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Gadager BB, Tang LH, Doherty P, Svendsen ML, Sibilitz KL, Harrison A, Maribo T. Are cardiac rehabilitation pathways influenced by diabetes: A cohort study. Int J Cardiol 2024; 411:132275. [PMID: 38880427 DOI: 10.1016/j.ijcard.2024.132275] [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: 12/16/2023] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is recommended following acute coronary syndrome (ACS). Diabetes is a common long-term condition associated with ACS, and the inclusion of these patients in CR has been less studied. This study examines the referral, uptake, and completion rates in the CR pathway for ACS patients with and without diabetes to identify potential barriers in the CR pathway. METHODS The study included patients aged 18 or above who were discharged after a diagnosis of ACS in the Central Denmark Region between 1 September 2017 and 31 August 2018. Diabetes information was obtained from three sources. Logistic regression models were used to examine the associations between having diabetes and the three outcomes: non-referral, non-uptake and non-completion. Results were reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS A total of 2447 patients were eligible for the study, of which 457 (18.7%) had diabetes. Only non-uptake was found to be significantly associated with diabetes after adjustment for prespecified variables (OR = 1.38, 95% CI 1.01-1.90). Associations for non-referral (OR = 1.11, 95% CI 0.87-1.41) and non-completion (OR = 1.06, 95 %CI 0.73-1.53) were not found to be statistically significant between ACS patients with diabetes and those without diabetes. CONCLUSION This study highlights a significant disparity in the uptake of CR between patients with and without diabetes following ACS, demonstrating that patients with diabetes require early promotion and increased assistance to enrol in CR.
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Affiliation(s)
- Birgitte Bitsch Gadager
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Lars Hermann Tang
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark
| | | | | | | | | | - Thomas Maribo
- Centre for Rehabilitation Research, Department of Public Health, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
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Shields GE, Wells A, Wright S, Vass CM, Doherty PJ, Capobianco L, Davies LM. Discrete choice experiment to investigate preferences for psychological intervention in cardiac rehabilitation. BMJ Open 2022; 12:e062503. [PMID: 36343991 PMCID: PMC9644324 DOI: 10.1136/bmjopen-2022-062503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is offered to people who recently experienced a cardiac event, and often comprises of exercise, education and psychological care. This stated preference study aimed to investigate preferences for attributes of a psychological therapy intervention in CR. METHODS A discrete choice experiment (DCE) was conducted and recruited a general population sample and a trial sample. DCE attributes included the modality (group or individual), healthcare professional providing care, information provided prior to therapy, location and the cost to the National Health Service (NHS). Participants were asked to choose between two hypothetical designs of therapy, with a separate opt-out included. A mixed logit model was used to analyse preferences. Cost to the NHS was used to estimate willingness to pay (WTP) for aspects of the intervention design. RESULTS Three hundred and four participants completed the DCE (general public sample (n=262, mean age 47, 48% female) and trial sample (n=42, mean age 66, 45% female)). A preference for receiving psychological therapy was demonstrated by both samples (general population WTP £1081; 95% CI £957 to £1206). The general population appeared to favour individual therapy (WTP £213; 95% CI £160 to £266), delivered by a CR professional (WTP £48; 9% % CI £4 to £93) and with a lower cost (β=-0.002; p<0.001). Participants preferred to avoid options where no information was received prior to starting therapy (WTP -£106; 95% CI -£153 to -£59). Results for the location attribute were variable and challenging to interpret. CONCLUSIONS The study demonstrates a preference for psychological therapy as part of a programme of CR, as participants were more likely to opt-in to therapy. Results indicate that some aspects of the delivery which may be important to participants can be tailored to design a psychological therapy. Preference heterogeneity is an issue which may prevent a 'one-size-fits-all' approach to psychological therapy in CR.
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Affiliation(s)
- Gemma E Shields
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Adrian Wells
- School of Psychological Sciences, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stuart Wright
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Caroline M Vass
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
- RTI Health Solutions, Manchester, UK
| | | | - Lora Capobianco
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Linda M Davies
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
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Tighe SA, Ball K, Kayser L, Kensing F, Maddison R. Qualitative study of the views of people living with cardiovascular disease, and healthcare professionals, towards the use of a digital platform to support cardiovascular disease self-management. BMJ Open 2022; 12:e056768. [PMID: 36319055 PMCID: PMC9628687 DOI: 10.1136/bmjopen-2021-056768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This paper focuses on formative research as part of a broader study to develop and evaluate an innovative digital health platform for the self-management of cardiovascular disease (CVD). The primary objective is to better understand the perceptions of key stakeholders towards the proposed platform (Salvio) and to identify the development considerations they may prioritise based on their own experiences of CVD management. DESIGN A qualitative research study using thematic analysis to explore patterns and themes within the various participant contributions. SETTING Triangulation of data collection methods were used to generate data, including focus group discussions, semistructured interviews and guided conversations. PARTICIPANTS Participants (n=26) were people with a diagnosis of CVD (n=18) and relevant healthcare professionals (n=8). RESULTS Findings indicate that the proposed platform would be a beneficial solution for certain groups whose health behaviour change is not currently supported by discrete solutions. Both participant groups perceive the digital health platform more trustworthy than accessing multiple interventions through unsupported digital repositories. Healthcare professionals agreed that they would endorse an evidence-based platform that had been rigorously developed and evaluated. CVD participants prioritised a decision support tool to guide them through the platform, as they perceive an unstructured approach as overly complex. Both participant groups perceived data sharing with certain self-selected individuals (eg, spouse) to be a useful method for gaining support with their health behaviour change. CONCLUSIONS A digital health platform offering a variety of existing, evidence-based interventions would provide users with suitable self-management solution(s) based on their own individual needs and preferences. Salvio could be enhanced by providing adequate support to platform users, guiding the diverse CVD population through a host of digital solutions, ensuring that Salvio is endorsed by trusted healthcare professionals and maintaining connections with usual care. Such a platform would augment existing self-management and secondary prevention services.
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Affiliation(s)
- Sarah Anne Tighe
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Lars Kayser
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Gadager BB, Tang LH, Ravn MB, Doherty P, Harrison A, Christensen J, Taylor RS, Zwisler AD, Maribo T. Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:295. [PMID: 35761178 PMCID: PMC9237976 DOI: 10.1186/s12872-022-02723-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/15/2022] [Indexed: 12/25/2022] Open
Abstract
Aim The benefits of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) are well established. However, the relative benefit of CR in those with comorbidities, including diabetes, is not well understood. This systematic review and meta-analysis examined the benefit of CR on exercise capacity and secondary outcomes in ACS patients with a co-diagnosis of diabetes compared to those without.
Methods Five databases were searched in May 2021 for randomised controlled trials (RCTs) and observational studies reporting CR outcomes in ACS patients with and without diabetes. The primary outcome of this study was exercise capacity expressed as metabolic equivalents (METs) at the end of CR and ≥ 12-month follow-up. Secondary outcomes included health-related quality of life, cardiovascular- and diabetes-related outcomes, lifestyle-related outcomes, psychological wellbeing, and return to work. If relevant/possible, studies were pooled using random-effects meta-analysis.
Results A total of 28 studies were included, of which 20 reported exercise capacity and 18 reported secondary outcomes. Overall, the studies were judged to have a high risk of bias. Meta-analysis of exercise capacity was undertaken based on 18 studies (no RCTs) including 15,288 patients, of whom 3369 had diabetes. This analysis showed a statistically significant smaller difference in the change in METs in ACS patients with diabetes (standardised mean difference (SMD) from baseline to end of CR: − 0.15 (95% CI: − 0.24 to − 0.06); SMD at the ≥ 12-month follow-up: − 0.16 (95% CI: − 0.23 to − 0.10, four studies)).
Conclusion The benefit of CR on exercise capacity in ACS patients was lower in those with diabetes than in those without diabetes. Given the small magnitude of this difference and the substantial heterogeneity in the results of the study caused by diverse study designs and methodologies, further research is needed to confirm our findings. Future work should seek to eliminate bias in observational studies and evaluate CR based on comprehensive outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02723-5.
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Affiliation(s)
- Birgitte Bitsch Gadager
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, P.P. Oerumsgade 11, building 1 b, 8000 Aarhus C, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals and The Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maiken Bay Ravn
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, P.P. Oerumsgade 11, building 1 b, 8000 Aarhus C, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, England
| | | | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland.,National Institute of Public Health, University of Suthern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Thomas Maribo
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, P.P. Oerumsgade 11, building 1 b, 8000 Aarhus C, Aarhus, Denmark. .,DEFACTUM, Central Denmark Region, Aarhus, Denmark.
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Tang LH, Harrison A, Skou ST, Taylor RS, Dalal H, Doherty P. Are patient characteristics and modes of delivery associated with completion of cardiac rehabilitation? A national registry analysis. Int J Cardiol 2022; 361:7-13. [DOI: 10.1016/j.ijcard.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/23/2022] [Accepted: 05/02/2022] [Indexed: 12/17/2022]
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Tang LH, Harrison A, Skou ST, Doherty P. To what extent are comorbidity profiles associated with referral and uptake to cardiac rehabilitation. Int J Cardiol 2021; 343:85-91. [PMID: 34534605 DOI: 10.1016/j.ijcard.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Given the high proportion of comorbidities in patients with coronary heart disease (CHD) and low participation rates in cardiac rehabilitation (CR), a better understanding of how comorbidity interacts with the CR pathway is needed. We investigated associations between comorbidity profiles and referral and uptake in everyday clinical CR across UK. METHOD Patients (≥18 years) diagnosed with a CHD between 1st of January 2014 and 31st of December 2019 registered in the National Audit of Cardiac Rehabilitation (NACR) database were eligible. Self-reported comorbidities from 15 disease categories were conceptualized into similar or dissimilar based on overall related pathophysiologic profile and care management as CHD. Regression models were conducted with four comorbidity profiles; similar conditions, dissimilar conditions, similar and dissimilar and no comorbidity. RESULTS 399,348 (61.8%) patients were eligible for referral from 198 programmes. The majority were males (70%), mean age of 67 (±12 SD) years. A non-significant association was found between comorbidity profiles and referral. Odds ratios (OR) for CR uptake were higher in patients with dissimilar (OR = 1.38 (95% CI 1.26-1.54)) and dissimilar and similar comorbidities profiles (OR = 1.35 (95% CI 1.21-1.43)) compared to patients with similar comorbidities. No significant differences in uptake were found between patients with similar comorbidities and those without comorbidities (OR = 0.985 (95% CI 0.854-1.125). CONCLUSION Using routine practice data, comorbidity profiles were not significantly associated with CR referral suggesting equality in referral. Dissimilar comorbidity profiles were associated with uptake. To increase the likelihood of starting CR, services should consider developing tailored participation strategies that include comorbidity profiles.
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Affiliation(s)
- Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark; Department of Health Sciences, University of York, England, United Kingdom.
| | - Alexander Harrison
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Denmark; Department of Health Sciences, University of York, England, United Kingdom
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, England, United Kingdom
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Neil-Sztramko SE, Smith-Turchyn J, Fong A, Kauffeldt K, Tomasone JR. Community-based exercise programs for cancer survivors: A scoping review of program characteristics using the Consolidated Framework for Implementation Research. Arch Phys Med Rehabil 2021; 103:542-558.e10. [PMID: 34375631 DOI: 10.1016/j.apmr.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the characteristics of exercise programs for cancer survivors conducted outside of a research laboratory (i.e., home-based, or community-based settings). DATA SOURCES A systematic search of published literature was conducted using Medline, Pubmed, CINAHL, PsychINFO, SPORTdiscus, and Embase from 1980 to January 2021. Where conference abstracts were identified, authors were contacted for other articles. STUDY SELECTION Two independent reviewers screened titles and abstracts, and full texts of potentially relevant studies with discrepancies resolved by discussion. Included studies were reports of exercise programs or interventions in which participants exercise at home, or in a community-based setting, and including individuals diagnosed with cancer either undergoing treatment or who had completed treatment. DATA EXTRACTION Data were extracted using the Oxford Implementation Index and coded under the five domains of the Consolidated Framework for Implementation Research (CFIR). Extraction and coding were completed by two independent reviewers, with discrepancies resolved through discussion. Data were synthesized narratively according to CFIR. DATA SYNTHESIS A total of 58 publications describing 34 individual programs from around the world were included. Of these, only 14 publications had the specific goal of reporting on program implementation and development. A variety of intervention characteristics and characteristics of individuals involved in the intervention were described. Reporting of factors related to the CFIR domains of inner setting, outer setting and implementation process were minimal. CONCLUSIONS This review summarizes the characteristics of existing programs that have been reported in the literature and finds that partnerships and collaboration in the inner and outer setting, and as part of the process of implementation. This review highlights key knowledge gaps to be answered in order to support the development of future community-based interventions.
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Affiliation(s)
| | | | - Angela Fong
- School of Kinesiology and Health Studies, Queens University
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Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2021; 41:255-323. [PMID: 31497854 DOI: 10.1093/eurheartj/ehz486] [Citation(s) in RCA: 2306] [Impact Index Per Article: 768.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Buckley JP, Riddell M, Mellor D, Bracken RM, Ross MK, LaGerche A, Poirier P. Acute glycaemic management before, during and after exercise for cardiac rehabilitation participants with diabetes mellitus: a joint statement of the British and Canadian Associations of Cardiovascular Prevention and Rehabilitation, the International Council for Cardiovascular Prevention and Rehabilitation and the British Association of Sport and Exercise Sciences. Br J Sports Med 2020; 55:bjsports-2020-102446. [PMID: 33361136 DOI: 10.1136/bjsports-2020-102446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 12/12/2022]
Abstract
Type 1 (T1) and type 2 (T2) diabetes mellitus (DM) are significant precursors and comorbidities to cardiovascular disease and prevalence of both types is still rising globally. Currently,~25% of participants (and rising) attending cardiac rehabilitation in Europe, North America and Australia have been reported to have DM (>90% have T2DM). While there is some debate over whether improving glycaemic control in those with heart disease can independently improve future cardiovascular health-related outcomes, for the individual patient whose blood glucose is well controlled, it can aid the exercise programme in being more efficacious. Good glycaemic management not only helps to mitigate the risk of acute glycaemic events during exercising, it also aids in achieving the requisite physiological and psycho-social aims of the exercise component of cardiac rehabilitation (CR). These benefits are strongly associated with effective behaviour change, including increased enjoyment, adherence and self-efficacy. It is known that CR participants with DM have lower uptake and adherence rates compared with those without DM. This expert statement provides CR practitioners with nine recommendations aimed to aid in the participant's improved blood glucose control before, during and after exercise so as to prevent the risk of glycaemic events that could mitigate their beneficial participation.
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Affiliation(s)
- John P Buckley
- Shrewsbury Centre for Active Living, University of Chester Faculty of Medicine and Life Sciences, Chester, Cheshire West and Chester, UK
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Riddell
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- LMC Healthcare, Diabetes and Endocrinology, Toronto, Ontario, Canada
| | - Duane Mellor
- Aston Medical School, Aston University, Birmingham, West Midlands, UK
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Richard M Bracken
- Sport and Exercise Science, Swansea University College of Engineering, Swansea, Wales, UK
| | - Marie-Kristelle Ross
- Hotel-Dieu de Levis, Laval University Faculty of Medicine, Quebec city, Quebec, Canada
| | - Andre LaGerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Paul Poirier
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Quebec, Canada
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Tighe SA, Ball K, Kensing F, Kayser L, Rawstorn JC, Maddison R. Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions. J Med Internet Res 2020; 22:e16774. [PMID: 33112239 PMCID: PMC7657720 DOI: 10.2196/16774] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the individual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. OBJECTIVE This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. METHODS A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. RESULTS A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD; n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. CONCLUSIONS Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.
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Affiliation(s)
- Sarah A Tighe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Finn Kensing
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
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Guía ESC 2019 sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes (EASD). Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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O’Toole K, Chamberlain D, Giles T. Exploration of a nurse practitioner‐led phase two cardiac rehabilitation programme on attendance and compliance. J Clin Nurs 2019; 29:785-793. [DOI: 10.1111/jocn.15133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/13/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Diane Chamberlain
- College of Nursing & Health Science Flinders University Adelaide SA Australia
| | - Tracey Giles
- College of Nursing & Health Science Flinders University Adelaide SA Australia
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