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Grigorovich A, Xi M, Lam N, Pakosh M, Chan BCF. A systematic review of economic analyses of home-based telerehabilitation. Disabil Rehabil 2022; 44:8188-8200. [PMID: 34965827 DOI: 10.1080/09638288.2021.2019327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions. MATERIALS AND METHODS Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist. RESULTS Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear. CONCLUSIONS More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.
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Affiliation(s)
- Alisa Grigorovich
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Canada.,KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Min Xi
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Natascha Lam
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Brian C F Chan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Abstract
This paper conducts a cost–benefit analysis of Australia’s Covid-19 lockdown strategy relative to pursuit of a mitigation strategy in March 2020. The estimated additional deaths from a mitigation strategy are 11,500 to 40,000, implying a Cost per Quality Adjusted Life Year saved by locking down of at least 11 times the generally employed figure of $100,000 for health interventions in Australia. The lockdowns do not then seem to have been justified by reference to the standard benchmark. Consideration of the information available to the Australian government in March 2020 yields a similar ratio and therefore the same conclusion that lockdown was not warranted. If Australia experiences a new outbreak, and cannot contain it without resort to a nationwide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign, lessons learned since March 2020, and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020. This would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.
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Affiliation(s)
- Martin Lally
- Capital Financial Consultants Ltd, 52 Friend St, Karori, Wellington, 6012, New Zealand.
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Bakhshayesh S, Hoseini B, Bergquist R, Nabovati E, Gholoobi A, Mohammad-Ebrahimi S, Eslami S. Cost-utility analysis of home-based cardiac rehabilitation as compared to usual post-discharge care: systematic review and meta-analysis of randomized controlled trials. Expert Rev Cardiovasc Ther 2020; 18:761-776. [PMID: 32893713 DOI: 10.1080/14779072.2020.1819239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Determining cost-utility differences between home-based cardiac rehabilitation (HBCR) on the one hand, and usual post-discharge care (UC) on the other, can improve resource-allocation in healthcare settings. AREAS COVERED In June 2019, PubMed, Web of Science, Scopus, and Cochrane library were searched for randomized controlled HBCR trials. Standardized mean differences (SMDs) of cost and quality-adjusted life years (QALYs) between HBCRs and UCs were calculated using random effect models. Heterogeneity was assessed by inconsistency index (I2) and publication bias by funnel plot and Egger's regression test. Thirteen articles, representing 2,992 participants, were deemed representative for final analysis. In the meta-analysis, a significant difference with respect to QALYs favored HBCR, while no significant cost difference was observed between HBCR and UC. However, subgroup-analysis of trials with different follow-up durations revealed somewhat different results, and HBCR was found to be significantly better with regard to both cost and QALYs for patients with heart failure. Cost-utility analysis categorizing interventions as 'dominant', 'effective', 'doubtful', and 'dominated', found HBCRs dominant. EXPERT OPINION Although HBCR tended to be superior compared to UC in this review, larger and more robust trials addressing specific patients groups are needed for definitive results.
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Affiliation(s)
- Samaneh Bakhshayesh
- Students Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Health Information Technology, Neyshabur University of Medical Sciences , Neyshabur, Iran
| | - Robert Bergquist
- Ingerod, SE-454 94 Brastad, Sweden, Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization , Geneva, Switzerland
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences , Kashan, Iran.,Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences , Kashan, Iran
| | - Arash Gholoobi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Shahab Mohammad-Ebrahimi
- Students Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Amsterdam UMC (location AMC), University of Amsterdam , Amsterdam, The Netherlands
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Kelly JT, Allman-Farinelli M, Chen J, Partridge SR, Collins C, Rollo M, Haslam R, Diversi T, Campbell KL. Dietitians Australia position statement on telehealth. Nutr Diet 2020; 77:406-415. [PMID: 32596950 PMCID: PMC7540717 DOI: 10.1111/1747-0080.12619] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Abstract
It is the position of Dietitians Australia that clients can receive high‐quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth‐delivered dietetic consultations are comparable to those delivered in‐person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth‐delivered dietetic consultations as a responsive and cost‐effective alternative or complement to traditional in‐person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet‐related health and well‐being, regardless of their location, income or literacy level, thereby addressing current inequities.
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Affiliation(s)
- Jaimon T Kelly
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Juliana Chen
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clare Collins
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Megan Rollo
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Rebecca Haslam
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | | | - Katrina L Campbell
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
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Farabi H, Rezapour A, Jahangiri R, Jafari A, Rashki Kemmak A, Nikjoo S. Economic evaluation of the utilization of telemedicine for patients with cardiovascular disease: a systematic review. Heart Fail Rev 2019; 25:1063-1075. [DOI: 10.1007/s10741-019-09864-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hannan AL, Harders MP, Hing W, Climstein M, Coombes JS, Furness J. Impact of wearable physical activity monitoring devices with exercise prescription or advice in the maintenance phase of cardiac rehabilitation: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2019; 11:14. [PMID: 31384474 PMCID: PMC6668165 DOI: 10.1186/s13102-019-0126-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Physical activity (PA) is a component of cardiac rehabilitation (CR). However, life-long engagement in PA is required to maintain benefits gained. Wearable PA monitoring devices (WPAM) are thought to increase PA. There appear to be no reviews which investigate the effect of WPAM in cardiac populations. We firstly aimed to systematically review randomised controlled trials within the cardiac population that investigated the effect WPAM had through the maintenance phase of CR. We specifically examined the effect on cardiorespiratory fitness (CRF), amount and intensity of daily PA, and sedentary time. Secondly, we aimed to collate outcome measures reported, reasons for drop out, adverse events, and psychological impact from utilising a WPAM. METHODS A systematic search (up to January 2019) of relevant databases was completed, followed by a narrative synthesis, meta-analysis and qualitative analysis. RESULTS Nine studies involving 1,352 participants were included. CRF was improved to a greater extent in participants using WPAM with exercise prescription or advice compared with controls (MD 1.65 mL/kg/min;95% confidence interval [CI; 0.64-2.66]; p = 0.001; I2 = 0%). There was no significant between group difference in six-minute walk test distance. In 70% of studies, step count was greater in participants using a WPAM with exercise prescription or advice, however the overall effect was not significant (SMD 0.45;95% [CI; - 0.17-1.07] p = 0.15; I2 = 81%). A sensitivity analysis resulted in significantly greater step counts in participants using a WPAM with exercise prescription or advice and reduced the heterogeneity from 81 to 0% (SMD 0.78;95% [CI;0.54-1.02]; p < 0.001; I2 = 0%). Three out of four studies reporting on intensity, found significantly increased time spent in moderate and moderate-vigorous intensity PA. No difference between groups was found for sedentary time. Three of six studies reported improved psychological benefits.No cardiac adverse events related to physical activity were reported and 62% of non-cardiac adverse events were primarily musculoskeletal injuries. Reasons for dropping out included medical conditions, lack of motivation, loss of interest, and technical difficulties. CONCLUSIONS Our meta-analysis showed WPAM with exercise prescription or advice are superior to no device in improving CRF in the maintenance phase of CR and no cardiac adverse events were reported with WPAM use. Our qualitative analysis showed evidence in favour of WPAM with exercise prescription or advice for both CRF and step count. WPAM with exercise prescription or advice did not change sedentary time. Psychological health and exercise intensity may potentially be enhanced by WPAM with exercise prescription or advice, however further research would strengthen this conclusion. TRIAL REGISTRATION PROSPERO Registration Number: CRD42019106591.
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Affiliation(s)
- Amanda L. Hannan
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
| | - Michael P. Harders
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
| | - Mike Climstein
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group Faculty of Health Sciences, University of Sydney, Lidcombe, NSW Australia
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD Australia
| | - Jeff S. Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - James Furness
- Faculty of Health Sciences and Medicine, Bond University, 2 Promethean Way, Robina, Qld, Gold Coast, Queensland 4226 Australia
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Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart 2018; 104:1403-1410. [PMID: 29654096 PMCID: PMC6109236 DOI: 10.1136/heartjnl-2017-312809] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/11/2018] [Accepted: 03/18/2018] [Indexed: 12/17/2022] Open
Abstract
Patients may be offered cardiac rehabilitation (CR), a supervised programme often including exercises, education and psychological care, following a cardiac event, with the aim of reducing morbidity and mortality. Cost-constrained healthcare systems require information about the best use of budget and resources to maximise patient benefit. We aimed to systematically review and critically appraise economic studies of CR and its components. In January 2016, validated electronic searches of the National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment, PsycINFO, MEDLINE and Embase databases were run to identify full economic evaluations published since 2001. Two levels of screening were used and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed using the NHS EED handbook and Drummond checklist. The majority of studies concluded that CR was cost-effective versus no CR (incremental cost-effectiveness ratios (ICERs) ranged from $1065 to $71 755 per quality-adjusted life-year (QALY)). Evidence for specific interventions within CR was varied; psychological intervention ranged from dominant (cost saving and more effective) to $226 128 per QALY, telehealth ranged from dominant to $588 734 per QALY and while exercise was cost-effective across all relevant studies, results were subject to uncertainty. Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation, hospitalisation and intervention costs, and utilities. This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.
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Affiliation(s)
- Gemma E Shields
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care NHS Trust, Manchester, UK
| | | | - Anthony Heagerty
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Deborah Buck
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Linda M Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
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Kourbelis C, Franzon J, Foote JW, Brown A, Daniel M, Coffee NT, Newman P, Ganesan A, Nicholls S, Clark RA. Adherence to activity monitoring devices or smartphone applications for improving physical activity in adults with cardiovascular disease: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:1634-1642. [DOI: 10.11124/jbisrir-2017-003584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Lentferink AJ, Oldenhuis HK, de Groot M, Polstra L, Velthuijsen H, van Gemert-Pijnen JE. Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: A Scoping Review. J Med Internet Res 2017; 19:e277. [PMID: 28765103 PMCID: PMC5558041 DOI: 10.2196/jmir.7288] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/03/2017] [Accepted: 06/05/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. OBJECTIVE The aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence. METHODS The scoping review methodology proposed by Arskey and O'Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. RESULTS The search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content. CONCLUSIONS This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective.
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Affiliation(s)
- Aniek J Lentferink
- Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands.,Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hilbrand Ke Oldenhuis
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Martijn de Groot
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Louis Polstra
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hugo Velthuijsen
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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Sangster J, Furber S, Phongsavan P, Redfern J, Mark A, Bauman A. Effects of a Pedometer-Based Telephone Coaching Intervention on Physical Activity Among People with Cardiac Disease in Urban, Rural and Semi-Rural Settings: A Replication Study. Heart Lung Circ 2016; 26:354-361. [PMID: 27622895 DOI: 10.1016/j.hlc.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 06/08/2016] [Accepted: 07/07/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to determine the replicability of a pedometer-based telephone coaching intervention by comparing the outcomes of a study conducted in rural and urban settings to a study that previously found the same intervention effective in a semi-rural setting. METHODS Replication studies are conducted to assess whether an efficacious intervention is effective in multiple different settings. This study compared the outcomes of a pedometer-based coaching intervention implemented in urban and rural settings (replication study) with the same intervention implemented in a semi-rural setting (reference study) on physical activity levels. RESULTS Improvements in total weekly physical activity time in the replication study were significant from baseline to six weeks (p<0.001 urban, p=0.006 rural) and remained significant at six months (p=0.029 urban, p=0.005 rural). These increases were comparable to those achieved in the original efficacy trial conducted in a semi-rural setting. CONCLUSIONS The pedometer-based telephone coaching intervention increases physical activity levels of people with cardiac disease referred to a CR program in diverse settings. This replication study indicates the suitability of this minimal contact, low-cost intervention for further scaling-up to address unmet need in community-dwelling cardiac patients.
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Affiliation(s)
- Janice Sangster
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia.
| | - Susan Furber
- Health Promotion Service, Illawarra and Shoalhaven Local Health District, Warrawong, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Julie Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Andrew Mark
- National Heart Foundation of Australia (Illawarra Shoalhaven Region NSW)
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW, Australia
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