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Chong MS, Sit JWH, Choi KC, Suhaimi A, Chair SY. Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross-sectional study. J Clin Nurs 2024; 33:1084-1093. [PMID: 37909483 DOI: 10.1111/jocn.16919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/01/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
AIMS AND OBJECTIVES The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. BACKGROUND Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country. DESIGN A cross-sectional study design. METHODS A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). RESULTS Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach. CONCLUSION Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. RELEVANCE TO CLINICAL PRACTICE By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.
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Affiliation(s)
- Mei Sin Chong
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
| | - Anwar Suhaimi
- Rehabilitation Medicine Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
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Rogerson MC, Jackson AC, Navaratnam HS, Le Grande MR, Higgins RO, Clarke J, Murphy BM. Behavioural and psychological telehealth support for people with cardiac conditions: randomized trial of the 'back on track' self-management programme. Eur J Cardiovasc Nurs 2024; 23:42-54. [PMID: 36989400 DOI: 10.1093/eurjcn/zvad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
AIMS Behaviour modification and mood management are essential to recovery after a cardiac event. Recent times have seen a major shift to remote delivery of cardiac services. This study assessed behavioural and psychological outcomes of the Back on Track online self-management programme, comparing the programme undertaken alone (self-directed) vs. with telephone support (supported). Relevance for people with depression was also assessed. METHODS AND RESULTS Participants with cardiac conditions (n = 122) were randomly assigned to self-directed or supported groups and given access to the online programme for 2 months. The programme addressed depression, anxiety, physical activity, and healthy eating. Supported group participants also received two telephone sessions facilitated by a trained counsellor to further enhance their self-management skills and engagement with the online modules. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Active Australia Survey and Diet Quality Tool were administered at baseline, 2, and 6 months. χ2 tests were used to compare self-directed and supported groups. Cochrane's Q tests assessed changes over time in depression, anxiety, and physical activity (PA) and healthy diet guideline achievement. Participants in both groups showed reduced depression rates (self-directed, P < 0.05) and increased PA after programme completion (both groups, P < 0.05). Amongst those classified as depressed at baseline, significantly fewer were classified as depressed over time (P < 0.001) and significantly more were achieving the PA guidelines (P < 0.01) compared to those who were not depressed at baseline. CONCLUSIONS The Back on Track telehealth programme was effective in assisting with behavioural and emotional recovery after a cardiac event. The programme may be particularly beneficial for those who are depressed early in their recovery period. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12620000102976.
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Affiliation(s)
- Michelle C Rogerson
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
- Centre on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong
- PRC Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Hema S Navaratnam
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
| | - Michael R Le Grande
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
- Department of Psychology, Deakin University, Geelong, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
| | - Joanne Clarke
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
| | - Barbara M Murphy
- Australian Centre for Heart Health, 75-79 Chetwynd St, PO Box 2137, North Melbourne, VIC 3051, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
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Thomas EE, Cartledge S, Murphy B, Abell B, Gallagher R, Astley C. Expanding access to telehealth in Australian cardiac rehabilitation services: a national survey of barriers, enablers, and uptake. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:21-29. [PMID: 38264703 PMCID: PMC10802819 DOI: 10.1093/ehjdh/ztad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 01/25/2024]
Abstract
Aims Cardiac rehabilitation (CR) is traditionally delivered in-person; however, the COVID-19 pandemic provided impetus for alternative offerings such as telehealth. We investigated uptake, barriers, and enablers in a national survey during the pandemic in Australia. Methods and results We surveyed CR programmes between April and June 2021 using professional association networks. The anonymous online questionnaire addressed programme characteristics, COVID-19 impacts, and barriers to and enablers of telehealth use. Open-text responses were coded and presented as themes. In total, there were responses from 105 programmes (33% response rate). All states and geographical areas were represented. The use of every modality of telehealth care (telephone, video conferencing, text messaging, and web-based) increased significantly during and after COVID with a strong preference for telephone (85% of services). Respondents perceived video (53%) and telephone (47%) formats as safe and effective for delivering CR. The most common barriers to telehealth were difficulties conducting assessments and reduced engagement with patients. Prominent enablers were increased reach and reduced patient barriers to CR access. Conclusion Telehealth use by CR programmes increased during the peak pandemic period. However, additional support is required to ensure that telehealth services can be maintained. There is considerable potential to increase the reach of CR by embedding telehealth into existing models of care.
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Affiliation(s)
- Emma E Thomas
- Centre for Online Health, The University of Queensland, Bldg 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland 4103, Australia
- Centre for Health Services Research, The University of Queensland, Bldg 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland 4103, Australia
| | - Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, Sydney, New South Wales 2050, Australia
| | - Barbara Murphy
- Australian Centre for Heart Health, 75-79 Chetwynd St, North Melbourne, Victoria 3051, Australia
- School of Psychological Sciences, University of Melbourne, Redmond Barry Bldg, Victoria 3052, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, Queensland 4059, Australia
- School of Public Health and Social Work, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, Queensland 4059, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, Sydney, New South Wales 2050, Australia
| | - Carolyn Astley
- College of Nursing and Health Science, Flinders University, North Sturt Road, Bedford Park, Adelaide, South Australia 5042, Australia
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Clinical Outcomes and Qualitative Perceptions of In-person, Hybrid, and Virtual Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:338-346. [PMID: 35420563 DOI: 10.1097/hcr.0000000000000688] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) is evolving to include both in-person and virtual delivery. Our objective was to compare, in CR patients, the association of in-person, hybrid, and virtual CR with change in performance on the 6-min walk test (6MWT) between enrollment and completion. METHODS Patients enrolled in CR between October 22, 2019, and May 10, 2021, were categorized into in-person, hybrid, or virtual groups by number of in-person and virtual visits. All patients received individualized exercise training and health behavior counseling. Cardiac rehabilitation was delivered to patients in the hybrid and virtual cohorts using synchronous video exercise and/or asynchronous telephone visits. Measurements at CR enrollment and completion included the 6MWT, blood pressure (BP), depression, anxiety, waist-to-hip ratio, and cardiac self-efficacy. RESULTS Of 187 CR patients, 37/97 (38.1%) were in-person patients and 58/90 (64.4%) were hybrid/virtual patients ( P = .001). Compared to in-person (51.5 ± 59.4 m) improvement in the 6MWT was similar in hybrid (63.4 ± 55.6; P = .46) and virtual (63.2 ± 59.6; P = .55) compared with in-person (51.5 ± 59.4). Hybrid and virtual patients experienced similar improvements in BP control and anxiety. Virtual patients experienced less improvement in depression symptoms. There were no statistically significant changes in waist-to-hip ratio or cardiac self-efficacy. Qualitative themes included the adaptability of virtual CR, importance of relationships between patients and CR staff, and need for training and organizational adjustments to adopt virtual CR. CONCLUSIONS Hybrid and virtual CR were associated with similar improvements in functional capacity to in-person. Virtual and hybrid CR have the potential to expand availability without compromising outcomes.
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Mone P, Izzo R, Marazzi G, Manzi MV, Gallo P, Campolongo G, Cacciotti L, Tartaglia D, Caminiti G, Varzideh F, Santulli G, Trimarco V. L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic. J Pharmacol Exp Ther 2022; 381:197-203. [PMID: 35339987 DOI: 10.1124/jpet.122.001149] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac rehabilitation (CR) following acute myocardial infarction (AMI) improves physical capacities and decreases hospitalizations and cardiovascular mortality. L-Arginine is the substrate used by nitric oxide (NO) synthase (NOS) to generate NO and it has been shown to exert its beneficial effects on endothelium driving vasodilatation, reducing inflammation, and ameliorating physical function. We hypothesized that L-Arginine could enhance physical capacities in patients who underwent CR after AMI. We designed a study aimed to assess the effects of L-arginine administration on the physical capacity of patients who underwent coronary revascularization after AMI. The trial was carried out amid the COVID-19 pandemic. Patients were assigned, with a 2:1 ratio, to add to their standard therapy 1 bottle containing 1.66 g of L-arginine or 1 bottle of identical aspect apart from not containing L-arginine, twice a day orally for 3 weeks. Patients performed a 6-minute walking test (6MWT) and were assessed their Borg modified 0-10 rating of perceived exertion (BRPE) before starting and at the end of the treatment. Seventy-five patients receiving L-Arginine, and thirty-five receiving placebo successfully completed the study. The 6MWT distance increased significantly in the L-Arginine group compared to both baseline and placebo (p<0.0001). Additionally, we observed a significant improvement in the BRPE in patients treated with L-arginine but not in the placebo group. Taken together, our data indicate that L-arginine potentiates the response to CR, independently of age, sex, baseline functional capacity, and comorbid conditions. Significance Statement This study shows for the first time that oral supplementation of L-arginine potentiates the response to cardiac rehabilitation after myocardial infarction and cardiac revascularization. Indeed, we observed a significant improvement in two fundamental parameters, namely, the 6-minute walking test and the Borg modified 0-10 rating of perceived exertion. Strikingly, the beneficial effects of L-arginine were independent from age, sex, comorbid conditions, and baseline functional capacity.
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