPs without mHealth. There was no significant reduction for mortality outcomes (RR: 1.72; 95% CI: 0.64-4.64) or major adverse cardiovascular events (RR: 0.68; 95% CI: 0.40-1.15). Conclusions DMPs integrated with mHealth should be considered an effective intervention for better outcomes in patients with CAD.
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Affiliation(s)
- Justin Braver
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
| | - Thomas H. Marwick
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
| | - Brian Oldenburg
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ayuba Issaka
- Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Melinda J. Carrington
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
- Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia
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12
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Grace SL, Taylor RS, Gaalema DE, Redfern J, Kotseva K, Ghisi G. Cardiac Rehabilitation: A Global Perspective on Where We Have Come and Where We Must Go. JACC. ADVANCES 2023; 2:100412. [PMID: 38938991 PMCID: PMC11198422 DOI: 10.1016/j.jacadv.2023.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Sherry L. Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rod S. Taylor
- Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, School of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Diann E. Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Julie Redfern
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, Australia
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Ireland
| | - Gabriela Ghisi
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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13
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Kim J, Aryee LMD, Bang H, Prajogo S, Choi YK, Hoch JS, Prado EL. Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis. JMIR Ment Health 2023; 10:e43066. [PMID: 36939820 PMCID: PMC10131603 DOI: 10.2196/43066] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. OBJECTIVE We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. RESULTS Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were -0.61 (95% CI -0.78 to -0.44; n=67 comparisons) for depression and -0.73 (95% CI -0.93 to -0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. CONCLUSIONS Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. TRIAL REGISTRATION PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Lois M D Aryee
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Steffi Prajogo
- Johns Hopkins Bayview Medical Center, Baltimore, MD, United States
| | - Yong K Choi
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Elizabeth L Prado
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, Davis, CA, United States
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14
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Kruse CS, Betancourt JA, Gonzales M, Dickerson K, Neer M. Leveraging Mobile Health to Manage Mental Health/Behavioral Health Disorders: Systematic Literature Review. JMIR Ment Health 2022; 9:e42301. [PMID: 36194896 PMCID: PMC9832355 DOI: 10.2196/42301] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mental health is a complex condition, highly related to emotion. The COVID-19 pandemic caused a significant spike in depression (from isolation) and anxiety (event related). Mobile Health (mHealth) and telemedicine offer solutions to augment patient care, provide education, improve symptoms of depression, and assuage fears and anxiety. OBJECTIVE This review aims to assess the effectiveness of mHealth to provide mental health care by analyzing articles published in the last year in peer-reviewed, academic journals using strong methodology (randomized controlled trial). METHODS We queried 4 databases (PubMed, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ScienceDirect) using a standard Boolean search string. We conducted this systematic literature review in accordance with the Kruse protocol and reported it in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist (n=33). RESULTS A total of 4 interventions (mostly mHealth) from 14 countries identified improvements in primary outcomes of depression and anxiety as well as in several secondary outcomes, namely, quality of life, mental well-being, cognitive flexibility, distress, sleep, self-efficacy, anger, decision conflict, decision regret, digestive disturbance, pain, and medication adherence. CONCLUSIONS mHealth interventions can provide education, treatment augmentation, and serve as the primary modality in mental health care. The mHealth modality should be carefully considered when evaluating modes of care. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022343489; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=343489.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Jose A Betancourt
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Matthew Gonzales
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Kennedy Dickerson
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Miah Neer
- School of Health Administration, Texas State University, San Marcos, TX, United States
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15
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Shahmoradi L, Rezaei N, Rezayi S, Zolfaghari M, Manafi B. Educational approaches for patients with heart surgery: a systematic review of main features and effects. BMC Cardiovasc Disord 2022; 22:292. [PMID: 35761186 PMCID: PMC9238074 DOI: 10.1186/s12872-022-02728-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery. Method and materiel A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Results A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong. Conclusion The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.
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Affiliation(s)
- Leila Shahmoradi
- Health Information Management Department and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Rezaei
- Medical Library and Information Science, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Medical Library and Information Science, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Sorayya Rezayi
- Health Information Management Department and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mitra Zolfaghari
- Department of eLearning in Medical Education, Virtual School of Tehran University of Medical Sciences, Naderi Street, Keshavarz Blvd, Tehran, Iran
| | - Babak Manafi
- Department of Heart Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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16
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Mamataz T, Uddin J, Ibn Alam S, Taylor RS, Pakosh M, Grace SL. Effects of cardiac rehabilitation in low-and middle-income countries: A systematic review and meta-analysis of randomised controlled trials. Prog Cardiovasc Dis 2022; 70:119-174. [PMID: 34271035 PMCID: PMC9187522 DOI: 10.1016/j.pcad.2021.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the effectiveness of cardiac rehabilitation (CR) in low- and middle-income countries (LMICs), given previous reviews have included scant trials from these settings and the great need there. METHODS Six electronic databases (PubMed, Medline, Embase, CINAHL, Cochrane Library, and APA PsycINFO) were searched from inception-May 2020. Randomised controlled CR (i.e., at least initial assessment and structured exercise; any setting; some Phase II) trials with any clinical outcomes (e.g., mortality and morbidity, functional capacity, risk factor control and psychosocial well-being) or cost, with usual care (UC) control or active comparison (AC), in acute coronary syndrome with or without revascularization or heart failure patients in LMICs were included. With regard to data extraction and data synthesis, two reviewers independently vetted identified citations and extracted data from included trials; Risk of bias was assessed using Cochrane's tool. Certainty of evidence was ascertained based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A random-effects model was used to calculate weighted mean differences and 95% confidence intervals (CI). RESULTS Twenty-six trials (6380 participants; 16.9% female; median follow-up = 3 months) were included. CR meaningfully improved functional capacity (VO2peak vs UC: 5 trials; mean difference [MD] = 3.13 ml/kg/min, 95% CI = 2.61 to 3.65; I2 = 9.0%); moderate-quality evidence), systolic blood pressure (vs UC: MD = -5.29 mmHg, 95% CI = -8.12 to -2.46; I2 = 45%; low-quality evidence), low-density lipoprotein cholesterol (vs UC: MD = -16.55 mg/dl, 95% CI = -29.97 to -3.14; I2 = 74%; very low-quality evidence), body mass index (vs AC: MD = -0.84 kg/m2, 95% CI = -1.61 to -0.07; moderate-quality evidence; I2 = 0%), and quality of life (QoL; vs UC; SF-12/36 physical: MD = 6.05, 95% CI = 1.77 to 10.34; I2 = 93%, low-quality evidence; mental: MD = 5.38, 95% CI = 1.13 to 9.63; I2 = 84%; low-quality evidence), among others. There were no evidence of effects on mortality or morbidity. Qualitative analyses revealed CR was associated with lower percutaneous coronary intervention, myocardial infarction, better cardiovascular function, and biomarkers, as well as return to life roles; there were other non-significant effects. Two studies reported low cost of home-based CR. CONCLUSIONS Low to moderate-certainty evidence establishes CR as delivered in LMICs improves functional capacity, risk factor control and QoL. While more high-quality research is needed, we must augment access to CR in these settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020185296).
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 222B, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Jamal Uddin
- Department of Cardiac Surgery, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbag, Dhaka, Bangladesh
| | - Sayed Ibn Alam
- Videncenter for Rehabilitering og Palliation REHPA, University of South Denmark, Nyborg, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, School of Medicine, Dentistry & Nursing, University of Glasgow, UK
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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