MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study

A randomized controlled Trial of telerehabilitation intervention for acute ischemic stroke patients Post-Discharge

BACKGROUND

The acute ischemic stroke (AIS) represents a significant contributor to global disability and mortality rates. Effective rehabilitation interventions play a critical role in enhancing patients' functional recovery and overall quality of life. With the advancement of telemedicine technology, post-discharge telerehabilitation interventions are becoming increasingly feasible, yet their efficacy requires validation through randomized controlled trials (RCT). This study aimed to evaluate the efficacy of a 12-week telerehabilitation program compared to standard post-discharge care in AIS patients.

METHODS

This study employed a randomized controlled design, enrolling 200 patients who had been discharged after an AIS. Participants were randomly assigned to either the intervention group or the control group in a 1:1 ratio. The intervention group received a 12-week telerehabilitation program, which included a personalized rehabilitation training plan, regular video consultations, and health education. The control group received standard post-discharge care, which consisted of a rehabilitation manual and biweekly outpatient follow-ups for up to 12 weeks. The primary outcome measure was the Barthel Index, assessing patients' ability to perform activities of daily living. Secondary outcome measures included the modified Rankin Scale (mRS, assessing the degree of disability), Hamilton Depression Rating Scale (HAMD, assessing the patients' mental health status), and World Health Organization Quality of Life-BREF (WHOQOL-BREF, assessing the patients' quality of life).

RESULTS

The mean score of the Barthel Index in the intervention group improved significantly from a baseline of 65.4 ± 12.3 to 88.7 ± 9.6, while the control group improved from 65.6 ± 12.1 to 74.9 ± 13.2 (P < 0.001). The mRS showed that 75 patients (75 %) in the intervention group achieved scores of 0-2 (no symptoms or mild disability), compared to 62 patients (62 %) in the control group, with significant improvement in the intervention group (P = 0.003). The HAMD scores indicated a significant reduction from a baseline of 17.5 ± 4.2 to 9.6 ± 3.1 in the intervention group, compared to a reduction from 17.3 ± 4.0 to 13.2 ± 4.5 in the control group (P < 0.001). The WHOQOL-BREF scores in the intervention group were significantly higher than those in the control group across all four domains: physical health, psychological health, social relationships, and environment (P < 0.05).

CONCLUSION

The findings of this study support telerehabilitation interventions as an effective rehabilitation method, significantly improving the rehabilitation outcomes and quality of life of patients discharged after mild AIS, and potentially reducing the risk of recurrence.

Design Requirements for Cardiac Telerehabilitation Technologies Supporting Athlete Values: Qualitative Interview Study

BACKGROUND

Cardiac telerehabilitation (CTR) interventions can provide accessible and affordable remote rehabilitation services. However, as cardiac rehabilitation (CR) primarily targets inactive patients, little is known about the experiences with CR of highly active patients (ie, recreational athletes or, simply, athletes) with established coronary artery disease. Consequently, existing CTR interventions do not address the specific needs of the athletic subpopulation. Understanding the needs and values of athletes is crucial for designing meaningful CTR interventions that enhance user acceptance and engagement, thereby facilitating effective rehabilitation for this patient subgroup.

OBJECTIVE

This study aimed to inform the design of technologies that facilitate CTR for athletes. We intended to identify athletes' values related to CR, including health and sports tracking, as well as high-level requirements for technologies that can facilitate the CTR of athletes according to the identified values.

METHODS

We used value-sensitive design with a human-centric design approach to elicit design requirements for CTR that can serve athletes with established coronary artery disease. To identify athletes' values, we conducted 25 value-oriented semistructured interviews with 15 athletic patients and 10 health care professionals involved in CR programs. In a second phase, we conducted 6 card-sorting focus group sessions with 13 patients and 7 health care professionals to identify desired CTR features. Finally, we derived high-level CTR technology requirements connected to the athletes' needs and values.

RESULTS

We defined 12 athlete values divided into 3 categories: body centric, care centric, and data and technology centric. We clustered findings from the card-sorting activity into CTR technology requirements, such as remotely monitored sport-specific training and training data representations next to clinical limitations, and paired them with corresponding values.

CONCLUSIONS

Athletes have distinct values and health goals in CR compared to general populations targeted by CTR interventions. Designing patient-centric CTR interventions that address these needs is crucial to support optimal recovery, safe return to sports, and adherence to CTR technologies in the home environment.

Cardiac Telerehabilitation After Heart Attack Using E-Learning Platforms and Monitoring Cardiovascular Risk Factors: A Narrative Review of the Literature

This narrative review aims to evaluate the current evidence on the use of cardiac telerehabilitation (CTR) in patients after myocardial infarction, focusing on the effectiveness of e-learning platforms and remote monitoring for addressing cardiovascular risk factors, improving physical fitness, and enhancing patient adherence. The review also explores the limitations and gaps in the literature, highlighting the need for future research to optimize CTR approaches. A comprehensive literature search was conducted using PubMed and Scopus, focusing on specific keywords. The search yielded fifteen randomized controlled trials. Data from these studies were analyzed to evaluate the methodology, interventions, patient characteristics, and outcomes related to the use of CTR in managing cardiovascular risk factors and improving physical fitness. The included studies demonstrated that CTR interventions, delivered via online platforms, phone calls, and smart devices, were effective in improving cardiovascular risk factors, physical activity levels, and overall patient satisfaction. CTR appears to be associated with improvements in exercise tolerance, VO2 max, body composition, and adherence. While the outcomes were promising, there is still limited evidence regarding the long-term impact of CTR on cardiovascular risk factors and lifestyle interventions, particularly in non-exercise components like dietary management and psychological support. Cardiac telerehabilitation presents a feasible and effective alternative to traditional in-hospital rehabilitation programs for patients recovering from myocardial infarction. The integration of e-learning platforms and smart devices enhances patient adherence, improves cardiovascular risk factors, and increases access to rehabilitation services, particularly for those who face barriers to traditional care. However, further large-scale studies are needed to establish standardized protocols and best practices for CTR. Additionally, future research should address disparities in access to digital health technologies, especially among rural and underserved populations, to ensure equitable access to these innovative approaches.

Methods for assessing exercise fidelity in unsupervised home-based cardiovascular rehabilitation: a scoping review

BACKGROUND

Home-based cardiac rehabilitation is increasingly popular for patients with cardiovascular diseases. However, this mode of rehabilitation involves unsupervised exercise, making it challenging to assess, correct, and monitor exercise fidelity (the extent to which the patient performs the exercise intended by the intervention provider). This review aimed to identify the range, validity, and acceptability of measures for assessing exercise fidelity in unsupervised, home-based cardiovascular rehabilitation.

METHODS

We searched PubMed, Embase, CINAHL, Medline, and PsycINFO for studies published between 2000 and 2024 to identify observational studies, trials, and protocols published in English with a home-based cardiovascular rehabilitation intervention and at least one measure of exercise fidelity (e.g., adherence to the intended frequency, intensity, time, type, safety, progression/regression). Two reviewers selected eligible studies and extracted data, including study characteristics, exercise components, adherence definition, adherence measures, and data on measurement validity or acceptability. We conducted a narrative synthesis using a comprehensive definition of exercise fidelity, which evolved as the analysis progressed.

RESULTS

Forty-six articles describing 41 studies were included. Exercise intensity was the most commonly measured fidelity component (38/41 studies), followed by exercise frequency (32/41 studies). Exercise intensity was mostly assessed by wearable devices (28/41 studies). Frequency of exercise was most commonly assessed subjectively using a self-reported exercise log or diary, but also (objectively) using wearable devices. Exercise quantity was most commonly assessed (in terms of time or duration) by self-reported exercise logs, diaries and wearable devices, or (in terms of steps or distance) mostly by wearable devices (pedometers, other step activity monitors). Safety was only assessed in 12/41 studies. No studies assessed progression or regression of exercise, quality of exercise (accuracy of movement) or the appropriateness of progression or regression.

CONCLUSIONS

Most studies to date have conceptualised exercise fidelity or adherence narrowly, ignoring important elements of the initial exercise prescription and many have relied on non-validated self-report measures. We present a comprehensive framework for assessing exercise fidelity, which may be useful for designing more robust assessments of exercise fidelity in home-based rehabilitation programmes.

Role of wearable devices in cardiac telerehabilitation: A scoping review

BACKGROUND

Cardiac rehabilitation (CR) is an evidence-based comprehensive program that includes exercise training, health education, physical activity promotion, and extensive counseling for the management of cardiovascular risk factors. Wearable devices monitor certain physiological functions, providing biometric data such as heart rate, movement, sleep, ECG analysis, blood pressure, energy expenditure, and numerous other parameters. Recent evidence supports wearable devices as a likely relevant component in cardiovascular risk assessment and disease prevention. The purpose of this scoping review is to better understand the role of wearable devices in home-based CR (HBCR) and to characterize the evidence regarding the incorporation of wearable devices in HBCR programs and cardiovascular outcomes.

METHODS & FINDINGS

We created a search strategy for multiple databases, including PubMed, Embase (Elsevier), CINAHL (Ebsco), Cochrane CENTRAL (Wiley), and Scopus (Elsevier). Studies were included if the patients were eligible for CR per Medicare guidelines and >18 years of age and if some type of wearable device was utilized during HBCR. Our search yielded 57 studies meeting all criteria. The studies were classified into 4 groups: patients with coronary heart disease (CHD) without heart failure (HF); patients with HF; patients with heart valve repair or replacement; and patients with exposure to center-based CR. In three groups, there was an upward trend toward improvement in quality of life (QOL) and peak VO2, less sedentary time, and an increase in daily step count in the intervention groups compared to control groups.

CONCLUSIONS

HBCR using wearable devices can be a comparable alternative or adjunct to center-based CR for patients with CHD and HF. More studies are needed to draw conclusions about the comparability of HBCR to center-based CR in patients with heart valve repair or replacement.

Competencies required by patients and health professionals regarding telerehabilitation: A scoping review

Background

Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care.

Objective

The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies.

Methods

We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home.

Results

One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear.

Conclusions

Telerehabilitation requires a variety of different competencies from patients and health professionals - going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.

Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review

BACKGROUND

An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature.

OBJECTIVE

We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients' perspectives on its usability, utility, acceptability, acceptance, and external variables.

METHODS

We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken.

RESULTS

The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors.

CONCLUSIONS

Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians.