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

Smartphone-based gamification intervention to increase physical activity participation among patients with coronary heart disease: A randomized controlled trial

INTRODUCTION

Despite proven benefits, patients with coronary heart disease (CHD) typically fail to participate in sufficient physical activity (PA). Effective interventions should be implemented to help patients maintain a healthy lifestyle and modify their present behavior. Gamification is the use of game design features (such as points, leaderboards, and progress bars) to improve motivation and engagement. It shows the potential for encouraging patients to engage in PA. However, empirical evidence on the efficacy of such interventions among patients with CHD is still emerging.

PURPOSE

The aim of the study is to explore whether a smartphone-based gamification intervention could increase PA participation and other physical and psychological outcomes in CHD patients.

METHODS

Participants with CHD were randomly assigned to three groups (control group, individual group, and team group). The individual and team groups received gamified behavior intervention based on behavioral economics. The team group combined gamified intervention with social interaction. The intervention lasted for 12 weeks, and the follow-up was12 weeks. The primary outcomes included the change in daily steps and the proportion of patient days that step goals were achieved. The secondary outcomes included competence, autonomy, relatedness, and autonomous motivation.

RESULTS

For the individual group, smartphone-based gamification intervention significantly increased PA among CHD patients over the 12-week period (step count difference 988; 95% CI 259-1717; p < 0.01) and had a good maintenance effect during the follow-up period (step count difference 819; 95% CI 24-1613; p < 0.01). There are also significant differences in competence, autonomous motivation, body mass index (BMI), and waist circumference in 12 weeks between the control group and individual group. For the team group, gamification intervention with collaboration didn't result in significant increases in PA. But patients in this group had a significant increase in competence, relatedness, and autonomous motivation.

CONCLUSION

A smartphone-based gamification intervention was proven to be an effective way to increase motivation and PA engagement, with a substantial maintenance impact (Chinese Clinical Trial Registry Identifier: ChiCTR2100044879).

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.

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

In the evolving landscape of cardiac rehabilitation (CR), adopting digital technologies, including synchronous/real-time digital interventions and smart applications, has emerged as a transformative approach. These technologies offer real-time health data access, continuous vital sign monitoring, and personalized educational enhanced patient self-management and engagement. Despite their potential benefits, challenges and limitations exist, necessitating careful consideration. Synchronous/real-time digital CR involves remote, two-way audiovisual communication, addressing issues of accessibility and promoting home-based interventions. Smart applications extend beyond traditional healthcare, providing real-time health data and fostering patient empowerment. Wearable devices and mobile apps enable continuous monitoring, tracking of rehabilitation outcomes, and facilitate lifestyle modifications crucial for cardiac health maintenance. As digital CR progresses, ensuring patient access, equitable implementation, and addressing the digital divide becomes paramount. Artificial intelligence holds promise in the early detection of cardiac events and tailoring patient-specific CR programs. However, challenges such as digital literacy, data privacy, and security must be addressed to ensure inclusive implementation. Moreover, the shift toward digital CR raises concerns about cost, safety, and potential depersonalization of therapeutic relationships. A transformative shift towards technologically enabled CR necessitates further research, focusing not only on technological advancements but also on customization to meet diverse patient needs. Overcoming challenges related to cost, safety, data security, and potential depersonalization is crucial for the widespread adoption of digital CR. Future studies should explore integrating moral values into digital therapeutic relationships and ensure that digital CR is accessible, equitable, and seamlessly integrated into routine cardiac care. Theoretical frameworks that accommodate the dynamic quality of real-time monitoring and feedback feature of digital CR interventions should be considered to guide intervention development.

Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section)

INTRODUCTION

The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future.

AIM

The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions.

METHODS

To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section.

RESULTS

The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure.

CONCLUSIONS

It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

Effect of Video Camera Angle on the Detection of Compensatory Movements during Motion Observation

When exercise instructions are provided over the Internet, such as in online personal training, an instructor checks the user's form by watching their motion video recorded using a single camera device. However, fixed shooting angles may affect the detection of incorrect forms, including compensatory movements. This study aimed to verify whether differences in the shooting direction could influence compensatory movement detection by conducting motion observation using training motion videos shot from two angles. Videos of four training movements, including compensatory movements, were simultaneously captured from the front and side. Ten university students studying physical therapy watched the videos from each angle to detect compensatory movements. This study revealed significant differences between the plane of motion in which the compensatory action occurred and the direction of shooting for the false responses in the compensatory action detection for the three movements (p < 0.05). The results indicated that the shooting direction and the plane of motion in which the compensatory action occurred affected the detection of compensatory movements, which was attributable to differences in information on the amount of joint change depending on the direction of joint motion observation and to a lack of binocular visual information necessary for depth motion detection.