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Flores-Sandoval C, Sibbald SL, Ryan BL, Adams TL, Suskin N, McKelvie R, Elliott J, Orange JB. Virtual care during COVID-19: The perspectives of older adults and their healthcare providers in a cardiac rehabilitation setting. Can J Aging 2024:1-8. [PMID: 38389488 DOI: 10.1017/s0714980824000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
The present study aimed to explore the perspectives of older adults and health providers on cardiac rehabilitation care provided virtually during COVID-19. A qualitative exploratory methodology was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Five themes emerged from the data: (1) Lack of emotional intimacy when receiving virtual care, (2) Inadequacy of virtual platforms, (3) Saving time with virtual care, (4) Virtual care facilitated accessibility, and (5) Loss of connections with patients and colleagues. Given that virtual care continues to be implemented, and in some instances touted as an optimal option for the delivery of cardiac rehabilitation, it is critical to address the needs of older adults living with cardiovascular disease and their healthcare providers. This is particularly crucial related to issues accessing and using technology, as well as older adults' need to build trust and emotional connection with their providers.
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Affiliation(s)
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
- Interfaculty Program in Public Health, Western University, London, Ontario, Canada
| | - Bridget L Ryan
- Departments of Family Medicine and Epidemiology and Biostatistics, Centre for Studies in Family Medicine
| | - Tracey L Adams
- Department of Sociology, Western University, London, Ontario, Canada
| | - Neville Suskin
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- St Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Ontario, Canada
- St. Joseph's Health Care London, Ontario, Canada
| | - Robert McKelvie
- St Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Ontario, Canada
- St. Joseph's Health Care London, Ontario, Canada
| | - Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
| | - Joseph B Orange
- Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Canadian Centre for Activity and Aging, Western University, London, Ontario, Canada
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Salarvand S, Farzanpour F, Gharaei HA. The effect of personalized mobile health (mHealth) in cardiac rehabilitation for discharged elderly patients after acute myocardial infarction on their inner strength and resilience. BMC Cardiovasc Disord 2024; 24:116. [PMID: 38373888 PMCID: PMC10877866 DOI: 10.1186/s12872-024-03791-5] [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: 11/11/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Given the importance of promoting self-care and quality of life for discharged elderly patients after acute Myocardial Infarction(MI), It is necessitated we conduct interventions to promote these items. This study was conducted to determine the effect of mHealth-Cardiac rehabilitation (CR) on the inner Strength and resilience of elderly patients with MI after discharge from the hospital. METHODS The present study was a randomized controlled trial that was conducted on 56 Elderly patients with myocardial infarction were discharged from the heart departments. In the intervention group after the patient's discharge, the patients were contacted twice a week for one month and the necessary training and support were given online. To gather data, the Mini-Mental State Examination (MMSE), the demographic and clinical characteristics questionnaire, the inner strength scale (ISS), and the Connor-Davidson Resilience Scale (CD-RISC) were completed pre- and post-intervention. The data analysis was done by SPSS16. RESULTS This study showed the mean resilience and inner strength scores before and after the intervention in the control group had no statistically significant difference(P˃0.05). There was a significant increase in the mean resilience and inner strength scores in the intervention group after the intervention (P ≤ 0.001). CONCLUSION The results of this study showed that mHealth as a kind of telenursing nursing has a significant effect on both variables of inner strength and resilience of post-discharge elderly patients after acute myocardial infarction. This means that using mHealth for these patients could increase the inner strength and resilience of the elderly discharged after myocardial infarction. Therefore, through using this method, elderly patients' self-care ability and quality of life could be increased.
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Affiliation(s)
- Shahin Salarvand
- Hepatitis Research Center, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Farzad Farzanpour
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Puri SN, Lalwani L. A Comparison Between Cardiac Telerehabilitation Program and Outpatient Hospital-Based Cardiac Rehabilitation Program for Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Review. Cureus 2023; 15:e48488. [PMID: 38073989 PMCID: PMC10704402 DOI: 10.7759/cureus.48488] [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: 08/20/2023] [Accepted: 11/08/2023] [Indexed: 06/09/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent and possibly fatal cardiovascular ailment, and it is treated surgically by coronary artery bypass grafting (CABG). The coronary arteries, which supply the heart with oxygen and nutrients, are the most commonly affected. Even though CABG is a frequently employed procedure to restore cardiac blood flow, prolonged rehabilitation is necessary for long-term success. For patients with heart disease, cardiac rehabilitation (CR) involves a comprehensive therapeutic approach. It consists of risk mitigation, regular exercise, health education, and efficient stress management. Information and communication technology is used in telerehabilitation (TR), a rehabilitation service that offers a flexible choice that improves self-management. This study examined novel approaches and effective intervention elements while comparing cardiac TR with center-based programs in terms of risk factor management, patient commitment, and satisfaction.
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Affiliation(s)
- Saurabh N Puri
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education And Research (DU), Wardha, IND
| | - Lajwanti Lalwani
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education And Research (DU), Wardha, IND
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Aboumrad M, Peritz D, Friedman S, Zwain G, Watts BV, Taub C. Rural-urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study. J Rural Health 2023; 39:844-852. [PMID: 37005093 DOI: 10.1111/jrh.12756] [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] [Indexed: 04/04/2023]
Abstract
PURPOSE To compare longitudinal rates of health care utilization, evidence-based treatment, and mortality between rural and urban-dwelling patients with congestive heart failure (CHF). METHODS We used electronic medical record data from the Veterans Health Administration (VHA) to identify adult patients with CHF from 2012 through 2017. We stratified our cohort using left ventricular ejection fraction percentage at diagnosis (<40% = reduced ejection fraction [HFrEF]; 40%-50% = midrange ejection fraction [HFmrEF]; >50% = preserved ejection fraction [HFpEF]). Within each ejection fraction cohort, we stratified patients into rural or urban groups. We used Poisson regression to estimate annual rates of health care utilization and CHF treatment. We used Fine and Gray regression to estimate annual hazards of CHF and non-CHF mortality. FINDINGS One-third of patients with HFrEF (N = 37,928/109,110), HFmrEF (N = 24,447/68,398), and HFpEF (N = 39,298/109,283) resided in a rural area. Rural compared to urban patients used VHA facilities at similar or lower annual rates for outpatient specialty care across all ejection fraction cohorts. Rural patients used VHA facilities at similar or higher rates for primary care and telemedicine-delivered specialty care. They also had lower and declining rates of VHA inpatient and urgent care use over time. There were no meaningful rural-urban differences in treatment receipt among patients with HFrEF. On multivariable analysis, the rate of CHF and non-CHF mortality was similar between rural and urban patients in each ejection fraction cohort. CONCLUSIONS Our findings suggest the VHA may have mitigated access and health outcome disparities typically observed for rural patients with CHF.
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Affiliation(s)
- Maya Aboumrad
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - David Peritz
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Scott Friedman
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Gabrielle Zwain
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Bradley V Watts
- White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Cynthia Taub
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Candelaria D, Kirkness A, Bruntsch C, Gullick J, Randall S, Ladak LA, Gallagher R. Exercise Self-efficacy Improvements During Cardiac Rehabilitation: IMPACT OF SOCIAL DISPARITIES. J Cardiopulm Rehabil Prev 2023; 43:179-185. [PMID: 36730614 DOI: 10.1097/hcr.0000000000000742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The objective of this study was to determine exercise self-efficacy improvements during cardiac rehabilitation (CR) and identify predictors of exercise self-efficacy change in CR participants. METHODS Patients with coronary heart disease at four metropolitan CR sites completed the Exercise Self-efficacy Scale at entry and completion. A general linear model identified independent predictors of change in exercise self-efficacy. RESULTS The mean age of patients (n = 194) was 65.9 ± 10.5 yr, and 81% were males. The majority (80%) were married or partnered, 76% were White, and 24% were from an ethnic minority background. Patients received CR in-person (n = 91, 47%) or remote-delivered (n = 103, 54%). Exercise self-efficacy mean scores improved significantly from 25.2 ± 5.8 at CR entry to 26.2 ± 6.3 points at completion ( P = .025). The majority of patients (59%) improved their self-efficacy scores, 34% worsened, and 7% had no change. Predictors of reduced exercise self-efficacy change were being from an ethnic minority (B =-2.96), not having a spouse/partner (B =-2.42), attending in-person CR (B =1.75), and having higher exercise self-efficacy at entry (B =-0.37) (adjusted R2 = 0.247). CONCLUSIONS Confidence for self-directed exercise improves in most, but not all, patients during CR. Those at risk for poor improvement (ethnic minorities, single patients) may need extra or tailored support, and screening for exercise self-efficacy at CR entry and completion is recommended. Differences identified from CR delivery mode need exploration using robust methods to account for complex factors.
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Affiliation(s)
- Dion Candelaria
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia (Mr Candelaria and Drs Gullick, Randall, Ladak, and Gallagher); Charles Perkins Centre, The University of Sydney, Sydney, Australia (Mr Candelaria and Dr Gallagher); Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia (Mss Kirkness and Bruntsch); and The Aga Khan University, Karachi, Pakistan (Dr Ladak)
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Hybrid and Traditional Cardiac Rehabilitation in a Rural Area: A RETROSPECTIVE STUDY. J Cardiopulm Rehabil Prev 2023:01273116-990000000-00062. [PMID: 36880962 DOI: 10.1097/hcr.0000000000000770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE Cardiac rehabilitation is a prescribed exercise intervention that reduces cardiovascular mortality, secondary events, and hospitalizations. Hybrid cardiac rehabilitation (HBCR) is an alternative method that overcomes barriers to participation, such as travel distance and transportation issues. To date, comparisons of HBCR and traditional cardiac rehabilitation (TCR) are limited to randomized controlled trials, which may influence outcomes due to supervision associated with clinical research. Coincidental to the COVID-19 pandemic, we investigated HBCR effectiveness (peak metabolic equivalents [peak METs]), resting heart rate (RHR), resting systolic (SBP) and diastolic blood pressure (DBP), body mass index (BMI), and depression outcomes (Patient Health Questionnaire-9 [PHQ-9]). METHODS Via retrospective analysis, TCR and HBCR were examined during the COVID-19 pandemic (October 1, 2020, and March 31, 2022). Key dependent variables were quantified at baseline (pre) and discharge (post). Completion was determined by participation in 18 monitored TCR exercise sessions and four monitored HBCR exercise sessions. RESULTS Peak METs increased at post-TCR and HBCR (P < .001); however, TCR resulted in greater improvements (P = .034). The PHQ-9 scores were decreased in all groups (P < .001), while post-SBP and BMI did not improve (SBP: P = .185, BMI: P = .355). Post-DBP and RHR increased (DBP: P = .003, RHR: P = .032), although associations between intervention and program completion were not observed (P = .172). CONCLUSIONS Peak METs and depression metric outcomes (PHQ-9) improved with TCR and HBCR. Improvements in exercise capacity were greater with TCR; however, HBCR did not produce inferior results by comparison, an outcome that may have been essential during the first 18 mo of the COVID-19 pandemic.
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Shahmoradi L, Rezaei N, Rezayi S, Zolfaghari M, Manafi B. Educational approaches for patients with heart surgery: a systematic review of main features and effects. BMC Cardiovasc Disord 2022; 22:292. [PMID: 35761186 PMCID: PMC9238074 DOI: 10.1186/s12872-022-02728-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery. Method and materiel A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Results A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong. Conclusion The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.
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Affiliation(s)
- Leila Shahmoradi
- Health Information Management Department and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Rezaei
- Medical Library and Information Science, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Medical Library and Information Science, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Sorayya Rezayi
- Health Information Management Department and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mitra Zolfaghari
- Department of eLearning in Medical Education, Virtual School of Tehran University of Medical Sciences, Naderi Street, Keshavarz Blvd, Tehran, Iran
| | - Babak Manafi
- Department of Heart Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Ownbey N, Soukup J, Fugate-Whitlock E, Newsham TMK. Evaluation of Telephone-Based Cardiac Rehabilitation Services Delivered to Adults 65 and Older During the Early Months of the COVID-19 Pandemic. J Appl Gerontol 2022; 41:2226-2234. [PMID: 35593005 PMCID: PMC9125130 DOI: 10.1177/07334648221104380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study was performed to evaluate the effectiveness of a hybrid,
telephone-based cardiac rehabilitation (TBCR) program implemented early in the
COVID-19 pandemic compared with in-person, center-based programming offered
prior to the pandemic. The focus was on older adults’ engagement and outcomes.
Matched groups of hybrid and in-person cardiac rehabilitation (CR) participants
were created from existing data and compared using t-tests and repeated measures
ANOVAs. Qualitative interviews were conducted with participating CR staff then
transcribed, coded, and analyzed for key themes. There were significant
differences in body mass index and weight from pre-to post-CR within both hybrid
and in-person groups. Despite this, CR staff believed exercise adherence was
reduced in the hybrid group when compared to those in the in-person program. In
the future, TBCR should be considered as an adjunct to in-person CR. Reluctance
to prescribe exercise needs to be addressed through CR staff training.
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Affiliation(s)
- Nicholas Ownbey
- Master of Science in Applied Gerontology Program, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Jeff Soukup
- Cardiopulmonary Rehabilitation & Wellness, 24520New Hanover Regional Medical Center (now Novant Health), Wilmington, NC, USA
| | - Elizabeth Fugate-Whitlock
- School of Health and Applied Human Sciences, 14621University of North Carolina Wilmington, Wilmington, NC, USA
| | - Tina M K Newsham
- School of Health and Applied Human Sciences, 14621University of North Carolina Wilmington, Wilmington, NC, USA
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Drwal KR, Hurst D, Wakefield BJ. Effectiveness of a Home-Based Pulmonary Rehabilitation Program in Veterans. Telemed J E Health 2022. [PMID: 35584256 DOI: 10.1089/tmj.2022.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study examined the effectiveness and safety of a home-based pulmonary rehabilitation (HBPR) program in Veterans. Methods: Patients were evaluated from five Veteran Affairs facilities that enrolled in the 12-week program. Pre- to postchanges were completed on clinical outcomes using paired t-tests and the Wilcoxon signed rank sum test. Descriptive statistics were used for patient demographics, emergency room visits, and hospitalizations. Results: Two hundred eighty-five patients with a mean age of 69.6 ± 8.3 years enrolled in the HBPR program from October 2018 to March 2020. There was a 62% (n = 176) completion rate of both pre- and post assessments. Significant improvements were detected after completion of the HBPR program in dyspnea (modified Medical Research Council: 3.1 ± 1.1 vs. 1.9 ± 1.1; p < 0.0001); exercise capacity (six-minute walk distance: 263.1 m ± 96.6 m vs. 311.0 m ± 103.6 m; p < 0.0001; Duke Activity Status Index: 13.8 ± 9.6 vs. 20.0 ± 12.7; p < 0.0001; self-reported steps per day: 1514.5 ± 1360.4 vs. 3033.8 ± 2716.2; p < 0.0001); depression (patient health questionnaire-9: 8.3 ± 5.7 vs. 6.4 ± 5.1); nutrition habits (rate your plate, heart: 45.3 ± 9.0 vs. 48.9 ± 9.2; p < 0.0001); multicomponent assessment tools (BODE Index: 5.1 ± 2.5 vs. 3.4 ± 2.4; p < 0.0001), GOLD ABCD Assessment: p < 0.0009); and quality of life (chronic obstructive pulmonary disease assessment test: 25.4 ± 7.7 vs. 18.7 ± 8.5; p < 0.0001). No adverse events were reported due to participation in HBPR. Conclusions: The HBPR program is a safe and effective model and provides an additional option to address the gap in pulmonary rehabilitation access and utilization in the Veterans Affairs.
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Affiliation(s)
- Kariann R Drwal
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Delanie Hurst
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Bonnie J Wakefield
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa, USA
- The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
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Telerehabilitation: Future of Phase II Cardiac Rehabilitation: Review of Preliminary Outcomes. J Med Syst 2022; 46:94. [PMID: 36367614 PMCID: PMC9650175 DOI: 10.1007/s10916-022-01878-0] [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: 08/26/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Abstract
In this brief communication, we reported Telehealth Home-Based Cardiac Rehabilitation (CR) program structure and preliminary outcomes from patients that completed a 12-week program after coronary artery bypass graft surgery (CABG). We aim to advocate the use of Telerehabilitation as a Phase II CR in patients immediately after the CABG. This approach was innovative and encouraging because the patients were still in subacute phase. The program can serve as a continuation of care for the patients after being discharged from a hospital while regaining their functional ability at home. Our preliminary outcomes demonstrated improvements in resting heart rate, activity level, nutrition status, self-efficacy for managing cardiac diseases, muscle strength, endurance and depression. There were no adverse events during the virtual sessions. Patient satisfaction score was high.
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Airola E. Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review. J Med Internet Res 2021; 23:e23804. [PMID: 34860664 PMCID: PMC8686468 DOI: 10.2196/23804] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/23/2020] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration. Objective The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use.
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Affiliation(s)
- Ella Airola
- Media Education Hub, Faculty of Education, University of Lapland, Rovaniemi, Finland
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Itoh H, Amiya E, Narita K, Shimbo M, Taya M, Komuro I, Hasegawa T, Makita S, Kimura Y. Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial. JMIR Res Protoc 2021; 10:e30725. [PMID: 34407925 PMCID: PMC8524329 DOI: 10.2196/30725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 01/14/2023] Open
Abstract
Background Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration University Hospital Medical Information Network—Clinical Trials Registry UMIN–CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID) DERR1-10.2196/30725
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Affiliation(s)
| | | | | | - Mai Shimbo
- The University of Tokyo Hospital, Tokyo, Japan
| | | | | | | | - Shigeru Makita
- Saitama Medical University International Medical Center, Saitama, Japan
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Pecci C, Ajmal M. Cardiac Rehab in the COVID-19 Pandemic. Am J Med 2021; 134:559-560. [PMID: 33577752 PMCID: PMC9745923 DOI: 10.1016/j.amjmed.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Cristina Pecci
- Cardiology Fellow, College of Medicine, University of Arizona, Phoenix
| | - Muhammad Ajmal
- Cardiology Fellow, College of Medicine, University of Arizona, Tucson.
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Drwal KR, Wakefield BJ, Forman DE, Wu WC, Haraldsson B, El Accaoui RN. Home-Based Cardiac Rehabilitation: EXPERIENCE FROM THE VETERANS AFFAIRS. J Cardiopulm Rehabil Prev 2021; 41:93-99. [PMID: 33647921 DOI: 10.1097/hcr.0000000000000594] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The conceptual utility of home-based cardiac rehabilitation (HBCR) is widely acknowledged. However, data substantiating its effectiveness and safety are limited. This study evaluated effectiveness and safety of the Veterans Affairs (VA) national HBCR program. METHODS Veterans completed a 12-wk HBCR program over 18 mo at 25 geographically dispersed VA hospitals. Pre- to post-changes were compared using paired t tests. Patient satisfaction and adverse events were also summarized descriptively. RESULTS Of the 923 Veterans with a mean age of 67.3 ± 10.6 yr enrolled in the HBCR program, 572 (62%) completed it. Findings included significant improvements in exercise capacity (6-min walk test distance: 355 vs 398 m; P < .05; Duke Activity Status Index: 27.1 vs 33.5; P < .05; self-reported steps/d: 3150 vs 4166; P < .05); depression measured by Patient Health Questionnaire (6.4 vs 4.9; P < .0001); cardiac self-efficacy (33.1 vs 39.2; P < .0001); body mass index (31.5 vs 31.1 kg/m2; P = .0001); and eating habits measured by Rate Your Plate, Heart (47.2 vs 51.1; P < .05). No safety issues were related to HBCR participation. Participants were highly satisfied. CONCLUSIONS The VA HBCR program demonstrates strong evidence of effectiveness and safety to a wide range of patients, including those with high clinical complexity and risk. HBCR provides an adjunct to site-based programs and access to cardiac rehabilitation. Additional research is needed to assess long-term effects, cost-effectiveness, and sustainability of the model.
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Affiliation(s)
- Kariann R Drwal
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Healthcare System, Iowa City (Ms Drwal, Drs Wakefield and El Accaoui, and Mr Haraldsson); The Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City (Ms Drwal, Dr Wakefield, and Mr Haraldsson); Sinclair School of Nursing, University of Missouri, Columbia (Dr Wakefield); VA Pittsburgh Healthcare System, Pittsburgh, Department of Medicine, University of Pittsburgh, Pittsburgh, and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Forman); Center of Innovation in Long Term Services and Support, Providence VA Medical Center, Providence, Cardiovascular Rehab Center, Miriam Hospital, Providence, and Alpert Medical School and School of Public Health, Brown University, Providence, Rhode Island (Dr Wu); and Division of Cardiovascular Medicine, University of Iowa, Iowa City (Dr El Accaoui)
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15
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Bakhshayesh S, Hoseini B, Bergquist R, Nabovati E, Gholoobi A, Mohammad-Ebrahimi S, Eslami S. Cost-utility analysis of home-based cardiac rehabilitation as compared to usual post-discharge care: systematic review and meta-analysis of randomized controlled trials. Expert Rev Cardiovasc Ther 2020; 18:761-776. [PMID: 32893713 DOI: 10.1080/14779072.2020.1819239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Determining cost-utility differences between home-based cardiac rehabilitation (HBCR) on the one hand, and usual post-discharge care (UC) on the other, can improve resource-allocation in healthcare settings. AREAS COVERED In June 2019, PubMed, Web of Science, Scopus, and Cochrane library were searched for randomized controlled HBCR trials. Standardized mean differences (SMDs) of cost and quality-adjusted life years (QALYs) between HBCRs and UCs were calculated using random effect models. Heterogeneity was assessed by inconsistency index (I2) and publication bias by funnel plot and Egger's regression test. Thirteen articles, representing 2,992 participants, were deemed representative for final analysis. In the meta-analysis, a significant difference with respect to QALYs favored HBCR, while no significant cost difference was observed between HBCR and UC. However, subgroup-analysis of trials with different follow-up durations revealed somewhat different results, and HBCR was found to be significantly better with regard to both cost and QALYs for patients with heart failure. Cost-utility analysis categorizing interventions as 'dominant', 'effective', 'doubtful', and 'dominated', found HBCRs dominant. EXPERT OPINION Although HBCR tended to be superior compared to UC in this review, larger and more robust trials addressing specific patients groups are needed for definitive results.
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Affiliation(s)
- Samaneh Bakhshayesh
- Students Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Health Information Technology, Neyshabur University of Medical Sciences , Neyshabur, Iran
| | - Robert Bergquist
- Ingerod, SE-454 94 Brastad, Sweden, Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization , Geneva, Switzerland
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences , Kashan, Iran.,Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences , Kashan, Iran
| | - Arash Gholoobi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Shahab Mohammad-Ebrahimi
- Students Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran.,Pharmaceutical Research Center, Mashhad University of Medical Sciences , Mashhad, Iran.,Department of Medical Informatics, Amsterdam UMC (location AMC), University of Amsterdam , Amsterdam, The Netherlands
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16
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Home-Based Cardiac Rehabilitation: A SCIENTIFIC STATEMENT FROM THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION, THE AMERICAN HEART ASSOCIATION, AND THE AMERICAN COLLEGE OF CARDIOLOGY. J Cardiopulm Rehabil Prev 2020; 39:208-225. [PMID: 31082934 DOI: 10.1097/hcr.0000000000000447] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.
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17
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Drwal KR, Forman DE, Wakefield BJ, El Accaoui RN. Cardiac Rehabilitation During COVID-19 Pandemic: Highlighting the Value of Home-Based Programs. Telemed J E Health 2020; 26:1322-1324. [PMID: 32552412 DOI: 10.1089/tmj.2020.0213] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cardiac rehabilitation (CR) is a class I treatment for cardiovascular disease, however, underutilization of these services remains. Home-based CR (HBCR) models have been implemented as a potential solution to addressing access barriers to CR services. Home-based models have been shown to be effective, however, there continues to be large variation of protocols and minimal evidence of effectiveness in higher risk populations. In addition, lack of reimbursement models has discouraged the widespread adoption of HBCR. During the coronavirus 2019 (COVID-19) pandemic, an even greater gap in CR care has been present due to decreased availability of on-site services. The COVID-19 pandemic presents a time to highlight the value and experiences of home-based models as clinicians search for ways to continue to provide care. Continued review and standardization of HBCR models are essential to provide care for a wider range of patients and circumstances.
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Affiliation(s)
- Kariann R Drwal
- VA Office of Rural Health, Veterans Rural Health Resource Center Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Comprehensive Access and Delivery Research and Evaluation Center Iowa City VA Healthcare System, Iowa City, Iowa, USA
| | - Daniel E Forman
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bonnie J Wakefield
- VA Office of Rural Health, Veterans Rural Health Resource Center Iowa City VA Healthcare System, Iowa City, Iowa, USA.,The Comprehensive Access and Delivery Research and Evaluation Center Iowa City VA Healthcare System, Iowa City, Iowa, USA.,Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Ramzi N El Accaoui
- VA Office of Rural Health, Veterans Rural Health Resource Center Iowa City VA Healthcare System, Iowa City, Iowa, USA.,Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa, USA
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18
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Kumar KR, Pina IL. Cardiac rehabilitation in older adults: New options. Clin Cardiol 2019; 43:163-170. [PMID: 31823400 PMCID: PMC7021654 DOI: 10.1002/clc.23296] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiaries which represent an older population, utilization of CR continues to remain low despite evidence that suggests lower hospitalization rates, Medicare costs, and improved symptoms. Given poor referral rates, enrollment rates, and completion rates, a call for new strategies has been made by all major societies. However, several barriers exist. Newer models of CR constructed to overcome these barriers are reviewed below. Some of these new strategies include alternative site CR or home‐based CR and the utilization of technology.
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Affiliation(s)
- Kartik R Kumar
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Ileana L Pina
- Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan
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19
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Beatty AL, Doll JA, Schopfer DW, Maynard C, Plomondon ME, Shen H, Whooley MA. Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2019; 7:e010010. [PMID: 30371315 PMCID: PMC6404876 DOI: 10.1161/jaha.118.010010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Cardiac rehabilitation (CR) is strongly recommended after percutaneous coronary intervention (PCI), but it is underused. We sought to evaluate CR participation variation after PCI and its association with mortality among veterans. Methods and Results Patients undergoing PCI between 2007 and 2011 were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking database and followed up until January 25, 2017. We excluded patients who died within 30 days of PCI and calculated the percentage participating in ≥1 outpatient CR visits within 12 months after PCI. We constructed multivariable hierarchical logistic regression models for CR participation, clustered by facility. We estimated propensity scores for CR participation, matched participants and nonparticipants by propensity score, calculated mortality rates, and estimated the association with mortality using Cox proportional hazards models. Participation in CR after PCI was 6.9% (2986/43 319) and varied significantly by PCI facility (range, 0%-36%). After 6.1 years median follow-up, CR participants had a 33% lower mortality rate than all nonparticipants (3.8 versus 5.7 deaths/100 person-years; hazard ratio, 0.67; 95% confidence interval, 0.61-0.75; P<0.001) and a 26% lower mortality rate than 2986 propensity-matched nonparticipants (3.8 versus 5.1 deaths/100 person-years; hazard ratio, 0.74; 95% confidence interval, 0.65-0.84; P<0.001). Participants attending ≥36 sessions had the lowest mortality rate (2.4 deaths/100 person-years; hazard ratio, 0.47; 95% confidence interval, 0.36-0.60; P<0.001). Conclusions CR participation after PCI among veterans is low overall, with significant facility-level variation. CR participation is associated with lower mortality rates in veterans. Additional efforts are needed to promote CR participation after PCI among veterans.
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Affiliation(s)
- Alexis L Beatty
- 1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.,2 Department of Medicine University of Washington Seattle WA
| | - Jacob A Doll
- 1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.,2 Department of Medicine University of Washington Seattle WA
| | - David W Schopfer
- 4 Department of Medicine San Francisco VA Medical Center San Francisco CA.,5 Department of Medicine University of California San Francisco CA
| | - Charles Maynard
- 1 Center of Innovation for Veteran-Centered and Value-Driven Care Veterans Affairs Puget Sound Health Care System Seattle WA.,3 School of Public Health University of Washington Seattle WA
| | - Mary E Plomondon
- 7 Veterans Affairs Clinical Assessment, Reporting, and Tracking VA Eastern Colorado Health Care System Denver CO
| | - Hui Shen
- 4 Department of Medicine San Francisco VA Medical Center San Francisco CA.,5 Department of Medicine University of California San Francisco CA
| | - Mary A Whooley
- 2 Department of Medicine University of Washington Seattle WA.,4 Department of Medicine San Francisco VA Medical Center San Francisco CA.,5 Department of Medicine University of California San Francisco CA.,6 Department of Epidemiology and Biostatistics University of California San Francisco CA
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20
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Wakefield BJ, Drwal K, Paez M, Grover S, Franciscus C, Reisinger HS, Kaboli PJ, El Accaoui R. Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration. BMC Cardiovasc Disord 2019; 19:242. [PMID: 31694570 PMCID: PMC6833278 DOI: 10.1186/s12872-019-1224-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) programs provide significant benefit for people with cardiovascular disease. Despite these benefits, such services are not universally available. We designed and evaluated a national home-based CR (HBCR) program in the Veterans Health Administration (VHA). The primary aim of the study was to examine barriers and facilitators associated with site-level implementation of HBCR. METHODS This study used a convergent parallel mixed-methods design with qualitative data to analyze the process of implementation, quantitative data to determine low and high uptake of the HBCR program, and the integration of the two to determine which facilitators and barriers were associated with adoption. Data were drawn from 16 VHA facilities, and included semi-structured interviews with multiple stakeholders, document analysis, and quantitative analysis of CR program attendance codes. Qualitative data were analyzed using the Consolidated Framework for Implementation Research codes including three years of document analysis and 22 interviews. RESULTS Comparing high and low uptake programs, readiness for implementation (leadership engagement, available resources, and access to knowledge and information), planning, and engaging champions and opinion leaders were key to success. High uptake sites were more likely to seek information from the external facilitator, compared to low uptake sites. There were few adaptations to the design of the program at individual sites. CONCLUSION Consistent and supportive leadership, both clinical and administrative, are critical elements to getting HBCR programs up and running and sustaining programs over time. All sites in this study had external funding to develop their program, but high adopters both made better use of those resources and were able to leverage existing resources in the setting. These data will inform broader policy regarding use of HBCR services.
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Affiliation(s)
- Bonnie J Wakefield
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA. .,The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA.
| | - Kariann Drwal
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA
| | - Monica Paez
- The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA
| | - Sara Grover
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA
| | - Carrie Franciscus
- The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA
| | - Heather Schacht Reisinger
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA.,The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Peter J Kaboli
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA.,The Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, Iowa City, IA, 52246-2208, USA.,The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Ramzi El Accaoui
- The Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
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21
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Imran HM, Baig M, Erqou S, Taveira TH, Shah NR, Morrison A, Choudhary G, Wu WC. Home-Based Cardiac Rehabilitation Alone and Hybrid With Center-Based Cardiac Rehabilitation in Heart Failure: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012779. [PMID: 31423874 PMCID: PMC6759908 DOI: 10.1161/jaha.119.012779] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Center‐based cardiac rehabilitation (CBCR) has been shown to improve outcomes in patients with heart failure (HF). Home‐based cardiac rehabilitation (HBCR) can be an alternative to increase access for patients who cannot participate in CBCR. Hybrid cardiac rehabilitation (CR) combines short‐term CBCR with HBCR, potentially allowing both flexibility and rigor. However, recent data comparing these initiatives have not been synthesized. Methods and Results We performed a meta‐analysis to compare functional capacity and health‐related quality of life (hr‐QOL) outcomes in HF for (1) HBCR and usual care, (2) hybrid CR and usual care, and (3) HBCR and CBCR. A systematic search in 5 standard databases for randomized controlled trials was performed through January 31, 2019. Summary estimates were pooled using fixed‐ or random‐effects (when I2>50%) meta‐analyses. Standardized mean differences (95% CI) were used for distinct hr‐QOL tools. We identified 31 randomized controlled trials with a total of 1791 HF participants. Among 18 studies that compared HBCR and usual care, participants in HBCR had improvement of peak oxygen uptake (2.39 mL/kg per minute; 95% CI, 0.28–4.49) and hr‐QOL (16 studies; standardized mean difference: 0.38; 95% CI, 0.19–0.57). Nine RCTs that compared hybrid CR with usual care showed that hybrid CR had greater improvements in peak oxygen uptake (9.72 mL/kg per minute; 95% CI, 5.12–14.33) but not in hr‐QOL (2 studies; standardized mean difference: 0.67; 95% CI, −0.20 to 1.54). Five studies comparing HBCR with CBCR showed similar improvements in functional capacity (0.0 mL/kg per minute; 95% CI, −1.93 to 1.92) and hr‐QOL (4 studies; standardized mean difference: 0.11; 95% CI, −0.12 to 0.34). Conclusions HBCR and hybrid CR significantly improved functional capacity, but only HBCR improved hr‐QOL over usual care. However, both are potential alternatives for patients who are not suitable for CBCR.
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Affiliation(s)
- Hafiz M Imran
- Providence Veterans Affairs Medical Center Providence RI.,Center for Cardiac Fitness The Miriam Hospital Providence RI.,Alpert Medical School Brown University Providence RI
| | | | - Sebhat Erqou
- Providence Veterans Affairs Medical Center Providence RI.,Alpert Medical School Brown University Providence RI
| | - Tracey H Taveira
- Providence Veterans Affairs Medical Center Providence RI.,University of Rhode Island College of Pharmacy Kingston RI
| | - Nishant R Shah
- Providence Veterans Affairs Medical Center Providence RI.,Alpert Medical School Brown University Providence RI
| | - Alan Morrison
- Providence Veterans Affairs Medical Center Providence RI.,Alpert Medical School Brown University Providence RI
| | - Gaurav Choudhary
- Providence Veterans Affairs Medical Center Providence RI.,Alpert Medical School Brown University Providence RI
| | - Wen-Chih Wu
- Providence Veterans Affairs Medical Center Providence RI.,Center for Cardiac Fitness The Miriam Hospital Providence RI.,Alpert Medical School Brown University Providence RI
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22
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Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA. Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Am Coll Cardiol 2019; 74:133-153. [PMID: 31097258 PMCID: PMC7341112 DOI: 10.1016/j.jacc.2019.03.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.
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23
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Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ, Kitzman DW, Regensteiner JG, Sanderson BK, Whooley MA. Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation 2019; 140:e69-e89. [PMID: 31082266 DOI: 10.1161/cir.0000000000000663] [Citation(s) in RCA: 206] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses patient education, health behavior modification, and exercise training to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, heart failure, or cardiac surgery but are significantly underused, with only a minority of eligible patients participating in CR in the United States. New delivery strategies are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). In contrast to center-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision and is provided mostly or entirely outside of the traditional center-based setting. Although HBCR has been successfully deployed in the United Kingdom, Canada, and other countries, most US healthcare organizations have little to no experience with such programs. The purpose of this scientific statement is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR in the United States. Previous randomized trials have generated low- to moderate-strength evidence that HBCR and center-based CR can achieve similar improvements in 3- to 12-month clinical outcomes. Although HBCR appears to hold promise in expanding the use of CR to eligible patients, additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and other higher-risk and understudied groups. In the interim, we conclude that HBCR may be a reasonable option for selected clinically stable low- to moderate-risk patients who are eligible for CR but cannot attend a traditional center-based CR program.
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24
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Rosario MBD, Lovell NH, Fildes J, Holgate K, Yu J, Ferry C, Schreier G, Ooi SY, Redmond SJ. Evaluation of an mHealth-Based Adjunct to Outpatient Cardiac Rehabilitation. IEEE J Biomed Health Inform 2017; 22:1938-1948. [PMID: 29990228 DOI: 10.1109/jbhi.2017.2782209] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A pilot study was conducted to determine if a smartphone-based adjunct to standard care could increase the completion rate of a cardiac rehabilitation program (CRP). Based on historical completion rates, 66 participants who were about to commence a hospital-based CRP were randomized so that half received three devices embedded with near-field communication, namely, a smartphone [pre-installed with an application (app) designed specifically for cardiac rehabilitation], portable blood pressure monitor, and weight scale while completing the CRP. The completion rate among participants who were randomized to the intervention group was 88%, compared to 67% in the control group ( = 0.038). This combined with the week-to-week frequency with which participants in the intervention group measured their blood pressure ( 5/week) demonstrated the ability of the intervention to increase the proportion of patients who completed the CRP. No significant differences were found between the treatment groups for the measurements taken at baseline and prior to discharge from the CRP. A statistically significant correlation ( = 0.472; = 0.013) was found between the average time participants walked each day (as estimated via the smartphone app) and participants' six minute walking distance (6MWD) before they were discharged from the CRP (a clinically validated measurement).
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25
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Donesky D, Selman L, McDermott K, Citron T, Howie-Esquivel J. Evaluation of the Feasibility of a Home-Based TeleYoga Intervention in Participants with Both Chronic Obstructive Pulmonary Disease and Heart Failure. J Altern Complement Med 2017; 23:713-721. [DOI: 10.1089/acm.2015.0279] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- DorAnne Donesky
- Department of Physiological Nursing, University of California, San Francisco, CA
| | - Lucy Selman
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | | | | | - Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, CA
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26
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Rohrbach G, Schopfer DW, Krishnamurthi N, Pabst M, Bettencourt M, Loomis J, Whooley MA. The Design and Implementation of a Home-Based Cardiac Rehabilitation Program. Fed Pract 2017; 34:34-39. [PMID: 30766279 PMCID: PMC6370433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A home-based cardiac rehabilitation program improves access and enrollment by using an evidence-based alternative model of care.
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Affiliation(s)
- Gregory Rohrbach
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
| | - David W Schopfer
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
| | - Nirupama Krishnamurthi
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
| | - Mark Pabst
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
| | - Michael Bettencourt
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
| | - Jo Loomis
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
| | - Mary A Whooley
- is a nurse practitioner, is a staff cardiologist, is the operations manager, measurement science QUERI, is an exercise physiologist, and is director of the measurement science QUERI, all at San Francisco VA Healthcare System in California. Dr. Schopfer is assistant professor of medicine, is an assistant professor, is a postdoctoral fellow, and Dr. Whooley is a professor of medicine, all at University of California, San Francisco
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Frohmader TJ, Lin F, Chaboyer W. Patient perceptions of nurse mentors facilitating the Aussie Heart Guide: A home-based cardiac rehabilitation programme for rural patients. Nurs Open 2015; 3:41-50. [PMID: 27708814 PMCID: PMC5047326 DOI: 10.1002/nop2.34] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/24/2015] [Indexed: 11/08/2022] Open
Abstract
AIM To explore and describe long-term thoughts and perceptions of the Aussie Heart Guide Programme including the role of the mentor, held by patients recovering from myocardial infarction. DESIGN A qualitative design. METHODS Thirteen patients recovering from myocardial infarction who were unable to attend a hospital-based or affiliated outpatient cardiac rehabilitation programme were interviewed by telephone at the completion of the programme and asked to describe the relationship with their assigned nurse mentor and their perception of the audiovisual used in the programme. RESULTS Three themes emerged; assisting me to cope, supporting me and my family and tailoring the programme to my needs. Patients were satisfied with the programme and appreciative of the supportive and caring relationships provided by mentors during their hospitalization through to their discharge from the programme.
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Affiliation(s)
- Terence John Frohmader
- Department of Intensive Care Medicine Launceston General Hospital Launceston Tasmania Australia
| | - Frances Lin
- School of Nursing and Midwifery - Centre for Health Practice Innovation (HPI) Griffith University Gold Coast Campus Queensland Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing Centre for Health Practice Innovation Menzies Health Institute Queensland Griffith University Gold Coast Campus Queensland Australia
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Dedov VN, Dedova IV. Development of the Internet-Enabled System for Exercise Telerehabilitation and Cardiovascular Training. Telemed J E Health 2015; 21:575-80. [PMID: 25734449 DOI: 10.1089/tmj.2014.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Sustained exercise training could significantly improve patient rehabilitation and management of noncommunicable diseases in the community. This study aimed to develop a universal telecare system for delivery of exercise rehabilitation and cardiovascular training services at home. MATERIALS AND METHODS An innovative bilateral leg training device was equipped with an electronic system for the ongoing measurement of training activities with the device. A single-item parameter reflecting the intensity of training was monitored using several modern telecommunication technologies. According to the application protocol, eight volunteers first tried the device for 30-60 min to determine their personal training capacity. Then, they were provided with equipment to use at home for 4 weeks. Adherence to daily training was assessed by the number of training days per week, training intensity, and duration of training sessions. RESULTS The system provided reliable recording of training activities with the device using (1) long-term data logging without an ongoing connection to the computer, (2) wireless monitoring and recording of training activities on a stand-alone computer, and (3) a secure cloud-based monitoring over the Internet connection using electronic devices, including smartphones. Overall analysis of recordings and phone feedbacks to participants took only approximately 5 h for the duration of study. CONCLUSIONS This study, although of a pilot nature, described the comprehensive exercise telerehabilitation system integrating mobile training equipment with personalized training protocols and remote monitoring. A single-item electronic parameter of the system usage facilitated time-effective data management. Wireless connection allowed various locations of device application and several monitoring arrangements ranging from real-time monitoring to long-term recording of exercise activities. A cloud-based software platform enabled management of multiple users at distance. Implementation of this model may facilitate both accessibility and availability of personalized exercise telerehabilitation services. Further studies would validate it in the clinical and healthcare environment.
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Affiliation(s)
- Vadim N Dedov
- 1 MDXD Pty Ltd. , Sans Souci, New South Wales, Australia
| | - Irina V Dedova
- 2 School of Medical Sciences, University of New South Wales , Sydney, New South Wales, Australia
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Selman L, McDermott K, Donesky D, Citron T, Howie-Esquivel J. Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: qualitative findings from a controlled pilot study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:21. [PMID: 25887324 PMCID: PMC4324792 DOI: 10.1186/s12906-015-0540-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 01/23/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are highly prevalent and associated with a large symptom burden, that is compounded in a dual HF-COPD diagnosis. Yoga has potential benefit for symptom relief; however functional impairment hinders access to usual yoga classes. We developed a Tele-Yoga intervention and evaluated it in a controlled pilot trial. This paper reports on the appropriateness and acceptability of the intervention and the evaluation design. METHODS A controlled, non-randomised trial was conducted of an 8-week Tele-Yoga intervention versus an educational control (information leaflets mailed to participants with one phone call a week). Biweekly one-hour Tele-Yoga classes were implemented via multipoint videoconferencing that connected participants to live classes via an Internet connection to their televisions. Semi-structured qualitative interviews were conducted with participants post study exit to explore reasons for and experiences of participating, including views of study outcome measures and physiological tests. Transcribed interviews were analysed using thematic content analysis. RESULTS Fifteen people participated in the pilot study (7 in the intervention group, 8 in the control). Of these, 12 participants were interviewed, 6 in each group, mean age 71.2 years (SD 10.09); 3 were male. Themes are reported in the following categories: acceptability and appropriateness of the intervention, potential active ingredients of the intervention, acceptability and appropriateness of the control, participation in the research, and acceptability of the testing procedures. The intervention was acceptable and appropriate: the intervention group reported enjoying yoga and valuing the home-based aspect and participants described a high symptom burden and social isolation. However, technological problems resulted in poor video-streaming quality for some participants. Potential active ingredients included physical postures, breathing exercises and guidance in relaxation and meditation. The educational control intervention was acceptable and appropriate, with participants reporting little effect on their well-being and no impact on mechanisms hypothesised to explain yoga's effectiveness. The questionnaires and home physiological testing were acceptable to participants. CONCLUSIONS Tele-Yoga is an acceptable and appropriate intervention in people with HF and COPD and further research is warranted to refine the technology used in its delivery. Findings provide guidance for researchers working in tele-interventions, yoga, and similar populations. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02078739 (4 March 2014).
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Affiliation(s)
- Lucy Selman
- Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, U.K.
| | - Kelly McDermott
- University of California, San Francisco, Osher Center for Integrative Medicine, 1545 Divisadero Street, 4th Floor, San Francisco, CA, 94115-3010, U.S.A.
| | - DorAnne Donesky
- Department of Physiological Nursing, UCSF School of Nursing Building, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, U.S.A.
| | - Tracie Citron
- Department of Physiological Nursing, UCSF School of Nursing Building, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, U.S.A.
| | - Jill Howie-Esquivel
- Department of Physiological Nursing, UCSF School of Nursing Building, University of California, San Francisco, 2 Koret Way, Box 0610, San Francisco, CA, 94143-0610, U.S.A.
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The Sustainability of Exercise Capacity Changes in Home Versus Center-Based Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2015; 35:21-8. [DOI: 10.1097/hcr.0000000000000084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Huang K, Liu W, He D, Huang B, Xiao D, Peng Y, He Y, Hu H, Chen M, Huang D. Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. Eur J Prev Cardiol 2014; 22:959-71. [PMID: 25488550 DOI: 10.1177/2047487314561168] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/04/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based recommendation for patients with coronary artery disease (CAD). However, CR is dramatically underutilized. Telehealth interventions have the potential to overcome barriers and may be an innovative model of delivering CR. This review aimed to determine the effectiveness of telehealth intervention delivered CR compared with center-based supervised CR. METHOD Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library and the Chinese BioMedical Literature Database (CBM), were searched to April 2014, without language restriction. Existing randomized controlled trials, reviews, relevant conference lists and gray literature were checked. Randomized controlled trials that compared telehealth intervention delivered CR with traditional center-based supervised CR in adults with CAD were included. Two reviewers selected studies and extracted data independently. Main clinical outcomes including clinical events, modifiable risk factors or other endpoints were measured. RESULTS Fifteen articles reporting nine trials were reviewed, most of which recruited patients with myocardial infarction or revascularization. No statistically significant difference was found between telehealth interventions delivered and center-based supervised CR in exercise capacity (standardized mean difference (SMD) -0.01; 95% confidence interval (CI) -0.12-0.10), weight (SMD -0.13; 95% CI -0.30-0.05), systolic and diastolic blood pressure (mean difference (MD) -1.27; 95% CI -3.67-1.13 and MD 1.00; 95% CI -0.42-2.43, respectively), lipid profile, smoking (risk ratio (RR) 1.03; 95% CI 0.78-1.38), mortality (RR 1.15; 95% CI 0.61-2.19), quality of life and psychosocial state. CONCLUSIONS Telehealth intervention delivered cardiac rehabilitation does not have significantly inferior outcomes compared to center-based supervised program in low to moderate risk CAD patients. Telehealth intervention offers an alternative deliver model of CR for individuals less able to access center-based cardiac rehabilitation. Choices should reflect preferences, anticipation, risk profile, funding, and accessibility to health service.
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Affiliation(s)
- Kaisen Huang
- Department of Cardiology, West China Hospital, PR China
| | - Wei Liu
- Department of Cardiology, West China Hospital, PR China
| | - Dingxiu He
- Emergency Department, People's Hospital of Deyang City, PR China
| | - Baotao Huang
- Department of Cardiology, West China Hospital, PR China
| | - Dan Xiao
- Department of Cardiology, West China Hospital, PR China
| | - Yong Peng
- Department of Cardiology, West China Hospital, PR China
| | - Yong He
- Department of Cardiology, West China Hospital, PR China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, PR China
| | - Mao Chen
- Department of Cardiology, West China Hospital, PR China
| | - Dejia Huang
- Department of Cardiology, West China Hospital, PR China
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Lear SA, Singer J, Banner-Lukaris D, Horvat D, Park JE, Bates J, Ignaszewski A. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:952-9. [PMID: 25271050 DOI: 10.1161/circoutcomes.114.001230] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Scott A Lear
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.).
| | - Joel Singer
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Davina Banner-Lukaris
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Dan Horvat
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Julie E Park
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Joanna Bates
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
| | - Andrew Ignaszewski
- From the Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada (S.A. L.); Division of Cardiology (S.A.L., J.E.P., A.I.) and Centre for Health Evaluation and Outcome Sciences (J.S.), Providence Health Care, Vancouver, Canada; School of Population and Public Health (J.S.), Department of Family Medicine, Faculty of Practice (D.H., J.B.), and Department of Medicine, Faculty of Practice (A.I.), University of British Columbia, Vancouver, Canada; and School of Nursing, University of Northern British Columbia, Vancouver, Canada (D.B.-L.)
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