Poor use of cardiac rehabilitation among older adults: a self-regulatory model for tailored interventions

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

BACKGROUND

Recent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI.

METHODS

We performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients.

RESULTS

All studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD  - 0.25, 95%CI  - 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD - 2.88, 95%CI - 5.19 to - 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol.

CONCLUSION

This systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.

Experience of cardiac tele-rehabilitation: analysis of patient narratives

INTRODUCTION

Research suggests the need for further studies of patients' experiences of cardiac tele-rehabilitation to understand how they adapt to life with heart disease in a program with long-distance contact, remote supervision and monitoring of health behavior. Therefore, the aim of this study was to explore patients' experiences of tele-rehabilitation and the perceived gains of taking part in the program.

MATERIALS AND METHODS

Seven patients were interviewed using a phenomenological-hermeneutic approach. Interview transcripts were analyzed as narratives using the interpretation theory of the French philosopher Paul Ricoeur. This involves three levels of textual analysis: a naïve reading as the first interpretation followed by a structural analysis, where the text is explored in detail, before identifying the most significant interpretation through critical interpretation.

RESULTS

Patients valued cardiac tele-rehabilitation because it was not restricted to the hospital setting. They felt that the program's flexibility was an advantage because the program could be adjusted to their daily lives. The patients showed greater acknowledgement of and commitment towards the rehabilitation interventions if they were consistent with the patients' self-image, and if the activities were already part of their daily lives. If they were not, they were experienced as an extra challenge.

CONCLUSIONS

Understanding patients' self-image and prior lifestyle may better inform clinicians about why it can be difficult for patients to follow rehabilitation recommendations. Therefore, clinicians may need to focus more on these two factors to help patients adapt to life with heart disease. IMPLICATIONS FOR REHABILITATION Patients' self-image and prior lifestyle may be important factors for how patients adapt to their new life situation with heart disease within a cardiac tele-rehabilitation program. Patients' commitment to selected rehabilitation interventions may be either too high or too low if it fails to take into consideration their self-image and prior lifestyle. Understanding patients' self-image and prior lifestyle may better inform clinicians and their understanding of why it can be difficult for patients to follow the rehabilitation recommendations.

A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious)

HIV is transmitted in social and sexual relationships, and HIV transmission risks, as well as protective actions, are evolving as HIV epidemics unfold. The current focus of HIV prevention is centered on antiretroviral medications used to reduce HIV infectiousness in persons already infected with HIV [treatment as prevention (TasP)]. The same medications used to treat infected persons can also be used by uninfected persons as pre-exposure prophylaxis (PrEP) to reduce the infectivity of HIV. Both PrEP and TasP are effective when adherence is high and individuals do not have co-occurring sexually transmitted infections. HIV prevention is most effective and efficient when delivered within sexual networks with high HIV prevalence. Specific network characteristics are recognized as important facilitators of HIV transmission; these characteristics include the degree of similarity among network members (homophily), gender role norms, and belief systems. Since 2011, HIV risk has been redefined based on infectiousness and infectivity, ushering in a new era of HIV prevention with the potential to end HIV epidemics.

Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence

BACKGROUND

HIV infection is clinically managed with antiretroviral therapy (ART), but only with sustained adherence. Cost-efficient interventions to improve and sustain ART adherence remain a pressing priority for populations challenged by nonadherence. The aim of this study was to test the independent and interactive effects of (1) brief phone-delivered self-regulation counseling and (2) daily phone-delivered text message medication reminders on HIV adherence and HIV viral suppression.

METHOD

A randomized 2 (5 sessions of phone-delivered adherence support counseling vs. contact-matched control) × 2 (daily ART text reminders vs. no reminders) trial with primary end points of monthly phone-based unannounced pill count-determined ART adherence and HIV viral suppression monitored over 12 months.

RESULTS

Self-regulation adherence counseling demonstrated significant improvements in achieving 90% ART adherence relative to the control group over the first 6 months of follow-up. Effects remained significant in sensitivity analyses conducted at 85% and 95% adherence. Counseling also demonstrated modest but significant effects on HIV suppression. There were no main effects or interactions for daily text message reminders, with some evidence for adverse effects on adherence self-efficacy.

CONCLUSIONS

Brief adherence support counseling delivered by phone demonstrates clinically meaningful improvements in ART adherence and HIV suppression, although these benefits were not evidenced in all patients or in the long-term. Advancing adherence interventions along with an effective means for sustaining gains in adherence remain priorities if ART is to achieve its potential clinical and public health benefits.

Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory

BACKGROUND

In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical.

AIMS

The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes.

METHODS

Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes.

RESULTS

Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance.

CONCLUSIONS

Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.

Exergames and cardiac rehabilitation: a review

INTRODUCTION

The newer generation of active video games (AVGs), which allow the participant to interact with the platform by performing exercise movements, seems promising in increasing physical activity (PA) and behavioral change toward a healthier lifestyle in several disease backgrounds. This literature review aims to establish a rationale for using AVGs as a complement to cardiac rehabilitation (CR).

METHODS

A systematic review was conducted to query whether AVGs are effective at improving various health parameters in adults/seniors, which could be useful for CR. From 134 identified studies, only 21 were finally included as trials meeting the required criteria. The majority reported gameplay intensities that could be classified as light-moderate PA. AVGs revealed superior effectiveness or noninferiority at improving balance.

DISCUSSION

AVGs seem to offer numerous relevant cardiovascular and noncardiovascular benefits and pose minimal risks for the adult/senior population. AVGs seem a feasible, effective, and safe supplementation strategy, in light of the specificities of the CR population. Clinicians could borrow several concepts incorporated in AVGs to develop a CR intervention that is fun and engaging to improve adherence.

CONCLUSION

On the basis of this review, the usefulness of AVGs to improve PA, cardiorespiratory fitness, and motor function in older adults appears to be poorly described. In particular, data on the impact of AVGs on the CR population seem inexistent. Nevertheless, there are reasons to believe that AVGs may prove important to address the health and well-being concerns of this population. More research in the specific setting of CR is warranted.