Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial

Determining a capability framework and training requirements to support provision of physiotherapy via telehealth in an Australian public tertiary health setting: a multi-methods study

BACKGROUND

Inadequate clinician training and support is a primary challenge to physiotherapists' adopting telehealth. Training must be underpinned by relevant capability frameworks and co-developed to meet the needs and preferences of the existing physiotherapy workforce.

OBJECTIVE

Establish a capability framework for delivery of care via telehealth and understand training requirements to achieve competency specifically for the publicly funded physiotherapy workforce.

METHODS

Sequential multi-methods study design. Phase 1: Physiotherapists with telehealth experience participated in a 2-round e-Delphi process to establish consensus on core capability framework domains (Round 1, n = 29; Round 2, n = 26). Phase 2: Physiotherapists (n = 35) subsequently rated their current knowledge and confidence for each capability item. Phase 3: Participatory focus groups, involving physiotherapists (n = 37) from six facilities, identified theoretical and practical domains most relevant to local contexts via thematic analysis.

RESULTS

Fifty-three capability items were produced across eight domains (Compliance, Patient privacy and confidentiality, Patient safety, Technology Skills, Telehealth Delivery, Assessment and Diagnosis, Care Planning and Management, Access and Equity). Knowledge and confidence were ranked lowest within the Technology Skills domain (% respondents reporting high levels of confidence = 28.6%-42.9%), and highest in Telehealth Delivery (% respondents reporting high levels of confidence = 54.2% -80%). Focus groups identified technology skills, risk management (patient safety) and superuser support as priority areas for training.

CONCLUSION

Physiotherapists identified additional local training competencies to compliment the 53-item capability framework. Adopting a sequential multi-methods and participatory approach successfully produced a training package framework suitable for implementation in a public outpatient setting.

Outcomes of electronic health interventions for patients with heart failure: a network meta-analysis

AIMS

The aim of this study was to compare the effectiveness of different types of tele-interventions in improving exercise capacity and cardiac function in patients with heart failure.

METHODS

We searched five databases from inception to September 2024 for randomized controlled trials (RCTs) of telerehabilitation in people with heart failure. The primary outcomes were 6‑min walk distance (6MWD) and left ventricular ejection fraction (LVEF). The secondary outcome was patient adherence to rehabilitation. We used Review Manager (RevMan) 5.4 and Stata 16.0 for the analyses.

RESULTS

Overall, 17 studies with a total of four telerehabilitation interventions were included in the final analysis. Network meta-analysis showed that remote monitoring (mean difference [MD] = 29.03 [7.94, 50.13]) and combined interventions (MD = 28.86 [4.85, 53.86]) were more effective than usual rehabilitation in improving 6MWD. Remote monitoring (MD = 2.45 [0.14, 4.76]) was superior to usual rehabilitation in improving LVEF. The surface under the cumulative ranking curve (SUCRA) results showed that remote monitoring is the most effective way to improve the 6MWD (SUCRA = 71.7%) and LVEF (SUCRA = 76.3%) in patients with heart failure.

CONCLUSION

The results of this study indicate that remote cardiac rehabilitation is effective in improving heart function and enhancing exercise capacity in patients with heart failure. Based on our data and the accessibility of remote rehabilitation equipment, telemedicine may be a useful and significant way to increase patient participation in cardiac rehabilitation.

Digital Technologies and Artificial Intelligence in Cardiac Rehabilitation: A Narrative Review

PURPOSE

This review explores the role and impact of digital technology in cardiac rehabilitation (CR), assessing its potential to enhance patient outcomes and address barriers to CR delivery.

REVIEW METHODS

A comprehensive literature search was conducted using curated search terms to target CR studies using digital technologies as an adjunct to in-person CR or as part of remote (ie, asynchronous) or virtual (ie, synchronous audiovisual communication) formats. The literature search focused on studies that evaluated the implementation and efficacy of using digital technologies within CR.

SUMMARY

Digital technology offers significant opportunities to improve CR by providing flexible and scalable solutions that can overcome traditional barriers to CR such as accessibility and capacity constraints. Remote or virtual CR delivery that incorporates digital technologies improves CR adherence and achieves similar improvements in exercise capacity when compared to in-person CR. While the majority of studies have focused on exercise, digital technologies are increasingly used to deliver comprehensive CR solutions as part of remote and virtual CR programs. However, challenges and gaps in the literature remain, such as the impact of digital literacy and promoting equitable CR access, particularly in high-risk and vulnerable populations. Further research needs to focus on longer term outcomes to evaluate the safety, efficacy, and cost-effectiveness of digital CR interventions. The potential of digital health to transform CR and reduce the burden of cardiovascular disease is substantial and warrants further investigation.

Conventional Training Integrated with SteamVR Tracking 2.0: Body Stability and Coordination Training Evaluation on ICAROS Pro

Technological advances continually reduce the effort to digitally transform health-related activities such as rehabilitation and training. Exemplary systems use tracking and vital sign monitoring to assess physical condition and training progress. This paper presents a system for body stability training and coordination evaluation, using cost-efficient tracking and monitoring solutions. It implements the use case of app-guided back posture tracking on the ICAROS Pro training device via SteamVR Tracking 2.0, with pulse and respiration rate monitoring via Zephyr BioHarness 3.0. A longitudinal study on training effects with 20 subjects was conducted, involving a representative procedure created with a sports manager. Posture errors served as the main progress indicator, and pulse and respiration rates as co-indicators. Outcomes suggest the system's capabilities to foster comprehension of effects and steering of exercises. Further, a secondary study presents a self-developed VR-based exergame demo for future system expansion. The Empatica EmbracePlus smartwatch was used as an alternative for vital sign acquisition. The user experiences of five subjects gathered via a survey highlight its motivating and entertaining character. For both the main and secondary studies, a thorough discussion elaborates on potentials and current limitations. The developed training system can serve as template and be adjusted for further use cases, and the exergame's reception revealed prospective extension directions. Software components are available via GitHub.

Exploring participant satisfaction with an eHealth intervention for low back pain and knee osteoarthritis: Enhancing physiotherapy access in rural Australia

INTRODUCTION

Accessing health services in rural Australia is challenging and innovative solutions to meet residents' needs are required. Research into eHealth is crucial as it offers potential solutions to these challenges. The study aimed to assess participants' satisfaction and experience with an eHealth physiotherapy intervention at improving physical function for low back pain and knee osteoarthritis in rural Australia.

METHODS

Telephone surveys collected data on participant satisfaction and experiences. Satisfaction was rated on a scale of 0-10, and the data was presented descriptively and compared between groups (eHealth and usual care) using Mann-Whitney U tests. Participant experiences with the pilot trial were gathered using open-ended questions, categorised and presented descriptively.

RESULTS

75/156 (48%) participants responded to the satisfaction survey. Overall satisfaction was significantly higher for the eHealth group, median = 9 [IQR: 8-10] compared with the usual care group, median = 8 [IQR: 5-9] (p = 0.025). Satisfaction was also significantly higher in the eHealth group for all secondary measures in the study, including accessibility to healthcare practitioner (p = 0.001), time to contact physiotherapist (p = 0.011), cost of intervention (p < 0.001) and distance travelled (p < 0.001). For the pilot experiences, inconvenient aspects such as completing forms/administration and travel were significantly higher in the usual care group, while difficulties with exercises, were significantly higher in the eHealth group (p = 0.005).

CONCLUSIONS

An eHealth intervention for physiotherapy is acceptable to patients with knee osteoarthritis and low back pain in rural Australia. Future telehealth interventions should pay special attention to participant's exercise workload and motivation.

Exercise-Based Telerehabilitation for Heart Failure Patients Declining Outpatient Rehabilitation-A Randomized Controlled Trial

PURPOSE

Cardiac rehabilitation participation rates are low despite strong recommendations, and many chronic heart failure patients remain physically inactive. Rural living, long travel distance, costs, age, and frailty might be factors explaining this. To increase cardiac rehabilitation uptake, we designed an exercise-based randomized controlled telerehabilitation trial enabling chronic heart failure patients unable or unwilling to participate in outpatient cardiac rehabilitation to exercise at home. Aim was to evaluate the long-term effects of telerehabilitation on physical activity levels.

METHODS AND RESULTS

Chronic heart failure patients ( n = 61) with reduced (≤40%), mildly reduced (41%-49%), or preserved ejection fraction (≥50%) were randomized (1:1) to telerehabilitation ( n = 31) with an initial 3-month group-based high-intensity exercise telerehabilitation program or control ( n = 30), with regular follow-up visits over a 2-yr period. All participants attended a "Living with heart failure" course. Outcomes were measures of physical activity, peak oxygen uptake, 6-min walk test distance, quality of life, morbidity, and mortality. We found no significant differences between groups for long-term changes in moderate to vigorous activity (MVPA) or peak oxygen uptake from baseline to the 2-yr follow-up. Nor quality of life differed between groups, but both groups had significant within-group improvements in score on the Minnesota Living with Heart Failure Questionnaire ( P = 0.000) and improvement in EQ-5D visual analog scale score was significant ( P = 0.05) in the telerehabilitation group.

CONCLUSIONS

Telerehabilitation performed as home-based real-time high-intensity exercise sessions provided by videoconferencing for participants unable or unwilling to participate in standard outpatient cardiac rehabilitation did not affect long-term physical activity levels or physical capacity as expected. Still, a positive effect on health-related quality of life was seen in both groups.

M-health with cardiac rehabilitation improves functional capacity: A systematic review with meta-analysis

BACKGROUND AND OBJECTIVE

In this systematic review and meta-analysis, we compared the effectiveness of the combined m-health and a cardiac rehabilitation program (CRP) and of CRP alone on functional capacity, adherence to CRP, and management of cardiovascular risk factors in cardiac patients.

METHODS

Medline, EMBASE, Central, PEDro, and SPORTDiscus were searched, from inception until July 2020, for randomized controlled trials (RCTs) comparing the m-health with CRP combination with CRP alone for adults with heart disease. The PEDro scale and GRADE approach was used to assess methodological and overall quality, respectively. Pooled estimates were calculated using a random-effects model to obtain the mean difference (MD) or standardized mean difference (SMD), and their respective 95 % confidence intervals (95 %CIs).

RESULTS

Twenty-two RCTs were eligible. The median risk-of-bias was 6.5/10. CRP with the m-Health intervention was more effective than CRP alone in improving VO2peak (MD: 1.02 95 %CI 0.50 -1.54) at short-term, and at medium-term follow-up (MD: 0.97, 95 %CI: 0.04 - 1.90. Similarly, CRP and m-Health were superior to CRP alone in increasing self-reported physical activity at short-term (SMD: 0.98, 95 %CI: 0.65 - 1.32] but not at medium-term follow-up (SMD: 0.18, 95 %CI:0.01 to 0.36). Furthermore, supervision of CRP with the m-Health intervention at short-term follow-up and M-Health and semi-supervised CRP - medium-term were more effective in improving VO2peak respectively (MD: 1.01, 95 %CI: 0.38‒1.64), (MD: 1.49, 95 %CI: 0.09, 2.89), and self-reported physical activity than supervised CRP at short-term (SMD: 0.98, 95 %CI: 0.65‒1.32) medium-term follow-ups (MD: 0.29 95 %CI: 0.12, 0.45].

CONCLUSION

Our review found high-quality evidence that m-health interventions combined with CRP was more effective than CRP alone in improving cardiorespiratory fitness, at the short and medium terms follow-up.

Exercise Training in Heart Failure: Current Evidence and Future Directions

Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO2) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET's effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes.

Use of mHealth Technology for Improving Exercise Adherence in Patients With Heart Failure: Systematic Review

BACKGROUND

The known and established benefits of exercise in patients with heart failure (HF) are often hampered by low exercise adherence. Mobile health (mHealth) technology provides opportunities to overcome barriers to exercise adherence in this population.

OBJECTIVE

This systematic review builds on prior research to (1) describe study characteristics of mHealth interventions for exercise adherence in HF including details of sample demographics, sample sizes, exercise programs, and theoretical frameworks; (2) summarize types of mHealth technology used to improve exercise adherence in patients with HF; (3) highlight how the term "adherence" was defined and how it was measured across mHealth studies and adherence achieved; and (4) highlight the effect of age, sex, race, New York Heart Association (NYHA) functional classification, and HF etiology (systolic vs diastolic) on exercise adherence.

METHODS

We searched for papers in PubMed, MEDLINE, and CINAHL databases and included studies published between January 1, 2015, and June 30, 2022. The risk of bias was analyzed.

RESULTS

In total, 8 studies (4 randomized controlled trials and 4 quasi-experimental trials) met our inclusion and exclusion criteria. A moderate to high risk of bias was noted in the studies. All studies included patients with HF in NYHA classification I-III, with sample sizes ranging from 12 to 81 and study durations lasting 4 to 26 weeks. Six studies had an equal distribution of male and female participants whose ages ranged between 53 and 73 years. Videoconferencing was used in 4 studies, while 4 studies used smartphone apps. Three studies using videoconferencing included an intervention that engaged participants in a group setting. A total of 1 study used a yoga program, 1 study used a walking program, 1 study combined jogging with walking, 1 study used a cycle ergometer, 2 studies combined walking with cycle ergometry, and 1 study used a stepper. Two studies incorporated resistance exercises in their program. Exercise programs varied, ranging between 3 and 5 days of exercise per week, with exercise sessions ranging from 30 to 60 minutes. The Borg rating of perceived exertion scale was mostly used to regulate exercise intensity, with 3 studies using heart rate monitoring using a Fitbit. Only 1 study implicitly mentions developing their intervention using a theoretical framework. Adherence was reported to the investigator-developed exercise programs. All studies were mostly feasibility or pilot studies, and the effect of age, sex, race, and NYHA classification on exercise adherence with the use of mHealth was not reported.

CONCLUSIONS

The results show some preliminary evidence of the feasibility of using mHealth technology for building exercise adherence in patients with HF; however, theoretically sound and fully powered studies, including studies on minoritized communities, are lacking. In addition, the sustainability of adherence beyond the intervention period is unknown.

Effects of exercise based cardiac rehabilitation delivery modes on chronic heart failure: a systematic review and network meta-analysis

Chronic heart failure (CHF) represents one of the most severe and advanced stages of cardiovascular disease. Despite the critical importance of cardiac rehabilitation (CR) in CHF management, while studies have explored the effectiveness of various CR delivery modes and offered valuable context-specific insights, their relative efficacy remains inconsistent across different patient groups, healthcare environments, and intervention approaches. A clearer understanding requires comprehensive comparisons and in-depth analyses to address these variations. Systematic searches were conducted in databases including Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, up to August 2024. Two researchers independently screened the literature according to strict inclusion criteria, extracted relevant data, and assessed the quality of included studies using Cochrane Collaboration tools and the Jadad scale. Subsequent pairwise and network meta-analyses were performed using statistical software, including Stata 17.0, to present the results graphically. The network meta-analysis included 9,552 articles, with 33 meeting the inclusion criteria and examining eleven different interventions. All interventions outperformed routine care. Combined CR with aerobic exercise and resistance training (HCR [AE + RE]) significantly improved Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores and 6-min walk test (6MWT) performance, and reduced rehospitalization rates [SUCRA = 96%]. Center-based cardiac rehabilitation (CBCR) with high-intensity interval training (HIIT) was the most effective in enhancing left ventricular ejection fraction (LVEF), while CBCR(AE) demonstrated the greatest improvement in peak oxygen uptake (Peak VO2) [RR = 3.64, 95% CI: 1.66-7.95]. Our analysis identifies HCR (AE + RE) as the most effective intervention for improving quality of life (MLHFQ), exercise capacity (6MWT), and reducing hospital readmissions. CBCR (HIIT) was optimal for enhancing cardiac function through improved LVEF, while CBCR (AE) effectively boosted peak VO2.PROSPERO: CRD42024517039, Review Completed not published.

Understanding Telerehabilitation Factors and Videoconference Usage in Physiotherapy: A Protocol for a Mixed-Methods Project

Background and Aims

The rapid evolution of healthcare technology introduced telerehabilitation (TR) as a novel intervention model. TR employs information and communication technologies for remote healthcare delivery. The COVID-19 pandemic prompted a significant increase in TR usage, notably videoconferencing, among physiotherapists in Spain, offering a safe and viable alternative during mobility restrictions and temporary closure of physiotherapy centers. The aim of this study is to collect data on the use and frequency of outpatient TR and its intended purposes among physiotherapists from the pre-COVID-19 era to the present, as well as to examine the perspectives, facilitators, and barriers related to videoconferencing among physiotherapists, patients, and managers.

Methods

A convergent two-phase mixed-methods project was designed. The first phase employs a quantitative methodology to explore how the frequency and purpose of physiotherapist TR usage changed from before the pandemic until the present, where 90% works at private practice and 10% at public services, using a retrospective online survey. Second, we focus on understanding videoconference usage through qualitative methodologies, which include focus groups with patients and physiotherapists and semi-structured interviews with managers.

Results

The expected results will be adoption and cessation of technology/ICT usage, changes in frequency and purpose of use; acceptance, satisfaction, and future expectations of videoconferencing by physiotherapists, patients, and managers.

Conclusions

This project can be used to investigate how different telemedicine technologies have progressed in a region over a period and why healthcare professionals, patients, and managers embrace these technologies. As a result of this research, it will be possible to improve the implementation of these technologies, as well as professional training and educational programs.

Adverse events associated with the delivery of telerehabilitation across rehabilitation populations: A scoping review

OBJECTIVE

This scoping review aimed to map existing research on adverse events encountered during telerehabilitation delivery, across rehabilitation populations. This includes identifying characteristics of adverse events (frequency/physical/non-physical, relatedness, severity) and examining adverse events by different modes of telerehabilitation delivery and disease states.

INTRODUCTION

Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic for remote service delivery. However, no prior scoping review, systematic review, or meta-analysis has identified and summarized the current primary research on adverse events in telerehabilitation. Understanding adverse events, such as falls during physiotherapy or aspiration pneumonia during speech therapy, is crucial for identifying limitations and optimizing delivery through risk mitigation and quality indicators. This understanding could also help to improve the uptake of telerehabilitation among clinicians and patients. This review addresses this gap by summarizing published literature on adverse events during telerehabilitation.

METHODS

The review followed the Joanna Briggs Institute framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The review protocol was registered and published on Open Science Framework. A comprehensive search across multiple databases (MEDLINE ALL/EMBASE/APA PsycINFO/CENTRAL/CINAHL) was conducted. Screening, extraction, and synthesis were performed in duplicate and independently. Data extraction followed the Template for Intervention Description and Replication framework and also involved extraction on authors, publication year (pre- or post-COVID), population, sample size, and modes of telerehabilitation delivery (asynchronous, synchronous, hybrid). For synthesis, data were summarized quantitatively using numerical counts and qualitatively via content analysis. The data were grouped by intervention type and by type of adverse event.

INCLUSION CRITERIA

This scoping review included qualitative and quantitative studies published between 2013-2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery were included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants were excluded.

RESULTS

The search identified 11,863 references, and 81 studies were included in this review with a total of 3,057 participants (mean age:59.3 years; females:44.6%). Modes of telerehabilitation delivery (whether asynchronous, synchronous or hybrid) used in the studies included videoconferencing (52), phone calls (25), text messaging (4), email (6), mobile apps (10), and internet-based virtual reality systems (3). A total of 295 adverse events occurred during 84,534 sessions (0.3%), with the majority being physical (e.g., falls or musculoskeletal pain), non-serious/non-severe/mild, and unrelated to (i.e., not caused by) to the telerehabilitation provided.

CONCLUSIONS

From the 81 included studies, telerehabilitation was delivered with related adverse events being rare, and mostly characterized as mild/non-severe. A comparable occurrence of adverse events (~30%) was found between asynchronous and synchronous telerehabilitation studies. When categorized by disease type, cardiac telerehabilitation studies had the most frequent adverse events. Detailed reporting of telerehabilitation interventions and adverse event characteristics is recommended for future studies (i.e., use of TIDieR reporting guidelines). Telerehabilitation has the potential to make rehabilitation services more accessible to patients; however, more evidence on the safety of telerehabilitation is needed.

Feasibility, safety and preliminary efficacy of telehealth-delivered group exercise for people with type 2 diabetes: A pilot trial

INTRODUCTION

Several barriers can preclude people with type 2 diabetes (T2D) from in-person exercise session participation. Telehealth may be an alternative mode of service delivery to increase uptake. We evaluated the feasibility, safety and preliminary efficacy of delivering group exercise via telehealth for people with T2D.

METHODS

Sixteen people with T2D (age 59.9 ± 12.7 years, 63% male, duration of T2D 11.5 ± 11.1 years) underwent an 8-week telehealth-delivered group exercise intervention. Weekly supervised sessions incorporated whole-body aerobic and resistance exercises, followed by education. Feasibility was evaluated by recruitment, enrolment, attendance and attrition rates, the practicality of telehealth delivery, and participant feedback. Adverse events were monitored throughout (safety). Preliminary efficacy was determined from changes in glycaemic control, body composition, blood pressure, exercise capacity, neuromuscular strength/fitness, quality of life and physical activity levels. The agreement/reliability of in-person clinician-measured versus telehealth-supervised participant-self-measured assessments was also evaluated.

RESULTS

Feasibility was supported by high attendance (97.1%) and low attrition (81%). All (100%) participants reported they would participate in telehealth-delivered exercise interventions in the future and would recommend them to other people with T2D. No serious adverse events were reported. There were improvements in hip circumference (Cohen's d -0.50), diastolic blood pressure (-0.75), exercise capacity (1.72), upper body strength (1.14), grip strength (0.58), health-related quality of life (0.76-0.81) and self-reported physical activity (1.14). Participant-self-measured assessment of body weight, 2-min step test and 30-sec sit-to-stand test were deemed acceptable.

DISCUSSION

Telehealth-delivered group exercise appears feasible, safe and efficacious for people with T2D. These findings warrant further exploration in a powered trial.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12622000379718).

Effectiveness of Telephysiotherapy in Improving Older Adults' Physical and Psychological Outcomes: A Systematic Review and Meta-Analysis

(1) Objective: to investigate the effectiveness of telephysiotherapy compared with traditional rehabilitation for elderly patients and determine the factors impacting its efficacy. (2) Method: Five online databases (PubMed, Google Scholar, Scopus, Web of Science, and Cochrane) were reviewed up to 31 July 2023. The search included the literature in English from 2014 to 2023, to capture the latest practices in telephysiotherapy for elderly patients. Data from all qualified studies were independently extracted by two authors, quantifying effect size to reflect treatment performance. (3) Results: 222 records from 19 articles were analyzed. The effect size for telephysiotherapy was 0.350 (95% C.I. = 0.283-0.416; p < 0.01). The standardized mean differences for physical and psychological outcomes were 0.406 (95% C.I. = 0.325-0.488; p < 0.01) and 0.223 (95% C.I. = 0.110-0.336; p < 0.01), respectively. (4) Conclusions: Telephysiotherapy was more effective than traditional rehabilitation, significantly improving the physical and psychological status of elderly patients. The factors influencing the effectiveness of telephysiotherapy were intervention type, intervention duration, outcome, and gender.

Cardiovascular telerehabilitation improves functional capacity, cardiorespiratory fitness and quality of life in older adults: A systematic review and meta-analysis

INTRODUCTION

The aim was to identify whether cardiovascular telerehabilitation programs (CV-T-REHAB) can improve functional capacity, cardiorespiratory fitness and quality of life (QoL) to the same extent of presential rehabilitation (CV-P-REHAB) in older adults, by meta-analysis of previous studies.

METHODS

Literature search was conducted in October 2020 in four databases to select controlled trials of CV-T-REHAB effects on functional capacity (six-minute walk test [6MWT]), cardiorespiratory fitness (maximal oxygen consumption [V ˙ O2max]), and QoL in older adults (> 50 years) and included new articles in April 2022.

RESULTS

CV-T-REHAB improved 6MWT (11.14 m [CI95% = 8.03; 14.26], p < 0.001), V ˙ O2max (1.18 ml/kg/min [CI95% = 0.70; 1.66], p < 0.001), and QoL (standardized mean difference [SMD] = 0.36 [CI95% = 0.05; 0.67], p = 0.02). CV-T-REHAB increased V ˙ O2max to a greater extent than CV-P-REHAB (1.08 ml/kg/min [0.39; 1.76], p = 0.002). Although the 6MWT and V ˙ O2max analyses proved consistent and homogeneous, the QoL analysis showed considerable inconsistency (I2 = 92.90%), suggesting the need for studies exploring the effect of CV-T-REHAB on QoL in this population. Part of the heterogeneity was explained by age differences, as CV-T-REHAB improved QoL in adults >65 years, but not in adults <64 years.

CONCLUSION

CV-T-REHAB improved cardiorespiratory fitness to a level equal to or higher than CV-P-REHAB and improved functional capacity and QoL; being mainly effective for QoL in older adults >65 years. Thus, CV-T-REHAB can be a good alternative, when not the best option and might be considered especially for individuals with limited access to participate in face-to-face programs.

Feasibility and Acceptability of a Mobile Health Exercise Intervention for Inactive Adults: 3-Arm Randomized Controlled Pilot Trial

BACKGROUND

Objective monitoring of self-directed physical activity (PA) is a common approach used in both fitness and health settings to promote exercise behavior, but adherence has been poor. Newer mobile health (mHealth) technologies could be a cost-effective approach to broadening accessibility and providing support for PA behavior change; yet, the optimal method of delivery of such interventions is still unclear.

OBJECTIVE

This study aimed to determine the feasibility and acceptability of an mHealth exercise intervention delivered in combination with objective monitoring in 3 ways: health education emails, asynchronous exercise videos, or synchronous videoconference exercise classes.

METHODS

Physically inactive (<30 min/wk) adults (cisgender women aged 31.5, SD 11.3 years, cisgender men aged 34.1, SD 28.9 years, and nonbinary individuals aged 22.0, SD 0 years) were randomized (1:1:1) to 8 weeks of increasing PA behavioral support: level 1 (health education+objective monitoring, n=26), level 2 (asynchronous contact, level 1+prerecorded exercise videos, n=30), or level 3 (synchronous contact, level 1+videoconference group exercise, n=28). Participants used a heart rate monitor during exercise and a mobile app for interaction. Primary outcomes were feasibility (accrual, retention, and adherence) and acceptability (user experience survey). Secondary outcomes assessed at baseline and 8 weeks included resting heart rate, self-reported PA, and quality of life. The exercise dose was evaluated throughout the intervention.

RESULTS

Between August 2020 and August 2021, 204 adults were screened for eligibility. Out of 135 eligible participants, 84 (62%) enrolled in the study. Retention was 50% (13/26) in level 1, 60% (18/30) in level 2 and 82% (23/28) in level 3, while adherence was 31% (8/26) in level 1, 40% (12/30) in level 2 and 75% (21/28) in level 3. A total of 83% (70/84) of the study sample completed the intervention, but low response rates (64%, 54/84) were observed postintervention at week-8 assessments. Program satisfaction was highest in participants receiving exercise videos (level 2, 80%, 8/10) or exercise classes (level 3, 80%, 12/15), while only 63% (5/8) of level 1 reported the program as enjoyable. Level 3 was most likely to recommend the program (87%, 13/15), compared to 80% (8/10) in level 2 and 46% (5/8) in level 1. Self-reported PA significantly increased from baseline to intervention in level 3 (P<.001) and level 2 (P=.003), with no change in level 1. Level 3 appeared to exercise at higher doses throughout the intervention.

CONCLUSIONS

Only the videoconference exercise class intervention met feasibility criteria, although postintervention response rates were low across all groups. Both videoconference and prerecorded videos had good acceptability, while objective monitoring and health education alone were not feasible or acceptable. Future studies are needed to examine the effectiveness of videoconference exercise interventions on health-related outcomes during nonpandemic times and how asynchronous interventions might maximize adherence.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05192421; https://clinicaltrials.gov/study/NCT05192421.

Delivery of Allied Health Interventions Using Telehealth Modalities: A Rapid Systematic Review of Randomized Controlled Trials

Objectives: To determine whether allied health interventions delivered using telehealth provide similar or better outcomes for patients compared with traditional face-to-face delivery modes. Study design: A rapid systematic review using the Cochrane methodology to extract eligible randomized trials. Eligible trials: Trials were eligible for inclusion if they compared a comparable dose of face-to-face to telehealth interventions delivered by a neuropsychologist, occupational therapist, physiotherapist, podiatrist, psychologist, and/or speech pathologist; reported patient-level outcomes; and included adult participants. Data sources: MEDLINE, CENTRAL, CINAHL, and EMBASE databases were first searched from inception for systematic reviews and eligible trials were extracted from these systematic reviews. These databases were then searched for randomized clinical trials published after the date of the most recent systematic review search in each discipline (2017). The reference lists of included trials were also hand-searched to identify potentially missed trials. The risk of bias was assessed using the Cochrane Risk of Bias Tool Version 1. Data Synthesis: Fifty-two trials (62 reports, n = 4470) met the inclusion criteria. Populations included adults with musculoskeletal conditions, stroke, post-traumatic stress disorder, depression, and/or pain. Synchronous and asynchronous telehealth approaches were used with varied modalities that included telephone, videoconferencing, apps, web portals, and remote monitoring, Overall, telehealth delivered similar improvements to face-to-face interventions for knee range, Health-Related Quality of Life, pain, language function, depression, anxiety, and Post-Traumatic Stress Disorder. This meta-analysis was limited for some outcomes and disciplines such as occupational therapy and speech pathology. Telehealth was safe and similar levels of satisfaction and adherence were found across modes of delivery and disciplines compared to face-to-face interventions. Conclusions: Many allied health interventions are equally as effective as face-to-face when delivered via telehealth. Incorporating telehealth into models of care may afford greater access to allied health professionals, however further comparative research is still required. In particular, significant gaps exist in our understanding of the efficacy of telehealth from podiatrists, occupational therapists, speech pathologists, and neuropsychologists. Protocol Registration Number: PROSPERO (CRD42020203128).

The iATTEND Trial: A Trial Comparing Hybrid Versus Standard Cardiac Rehabilitation

The improving ATTENDance (iATTEND) to cardiac rehabilitation (CR) trial tested the hypotheses that hybrid CR (HYCR) (combination of virtual and in-facility CR sessions) would result in greater attendance compared with traditional, facility-based only CR (FBCR) and yield equivalent improvements in exercise capacity and health status. Patients were randomized to HYCR (n = 142) or FBCR (n = 140), stratified by gender and race. Attendance was assessed as number of CR sessions completed within 6 months (primary end point) and the percentage of patients completing 36 CR sessions. Other end points (tested for equivalency) included exercise capacity and self-reported health status. HYCR patients completed 1 to 12 sessions in-facility, with the balance completed virtually using synchronized, 2-way audiovisual technology. Neither total number of CR sessions completed within 6 months (29 ± 12 vs 28 ± 12 visits, adjusted p = 0.94) nor percentage of patients completing 36 sessions (59 ± 4% vs 51 ± 4%, adjusted p = 0.32) were significantly different between HYCR and FBCR, respectively. The between-group changes for exercise capacity (peak oxygen uptake, 6-minute walk distance) and health status were equivalent. Regarding safety, no sessions required physician involvement, there was 1 major adverse event after a virtual session, and no falls required medical attention. In conclusion, although we rejected our primary hypothesis that attendance would be greater with HYCR versus FBCR, we showed that FBCR and HYCR resulted in similar patient attendance patterns and equivalent improvements in exercise capacity and health status. HYCR which incorporates virtually supervised exercise should be considered an acceptable alternative to FBCR. NCT Identifier: 03646760; The Improving ATTENDance to Cardiac Rehabilitation Trial - Full-Text View - ClinicalTrials. gov; https://classic.clinicaltrials.gov/ct2/show/NCT03646760.

Different Models of Cardiac Telerehabilitation for People with Coronary Artery Disease: Features and Effectiveness: A Systematic Review and Meta-Analysis

Objectives: Cardiac telerehabilitation (TR) for coronary artery disease (CAD) is a feasible alternative to the center-based rehabilitation delivery model. However, the features of exercise-based cardiac TR are still heterogeneous among studies, making it difficult to disentangle the preferable reference strategies to be recommended for the adoption of this new delivery of care. In addition, little is known about the effectiveness of different models, such as the hybrid model (CRh) including both center-based and home-based telerehabilitation approaches, and the solely home-based telerehabilitation (CTR). Methods: We conducted a systematic review of randomized controlled trials (RCTs) that included TR intervention in patients with CAD to profile the features of the telerehabilitation approach for CAD. We also conducted a meta-analysis to separately assess the effectiveness of CTR and CRh on medical benefit outcome measures compared to conventional intervention (CI). Results: Out of 17.692 studies, 28 RCTs involving 2.662 CAD patients were included in the review. The studies presented an equal proportion of the CTR and CRh models. The interventions were mainly multidimensional, with a frequency of 1 month to 6 months, with each session ranging between 20 to 70 min. In CRh, the intervention was mainly consecutive to center-based rehabilitation. All studies adopted asynchronous communication in TR, mainly providing monitoring/assessment, decisions, and offline feedback. Few studies reported mortality, and none reported data about re-hospitalization or morbidity. Adherence to the CTR and CRh interventions was high (over 80%). The meta-analyses showed the superior effect of CTR compared to CI in exercise capacity. An overall noninferiority effect of both CTR and CRh compared to CI was found with factors including risk control and participation. Conclusions: The results of the review and meta-analyses indicated that CTR and CRh are equally effective, safe, convenient, and valid alternatives to cardiac conventional interventions. The evidence suggests that telerehabilitation may represent a valid alternative to overcome cardiac rehabilitation barriers.

Access, Readiness and Willingness to Engage in Allied Health Telerehabilitation Services for Adults: Does Cultural and Linguistic Diversity Make a Difference?

Telerehabilitation is an appealing service delivery option for optimising recovery. Internationally, the equity of telerehabilitation services for people from culturally and linguistically diverse (CALD) backgrounds has been questioned. Using a 31-item survey, our study explored the access, readiness and willingness of 260 patients receiving allied health services from a large tertiary health service located in Sydney, Australia, to use telerehabilitation for adults. Overall, 72% patients reported having access to technology, 38% met our readiness criteria and 53% reported willingness to engage in telerehabilitation. There were no differences in access, readiness and willingness to engage in telerehabilitation between patients from CALD and non-CALD backgrounds. Age was the only factor that influenced access (OR = 0.94, 95% CI 0.90 to 0.97), readiness (OR = 0.95, 95% CI 0.92 to 0.98) and willingness (OR = 0.97, 95% CI 0.95 to 1.00) to engage in telerehabilitation. Past experience of telerehabilitation was related to willingness (OR = 2.73, 95% CI 1.55-4.79) but not access (OR = 1.79, 95% CI 0.87 to 3.68) or readiness (OR = 1.90, 95% CI 0.93 to 3.87). Our findings highlight the importance of ensuring positive patient experiences to promote ongoing willingness to use telerehabilitation. Efforts are needed to improve patients' digital health literacy, especially patients from older age groups, to ensure equitable engagement in telerehabilitation services.

The effectiveness of cardiac telerehabilitation in comparison to centre-based cardiac rehabilitation programmes: A literature review

INTRODUCTION

Cardiac rehabilitation (CR) is an effective, yet under-utilised, form of secondary prevention in cardiac patients. Telemedicine is one method of overcoming barriers to accessing CR. Previous systematic reviews highlight variation in the effectiveness of telerehabilitation programmes and current literature lacks identification of which telemedicine interventions are most effective, despite differences in the results of primary studies. The objectives of this literature review were to: evaluate the effectiveness of cardiac telerehabilitation compared to centre-based programmes for managing cardiac risk factors, satisfaction and adherence in cardiac patients; identify the technologies used to deliver CR; identify the key components of effective interventions.

METHODS

A literature search was conducted using MEDLINE, EMBASE and Scopus. Randomised controlled trials (RCTs) involving an intervention group that received telerehabilitation and a control group that attended a CR centre were included.

RESULTS

Twelve RCTs met the inclusion criteria. There is evidence to suggest that telerehabilitation programmes have similar effectiveness to centre-based CR. Phones were the most commonly used technology. Most studies used a combination of technologies including personal computers and self-monitoring equipment. Phase III telerehabilitation programmes using self-monitoring, motivational feedback and education were more effective than centre-based CR for increasing physical activity and functional capacity.

CONCLUSION

Cardiac telerehabilitation is delivered by a range of technologies and has a similar effectiveness to centre-based programmes. While evidence suggests that additional health benefits are seen in patients who receive a telemedicine intervention in Phase III of CR, further evidence would be required to confidently draw this conclusion.

Telerehabilitation in Physical Therapist Practice: A Clinical Practice Guideline From the American Physical Therapy Association

A clinical practice guideline on telerehabilitation was developed by an American Physical Therapy Association volunteer guideline development group consisting of international physical therapists and physiotherapists, a physician, and a consumer. The guideline was based on systematic reviews of current scientific literature, clinical information, and accepted approaches to telerehabilitation in physical therapist practice. Seven recommendations address the impact of, preparation for, and implementation of telerehabilitation in physical therapist practice. Research recommendations identify current gaps in knowledge. Overall, with shared decision-making between clinicians and patients to inform patients of service delivery options, direct and indirect costs, barriers, and facilitators of telerehabilitation, the evidence supports the use of telerehabilitation by physical therapists for both examination and intervention. The Spanish and Chinese versions of this clinical practice guideline, as well as the French version of the recommendations, are available as supplementary material (Suppl. Materials).

The Role of Tele-Exercise for People with Type 2 Diabetes: A Scoping Review

BACKGROUND

Supervised exercise interventions tend to be more effective than unsupervised exercises or physical activity advice alone. However, people with type 2 diabetes may find it difficult to attend supervised exercise interventions due to several obstacles. Tele-exercise, or utilizing technology to deliver home-based exercise, might be a solution.

OBJECTIVE

This scoping review aimed to explore clinical trials investigating the impact of tele-exercise interventions in individuals with type 2 diabetes Methods: Four electronic databases were searched for the period up to January 2024 for clinical trials investigating the impact of tele-exercise on health-related outcomes in adults with type 2 diabetes.

RESULTS

Seven trials involving 460 individuals with type 2 diabetes met the inclusion criteria. In these trials, combined aerobic and resistance exercise programs were the main types delivered remotely. To deliver such programs, both synchronous (n = 4) and asynchronous (n = 3) delivery modes were adopted. Regardless of the delivery mode, all tele-exercise interventions led to improvements in various factors related to type 2 diabetes and its complications, including glycemic control, blood lipids, body composition, functional capacity, muscle strength, and quality of life. The improvements were also found to be as effective as those of supervised exercise.

CONCLUSIONS

Tele-exercise interventions seem to be feasible and as effective as supervised exercise interventions in terms of improving glycemic control, blood lipids, functional capacity, muscle strength, body composition, and quality of life for people with type 2 diabetes.

Effectiveness of guided telerehabilitation on functional performance in community-dwelling older adults: A systematic review

OBJECTIVE

To systematically review the effectiveness of guided telerehabilitation on improving functional performance in community-dwelling older adults.

DATA SOURCES

Articles published in PubMed, Cochrane Library and Embase (Ovid) from 01 January 2010 up to 17 October 2023.

REVIEW METHODS

Included studies had (1) a randomised controlled trial design, (2) an average population age of 65 years or older, (3) a home-based setting and (4) evaluated the effectiveness of functional performance outcome measures. The intervention was considered telerehabilitation when guided by a healthcare professional using video, audio and/or text communication technologies with a minimum frequency of once per week. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement guideline was followed. Methodological quality was appraised using the revised Cochrane Risk of Bias tool.

RESULTS

A total of 26 randomised controlled trials were included. Telerehabilitation had superior (N = 15), non-superior (N = 16) or non-inferior (N = 11) effectiveness for improving functional performance outcome measures compared to control interventions. No studies found the control intervention to be superior over telerehabilitation. Between study differences in intervention characteristics contributed to significant clinical heterogeneity. Five studies were found to present an overall 'low' risk of bias, 12 studies to present 'some' risk of bias and 9 studies to present an overall 'high' risk of bias.

CONCLUSION

The findings suggest that telerehabilitation could be a promising alternative to in-person rehabilitation for improving functional performance in community-dwelling older adults. Additional well-designed studies with minimised bias are needed for a better understanding of effective telerehabilitation intervention strategies.

Telemedicine and patients with heart failure: evidence and unresolved issues

BACKGROUND

Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.

From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

BACKGROUND

As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed.

MAIN BODY

This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions.

CONCLUSION

PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.

Using telehealth to deliver Qi Gong and Tai Chi programs: A mixed-methods systematic review on feasibility, acceptability and participant engagement factors

INTRODUCTION

Due to the COVID-19 pandemic, the use of digitally delivered exercise classes to promote physical activity has become widespread amongst various populations as an alternative to in-person activities.

OBJECTIVES

To examine the feasibility, acceptability, and participant engagement variables to delivering Qi Gong and Tai Chi programs through telehealth interventions.

METHODS

Ten databases (Seven English databases; three Chinese databases) were searched between October and November 2021. Studies published in English or Chinese, or having translations in English or Chinese, were included. Titles and abstracts of identified articles were screened, relevant studies were then retrieved for full-text screening. Study selection, assessment of methodological quality, data extraction, data transformation, and data synthesis were completed following a convergent integrated approach to mixed method systematic reviews.

RESULTS

Seven articles were included in review. Digital literacy of both participants and providers was found to be a significant hurdle towards digital program implementation. There were no notable issues pertaining to access to an internet connection, participant safety, program costs, or connectivity. A major theme for sustaining program engagement was found to be individual perceived relevance for intervention involvement. Online social involvement was noted to be both a facilitator for participant acceptability and engagement. Overall, participants expressed satisfaction with the use of telehealth, while providers expressed acceptability concerns regarding quality of care.

CONCLUSION

It is recommended that planned measures be taken prior to program commencement to decrease digital literacy requirements while also including a participatory approach to encourage uptake. During the program, provision of technical support alongside appropriate social-environmental engagement facilitators would promote sustained adherence.

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review

OBJECTIVE

To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients.

DATA SOURCES

A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews.

METHODS

The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized.

RESULTS

The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies.

CONCLUSIONS

This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.

Post-intensive care syndrome follow-up system after hospital discharge: a narrative review

BACKGROUND

Post-intensive care syndrome (PICS) is the long-lasting impairment of physical functions, cognitive functions, and mental health after intensive care. Although a long-term follow-up is essential for the successful management of PICS, few reviews have summarized evidence for the efficacy and management of the PICS follow-up system.

MAIN TEXT

The PICS follow-up system includes a PICS follow-up clinic, home visitations, telephone or mail follow-ups, and telemedicine. The first PICS follow-up clinic was established in the U.K. in 1993 and its use spread thereafter. There are currently no consistent findings on the efficacy of PICS follow-up clinics. Under recent evidence and recommendations, attendance at a PICS follow-up clinic needs to start within three months after hospital discharge. A multidisciplinary team approach is important for the treatment of PICS from various aspects of impairments, including the nutritional status. We classified face-to-face and telephone-based assessments for a PICS follow-up from recent recommendations. Recent findings on medications, rehabilitation, and nutrition for the treatment of PICS were summarized.

CONCLUSIONS

This narrative review aimed to summarize the PICS follow-up system after hospital discharge and provide a comprehensive approach for the prevention and treatment of PICS.

Home Based Cardiac Rehabilitation Participation Among Patients With Heart Failure

INTRODUCTION

Patients with Heart Failure (HF) have significant morbidity and mortality. Home Based Cardiac Rehabilitation (HBCR) is a form of Cardiac Rehabilitation (CR) which has been proven beneficial for the patients with cardiovascular disease; However, cardiovascular outcomes in patients with HF who was referred to HBCR is not known.

METHODS

A retrospective study of 188 patients with HF (HFrEF or heart failure with reduced ejection fraction and HFpEF or heart failure with preserved ejection fraction) referred to HBCR at Veterans Affairs Medical Center (VAMC) from November 2017 to March 2020. We used the outcomes of patients with HF who attended HBCR and compared with the outcomes of patients who did not attend HBCR (Non-HBCR) from 3 months after starting HBCR till 12 months. Primary outcome was composite of all-cause mortality and cardiovascular hospitalizations. Secondary outcomes were all-cause mortality, cardiovascular hospitalizations and all-cause hospitalization, separately. We used cox proportional methods to calculate hazard ratios (HR) and 95% CI. We adjusted for imbalanced characteristics at baseline: age, smoking, PCI and CABG status. In subgroup analysis, we compared HFrEF and HFpEF patients who have completed HBCR and compared differences of their outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test, duke score and PHQ-9) pre- and post-HBCR.

RESULTS

Mean age of the patients was 72 year and 98% were male. Out of 188 patients total, 11 patients were excluded for the main analysis as their outcomes occurred within first 90 days of HBCR enrollment, 105/177 (59%) patients attended HBCR while 72/177 (41%) patients did not attend HBCR and 93/105 (89%) patients have completed HBCR. The primary outcome occurred in 14 patients (13.3%) in the HBCR group and 19 patients (26.4%) in the Non-HBCR group (adjusted HR=0.32, CI 0.15-0.68). There was no difference in cardiovascular hospitalization among two groups, however patients in HBCR group have lower all-cause hospitalizations and all-cause death, separately. After HBCR completion, all outcomes (weight, blood pressure, cholesterol, LDL, HDL, triglycerides, HbA1C, 6 Minutes walking test, duke score and PHQ-9) have improved in both HFrEF and HFpEF group.

CONCLUSION

Patients with HF who have completed HBCR have a lower risk of all-cause mortality, all cause hospitalization separately and lower risk of combined all-cause mortality and cardiovascular hospitalization. Patients with HFrEF and HFpEF have equal degree of improvement after completing HBCR when compared with each other. HBCR is an ideal opportunity for patients with HF who cannot attend center-based CR and also for patients with HFpEF since CR is not approved for those patients.

Telerehabilitation use and experiences in occupational and physical therapy through the early stages of the COVID-19 pandemic

Telehealth has helped to increase access to rehabilitative services such as occupational and physical therapy. The early COVID-19 pandemic amplified the need for remote access to care, and the rapid implementation of telehealth systems provided a unique opportunity to learn from clinicians' experiences adopting telehealth for telerehabilitation applications. To understand these experiences, a self-administered online survey was conducted to capture perspectives on ease of telerehabilitation use and adoption from occupational and physical therapists. The survey captured retrospective views on telerehabilitation use pre-pandemic as well as real-time perspectives on telerehabilitation during the early stages of the pandemic (July to August 2020). The survey gathered information on clinician demographics (N = 109), clinicians' experiences with adopting or utilizing telerehabilitation systems, and their perceptions on remotely performing cognitive, emotional, and physical assessments via video-conferencing (a common mode of telehealth). Responses demonstrated a modest increase in telerehabilitation as a care setting (rate increase from 3.4% to 19.3%), and telerehabilitation was more generally tried during the early stages of the pandemic (41 clinicians explicitly reported telerehabilitation use). However, technology access and acceptance remained low, with 38 clinicians (35%) expressing concerns that technology was ineffective or impractical, unavailable, not covered by insurance, or not desired by their patients. Video-conferencing technology was perceived as generally ill-equipped to support clinicians in performing remote assessment tasks. Physical assessment tasks were considered particularly difficult, with 55% of clinicians rating their ability to perform these tasks in the range of moderately difficult to unable to perform. To address these difficulties and better augment clinical care, clinicians require more robust assessment methods that may combine video, mobile, and wearable technologies that would be accessible to a patient at home. When designing future telerehabilitation tools, information captured through these modes must be task-relevant, standardized, and understandable to a remote clinician.

Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis

BACKGROUND

Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults.

OBJECTIVE

This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs.

METHODS

Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria.

RESULTS

Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed.

CONCLUSION

Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.

Effectiveness of home-based cardiac telerehabilitation in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials

AIMS AND OBJECTIVES

To evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure.

DESIGN

This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test.

DATA SOURCES

A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify studies in English or Chinese on randomised controlled trials up to 15 August 2022.

RESULTS

A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators.

CONCLUSION

Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation.

IMPACT

This systematic review and meta-analysis found that patients with heart failure would benefit from home-based cardiac telerehabilitation intervention in terms of cardiac function, functional capacity, quality-of-life management and readmission rate. Future clinical interventions should consider home-based cardiac telerehabilitation as an alternative to conventional cardiac rehabilitation in patients with heart failure to improve their quality of life.

NO PATIENT OR PUBLIC CONTRIBUTION

Our paper is a systematic review and meta-analysis, and such details do not apply to our work.

No transport? No worries! Cardiac telerehabilitation is a feasible and effective alternative to centre-based programs

Given the under-utilisation of cardiac rehabilitation despite its benefits, there has been a shift towards alternative delivery models. The recent coronavirus disease 2019 (COVID-19) pandemic has accelerated this shift, leading to a growing interest in home-based cardiac rehabilitation including telerehabilitation. There is increasing evidence to support cardiac telerehabilitation, with studies generally demonstrating comparable outcomes and potential cost-benefits. This review aims to provide a synopsis of the current evidence on home-based cardiac rehabilitation with a focus on telerehabilitation and practical considerations.

A pilot study of an integrated, personalized, respiratory and motor telerehabilitation program for pediatric patients with hereditary neuromuscular disorders

INTRODUCTION

Telerehabilitation provides physical training to patients through telecommunication networks. We examined the feasibility, safety, and efficacy of an integrated, personalized, respiratory and motor telerehabilitation program for pediatric patients with hereditary neuromuscular disorders (NMDs).

METHODS

Stable pediatric patients were recruited for a 16-week home training program with personalized pulmonary, upper and lower limb exercises. Patients reviewed instructional videos at home and attended bi-weekly follow-ups through video or audio calls, text messages, or emails. The primary outcomes were respiratory function, Medical Research Council (MRC) grading, hand/pinch strength, 6-minute walk test, and Pediatric Quality-of-Life Inventory 3.0 Neuromuscular Module survey. The secondary outcomes were study compliance and user feedback.

RESULTS

Patients with spinal muscular atrophy (n = 4), congenital myasthenic syndrome (n = 2), and Duchenne muscular dystrophy (n = 2) completed the program. The median weekly exercise time was 101.3 min (range: 30.0-266.9). No extra face-to-face physiotherapy sessions were requested by the patients. No adverse events were reported. After the study, patients showed improvements in maximal expiratory pressure (35.0 vs. 47.5 cm H2O, p = .028) and maintained their MRC grade, hand/pinch strength, and walking distance. Patients also reported improvements in the Pediatric Quality-of-Life Inventory 3.0 Neuromuscular Module survey score (74.5 vs. 87.0, p = .036). Patients rated the overall program highly (mean: 4.00/5.00) and recommended it as a standard of care (mean: 4.38/5.00).

DISCUSSION

Our telerehabilitation program was feasible, safe, and possibly effective for this pilot cohort of stable pediatric patients with hereditary NMDs. Larger-scale studies for longer periods are warranted to confirm the results.

Home-based versus centre-based cardiac rehabilitation

BACKGROUND

Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017.

OBJECTIVES

To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied.

SELECTION CRITERIA

We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE.

MAIN RESULTS

We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar.

AUTHORS' CONCLUSIONS

This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.

Nurse-coordinated home-based cardiac rehabilitation for patients with heart failure: A scoping review

Objectives

This study aimed to review and summarize the studies of nurse-coordinated home-based cardiac rehabilitation for patients with heart failure.

Methods

The review was performed using Arksey and O'Malley's scoping review framework. A systematic search was conducted across eight databases, including PubMed, Embase, Web of Science, EBSCO, China Biomedical Literature Service System (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journals (CSTJ) Database, and Chinese Clinical Trial Registry, from inception to 30 April 2023. Articles relevant to the nurse-coordinated home-based cardiac rehabilitation for patients with heart failure were included.

Results

Eighteen studies were included in this review. These studies showed that nurses primarily focused on patient assessment, home-based cardiac rehabilitation planning and guidance, and follow-up. The studies also reported positive outcomes in patient safety, feasibility, and efficacy of the programs coordinated by nurses.

Conclusions

Home-based cardiac rehabilitation coordinated by nurses is beneficial to patients with heart failure. Future research will explore the potential of nurses in home-based cardiac rehabilitation for patients with heart failure, determine optimal evaluation criteria, and formulate safe, effective, and economical rehabilitation programs suitable for the patients.

Virtual healthcare solutions in heart failure: a literature review

The widespread adoption of mobile technologies offers an opportunity for a new approach to post-discharge care for patients with heart failure (HF). By enabling non-invasive remote monitoring and two-way, real-time communication between the clinic and home-based patients, as well as a host of other capabilities, mobile technologies have a potential to significantly improve remote patient care. This literature review summarizes clinical evidence related to virtual healthcare (VHC), defined as a care team + connected devices + a digital solution in post-release care of patients with HF. Searches were conducted on Embase (06/12/2020). A total of 171 studies were included for data extraction and evidence synthesis: 96 studies related to VHC efficacy, and 75 studies related to AI in HF. In addition, 15 publications were included from the search on studies scaling up VHC solutions in HF within the real-world setting. The most successful VHC interventions, as measured by the number of reported significant results, were those targeting reduction in rehospitalization rates. In terms of relative success rate, the two most effective interventions targeted patient self-care and all-cause hospital visits in their primary endpoint. Among the three categories of VHC identified in this review (telemonitoring, remote patient management, and patient self-empowerment) the integrated approach in remote patient management solutions performs the best in decreasing HF patients' re-admission rates and overall hospital visits. Given the increased amount of data generated by VHC technologies, artificial intelligence (AI) is being investigated as a tool to aid decision making in the context of primary diagnostics, identifying disease phenotypes, and predicting treatment outcomes. Currently, most AI algorithms are developed using data gathered in clinic and only a few studies deploy AI in the context of VHC. Most successes have been reported in predicting HF outcomes. Since the field of VHC in HF is relatively new and still in flux, this is not a typical systematic review capturing all published studies within this domain. Although the standard methodology for this type of reviews was followed, the nature of this review is qualitative. The main objective was to summarize the most promising results and identify potential research directions.

Effects of videoconferencing intervention on stroke survivors: A systematic review and meta-analysis of randomised controlled studies

BACKGROUND

Videoconferencing has been proposed as an innovative telerehabilitation approach for stroke survivors, demand for which is growing.

AIM

To evaluate the efficacy of a videoconferencing intervention for stroke survivors.

DESIGN

Systematic review and meta-analysis.

METHODS

We conducted a systematic review of the literature in the databases Academic Search Complete, CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, Ovid (and its companion UpToDate), and Web of Science published from January 1, 2002, to May 27, 2021. The methodologic quality of the included studies was evaluated using version 2 of the Cochrane risk-of-bias tool. A meta-analysis using a random-effects model calculated the pooled standardised mean difference (SMD) for using a videoconferencing intervention with stroke survivors and for the ability of survivors to perform activities of daily living (ADLs) and to maintain balance. The Stata software application (version 16.0: StataCorp LP) was used for the statistical analysis.

RESULTS

Nine studies with 603 participants were included in the analysis. Videoconferencing interventions were observed to be effective in improving the ability of stroke survivors to carry out their ADLs (SMD: 0.57; 95% confidence interval [CI]: 0.13 to 1.01) and to recover their balance (SMD: 1.96; 95% CI: 1.27 to 2.66).

CONCLUSIONS

Stroke survivors were able effectively to improve their ADL and balancing abilities. Further studies could consider the frequency, duration, and standard protocol for videoconferencing interventions.

RELEVANCE TO CLINICAL PRACTICE

This study could change the approach to patient support in future clinical practice and might constitute an alternative for improving care for stroke survivors in their homes or in long-term care facilities.

Feasibility of telerehabilitation for heart failure patients inaccessible for outpatient rehabilitation

AIMS

Despite strong recommendations, outpatient cardiac rehabilitation is underused in chronic heart failure (CHF) patients. Possible barriers are frailty, accessibility, and rural living, which may be overcome by telerehabilitation. We designed a randomized, controlled trial to evaluate the feasibility of a 3-month real-time, home-based telerehabilitation, high-intensity exercise programme for CHF patients who are either unable or unwilling to participate in standard outpatient cardiac rehabilitation and to explore outcomes of self-efficacy and physical fitness at 3 months post-intervention.

METHODS AND RESULTS

CHF patients with reduced (≤40%), mildly reduced (41-49%), or preserved ejection fraction (≥50%) (n = 61) were randomized 1:1 to telerehabilitation or control in a prospective controlled trial. The telerehabilitation group (n = 31) received real-time, home-based, high-intensity exercise for 3 months. Inclusion criteria were (i) ≥18 years, (ii) New York Heart Association class II-III, stable on optimized medical therapy for >4 weeks, and (iii) N-terminal pro-brain natriuretic peptide >300 ng/L. All participants participated in a 2-day 'Living with heart failure' course. No other intervention beyond standard care was provided for controls. Outcome measures were adherence, adverse events, self-reported outcome measures, the general perceived self-efficacy scale, peak oxygen uptake (VO2peak ) and a 6-min walk test (6MWT). The mean age was 67.6 (11.3) years, and 18% were women. Most of the telerehabilitation group (80%) was adherent or partly adherent. No adverse events were reported during supervised exercise. Ninety-six per cent (26/27) reported that they felt safe during real-time, home-based telerehabilitation, high-intensity exercise, and 96% (24/25) reported that, after the home-based supervised telerehabilitation, they were motivated to participate in further exercise training. More than half the population (15/26) reported minor technical issues with the videoconferencing software. 6MWT distance increased significantly in the telerehabilitation group (19 m, P = 0.02), whereas a significant decrease in VO2peak (-0.72 mL/kg/min, P = 0.03) was observed in the control group. There were no significant differences between the groups in general perceived self-efficacy scale, VO2peak , and 6MWT distance after intervention or at 3 months post-intervention.

CONCLUSIONS

Home-based telerehabilitation was feasible in chronic heart failure patients inaccessible for outpatient cardiac rehabilitation. Most participants were adherent when given more time and felt safe exercising at home under supervision, and no adverse events occurred. The trial suggests that telerehabilitation can increase the use of cardiac rehabilitation, but the clinical benefit of telerehabilitation must be evaluated in larger trials.

Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial

BACKGROUND

Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients.

METHODS

In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate.

DISCUSSION

The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone.

TRIAL REGISTRATION

Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.

Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program

The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement's collaborative model was adopted. Multiple plan-do-study-act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.

Cardiac rehabilitation for heart failure: 'Cinderella' or evidence-based pillar of care?

Cardiac rehabilitation remains the 'Cinderella' of treatments for heart failure. This state-of-the-art review provides a contemporary update on the evidence base, clinical guidance, and status of cardiac rehabilitation delivery for patients with heart failure. Given that cardiac rehabilitation participation results in important improvements in patient outcomes, including health-related quality of life, this review argues that an exercise-based rehabilitation is a key pillar of heart failure management alongside drug and medical device provision. To drive future improvements in access and uptake, health services should offer heart failure patients a choice of evidence-based modes of rehabilitation delivery, including home, supported by digital technology, alongside traditional centre-based programmes (or combinations of modes, 'hybrid') and according to stage of disease and patient preference.

Telerehabilitation as a Therapeutic Exercise Tool versus Face-to-Face Physiotherapy: A Systematic Review

Digital physiotherapy, often referred to as "Telerehabilitation", consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed.

METHODS

We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group.

RESULTS

a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the studies, results proved to be similar for telerehabilitation and face-to-face rehabilitation in both groups when measuring functionality, quality of life and satisfaction.

CONCLUSION

this review generally concludes that intervention through telerehabilitation programs is as feasible and efficient as conventional physiotherapy in terms of functionality level and quality of life. In addition, telerehabilitation shows high levels of patients' satisfaction and adherence, being values equivalent to traditional rehabilitation.

A six-week physical therapy exercise program delivered via home-based telerehabilitation is comparable to in-person programs for patients with burn injuries: A randomized, controlled, non-inferiority clinical pilot trial

BACKGROUND

Exercise programmes are essential for burn rehabilitation, however patients often have barriers accessing these services. Home-based telerehabilitation (HBT) may be an alternative. This study aimed to determine if exercise programs delivered via HBT were as effective as in-person (IP) programs with respect to clinical outcomes and participant and therapist satisfaction.

METHODS

A single center, randomized, controlled, non-inferiority pilot trial with blinded assessment was undertaken. Forty-five adults with ≤ 25% total body surface area (TBSA) burns were randomized to receive a 6-week exercise program delivered either by HBT or IP. The primary outcome was burn-specific quality of life (Burn Specific Health Scale - Brief). Secondary outcomes included health-related quality of life, burn scar-specific outcomes, exercise self-efficacy, pain severity, muscle strength and range of motion (ROM). Participant and therapist satisfaction, technical disruptions and adverse events were also recorded.

RESULTS

We found no significant within- or between-group differences for any outcome measures except ROM. Achievement of full ROM was significantly different between groups at Week 12 (IP=100% vs HBT=70%, p = 0.005). Non-inferiority was inconclusive. Participant satisfaction was high (median ≥ 9.8/10), with no significant between-group differences. Therapist satisfaction was high (median ≥ 8.9/10), major technical disruptions low (8%) and no adverse events reported.

CONCLUSION

HBT is a safe, effective option to deliver exercise programs for patients with burn injuries ≤ 25% TBSA with comparable clinical outcomes to in-person programmes. Ongoing research is required to further analyze ROM and investigate the effectiveness of HBT for patients with larger burns.

Virtual Care Initiatives for Older Adults in Australia: Scoping Review

BACKGROUND

There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia.

OBJECTIVE

We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia.

METHODS

A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework.

RESULTS

Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers.

CONCLUSIONS

Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.

The state of the art in telerehabilitation for musculoskeletal conditions

BACKGROUND

Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future.

MAIN BODY

Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users.

CONCLUSIONS

Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.

Health Techequity: Opportunities for Digital Health Innovations to Improve Equity and Diversity in Cardiovascular Care

Purpose of Review

In this review, we define health equity, disparities, and social determinants of health; the different components of digital health; the barriers to digital health equity; and cardiovascular digital health trials and possible solutions to improve health equity through digital health.

Recent Findings

Digital health interventions show incredible potential to improve cardiovascular diseases by obtaining longitudinal, continuous, and actionable patient data; increasing access to care; and by decreasing delivery barriers and cost. However, certain populations have experienced decreased access to digital health innovations and decreased representation in cardiovascular digital health trials.

Summary

Special efforts will need to be made to expand access to the different elements of digital health, ensuring that the digital divide does not exacerbate health disparities. As the expansion of digital health technologies continues, it is vital to increase representation of minoritized groups in all stages of the process: product development (needs findings and screening, concept generation, product creation, and testing), clinical research (pilot studies, feasibility studies, and randomized control trials), and finally health services deployment.

Telerehabilitation Approaches for People with Chronic Heart Failure: A Systematic Review and Meta-Analysis

INTRODUCTION

Telerehabilitation (TR) for chronic heart failure (CHF) allows for overcoming distance barriers and reducing exacerbations. However, little is known about TR descriptors, components, and efficacy in CHF.

METHODS

This work systematically reviewed the TR strategies of randomized controlled trials in people with CHF. A meta-analysis was run to test its effect on exercise capacity and quality of life compared to no rehabilitation (NI) and conventional intervention (CI).

RESULTS

Out of 6168 studies, 11 were eligible for the systematic review, and 8 for the meta-analysis. TR intervention was individual and multidimensional, with a frequency varying from 2 to 5 times per 8-12 weeks. The TR components mainly included an asynchronous model, monitoring/assessment, decision, and offline feedback. A few studies provided a comprehensive technological kit. Minimal adverse events and high adherence were reported. A large effect of TR compared to NI and a non-inferiority effect compared to CI was registered on exercise capacity, but no effects of TR compared to NI and CI on quality of life were observed.

CONCLUSIONS

TR for people with CHF adopted established effective strategies. Future interventions may identify the precise TR dose for CHF, technological requirements, and engagement components affecting the patient's quality of life.