Comprehensive and personalized approach is a critical area for developing remote cardiac rehabilitation programs

Exploring the Willingness of Young and Middle-Aged CHD Patients to Participate in Home-Based Cardiac Rehabilitation: A Qualitative Study

Purpose

With the rapid development of medical science and technology and the increasing trend of coronary heart disease (CHD) rejuvenation, home-based cardiac rehabilitation (HBCR), with its unique advantages, shows great potential for application in the field of prevention and treatment of CHD. In-depth understanding of the subjective perception and willingness to participate in HBCR of patients with CHD is crucial to the precise formulation of rehabilitation programs and the promotion of the clinical application of HBCR. The aim of this study was to explore the factors influencing young and middle-aged CHD patients' willingness to participate in HBCR.

Patients and Methods

This study used the qualitative descriptive approach. Using purposive sampling, a total of 20 young and middle-aged patients with CHD who were admitted to a tertiary hospital in Taiyuan from June to August 2024 were selected to participate in this study. This study used the theory of planned behavior (TPB) as the theoretical framework to carry out data collection and analysis. Face-to-face, semi-structured interviews were used to collect the data. Data were analyzed using content analysis. Two researchers independently read, coded, categorized, and refined themes.

Results

Based on the framework of the TPB, four themes emerged from the analysis: (1) attitude; (2) subjective norm; (3) perceived behavioral control; and (4) Knowledge mastery level. Of the 20 participants in this study, 15 participants had positive attitudes toward HBCR, but their willingness to participate was still influenced by multiple factors. Economic conditions are the fundamental factor influencing patients' willingness to participate in HBCR. Social support, self-efficacy, emotional state, and knowledge mastery level are also crucial. The lack of face-to-face professional guidance and the HBCR risks perceived by patients impede their participation. Moreover, the social roles of young and middle-aged CHD patients are a unique factor influencing their willingness to participate.

Conclusion

Under the guidance of TPB, this study deeply explored the factors influencing young and middle-aged CHD patients' willingness to participate in HBCR. Based on these factors, it is necessary to make precise interventions in the future at the government level, among healthcare professionals, and within social support systems. By identifying these factors, we can not only improve patients' willingness to rehabilitate and the rehabilitation effect, help them return to society, and reduce social pressure, but also promote the clinical application of HBCR and optimize the CR grading system.

Exercise-based telerehabilitation for patients with multiple sclerosis using physical activity: a systematic review

BACKGROUND

Telerehabilitation is a practical option for individuals with multiple sclerosis (MS) to engage in sustained physical activity without -visiting a rehabilitation facility. The aim of this systematic review was to evaluate the feasibility, effectiveness, safety, and adherence of exercise-based telerehabilitation as compared with usual care for MS patients.

METHODS

A comprehensive literature search adhering to PRISMA guidelines was conducted, focusing on studies published in English since 2000. The systematic review protocol was registered in PROSPERO. The selection process involved strict criteria, including studies focusing on people with MS, telerehabilitation centred on regular exercise, a control group receiving usual care, valid exercise testing, and adherence to randomized controlled trial principles. Methodological quality was assessed using the TESTEX tool, ensuring rigour in study design and reporting.

RESULTS

Among the 281 records screened, 10 studies met the criteria. Telerehabilitation interventions varied in format and outcomes were assessed using diverse exercise tests and questionnaires. Despite variations, the studies collectively demonstrated promising feasibility and safety, with minimal withdrawals and minor adverse events. Effectiveness varied, with 5 out of 10 studies showing significant improvements in the intervention group. Adherence rates ranged from 38% to 100%.

CONCLUSION

In most of the assessed aspects, telerehabilitation is comparable to regular centre-based rehabilitation.

Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a remote area

BACKGROUND

Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients.

METHODS

We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle.

RESULTS

The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities.

CONCLUSION

The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.

Effects of home-based exercise with telehealth guidance in lymphoma cancer survivors entering cardio-oncology rehabilitation: rationale and design of the tele@home study

BACKGROUND

Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The lasting effects on cardiorespiratory fitness and physical activity are uncertain. Hence, a novel approach via telehealth management based on objectively measured exercise at home was proposed.

OBJECTIVES

To improve self-monitoring, such as self-confidence, behavioral change, and goal setting for individual exercise, and afterward, increase long-term effects concerning cardiorespiratory fitness.

DESIGN

This randomized controlled trial compares a 12-week guided home exercise telehealth intervention with a center-based exercise intervention of the same duration and intensity of exercise in lymphoma cancer survivors entering cardio-oncology rehabilitation after treatment. Participants will be instructed to exercise gradually at 60-85% of their maximum heart rate for 30-50 min 3 times a week. Participants will receive individual remote guidance (feedback about frequency, duration, and exercise intensity) by preferred contact (phone call, text message) once a week based on shared exercise data through the web platform. The primary outcome is a change in cardiorespiratory fitness expressed as maximal oxygen uptake assessed through cardiopulmonary exercise test at baseline, 12 weeks, and 1 year. Secondary objectives are quality of life, muscle strength, body composition, incidence of adverse events, and exercise adherence. This study will determine whether a telehealth model is effective and safe compared to a center-based model in cancer survivors and whether exercise prescriptions are followed by participants. Additionally, an overview of the long-term effectiveness of telehealth cardio-oncology rehabilitation will be provided. This approach aligns with the trend of moving non-complex healthcare services into the patients' home environment.

TRIAL REGISTRATION

ClinicalTrials.Gov Identifier: NCT05779605.