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Dawson JK, Ede A, Phan M, Sequeira A, Teng HL, Donlin A. Feasibility and Acceptability of a Mobile Health Exercise Intervention for Inactive Adults: 3-Arm Randomized Controlled Pilot Trial. JMIR Form Res 2024; 8:e52428. [PMID: 39120078 DOI: 10.2196/52428] [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: 09/03/2023] [Revised: 02/01/2024] [Accepted: 04/11/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Objective monitoring of self-directed physical activity (PA) is a common approach used in both fitness and health settings to promote exercise behavior, but adherence has been poor. Newer mobile health (mHealth) technologies could be a cost-effective approach to broadening accessibility and providing support for PA behavior change; yet, the optimal method of delivery of such interventions is still unclear. OBJECTIVE This study aimed to determine the feasibility and acceptability of an mHealth exercise intervention delivered in combination with objective monitoring in 3 ways: health education emails, asynchronous exercise videos, or synchronous videoconference exercise classes. METHODS Physically inactive (<30 min/wk) adults (cisgender women aged 31.5, SD 11.3 years, cisgender men aged 34.1, SD 28.9 years, and nonbinary individuals aged 22.0, SD 0 years) were randomized (1:1:1) to 8 weeks of increasing PA behavioral support: level 1 (health education+objective monitoring, n=26), level 2 (asynchronous contact, level 1+prerecorded exercise videos, n=30), or level 3 (synchronous contact, level 1+videoconference group exercise, n=28). Participants used a heart rate monitor during exercise and a mobile app for interaction. Primary outcomes were feasibility (accrual, retention, and adherence) and acceptability (user experience survey). Secondary outcomes assessed at baseline and 8 weeks included resting heart rate, self-reported PA, and quality of life. The exercise dose was evaluated throughout the intervention. RESULTS Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Retention was 50% (13/26) in level 1, 60% (18/30) in level 2 and 82% (23/28) in level 3, while adherence was 31% (8/26) in level 1, 40% (12/30) in level 2 and 75% (21/28) in level 3. A total of 83% (70/84) of the study sample completed the intervention, but low response rates (64%, 54/84) were observed postintervention at week-8 assessments. Program satisfaction was highest in participants receiving exercise videos (level 2, 80%, 8/10) or exercise classes (level 3, 80%, 12/15), while only 63% (5/8) of level 1 reported the program as enjoyable. Level 3 was most likely to recommend the program (87%, 13/15), compared to 80% (8/10) in level 2 and 46% (5/8) in level 1. Self-reported PA significantly increased from baseline to intervention in level 3 (P<.001) and level 2 (P=.003), with no change in level 1. Level 3 appeared to exercise at higher doses throughout the intervention. CONCLUSIONS Only the videoconference exercise class intervention met feasibility criteria, although postintervention response rates were low across all groups. Both videoconference and prerecorded videos had good acceptability, while objective monitoring and health education alone were not feasible or acceptable. Future studies are needed to examine the effectiveness of videoconference exercise interventions on health-related outcomes during nonpandemic times and how asynchronous interventions might maximize adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT05192421; https://clinicaltrials.gov/study/NCT05192421.
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Affiliation(s)
- Jacqueline Kiwata Dawson
- Department of Physical Therapy, California State University, Long Beach, Long Beach, CA, United States
| | - Alison Ede
- Department of Kinesiology, California State University, Long Beach, Long Beach, CA, United States
| | - Madeleine Phan
- Department of Chemistry and Biochemistry, California State University, Long Beach, Long Beach, CA, United States
| | - Alec Sequeira
- Department of Kinesiology, California State University, Long Beach, Long Beach, CA, United States
| | - Hsiang-Ling Teng
- Department of Physical Therapy, California State University, Long Beach, Long Beach, CA, United States
| | - Ayla Donlin
- LifeFit Center, Department of Kinesiology, California State University, Long Beach, Long Beach, CA, United States
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Raymond MJ, Christie LJ, Kramer S, Malaguti C, Mok Z, Gardner B, Giummarra MJ, Alves-Stein S, Hudson C, Featherston J, Holland AE, Lannin NA. Delivery of Allied Health Interventions Using Telehealth Modalities: A Rapid Systematic Review of Randomized Controlled Trials. Healthcare (Basel) 2024; 12:1217. [PMID: 38921331 PMCID: PMC11203162 DOI: 10.3390/healthcare12121217] [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: 03/31/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
Objectives: To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. Study design: A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Eligible trials: Trials were eligible for inclusion if they compared a comparable dose of face-to-face to telehealth interventions delivered by a neuropsychologist, occupational therapist, physiotherapist, podiatrist, psychologist, and/or speech pathologist; reported patient-level outcomes; and included adult participants. Data sources: MEDLINE, CENTRAL, CINAHL, and EMBASE databases were first searched from inception for systematic reviews and eligible trials were extracted from these systematic reviews. These databases were then searched for randomized clinical trials published after the date of the most recent systematic review search in each discipline (2017). The reference lists of included trials were also hand-searched to identify potentially missed trials. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 1. Data Synthesis: Fifty-two trials (62 reports, n = 4470) met the inclusion criteria. Populations included adults with musculoskeletal conditions, stroke, post-traumatic stress disorder, depression, and/or pain. Synchronous and asynchronous telehealth approaches were used with varied modalities that included telephone, videoconferencing, apps, web portals, and remote monitoring, Overall, telehealth delivered similar improvements to face-to-face interventions for knee range, Health-Related Quality of Life, pain, language function, depression, anxiety, and Post-Traumatic Stress Disorder. This meta-analysis was limited for some outcomes and disciplines such as occupational therapy and speech pathology. Telehealth was safe and similar levels of satisfaction and adherence were found across modes of delivery and disciplines compared to face-to-face interventions. Conclusions: Many allied health interventions are equally as effective as face-to-face when delivered via telehealth. Incorporating telehealth into models of care may afford greater access to allied health professionals, however further comparative research is still required. In particular, significant gaps exist in our understanding of the efficacy of telehealth from podiatrists, occupational therapists, speech pathologists, and neuropsychologists. Protocol Registration Number: PROSPERO (CRD42020203128).
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Affiliation(s)
- Melissa J. Raymond
- School of Translational Medicine, Monash University, Melbourne 3004, Australia; (S.K.); (M.J.G.); (S.A.-S.); (A.E.H.); (N.A.L.)
| | - Lauren J. Christie
- Allied Health Research Unit, St Vincent’s Health Network Sydney, Darlinghurst 2000, Australia;
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Darlinghurst 2010, Australia
| | - Sharon Kramer
- School of Translational Medicine, Monash University, Melbourne 3004, Australia; (S.K.); (M.J.G.); (S.A.-S.); (A.E.H.); (N.A.L.)
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
| | - Carla Malaguti
- Department of Cardiorespiratory and Skeletal Muscle, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
| | - Zaneta Mok
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
| | | | - Melita J. Giummarra
- School of Translational Medicine, Monash University, Melbourne 3004, Australia; (S.K.); (M.J.G.); (S.A.-S.); (A.E.H.); (N.A.L.)
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
| | - Serena Alves-Stein
- School of Translational Medicine, Monash University, Melbourne 3004, Australia; (S.K.); (M.J.G.); (S.A.-S.); (A.E.H.); (N.A.L.)
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
| | - Claire Hudson
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
| | - Jill Featherston
- School of Medicine, Cardiff University, Wales CF10 2AF, UK
- Western Sydney Podiatry, Penrith 2750, Australia
| | - Anne E. Holland
- School of Translational Medicine, Monash University, Melbourne 3004, Australia; (S.K.); (M.J.G.); (S.A.-S.); (A.E.H.); (N.A.L.)
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
- Institute for Breathing and Sleep, Melbourne 3084, Australia
| | - Natasha A. Lannin
- School of Translational Medicine, Monash University, Melbourne 3004, Australia; (S.K.); (M.J.G.); (S.A.-S.); (A.E.H.); (N.A.L.)
- Alfred Health, Melbourne 3000, Australia; (Z.M.); (C.H.)
- Department of Cardiorespiratory and Skeletal Muscle, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Brazil
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Keteyian SJ, Grimshaw C, Ehrman JK, Kerrigan DJ, Abdul-Nour K, Lanfear DE, Brawner CA. The iATTEND Trial: A Trial Comparing Hybrid Versus Standard Cardiac Rehabilitation. Am J Cardiol 2024; 221:94-101. [PMID: 38670326 PMCID: PMC11144075 DOI: 10.1016/j.amjcard.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/22/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
The improving ATTENDance (iATTEND) to cardiac rehabilitation (CR) trial tested the hypotheses that hybrid CR (HYCR) (combination of virtual and in-facility CR sessions) would result in greater attendance compared with traditional, facility-based only CR (FBCR) and yield equivalent improvements in exercise capacity and health status. Patients were randomized to HYCR (n = 142) or FBCR (n = 140), stratified by gender and race. Attendance was assessed as number of CR sessions completed within 6 months (primary end point) and the percentage of patients completing 36 CR sessions. Other end points (tested for equivalency) included exercise capacity and self-reported health status. HYCR patients completed 1 to 12 sessions in-facility, with the balance completed virtually using synchronized, 2-way audiovisual technology. Neither total number of CR sessions completed within 6 months (29 ± 12 vs 28 ± 12 visits, adjusted p = 0.94) nor percentage of patients completing 36 sessions (59 ± 4% vs 51 ± 4%, adjusted p = 0.32) were significantly different between HYCR and FBCR, respectively. The between-group changes for exercise capacity (peak oxygen uptake, 6-minute walk distance) and health status were equivalent. Regarding safety, no sessions required physician involvement, there was 1 major adverse event after a virtual session, and no falls required medical attention. In conclusion, although we rejected our primary hypothesis that attendance would be greater with HYCR versus FBCR, we showed that FBCR and HYCR resulted in similar patient attendance patterns and equivalent improvements in exercise capacity and health status. HYCR which incorporates virtually supervised exercise should be considered an acceptable alternative to FBCR. NCT Identifier: 03646760; The Improving ATTENDance to Cardiac Rehabilitation Trial - Full-Text View - ClinicalTrials. gov; https://classic.clinicaltrials.gov/ct2/show/NCT03646760.
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Affiliation(s)
- Steven J Keteyian
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan.
| | - Crystal Grimshaw
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Dennis J Kerrigan
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Khaled Abdul-Nour
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - David E Lanfear
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Health Detroit, Michigan
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Pagliari C, Isernia S, Rapisarda L, Borgnis F, Lazzeroni D, Bini M, Geroldi S, Baglio F, Brambilla L. Different Models of Cardiac Telerehabilitation for People with Coronary Artery Disease: Features and Effectiveness: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3396. [PMID: 38929925 PMCID: PMC11203811 DOI: 10.3390/jcm13123396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives: Cardiac telerehabilitation (TR) for coronary artery disease (CAD) is a feasible alternative to the center-based rehabilitation delivery model. However, the features of exercise-based cardiac TR are still heterogeneous among studies, making it difficult to disentangle the preferable reference strategies to be recommended for the adoption of this new delivery of care. In addition, little is known about the effectiveness of different models, such as the hybrid model (CRh) including both center-based and home-based telerehabilitation approaches, and the solely home-based telerehabilitation (CTR). Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included TR intervention in patients with CAD to profile the features of the telerehabilitation approach for CAD. We also conducted a meta-analysis to separately assess the effectiveness of CTR and CRh on medical benefit outcome measures compared to conventional intervention (CI). Results: Out of 17.692 studies, 28 RCTs involving 2.662 CAD patients were included in the review. The studies presented an equal proportion of the CTR and CRh models. The interventions were mainly multidimensional, with a frequency of 1 month to 6 months, with each session ranging between 20 to 70 min. In CRh, the intervention was mainly consecutive to center-based rehabilitation. All studies adopted asynchronous communication in TR, mainly providing monitoring/assessment, decisions, and offline feedback. Few studies reported mortality, and none reported data about re-hospitalization or morbidity. Adherence to the CTR and CRh interventions was high (over 80%). The meta-analyses showed the superior effect of CTR compared to CI in exercise capacity. An overall noninferiority effect of both CTR and CRh compared to CI was found with factors including risk control and participation. Conclusions: The results of the review and meta-analyses indicated that CTR and CRh are equally effective, safe, convenient, and valid alternatives to cardiac conventional interventions. The evidence suggests that telerehabilitation may represent a valid alternative to overcome cardiac rehabilitation barriers.
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Affiliation(s)
- Chiara Pagliari
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Laura Rapisarda
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
- Faculty of Psychology, Catholic University of Sacred Heart of Milan, 20123 Milan, Italy
| | - Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Davide Lazzeroni
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Matteo Bini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Simone Geroldi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
| | - Lorenzo Brambilla
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy; (C.P.); (L.R.); (F.B.); (D.L.); (M.B.); (S.G.); (F.B.); (L.B.)
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Tang CY, Bastani A, Sidhu B, Saberi G, Baker E. Access, Readiness and Willingness to Engage in Allied Health Telerehabilitation Services for Adults: Does Cultural and Linguistic Diversity Make a Difference? Healthcare (Basel) 2024; 12:1141. [PMID: 38891216 PMCID: PMC11172156 DOI: 10.3390/healthcare12111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/08/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients receiving allied health services from a large tertiary health service located in Sydney, Australia, to use telerehabilitation for adults. Overall, 72% patients reported having access to technology, 38% met our readiness criteria and 53% reported willingness to engage in telerehabilitation. There were no differences in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access (OR = 0.94, 95% CI 0.90 to 0.97), readiness (OR = 0.95, 95% CI 0.92 to 0.98) and willingness (OR = 0.97, 95% CI 0.95 to 1.00) to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness (OR = 2.73, 95% CI 1.55-4.79) but not access (OR = 1.79, 95% CI 0.87 to 3.68) or readiness (OR = 1.90, 95% CI 0.93 to 3.87). Our findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients' digital health literacy, especially patients from older age groups, to ensure equitable engagement in telerehabilitation services.
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Affiliation(s)
- Clarice Y. Tang
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Allied Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- College of Sport, Health and Engineering, Victoria University, Melbourne, VIC 3011, Australia
| | - Andisheh Bastani
- College of Sport, Health and Engineering, Victoria University, Melbourne, VIC 3011, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Balwinder Sidhu
- Multicultural Services, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Golsa Saberi
- Multicultural Services, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Elise Baker
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Allied Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
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Owen O, O’Carroll V. The effectiveness of cardiac telerehabilitation in comparison to centre-based cardiac rehabilitation programmes: A literature review. J Telemed Telecare 2024; 30:631-646. [PMID: 35369770 PMCID: PMC11027439 DOI: 10.1177/1357633x221085865] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/07/2022] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is an effective, yet under-utilised, form of secondary prevention in cardiac patients. Telemedicine is one method of overcoming barriers to accessing CR. Previous systematic reviews highlight variation in the effectiveness of telerehabilitation programmes and current literature lacks identification of which telemedicine interventions are most effective, despite differences in the results of primary studies. The objectives of this literature review were to: evaluate the effectiveness of cardiac telerehabilitation compared to centre-based programmes for managing cardiac risk factors, satisfaction and adherence in cardiac patients; identify the technologies used to deliver CR; identify the key components of effective interventions. METHODS A literature search was conducted using MEDLINE, EMBASE and Scopus. Randomised controlled trials (RCTs) involving an intervention group that received telerehabilitation and a control group that attended a CR centre were included. RESULTS Twelve RCTs met the inclusion criteria. There is evidence to suggest that telerehabilitation programmes have similar effectiveness to centre-based CR. Phones were the most commonly used technology. Most studies used a combination of technologies including personal computers and self-monitoring equipment. Phase III telerehabilitation programmes using self-monitoring, motivational feedback and education were more effective than centre-based CR for increasing physical activity and functional capacity. CONCLUSION Cardiac telerehabilitation is delivered by a range of technologies and has a similar effectiveness to centre-based programmes. While evidence suggests that additional health benefits are seen in patients who receive a telemedicine intervention in Phase III of CR, further evidence would be required to confidently draw this conclusion.
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Affiliation(s)
- Olivia Owen
- Olivia Owen, School of Medicine, University of St Andrews, St Andrews, KY16 9TF, Scotland.
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Lee AC, Deutsch JE, Holdsworth L, Kaplan SL, Kosakowski H, Latz R, McNeary LL, O’Neil J, Ronzio O, Sanders K, Sigmund-Gaines M, Wiley M, Russell T. Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association. Phys Ther 2024; 104:pzae045. [PMID: 38513257 PMCID: PMC11140266 DOI: 10.1093/ptj/pzae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/01/2024] [Indexed: 03/23/2024]
Abstract
A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).
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Affiliation(s)
- Alan C Lee
- Physical Therapy Department, Mount Saint Mary’s University, Los Angeles, California, USA
| | - Judith E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Sciences, Program Physical Therapy, Rutgers University, New Brunswick, New Jersey, USA
- Department of Rehabilitation and Movement Sciences, Program Physical Therapy, Graduate School, Rutgers University, New Brunswick, New Jersey, USA
| | - Lesley Holdsworth
- NHS 24, Caledonia House, 140 Fifty Pitches Rd, Cardinals, Glasgow, Scotland, United Kingdom
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences, Program Physical Therapy, Rutgers University, New Brunswick, New Jersey, USA
| | - Heidi Kosakowski
- World Physiotherapy, Head of Membership and Policy, Unit 17, Empire Square, London, United Kingdom
| | - Robert Latz
- Chief Information Office (CIO), Trinity Rehabilitation Services, Florence, Kentucky, USA
| | - Lydia Lennox McNeary
- School of Medicine, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Jennifer O’Neil
- Physiotherapy Program, School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Oscar Ronzio
- Member of World Physiotherapy, Argentine Association of Kinesiology, Buenos Aires, Argentina
| | - Kelly Sanders
- Movement for Life Physical Therapy, Atascadero, California, USA
| | | | - Michele Wiley
- Department of Physical Therapy, Shenandoah University, Winchester, Virginia, USA
| | - Trevor Russell
- RECOVER Injury Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Albalawi HFA. The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review. Healthcare (Basel) 2024; 12:917. [PMID: 38727474 PMCID: PMC11083061 DOI: 10.3390/healthcare12090917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution. OBJECTIVE This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes. RESULTS Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise. CONCLUSIONS Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.
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Affiliation(s)
- Hani Fahad A Albalawi
- Department of Health Rehabilitation Sciences, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk 71491, Saudi Arabia
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Gamble CJ, van Haastregt JCM, van Dam van Isselt EF, Zwakhalen SMG, Schols JMGA. Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review. Clin Rehabil 2024; 38:457-477. [PMID: 38013415 PMCID: PMC10898211 DOI: 10.1177/02692155231217411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults. DATA SOURCES Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023. REVIEW METHODS Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool. RESULTS A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias. CONCLUSION The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.
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Affiliation(s)
- CJ Gamble
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
- Stichting Valkenhof, Valkenswaard, The Netherlands
| | - JCM van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - EF van Dam van Isselt
- University Network for the Care sector Zuid-Holland, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - SMG Zwakhalen
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
| | - JMGA Schols
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Living Lab of Ageing and Long Term Care, Maastricht, The Netherlands
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10
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Accorsi TAD, dos Santos GGR, Nemoto RP, Moreira FT, De Amicis K, Köhler KF, Cordioli E, Pedrotti CHS. Telemedicine and patients with heart failure: evidence and unresolved issues. EINSTEIN-SAO PAULO 2024; 22:eRW0393. [PMID: 38451690 PMCID: PMC10948100 DOI: 10.31744/einstein_journal/2024rw0393] [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: 11/24/2022] [Accepted: 10/26/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.
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Affiliation(s)
| | | | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karine De Amicis
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karen Francine Köhler
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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11
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Liu K, Tronstad O, Flaws D, Churchill L, Jones AYM, Nakamura K, Fraser JF. From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome. J Intensive Care 2024; 12:11. [PMID: 38424645 PMCID: PMC10902959 DOI: 10.1186/s40560-024-00724-4] [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: 10/18/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed. MAIN BODY This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions. CONCLUSION PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.
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Affiliation(s)
- Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan.
| | - Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Science, Queensland University of Technology, Brisbane, Australia
| | - Luke Churchill
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Alice Y M Jones
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Kanagawa, Japan
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- St. Andrews War Memorial Hospital, Brisbane, Australia
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12
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Teo JL, Bird SR, Wang X, Zheng Z. Using telehealth to deliver Qi Gong and Tai Chi programs: A mixed-methods systematic review on feasibility, acceptability and participant engagement factors. Arch Gerontol Geriatr 2024; 117:105203. [PMID: 37741135 DOI: 10.1016/j.archger.2023.105203] [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: 07/20/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Due to the COVID-19 pandemic, the use of digitally delivered exercise classes to promote physical activity has become widespread amongst various populations as an alternative to in-person activities. OBJECTIVES To examine the feasibility, acceptability, and participant engagement variables to delivering Qi Gong and Tai Chi programs through telehealth interventions. METHODS Ten databases (Seven English databases; three Chinese databases) were searched between October and November 2021. Studies published in English or Chinese, or having translations in English or Chinese, were included. Titles and abstracts of identified articles were screened, relevant studies were then retrieved for full-text screening. Study selection, assessment of methodological quality, data extraction, data transformation, and data synthesis were completed following a convergent integrated approach to mixed method systematic reviews. RESULTS Seven articles were included in review. Digital literacy of both participants and providers was found to be a significant hurdle towards digital program implementation. There were no notable issues pertaining to access to an internet connection, participant safety, program costs, or connectivity. A major theme for sustaining program engagement was found to be individual perceived relevance for intervention involvement. Online social involvement was noted to be both a facilitator for participant acceptability and engagement. Overall, participants expressed satisfaction with the use of telehealth, while providers expressed acceptability concerns regarding quality of care. CONCLUSION It is recommended that planned measures be taken prior to program commencement to decrease digital literacy requirements while also including a participatory approach to encourage uptake. During the program, provision of technical support alongside appropriate social-environmental engagement facilitators would promote sustained adherence.
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Affiliation(s)
- Junsheng L Teo
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Stephen R Bird
- School of Health and Biostatistics, Swinburne University, Melbourne, Australia
| | - Xiaoqiu Wang
- Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
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13
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Jacobsson RJ, Oikarinen A, Krogell J, Kankkunen P. Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review. Clin Rehabil 2024; 38:184-201. [PMID: 37731365 PMCID: PMC10725089 DOI: 10.1177/02692155231202855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. DATA SOURCES A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. METHODS The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. RESULTS The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. CONCLUSIONS This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.
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Affiliation(s)
- Renuka J Jacobsson
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Anne Oikarinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jenni Krogell
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
| | - Päivi Kankkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio,
Finland
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14
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Nakanishi N, Liu K, Hatakeyama J, Kawauchi A, Yoshida M, Sumita H, Miyamoto K, Nakamura K. Post-intensive care syndrome follow-up system after hospital discharge: a narrative review. J Intensive Care 2024; 12:2. [PMID: 38217059 PMCID: PMC10785368 DOI: 10.1186/s40560-023-00716-w] [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: 10/27/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is the long-lasting impairment of physical functions, cognitive functions, and mental health after intensive care. Although a long-term follow-up is essential for the successful management of PICS, few reviews have summarized evidence for the efficacy and management of the PICS follow-up system. MAIN TEXT The PICS follow-up system includes a PICS follow-up clinic, home visitations, telephone or mail follow-ups, and telemedicine. The first PICS follow-up clinic was established in the U.K. in 1993 and its use spread thereafter. There are currently no consistent findings on the efficacy of PICS follow-up clinics. Under recent evidence and recommendations, attendance at a PICS follow-up clinic needs to start within three months after hospital discharge. A multidisciplinary team approach is important for the treatment of PICS from various aspects of impairments, including the nutritional status. We classified face-to-face and telephone-based assessments for a PICS follow-up from recent recommendations. Recent findings on medications, rehabilitation, and nutrition for the treatment of PICS were summarized. CONCLUSIONS This narrative review aimed to summarize the PICS follow-up system after hospital discharge and provide a comprehensive approach for the prevention and treatment of PICS.
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Affiliation(s)
- Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-Ward, Kobe, 650-0017, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Rd, St Lucia, QLD, 4067, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Akira Kawauchi
- Department of Critical Care and Emergency Medicine, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-Machi, Maebashi-Shi, Gunma, 371-0811, Japan
| | - Minoru Yoshida
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216- 8511, Japan
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-Cho, Toyokawa, Aichi, 441-0105, Japan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawaku, Yokohama, 236-0004, Japan.
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15
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McDonagh STJ, Dalal H, Moore S, Clark CE, Taylor RS. Cochrane corner: centre versus telemedicine approaches to cardiac rehabilitation. Heart 2023; 110:7-10. [PMID: 37487697 DOI: 10.1136/heartjnl-2023-322640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Affiliation(s)
- Sinéad T J McDonagh
- Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Research, Development and Innovation, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Sarah Moore
- Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, School of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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16
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Hammad Jafri S, Qureshi R, Ho TTT, Chung HE, Ngamdu KS, Medbury E, Ursillo J, Robitaille J, Wu WC. Home Based Cardiac Rehabilitation Participation Among Patients With Heart Failure. Curr Probl Cardiol 2023; 48:102013. [PMID: 37544630 DOI: 10.1016/j.cpcardiol.2023.102013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Patients with Heart Failure (HF) have significant morbidity and mortality. Home Based Cardiac Rehabilitation (HBCR) is a form of Cardiac Rehabilitation (CR) which has been proven beneficial for the patients with cardiovascular disease; However, cardiovascular outcomes in patients with HF who was referred to HBCR is not known. METHODS A retrospective study of 188 patients with HF (HFrEF or heart failure with reduced ejection fraction and HFpEF or heart failure with preserved ejection fraction) referred to HBCR at Veterans Affairs Medical Center (VAMC) from November 2017 to March 2020. We used the outcomes of patients with HF who attended HBCR and compared with the outcomes of patients who did not attend HBCR (Non-HBCR) from 3 months after starting HBCR till 12 months. Primary outcome was composite of all-cause mortality and cardiovascular hospitalizations. Secondary outcomes were all-cause mortality, cardiovascular hospitalizations and all-cause hospitalization, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: age, smoking, PCI and CABG status. In subgroup analysis, we compared HFrEF and HFpEF patients who have completed HBCR and compared differences of their outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test, duke score and PHQ-9) pre- and post-HBCR. RESULTS Mean age of the patients was 72 year and 98% were male. Out of 188 patients total, 11 patients were excluded for the main analysis as their outcomes occurred within first 90 days of HBCR enrollment, 105/177 (59%) patients attended HBCR while 72/177 (41%) patients did not attend HBCR and 93/105 (89%) patients have completed HBCR. The primary outcome occurred in 14 patients (13.3%) in the HBCR group and 19 patients (26.4%) in the Non-HBCR group (adjusted HR=0.32, CI 0.15-0.68). There was no difference in cardiovascular hospitalization among two groups, however patients in HBCR group have lower all-cause hospitalizations and all-cause death, separately. After HBCR completion, all outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test, duke score and PHQ-9) have improved in both HFrEF and HFpEF group. CONCLUSION Patients with HF who have completed HBCR have a lower risk of all-cause mortality, all cause hospitalization separately and lower risk of combined all-cause mortality and cardiovascular hospitalization. Patients with HFrEF and HFpEF have equal degree of improvement after completing HBCR when compared with each other. HBCR is an ideal opportunity for patients with HF who cannot attend center-based CR and also for patients with HFpEF since CR is not approved for those patients.
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Affiliation(s)
- S Hammad Jafri
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI.
| | - Reema Qureshi
- Alpert Medical School, Brown University, Providence, RI
| | | | - Hojune E Chung
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | - Kyari Sumayin Ngamdu
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
| | | | | | | | - Wen-Chih Wu
- Providence Veterans Affairs Medical Center, Providence, RI; Alpert Medical School, Brown University, Providence, RI
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17
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Nguyen G, King K, Stirling L. Telerehabilitation use and experiences in occupational and physical therapy through the early stages of the COVID-19 pandemic. PLoS One 2023; 18:e0291605. [PMID: 37939089 PMCID: PMC10631673 DOI: 10.1371/journal.pone.0291605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/31/2023] [Indexed: 11/10/2023] Open
Abstract
Telehealth has helped to increase access to rehabilitative services such as occupational and physical therapy. The early COVID-19 pandemic amplified the need for remote access to care, and the rapid implementation of telehealth systems provided a unique opportunity to learn from clinicians' experiences adopting telehealth for telerehabilitation applications. To understand these experiences, a self-administered online survey was conducted to capture perspectives on ease of telerehabilitation use and adoption from occupational and physical therapists. The survey captured retrospective views on telerehabilitation use pre-pandemic as well as real-time perspectives on telerehabilitation during the early stages of the pandemic (July to August 2020). The survey gathered information on clinician demographics (N = 109), clinicians' experiences with adopting or utilizing telerehabilitation systems, and their perceptions on remotely performing cognitive, emotional, and physical assessments via video-conferencing (a common mode of telehealth). Responses demonstrated a modest increase in telerehabilitation as a care setting (rate increase from 3.4% to 19.3%), and telerehabilitation was more generally tried during the early stages of the pandemic (41 clinicians explicitly reported telerehabilitation use). However, technology access and acceptance remained low, with 38 clinicians (35%) expressing concerns that technology was ineffective or impractical, unavailable, not covered by insurance, or not desired by their patients. Video-conferencing technology was perceived as generally ill-equipped to support clinicians in performing remote assessment tasks. Physical assessment tasks were considered particularly difficult, with 55% of clinicians rating their ability to perform these tasks in the range of moderately difficult to unable to perform. To address these difficulties and better augment clinical care, clinicians require more robust assessment methods that may combine video, mobile, and wearable technologies that would be accessible to a patient at home. When designing future telerehabilitation tools, information captured through these modes must be task-relevant, standardized, and understandable to a remote clinician.
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Affiliation(s)
- Golda Nguyen
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Katelyn King
- Department of Biomedical Engineering, Department of Robotics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Leia Stirling
- Department of Industrial and Operations Engineering, Department of Robotics, University of Michigan, Ann Arbor, Michigan, United States of America
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18
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Wicks M, Dennett AM, Peiris CL. Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis. Age Ageing 2023; 52:afad207. [PMID: 37979183 PMCID: PMC10657214 DOI: 10.1093/ageing/afad207] [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: 07/10/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults. OBJECTIVE This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs. METHODS Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed. CONCLUSION Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.
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Affiliation(s)
- Matoula Wicks
- Community Health Program, Eastern Health, Box Hill, VIC 3128, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC 3128, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC 3086, Australia
- Allied Health, Royal Melbourne Hospital, Parkville, VIC 3052, Australia
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19
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Gao Y, Wang N, Zhang L, Liu N. Effectiveness of home-based cardiac telerehabilitation in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:7661-7676. [PMID: 37062028 DOI: 10.1111/jocn.16726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/13/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure. DESIGN This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. DATA SOURCES A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify studies in English or Chinese on randomised controlled trials up to 15 August 2022. RESULTS A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators. CONCLUSION Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation. IMPACT This systematic review and meta-analysis found that patients with heart failure would benefit from home-based cardiac telerehabilitation intervention in terms of cardiac function, functional capacity, quality-of-life management and readmission rate. Future clinical interventions should consider home-based cardiac telerehabilitation as an alternative to conventional cardiac rehabilitation in patients with heart failure to improve their quality of life. NO PATIENT OR PUBLIC CONTRIBUTION Our paper is a systematic review and meta-analysis, and such details do not apply to our work.
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Affiliation(s)
- Yan Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Naiquan Liu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
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20
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Hwang R, Gane EM, Morris NR. No transport? No worries! Cardiac telerehabilitation is a feasible and effective alternative to centre-based programs. Heart Fail Rev 2023; 28:1277-1284. [PMID: 36802044 PMCID: PMC9938679 DOI: 10.1007/s10741-023-10301-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
Given the under-utilisation of cardiac rehabilitation despite its benefits, there has been a shift towards alternative delivery models. The recent coronavirus disease 2019 (COVID-19) pandemic has accelerated this shift, leading to a growing interest in home-based cardiac rehabilitation including telerehabilitation. There is increasing evidence to support cardiac telerehabilitation, with studies generally demonstrating comparable outcomes and potential cost-benefits. This review aims to provide a synopsis of the current evidence on home-based cardiac rehabilitation with a focus on telerehabilitation and practical considerations.
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Affiliation(s)
- Rita Hwang
- Department of Physiotherapy, Princess Alexandra Hospital, Metro South Health, Ipswich Road, Woolloongabba, QLD 4102, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Gold Coast, Australia.
| | - Elise M Gane
- Department of Physiotherapy, Princess Alexandra Hospital, Metro South Health, Ipswich Road, Woolloongabba, QLD 4102, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Norman R Morris
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Health, Brisbane, Australia
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21
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Yu MKL, Chiu AYY, Chau SK, Rosa Duque JS, Wong WHS, Chan SHS. A pilot study of an integrated, personalized, respiratory and motor telerehabilitation program for pediatric patients with hereditary neuromuscular disorders. Muscle Nerve 2023; 68:857-864. [PMID: 37837303 DOI: 10.1002/mus.27982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Telerehabilitation provides physical training to patients through telecommunication networks. We examined the feasibility, safety, and efficacy of an integrated, personalized, respiratory and motor telerehabilitation program for pediatric patients with hereditary neuromuscular disorders (NMDs). METHODS Stable pediatric patients were recruited for a 16-week home training program with personalized pulmonary, upper and lower limb exercises. Patients reviewed instructional videos at home and attended bi-weekly follow-ups through video or audio calls, text messages, or emails. The primary outcomes were respiratory function, Medical Research Council (MRC) grading, hand/pinch strength, 6-minute walk test, and Pediatric Quality-of-Life Inventory 3.0 Neuromuscular Module survey. The secondary outcomes were study compliance and user feedback. RESULTS Patients with spinal muscular atrophy (n = 4), congenital myasthenic syndrome (n = 2), and Duchenne muscular dystrophy (n = 2) completed the program. The median weekly exercise time was 101.3 min (range: 30.0-266.9). No extra face-to-face physiotherapy sessions were requested by the patients. No adverse events were reported. After the study, patients showed improvements in maximal expiratory pressure (35.0 vs. 47.5 cm H2O, p = .028) and maintained their MRC grade, hand/pinch strength, and walking distance. Patients also reported improvements in the Pediatric Quality-of-Life Inventory 3.0 Neuromuscular Module survey score (74.5 vs. 87.0, p = .036). Patients rated the overall program highly (mean: 4.00/5.00) and recommended it as a standard of care (mean: 4.38/5.00). DISCUSSION Our telerehabilitation program was feasible, safe, and possibly effective for this pilot cohort of stable pediatric patients with hereditary NMDs. Larger-scale studies for longer periods are warranted to confirm the results.
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Affiliation(s)
- Michael Kwan Leung Yu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Alice Yuen Yee Chiu
- Department of Physiotherapy, The Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong
| | - Shuk Kuen Chau
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
- Department of Paediatrics and Adolescent Medicine, The Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong
| | - Jaime S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
- Department of Paediatrics and Adolescent Medicine, The Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong
| | - Wilfred Hing Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Sophelia Hoi Shan Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
- Department of Paediatrics and Adolescent Medicine, The Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong
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22
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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23
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Ruan T, Xu M, Zhu L, Ding Y. Nurse-coordinated home-based cardiac rehabilitation for patients with heart failure: A scoping review. Int J Nurs Sci 2023; 10:435-445. [PMID: 38020827 PMCID: PMC10667294 DOI: 10.1016/j.ijnss.2023.09.022] [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: 03/17/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study aimed to review and summarize the studies of nurse-coordinated home-based cardiac rehabilitation for patients with heart failure. Methods The review was performed using Arksey and O'Malley's scoping review framework. A systematic search was conducted across eight databases, including PubMed, Embase, Web of Science, EBSCO, China Biomedical Literature Service System (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journals (CSTJ) Database, and Chinese Clinical Trial Registry, from inception to 30 April 2023. Articles relevant to the nurse-coordinated home-based cardiac rehabilitation for patients with heart failure were included. Results Eighteen studies were included in this review. These studies showed that nurses primarily focused on patient assessment, home-based cardiac rehabilitation planning and guidance, and follow-up. The studies also reported positive outcomes in patient safety, feasibility, and efficacy of the programs coordinated by nurses. Conclusions Home-based cardiac rehabilitation coordinated by nurses is beneficial to patients with heart failure. Future research will explore the potential of nurses in home-based cardiac rehabilitation for patients with heart failure, determine optimal evaluation criteria, and formulate safe, effective, and economical rehabilitation programs suitable for the patients.
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Affiliation(s)
- Tiantian Ruan
- Department of Nursing, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengqi Xu
- Department of Nursing, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingyan Zhu
- Department of Nursing, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Ding
- Department of Nursing, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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24
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Lee KCS, Breznen B, Ukhova A, Martin SS, Koehler F. Virtual healthcare solutions in heart failure: a literature review. Front Cardiovasc Med 2023; 10:1231000. [PMID: 37745104 PMCID: PMC10513031 DOI: 10.3389/fcvm.2023.1231000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.
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Affiliation(s)
| | - Boris Breznen
- Evidence Synthesis, Evidinno Outcomes Research Inc., Vancouver, BC, Canada
| | | | - Seth Shay Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Friedrich Koehler
- Deutsches Herzzentrum der Charité (DHZC), Centre for Cardiovascular Telemedicine, Campus Charité Mitte, Berlin, Germany
- Division of Cardiology and Angiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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25
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Tarihoran DETAU, Daryanti Saragih I, Saragih IS, Tzeng HM. Effects of videoconferencing intervention on stroke survivors: A systematic review and meta-analysis of randomised controlled studies. J Clin Nurs 2023; 32:5938-5947. [PMID: 37035861 DOI: 10.1111/jocn.16716] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 06/03/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Videoconferencing has been proposed as an innovative telerehabilitation approach for stroke survivors, demand for which is growing. AIM To evaluate the efficacy of a videoconferencing intervention for stroke survivors. DESIGN Systematic review and meta-analysis. METHODS We conducted a systematic review of the literature in the databases Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Ovid (and its companion UpToDate), and Web of Science published from January 1, 2002, to May 27, 2021. The methodologic quality of the included studies was evaluated using version 2 of the Cochrane risk-of-bias tool. A meta-analysis using a random-effects model calculated the pooled standardised mean difference (SMD) for using a videoconferencing intervention with stroke survivors and for the ability of survivors to perform activities of daily living (ADLs) and to maintain balance. The Stata software application (version 16.0: StataCorp LP) was used for the statistical analysis. RESULTS Nine studies with 603 participants were included in the analysis. Videoconferencing interventions were observed to be effective in improving the ability of stroke survivors to carry out their ADLs (SMD: 0.57; 95% confidence interval [CI]: 0.13 to 1.01) and to recover their balance (SMD: 1.96; 95% CI: 1.27 to 2.66). CONCLUSIONS Stroke survivors were able effectively to improve their ADL and balancing abilities. Further studies could consider the frequency, duration, and standard protocol for videoconferencing interventions. RELEVANCE TO CLINICAL PRACTICE This study could change the approach to patient support in future clinical practice and might constitute an alternative for improving care for stroke survivors in their homes or in long-term care facilities.
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Affiliation(s)
- Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana, Jakarta, Indonesia
- School of Nursing Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | - Huey-Ming Tzeng
- School of Nursing, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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26
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van Leunen MMCJ, de Lathauwer ILJ, Verstappen CCAG, Visser-Stevelink DMG, Brouwers RWM, Herkert C, Tio RA, Spee RF, Lu Y, Kemps HMC. Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial. BMC Cardiovasc Disord 2023; 23:379. [PMID: 37516829 PMCID: PMC10386674 DOI: 10.1186/s12872-023-03407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients. METHODS In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate. DISCUSSION The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.
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Affiliation(s)
- Mayke M C J van Leunen
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Ignace L J de Lathauwer
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Cindy C A G Verstappen
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Cyrille Herkert
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - René A Tio
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Ruud F Spee
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Yuan Lu
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, the Netherlands
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27
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Loureiro Diaz J, Foster LD, Surendran PJ, Jacob P, Ibrahim O, Gupta P. Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program. BMJ Open Qual 2023; 12:bmjoq-2022-002202. [PMID: 37257915 DOI: 10.1136/bmjoq-2022-002202] [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: 11/30/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement's collaborative model was adopted. Multiple plan-do-study-act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.
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Affiliation(s)
- Javier Loureiro Diaz
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Liam David Foster
- Cardiac Rehabilitation Department, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar Ibrahim
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Poonam Gupta
- Performance Improvement Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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28
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Muñoz-Tomás MT, Burillo-Lafuente M, Vicente-Parra A, Sanz-Rubio MC, Suarez-Serrano C, Marcén-Román Y, Franco-Sierra MÁ. Telerehabilitation as a Therapeutic Exercise Tool versus Face-to-Face Physiotherapy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4358. [PMID: 36901375 PMCID: PMC10002129 DOI: 10.3390/ijerph20054358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed. METHODS We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group. RESULTS a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the studies, results proved to be similar for telerehabilitation and face-to-face rehabilitation in both groups when measuring functionality, quality of life and satisfaction. CONCLUSION this review generally concludes that intervention through telerehabilitation programs is as feasible and efficient as conventional physiotherapy in terms of functionality level and quality of life. In addition, telerehabilitation shows high levels of patients' satisfaction and adherence, being values equivalent to traditional rehabilitation.
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Affiliation(s)
| | | | | | - Mª Concepción Sanz-Rubio
- Physiotherapy Primary Care, Department of Nursing, Physiotherapy and Occupational Therapy, University of Zaragoza, 50009 Zaragoza, Spain
| | | | - Yolanda Marcén-Román
- Department of Anatomy and Human Embryology, IIS Aragón, University of Zaragoza, 50009 Zaragoza, Spain
| | - Mª Ángeles Franco-Sierra
- Department of Nursing, Physiotherapy and Occupational Therapy, IIS Aragón, University of Zaragoza, 50009 Zaragoza, Spain
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29
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Plaza A, Paratz J, Cottrell M. A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial. Burns 2023; 49:55-67. [PMID: 36115795 DOI: 10.1016/j.burns.2022.08.014] [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: 02/06/2022] [Revised: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction. METHODS A single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale - Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded. RESULTS We found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported. CONCLUSION HBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.
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Affiliation(s)
- Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia; Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Jennifer Paratz
- Physiotherapy Department, Griffith University, Brisbane, QLD 4222, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia
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Kukafka R, Gupta A, Gilbert C, Huggins CE, Browning C, Chapman W, Haines T, Peeters A. Virtual Care Initiatives for Older Adults in Australia: Scoping Review. J Med Internet Res 2023; 25:e38081. [PMID: 36652291 PMCID: PMC9892987 DOI: 10.2196/38081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/03/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. OBJECTIVE We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. METHODS A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework. RESULTS Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. CONCLUSIONS Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.
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Affiliation(s)
| | - Adyya Gupta
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Catherine E Huggins
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Colette Browning
- Health Innovation and Transformation Centre, Federation University, Ballarat, Australia.,Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Terry Haines
- National Centre for Healthy Ageing, Monash University, Frankston, Australia.,School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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Baroni MP, Jacob MFA, Rios WR, Fandim JV, Fernandes LG, Chaves PI, Fioratti I, Saragiotto BT. The state of the art in telerehabilitation for musculoskeletal conditions. Arch Physiother 2023; 13:1. [PMID: 36597130 PMCID: PMC9810517 DOI: 10.1186/s40945-022-00155-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future. MAIN BODY Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users. CONCLUSIONS Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.
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Affiliation(s)
- Marina P. Baroni
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Maria Fernanda A. Jacob
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Wesley R. Rios
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Junior V. Fandim
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Lívia G. Fernandes
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Pedro I. Chaves
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Iuri Fioratti
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil
| | - Bruno T. Saragiotto
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, São Paulo 03071-000 Brazil ,Centre for Pain, Health and Lifestyle, São Paulo São Paulo, Brazil ,grid.117476.20000 0004 1936 7611Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, NSW 2000 Sydney, Australia
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Hernandez MF, Rodriguez F. Health Techequity: Opportunities for Digital Health Innovations to Improve Equity and Diversity in Cardiovascular Care. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:1-20. [PMID: 36465151 PMCID: PMC9703416 DOI: 10.1007/s12170-022-00711-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review In this review, we define health equity, disparities, and social determinants of health; the different components of digital health; the barriers to digital health equity; and cardiovascular digital health trials and possible solutions to improve health equity through digital health. Recent Findings Digital health interventions show incredible potential to improve cardiovascular diseases by obtaining longitudinal, continuous, and actionable patient data; increasing access to care; and by decreasing delivery barriers and cost. However, certain populations have experienced decreased access to digital health innovations and decreased representation in cardiovascular digital health trials. Summary Special efforts will need to be made to expand access to the different elements of digital health, ensuring that the digital divide does not exacerbate health disparities. As the expansion of digital health technologies continues, it is vital to increase representation of minoritized groups in all stages of the process: product development (needs findings and screening, concept generation, product creation, and testing), clinical research (pilot studies, feasibility studies, and randomized control trials), and finally health services deployment.
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Affiliation(s)
- Mario Funes Hernandez
- grid.168010.e0000000419368956Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA USA
| | - Fatima Rodriguez
- grid.168010.e0000000419368956Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, 453 Quarry Road, Room 332B, Stanford, CA 94305 USA
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Telerehabilitation Approaches for People with Chronic Heart Failure: A Systematic Review and Meta-Analysis. J Clin Med 2022; 12:jcm12010064. [PMID: 36614865 PMCID: PMC9820837 DOI: 10.3390/jcm12010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Telerehabilitation (TR) for chronic heart failure (CHF) allows for overcoming distance barriers and reducing exacerbations. However, little is known about TR descriptors, components, and efficacy in CHF. METHODS This work systematically reviewed the TR strategies of randomized controlled trials in people with CHF. A meta-analysis was run to test its effect on exercise capacity and quality of life compared to no rehabilitation (NI) and conventional intervention (CI). RESULTS Out of 6168 studies, 11 were eligible for the systematic review, and 8 for the meta-analysis. TR intervention was individual and multidimensional, with a frequency varying from 2 to 5 times per 8-12 weeks. The TR components mainly included an asynchronous model, monitoring/assessment, decision, and offline feedback. A few studies provided a comprehensive technological kit. Minimal adverse events and high adherence were reported. A large effect of TR compared to NI and a non-inferiority effect compared to CI was registered on exercise capacity, but no effects of TR compared to NI and CI on quality of life were observed. CONCLUSIONS TR for people with CHF adopted established effective strategies. Future interventions may identify the precise TR dose for CHF, technological requirements, and engagement components affecting the patient's quality of life.
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Nacarato D, Sardeli AV, Mariano LO, Chacon-Mikahil MPT. Cardiovascular telerehabilitation improves functional capacity, cardiorespiratory fitness and quality of life in older adults: A systematic review and meta-analysis. J Telemed Telecare 2022:1357633X221137626. [PMID: 36469017 DOI: 10.1177/1357633x221137626] [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: 02/17/2024]
Abstract
INTRODUCTION The aim was to identify whether cardiovascular telerehabilitation programs (CV-T-REHAB) can improve functional capacity, cardiorespiratory fitness and quality of life (QoL) to the same extent of presential rehabilitation (CV-P-REHAB) in older adults, by meta-analysis of previous studies. METHODS Literature search was conducted in October 2020 in four databases to select controlled trials of CV-T-REHAB effects on functional capacity (six-minute walk test [6MWT]), cardiorespiratory fitness (maximal oxygen consumption [V ˙ O2max]), and QoL in older adults (> 50 years) and included new articles in April 2022. RESULTS CV-T-REHAB improved 6MWT (11.14 m [CI95% = 8.03; 14.26], p < 0.001), V ˙ O2max (1.18 ml/kg/min [CI95% = 0.70; 1.66], p < 0.001), and QoL (standardized mean difference [SMD] = 0.36 [CI95% = 0.05; 0.67], p = 0.02). CV-T-REHAB increased V ˙ O2max to a greater extent than CV-P-REHAB (1.08 ml/kg/min [0.39; 1.76], p = 0.002). Although the 6MWT and V ˙ O2max analyses proved consistent and homogeneous, the QoL analysis showed considerable inconsistency (I2 = 92.90%), suggesting the need for studies exploring the effect of CV-T-REHAB on QoL in this population. Part of the heterogeneity was explained by age differences, as CV-T-REHAB improved QoL in adults >65 years, but not in adults <64 years. CONCLUSION CV-T-REHAB improved cardiorespiratory fitness to a level equal to or higher than CV-P-REHAB and improved functional capacity and QoL; being mainly effective for QoL in older adults >65 years. Thus, CV-T-REHAB can be a good alternative, when not the best option and might be considered especially for individuals with limited access to participate in face-to-face programs.
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Affiliation(s)
- Diego Nacarato
- Laboratory of Exercise Physiology, School of Physical Education, State University of Campinas, Campinas, SP, Brazil
- Gerontology Program - School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Amanda V Sardeli
- Laboratory of Exercise Physiology, School of Physical Education, State University of Campinas, Campinas, SP, Brazil
- Gerontology Program - School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
- Institute of Inflammation and Ageing, 1724University of Birmingham, Birmingham, UK
| | - Lilian O Mariano
- Laboratory of Exercise Physiology, School of Physical Education, State University of Campinas, Campinas, SP, Brazil
- Gerontology Program - School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Mara Patrícia T Chacon-Mikahil
- Laboratory of Exercise Physiology, School of Physical Education, State University of Campinas, Campinas, SP, Brazil
- Gerontology Program - School of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
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Fernandez D, Wilkins SS, Melrose RJ, Hall KM, Abbate LM, Morey MC, Castle SC, Zeng A, Lee CC. Physical Function Effects of Live Video Group Exercise Interventions for Older Adults: A Systematic Review and Veteran's Gerofit Group Case Study. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniel Fernandez
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Stacy Schantz Wilkins
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Rebecca J. Melrose
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Katherine M. Hall
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Roybal Center, Duke University Medical Center, Durham, North Carolina, USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren M. Abbate
- Geriatric Research, Education, and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Steven C. Castle
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Angela Zeng
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Cathy C. Lee
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
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Fernandes LG, Oliveira RFF, Barros PM, Fagundes FRC, Soares RJ, Saragiotto BT. Physical therapists and public perceptions of telerehabilitation: An online open survey on acceptability, preferences, and needs. Braz J Phys Ther 2022; 26:100464. [PMID: 36410257 PMCID: PMC9659283 DOI: 10.1016/j.bjpt.2022.100464] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, telerehabilitation allowed the continuation of physical therapy care in parallel with public health measures to prevent the virus spread. However, in low- and middle-income countries including Brazil, telerehabilitation was unfamiliar to most of the population. OBJECTIVE To investigate acceptability, preferences, and needs in telerehabilitation by Brazilian physical therapists and the general population. METHODS We conducted an observational cross-sectional study with an online survey consisting of 13 multiple-choice items. Items were distributed among acceptability, preferences, and needs sections, and encompassed confidence in delivering or receiving telerehabilitation, its perceived efficacy and costs, and suitable content. RESULTS A total of 1107 responses were registered, 717 from physical therapists. Half of them self-reported confidence in conducting telerehabilitation through the internet (synchronous or asynchronous). The same proportion disagreed that telerehabilitation is as effective as in-person interventions. Physical therapists agreed telerehabilitation should contain educational, self-management strategies, and exercises information, but the general population endorsed the provision of technical advice on exercise execution. The general population mostly reported that telerehabilitation could help their specific health condition (86%), but only 14% of respondents would pay the same as they pay for in-person consultations. Participants reported an overall preference for synchronous communication and concern about the lack of a hands-on approach. CONCLUSION Physical therapists and the general population appear to demonstrate apprehension towards telerehabilitation. Insufficient preparation or inadequate knowledge might influence participants' acceptance, preferences, and needs.
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Affiliation(s)
- Lívia G Fernandes
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Centre for Pain, Health, and Lifestyle (CPHL) Brazil.
| | - Rafael F F Oliveira
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Centre for Pain, Health, and Lifestyle (CPHL) Brazil
| | - Pamela M Barros
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Felipe R C Fagundes
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Renato J Soares
- Physical Therapy Department, Universidade de Taubaté, Taubaté, São Paulo, Brazil
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Centre for Pain, Health, and Lifestyle (CPHL) Brazil; Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
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Marques-Sule E, Sempere-Rubio N, Esparcia-Sánchez S, Deka P, Sentandreu-Mañó T, Sánchez-González JL, Klompstra L, Moreno-Segura N. Physical Therapy Programs in Older Adults with Coronary Artery Disease: Preferences to Technology-Based Cardiac Physical Therapy Programs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13130. [PMID: 36293707 PMCID: PMC9602975 DOI: 10.3390/ijerph192013130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Assessing preferences in technology-based cardiac physical therapy programs in older adults with coronary artery disease (CAD) is fundamental to promoting adherence to healthy lifestyles and healthy aging. This study aimed at analyzing preferences in technology-based cardiac physical therapy programs in older adults with CAD. Additionally, a comparison by sex was performed. (2) Methods: Cross-sectional study. 70 older adults with CAD (mean age 66.73 ± 0.77, 80% men) were evaluated. Technology use and preferences in technology-based cardiac physical therapy programs (Technology Usage Questionnaire) were assessed. (3) Results: 97.1% of the sample had Smartphones and 81.4% accessed the Internet every day, mostly with their Smartphones (75.5%). A total of 54.3% were interested in receiving rehabilitation via their Smartphone, and most of the sample considered ideas to manage stress (92.9%), healthy meal ideas and recipes (85.7%), exercise ideas (84.3%), exercise prompts (72.9%), setting goals (67.1%), exercise taught by a virtual therapist (65.7%), ideas to overcome cigarette cravings (62.9%), information on local exercise opportunities (60%), ideas to remember to take medications (57.1%), steps to achieve goals (54.3%) and eating tips for takeaways (51.7%) very useful. Additionally, men considered the technology-based advice about exercise prompts, healthy meal ideas and recipes, and ideas to manage stress more useful than women, and had more frequently a Smartphone, less frequently made phone calls, had more regular access to the Internet, and used the Internet more often. (4) Conclusions: Clinicians should encourage older adults to engage in cardiac technology-based physical therapy programs to provide meaningful exercise counselling, promote healthy lifestyle and healthy aging.
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Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Gasco Oliag 5, 46010 Valencia, Spain
| | - Nuria Sempere-Rubio
- Clinical Biomechanics Research Unit (UBIC), Department of Physiotherapy, Universitat de València, Gasco Oliag 5, 46010 Valencia, Spain
| | | | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | | | | | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, 58185 Linkoping, Sweden
| | - Noemí Moreno-Segura
- Department of Physiotherapy, University of Valencia, Gasco Oliag 5, 46010 Valencia, Spain
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Nizeyimana E, Joseph C, Plastow N, Dawood G, Louw QA. A scoping review of feasibility, cost, access to rehabilitation services and implementation of telerehabilitation: Implications for low- and middle-income countries. Digit Health 2022; 8:20552076221131670. [PMID: 36249480 PMCID: PMC9557862 DOI: 10.1177/20552076221131670] [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: 05/21/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
Objective To scope all published information reporting on the feasibility, cost, access
to rehabilitation services, implementation processes including barriers and
facilitators of telerehabilitation (TR) in low- and middle-income countries
(LMICs) and high-income countries (HICs). Methods A comprehensive electronic search of PubMed, Scopus, PEDro, Cochrane library,
EBSCOhost (Academic search premier, Africa-wide information, CINAHL, Eric,
MEDLINE, Health sources - Nursing/Academic edition), Africa online, as well
as ProQuest databases were conducted. To maximise the coverage of the
literature, the reference lists of included articles identified through the
search were also screened. The analysis included both descriptive summary
and inductive thematic analysis. Results Twenty-nine studies were included. TR was reported to be feasible,
cost-saving and improved access to rehabilitation services in both HICs and
LMICs settings. Asynchronous methods using different mobile apps (Skype,
WhatsApp, Google meet, Facebook messenger, Viber, Face time and Emails) were
the most common mode of TR delivery. Barriers to the implementation were
identified and categorised in terms of human, organisational, technical and
clinical practice related factors. Facilitators for health professionals and
patients/caregivers’ dyads were also identified. Conclusion TR could be considered a feasible service delivery mode in both HICs and
LMICs. However, the mitigation of barriers such as lack of knowledge and
technical skills among TR providers and service users, lack of secure
platform dedicated for TR, lack of resources and connectivity issues which
are particularly prevalent in LMICs will be important to optimise the
benefits of TR.
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Affiliation(s)
- Eugene Nizeyimana
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa,Eugene Nizeyimana, Division of
Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch
University, Francie Van Zijl Dr, Parow, 7505, Cape Town, South Africa.
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Nicola Plastow
- Division of Occupational Therapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Gouwa Dawood
- Division of Speech, Language and Hearing Therapy, Department of
Health and Rehabilitation Sciences, Stellenbosch
University, Cape Town, South Africa
| | - Quinette A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation
Sciences, Stellenbosch
University, Cape Town, South Africa
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Clinical Determinants and Barriers to Cardiac Rehabilitation Enrollment of Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center Study in Portugal. J Cardiovasc Dev Dis 2022; 9:jcdd9100344. [PMID: 36286296 PMCID: PMC9604186 DOI: 10.3390/jcdd9100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Despite cardiac rehabilitation (CR) being a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF), it is still underused. This study investigated the clinical determinants and barriers to enrollment in a CR program for HFrEF patients. We conducted a cohort study using the Cardiac Rehabilitation Barriers Scale (CRBS) to assess the reason for non-enrollment. Of 214 HFrEF patients, 65% had not been enrolled in CR. Patients not enrolled in CR programs were older (63 vs. 58 years; p < 0.01) and were more likely to have chronic obstructive pulmonary disease (COPD) (20% vs. 5%; p < 0.01). Patients enrolled in CR were more likely to be treated with sacubitril/valsartan (34% vs. 19%; p = 0.01), mineralocorticoid receptor antagonists (84% vs. 72%; p = 0.04), an implantable cardioverter defibrillator (ICD) (41% vs. 20%; p < 0.01), and cardiac resynchronization therapy (21% vs. 10%; p = 0.03). Multivariate analysis revealed that age (adjusted OR 1.04; 95% CI 1.01−1.07), higher education level (adjusted OR 3.31; 95% CI 1.63−6.70), stroke (adjusted OR 3.29; 95% CI 1.06−10.27), COPD (adjusted OR 4.82; 95% CI 1.53−15.16), and no ICD status (adjusted OR 2.68; 95% CI 1.36−5.26) were independently associated with CR non-enrollment. The main reasons for not being enrolled in CR were no medical referral (31%), concomitant medical problems (28%), patient refusal (11%), and geographical distance to the hospital (9%). Despite the relatively high proportion (35%) of HFrEF patients who underwent CR, the enrollment rate can be further improved. Innovative multi-level strategies addressing physicians’ awareness, patients’ comorbidities, and geographical issues should be pursued.
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Flannery T, Brady-Sawant H, Tarrant R, Davison J, Shardha J, Halpin S, Sivan M, Ross D. A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12680. [PMID: 36231979 PMCID: PMC9566175 DOI: 10.3390/ijerph191912680] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Long COVID (LC) symptoms can be long standing, diverse and debilitating; comprehensive multidisciplinary rehabilitation programs are required to address this. A 10-week LC Virtual Rehabilitation Program (VRP) was developed to provide early education and self-management techniques to address the main symptoms of LC and was delivered to a group of persons with Long COVID (PwLC) online, facilitated by members of the multi-disciplinary rehabilitation team. This paper describes an evaluation of this VRP. Questionnaires completed by Healthcare Professionals (HCP) delivering the VRP were thematically analyzed to gain a priori themes and design semi-structured telephone interview questions for PwLC. Template analysis (TA) was used to analyze interview data. Routinely collected patient demographics and service data were also examined. Seventeen HCP survey responses were obtained and 38 PwLC telephone questionnaires were completed. The HCP interviews generated three a priori themes (1. Attendance and Availability, 2. Content, 3. Use of Digital Technology). TA was applied and three further themes emerged from the combined HCP and PwLC responses (4. Group Dynamics, 5. Individual Factors, 6. Internal Change). Key outcomes demonstrated that: the VRP was highly valued; digital delivery enabled self-management; barriers to attendance included work/life balance, use of technology, health inequalities; and LC was poorly understood by employers. Recommendations are provided for the design of VRPs for LC.
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Affiliation(s)
- Thuvia Flannery
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
- Department of Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Hannah Brady-Sawant
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
| | - Rachel Tarrant
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
| | - Jennifer Davison
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
| | - Jenna Shardha
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
| | - Stephen Halpin
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
- Department of Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds LS1 3EX, UK
| | - Manoj Sivan
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
- Department of Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds LS1 3EX, UK
| | - Denise Ross
- Leeds Long COVID Rehabilitation Department, Leeds Community Healthcare Trust, Leeds LS12 5SG, UK
- Department of Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
- Academic Department of Rehabilitation Medicine, University of Leeds, Leeds LS1 3EX, UK
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R Thompson D, F Ski C, M Clark A, M Dalal H, S Taylor R. Why Do so Few People with Heart Failure Receive Cardiac Rehabilitation? Card Fail Rev 2022; 8:e28. [PMID: 36303590 PMCID: PMC9585646 DOI: 10.15420/cfr.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022] Open
Abstract
Many people with heart failure do not receive cardiac rehabilitation despite a strong evidence base attesting to its effectiveness, and national and international guideline recommendations. A more holistic approach to heart failure rehabilitation is proposed as an alternative to the predominant focus on exercise, emphasising the important role of education and psychosocial support, and acknowledging that this depends on patient need, choice and preference. An individualised, needs-led approach, exploiting the latest digital technologies when appropriate, may help fill existing gaps, improve access, uptake and completion, and ensure optimal health and wellbeing for people with heart failure and their families. Exercise, education, lifestyle change and psychosocial support should, as core elements, unless contraindicated due to medical reasons, be offered routinely to people with heart failure, but tailored to individual circumstances, such as with regard to age and frailty, and possibly for recipients of cardiac implantable electronic devices or left ventricular assist devices.
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Affiliation(s)
- David R Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Alexander M Clark
- School of Health Disciplines, Athabasca University, Edmonton, Canada
| | - Hasnain M Dalal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rodney S Taylor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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The Potential of Cardiac Telerehabilitation as Delivery Rehabilitation Care Model in Heart Failure during COVID-19 and Transmissible Disease Outbreak: A Systematic Scoping Review of the Latest RCTs. Medicina (B Aires) 2022; 58:medicina58101321. [PMID: 36295482 PMCID: PMC9609719 DOI: 10.3390/medicina58101321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023] Open
Abstract
Background and objective: Patients with heart failure are a high-risk group who may have a higher mortality rate if infected during the COVID-19 pandemic. The problem of a patient’s non-adherence to cardiac rehabilitation programs is still a challenge, resulting in disappointing long-term benefits of cardiac rehabilitation. Telehealth, including telerehabilitation, has grown in popularity to improve access to quality healthcare. It is more valuable and safer compared to usual rehabilitation care, especially during the current COVID-19 pandemic, to cut down unnecessary hospital visits and reduce the risk of cluster infections. This study aims to identify the efficacy of relevant randomized control trials (RCTs) using telerehabilitation in managing heart failure. The model, delivery care, safety, and efficacy were assessed. Material andMethods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). The authors included relevant records published in the last ten years from three databases: PubMed/MEDLINE, ProQuest, and EBSCO. Each included study was further assessed using Cochrane’s Risk of Bias (Rob 2) tool. Results: The telerehabilitation models consisted of cellphones, instant messaging, or online videoconferencing software. Some also included tool sets to monitor patients’ vital signs regularly or during exercise. Most patients adhered to and completed all provided programs. Cardiac telerehabilitation successfully improved patients’ physical fitness, quality of life, and mental health. No major adverse outcomes or significant complications were associated with the program. Conclusion: Cardiac telerehabilitation has the potential to deliver rehabilitation for heart failure patients, evidenced by its feasibility, efficacy, and safety. As a future perspective, this delivery care type can be applied throughout transmissible disease outbreaks or even globally.
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Mocan B, Mocan M, Fulea M, Murar M, Feier H. Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11628. [PMID: 36141899 PMCID: PMC9517082 DOI: 10.3390/ijerph191811628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 06/01/2023]
Abstract
This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a robotic and Virtual Reality module for cardiac patients to be used in their rehabilitation program. In this study, a novel strategy was used to integrate existing equipment and applications with newly developed ones, with the aim of reducing the need for technical skills of patients using remote control. Patients with acute or chronic heart diseases require long-term, individualized rehabilitation in order to promote their motor recovery and maintain an active and independent lifestyle. This will be accomplished by creating a system for at-home cardiac telerehabilitation augmented by a VR and cobot systems, which can be used long-term at home by each individual patient. In the pre-feasibility study carried out on healthy volunteers familiar with software applications and robotic systems, we demonstrate that RoboTeleRehab could be technically feasible both hardware and software.
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Affiliation(s)
- Bogdan Mocan
- Department of Design Engineering and Robotics, Technical University of Cluj-Napoca, 400020 Cluj-Napoca, Romania
| | - Mihaela Mocan
- Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Mircea Fulea
- Department of Design Engineering and Robotics, Technical University of Cluj-Napoca, 400020 Cluj-Napoca, Romania
| | - Mircea Murar
- Department of Design Engineering and Robotics, Technical University of Cluj-Napoca, 400020 Cluj-Napoca, Romania
| | - Horea Feier
- Institute for Cardiovascular Diseases Timisoara, University of Medicine and Pharmacy Timisoara, Gheorghe Adam Nr. 13A, 300310 Timisoara, Romania
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44
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Dennett AM, Taylor NF, Williams K, Lewis AK, Brann P, Hope JD, Wilton AM, Harding KE. Consumer perspectives of telehealth in ambulatory care in an Australian health network. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1903-1912. [PMID: 34558144 DOI: 10.1111/hsc.13569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n = 379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face-to-face care and 29% reported they would choose to use telehealth over face-to-face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations.
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Affiliation(s)
- Amy M Dennett
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
| | - Nicholas F Taylor
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
| | | | - Annie K Lewis
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
| | - Peter Brann
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Clinical Sciences, Monash University, Clayton, Vic., Australia
| | - Judith D Hope
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- Eastern Health Clinical School, Monash University, Clayton, Vic., Australia
| | - Anita M Wilton
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
| | - Katherine E Harding
- Department of Allied Health, Eastern Health, Box Hill, Vic., Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic., Australia
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45
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Keteyian SJ, Michaels A. Heart Failure in Cardiac Rehabilitation: A REVIEW AND PRACTICAL CONSIDERATIONS. J Cardiopulm Rehabil Prev 2022; 42:296-303. [PMID: 35836338 DOI: 10.1097/hcr.0000000000000713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Exercise cardiac rehabilitation (CR) represents an evidence-based therapy for patients with heart failure with reduced ejection fraction (HFrEF) and this article provides a concise review of the relevant exercise testing and CR literature, including aspects unique to their care. CLINICAL CONSIDERATIONS A hallmark feature of HFrEF is exercise intolerance (eg, early-onset fatigue). Drug therapies for HFrEF target neurohormonal pathways to blunt negative remodeling of the cardiac architecture and restore favorable loading conditions. Guideline drug therapy includes β-adrenergic blocking agents; blockade of the renin-angiotensin system; aldosterone antagonism; sodium-glucose cotransport inhibition; and diuretics, as needed. EXERCISE TESTING AND TRAINING Various assessments are used to quantify exercise capacity in patients with HFrEF, including peak oxygen uptake measured during an exercise test and 6-min walk distance. The mechanisms responsible for the exercise intolerance include abnormalities in ( a ) central transport (chronotropic response, stroke volume) and ( b ) the diffusion/utilization of oxygen in skeletal muscles. Cardiac rehabilitation improves exercise capacity, intermediate physiologic measures (eg, endothelial function and sympathetic nervous system activity), health-related quality of life (HRQoL), and likely clinical outcomes. The prescription of exercise in patients with HFrEF is generally similar to that for other patients with cardiovascular disease; however, patients having undergone an advanced surgical therapy do present with features that require attention. SUMMARY Few patients with HFrEF enroll in CR and as such, many miss the derived benefits, including improved exercise capacity, a likely reduction in risk for subsequent clinical events (eg, rehospitalization), improved HRQoL, and adoption of disease management strategies.
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Affiliation(s)
- Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital and Medical Group, Detroit, Michigan
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46
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Stefanakis M, Batalik L, Antoniou V, Pepera G. Safety of home-based cardiac rehabilitation: A systematic review. Heart Lung 2022; 55:117-126. [PMID: 35533492 DOI: 10.1016/j.hrtlng.2022.04.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiac rehabilitation is an evidence-based intervention that aims to improve health outcomes in cardiovascular disease patients, but it is largely underutilized. One strategy for improving utilization is home-based cardiac rehabilitation (HBCR). Previous research has shown that HBCR programs are feasible and effective. However, there is a lack of evidence on safety issues in different cardiac populations. This systematic review aimed to provide an evidence-based overview of the safety of HBCR. OBJECTIVES To examine the incidence and severity of adverse events of HBCR. METHODS The following databases were searched: CINAHL, The Cochrane Library, Embase, MEDLINE, PubMed, Web of Science, Global Health, and Chinese BioMedical Literature Database for randomized controlled trials. The included trials were written in English and analyzed the incidence of adverse events (AEs) as a primary or secondary intervention outcome. RESULTS Five studies showed AEs incidence, of which only one study reported severe AE associated with HBCR exercise. The incidence rate of severe AEs from the sample (n = 808) was estimated as 1 per 23,823 patient-hour of HBCR exercise. More than half patients included were stratified into a high-risk group. In the studies were found no deaths or hospitalizations related to HBCR exercise. CONCLUSION The risk of AEs during HBCR seems very low. Our results concerning the safety of HBCR should induce cardiac patients to be more active in their environment and practice physical exercise regularly.
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Affiliation(s)
- Marios Stefanakis
- Physiotherapy Department, University of West Attica, Egaleo, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital, Jihlavska 20, Brno 62500, Czech Republic; Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, Lamia, Greece
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47
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Marzuca-Nassr GN, Seron P, Román C, Gálvez M, Navarro R, Latin G, Marileo T, Molina JP, Sepúlveda P, Oliveros MJ. A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease. Front Physiol 2022; 13:948273. [PMID: 35991183 PMCID: PMC9389047 DOI: 10.3389/fphys.2022.948273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary heart disease is the most common cause of death worldwide. Standard cardiac rehabilitation (face-to-face sessions) has shown benefits in increasing muscle strength and functional exercise capacity in adults and older people. However, it is unknown whether hybrid cardiac rehabilitation (a first face-to-face phase + a second remote monitoring phase) will have similar benefits in adults versus older subjects. The aim of this study was to compare the effects of a hybrid exercise-based cardiac rehabilitation program on muscle strength and functional exercise capacity in “adult” versus “older” people with coronary artery disease. We hypothesized that a hybrid exercise-based cardiac rehabilitation program would improve muscle strength and functional exercise capacity, but the impact would be smaller in the older group than the adult individuals. This study is part of a larger project (The Hybrid Cardiac Rehabilitation Trial-HYCARET). We subjected 22 adult (<60 y) females and males (ADULT; n = 5/17 (f/m); 52 ± 5 y; 28.9 ± 3.4 kg·m-2) and 20 older (≥60 y) females and males (OLDER; n = 6/14 (f/m); 66 ± 4 y; 27.4 ± 3.9 kg·m-2) with coronary artery disease to 12 weeks of hybrid exercise-based cardiac rehabilitation program. Prior to and after 12 weeks of a hybrid exercise-based cardiac rehabilitation program, grip strength (handgrip), leg strength (chair stand test), and functional exercise capacity (6-minute walk test, 6MWT) were assessed. The hybrid exercise-based cardiac rehabilitation program resulted in a 9.4 ± 14.6% and a 6.2 ± 12.1% grip strength increase, a 14.4 ± 39.4% and a 28.9 ± 48.1% legs strength increase, and a 14.6 ± 26.4% and a 6.8 ± 14.0% functional exercise capacity improvement in ADULT and OLDER, respectively (p < 0.05) with no differences between groups. In conclusion, a hybrid exercise-based cardiac rehabilitation program could increase muscle strength and improve functional exercise capacity in adults and older people with coronary artery disease. More future studies comparing effectiveness among these age groups are needed to strengthen this conclusion.
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Affiliation(s)
- Gabriel Nasri Marzuca-Nassr
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - Pamela Seron
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- *Correspondence: Pamela Seron,
| | - Claudia Román
- Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, Santiago, Chile
- Complejo Hospitalario San José, Santiago, Chile
| | | | - Rocío Navarro
- Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Gonzalo Latin
- Hospital Clínico San Borja-Arriarán, Santiago, Chile
| | - Tania Marileo
- Hospital Regional de Antofagasta, Antofagasta, Chile
| | | | - Pablo Sepúlveda
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - María José Oliveros
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
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48
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Bittner AK, Yoshinaga PD, Shepherd JD, Kaminski JE, Malkin AG, Chun MW, Chan TL, Deemer AD, Ross NC. Acceptability of Telerehabilitation for Magnification Devices for the Visually Impaired Using Various Approaches to Facilitate Accessibility. Transl Vis Sci Technol 2022; 11:4. [PMID: 35917136 PMCID: PMC9358294 DOI: 10.1167/tvst.11.8.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We examined different methods to reduce the burden of accessing technology for videoconferencing during telerehabilitation for magnification devices for the visually impaired. Methods During telerehabilitation studies over the past 5 years, vision rehabilitation providers assessed and gave training to visually impaired participants with newly dispensed magnification devices at home who connected to Zoom videoconferencing via loaner tablets or smartphones with assistance from (phase 1; n = 10) investigators by phone, (phase 2; n = 11) local Lions Club volunteers in participants’ homes, or (phase 3; n = 24) remote access control software in a randomized controlled trial with 13 usual care controls who received in-office training. All participants completed the same post-telerehabilitation phone survey. Results A significantly greater proportion of phase 3 subjects indicated they strongly or mostly agreed that the technology did not interfere with the session (96%) compared to phase 1 (60%; 95% confidence interval [CI], 1.2–12.5; P = 0.03) or phase 2 (55%; 95% CI, 1.8–188; P = 0.01). The majority indicated telerehabilitation was as accurate as in person (68%), they were comfortable with telerehabilitation (91%) and interested in a future session (83%), and their magnifier use improved (79%), with no significant differences in these responses between phases (all P > 0.10), including comparisons of participants randomized to telerehabilitation or in-office training in phase 3 who reported similar overall satisfaction levels (P = 0.84). Conclusions Participants across all phases reported high levels of acceptance for telerehabilitation, with least interference from technology using remote access control in phase 3. Translational Relevance With accommodations for accessibility to videoconferencing technology, telerehabilitation for magnification devices can be a feasible, acceptable, and valuable option in countries with resources to support the technology.
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Affiliation(s)
- Ava K Bittner
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA.,College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Patrick D Yoshinaga
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA
| | - John D Shepherd
- Department of Ophthalmology, Truhlsen Eye Institute, Weigel Williamson Center for Visual Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Melissa W Chun
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tiffany L Chan
- Frank Stein & Paul S. May Center for Low Vision Rehabilitation, San Francisco, CA, USA
| | - Ashley D Deemer
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA
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49
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Davies L, Hinman RS, Russell T, Lawford B, Merolli M, Bennell KL. Self-reported confidence of final year Australian physiotherapy entry-to-practice students and recent graduates in their capability to deliver care via videoconferencing. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2022. [DOI: 10.1080/21679169.2022.2100928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Luke Davies
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Rana S. Hinman
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Belinda Lawford
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Mark Merolli
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Kim L. Bennell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
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50
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Keteyian SJ, Jackson SL, Chang A, Brawner CA, Wall HK, Forman DE, Sukul D, Ritchey MD, Sperling LS. Tracking Cardiac Rehabilitation Utilization in Medicare Beneficiaries: 2017 UPDATE. J Cardiopulm Rehabil Prev 2022; 42:235-245. [PMID: 35135961 PMCID: PMC10865223 DOI: 10.1097/hcr.0000000000000675] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study updates cardiac rehabilitation (CR) utilization data in a cohort of Medicare beneficiaries hospitalized for CR-eligible events in 2017, including stratification by select patient demographics and state of residence. METHODS We identified Medicare fee-for-service beneficiaries who experienced a CR-eligible event and assessed their CR participation (≥1 CR sessions in 365 d), engagement, and completion (≥36 sessions) rates through September 7, 2019. Measures were assessed overall, by beneficiary characteristics and state of residence, and by primary (myocardial infarction; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant) and secondary (angina; heart failure) qualifying event type. RESULTS In 2017, 412 080 Medicare beneficiaries had a primary CR-eligible event and 28.6% completed ≥1 session of CR within 365 d after discharge from a qualifying event. Among beneficiaries who completed ≥1 CR session, the mean total number of sessions was 25 ± 12 and 27.6% completed ≥36 sessions. Nebraska had the highest enrollment rate (56.1%), with four other states also achieving an enrollment rate >50% and 23 states falling below the overall rate for the United States. CONCLUSIONS The absolute enrollment, engagement, and program completion rates remain low among Medicare beneficiaries, indicating that many patients did not benefit or fully benefit from a class I guideline-recommended therapy. Additional research and continued widespread adoption of successful enrollment and engagement initiatives are needed, especially among identified populations.
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Affiliation(s)
- Steven J. Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | | | - Anping Chang
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Clinton A. Brawner
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | | | - Daniel E. Forman
- Divisions of Geriatrics and Cardiology, University of Pittsburgh and the VA Pittsburgh GRECC, Pittsburgh, PA
| | - Devraj Sukul
- Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, MI
| | | | - Laurence S. Sperling
- Centers for Disease Control and Prevention, Atlanta, GA
- Emory University School of Medicine, Center for Heart Disease Prevention, Atlanta, GA
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