Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis

Impact of dynamic health intervention models through online and offline on self-efficacy and quality of life among chronic disease patients

BackgroundThe increasing prevalence of chronic diseases in China has prompted a surge in demand for nursing services, yet conventional care models often fail to coordinate effectively between hospitals and homes, leading to significant care disconnection and reduced patient satisfaction. Dynamic health intervention models, delivered through mobile networks both online and offline, offer comprehensive and proactive care experiences for chronic disease patients.ObjectiveThis study explores the impact of dynamic health intervention models through online and offline mobile networks on the patients self-efficacy and quality of life undergoing chronic disease examinations.MethodsNinety chronic disease patients who underwent examinations at our hospital from July 2021 to August 2022 were selected. They were randomly divided into a control group (45 cases, receiving routine health care intervention) and a research group (45 cases, undergoing dynamic health intervention care through online and offline mobile networks). The intervention lasted for six months. nursing compliance to health interventions, and nursing satisfaction with health intervention were compared between two groups.ResultsAfter six months of health intervention, the research group showed higher scores in Exercise of Self-Care Agency Scale (ESCA), General Self-Efficacy Scale (GSES), and Chinese version of the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF) compared to the control group (P < 0.05). Nursing compliance during health intervention was higher in the research group than in the control group (97.78% vs. 77.78%), and the health intervention services in nursing satisfaction was also higher in the research group (100.00% vs. 86.67%) (P < 0.05).ConclusionTo carry out the dynamic health intervention model of mobile network online and offline in patients with chronic diseases is beneficial to improve the self-care ability of patients, enhance their sense of self-efficacy and improve their quality of life, patients had higher nursing compliance and satisfaction.

Effects of Cancer Rehabilitation Interventions for Women Treated for Gynaecological Cancers: A Meta-Analysis of Randomised Controlled Trials

AIM

To analyse and synthesise current evidence on the effectiveness of cancer rehabilitation interventions in increasing physical activity, increasing healthy dietary habits, alleviating psychological distress, and increasing health-related quality of life (HRQoL) in women treated for gynaecological cancers (GCs).

DESIGN

A meta-analysis of randomised controlled trials (RCTs).

DATA SOURCES

A systematic search was conducted in 12 databases from inception to 31 May 2024.

REVIEW METHODS

The quantitative results from comparable RCTs were pooled and meta-analysed using Review Manager 5.4 software. The results from non-comparable (i.e., clinically heterogeneous) RCTs were narratively summarised. The methodological quality of all RCTs was assessed using Version 2 of the Cochrane risk of bias tool for randomised trials.

RESULTS

Nine RCTs reported in a total of 12 articles met the inclusion criteria and comprised a total of 418 patients. The interventions had significant effects on total physical activity levels at post-intervention, 6-month follow-up, and 12-month follow-up, and on self-efficacy in physical activity at post-intervention and 3-month follow-up. However, the interventions did not significantly improve overall HRQoL or healthy dietary habits and did not significantly alleviate anxiety and depression. The key intervention components were information provision on health-promoting behaviours; adoption of behavioural change techniques (goal setting, action planning, relapse prevention, problem-solving, self-monitoring, and social support); and stress and emotion management.

CONCLUSION

Rehabilitation interventions effectively increase physical activity in women treated for GCs, leading to sustainable effects. However, there is limited evidence on the effectiveness of such interventions in improving overall HRQoL, encouraging healthy eating, and alleviating psychological distress in women treated for GCs.

RELEVANCE TO CLINICAL PRACTICE

This review found that rehabilitation interventions can increase physical activity levels among women treated for GCs. It also identified the key effective components of such interventions.

REPORTING METHOD

This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

PATIENT OR PUBLIC CONTRIBUTION

None.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews registration number: CRD42023442877.

Effect of Digital Exercise Therapy on the Pain and Physical Function of Patients With Osteoarthritis: Systematic Review and Meta-Analysis

BACKGROUND

Osteoarthritis (OA) is a chronic degenerative bone and joint disease that significantly impacts patients' quality of life and mental health, while also imposing a substantial economic burden on society. However, access to rehabilitation for patients with OA is challenging upon hospital discharge. Digital exercise therapy represents a promising telemedicine strategy for enhancing the management of OA, but its effect on OA is not yet clear.

OBJECTIVE

This study aimed to systematically evaluate the therapeutic effects of digital exercise therapy on pain and physical function in patients with OA.

METHODS

Databases including PubMed, Embase, Cochrane Library, Web of Science, and SPORTDiscus were searched for randomized controlled trials on using digital exercise therapy for OA until October 25, 2023. The primary outcomes included the measures of pain scores or physical function scores immediately after the intervention and at full follow-up. The risk of bias was evaluated using the Physiotherapy Evidence Database scale. Relevant data were extracted, and a meta-analysis was performed using RevMan5.3 software (Cochrane Collaboration).

RESULTS

A total of 9 studies with 1604 patients were included in the final meta-analysis. Compared with the conventional treatment group, digital exercise therapy significantly reduced numerical rating scale pain scores (mean difference [MD]=-1.07, 95% CI -1.35 to -0.78; P<.001) and Western Ontario and McMaster Universities Osteoarthritis Index physical function scores (MD=-2.39, 95% CI -3.68 to -1.10; P<.001) in patients with OA immediately after the intervention. However, follow-up results revealed no statistically significant difference in numerical rating scale pain scores (MD=-0.20, 95% CI -0.59 to 0.20; P=.34), while Western Ontario and McMaster Universities Osteoarthritis Index physical function scores showed a significant improvement in the digital exercise therapy group compared with the control group (MD=-1.89, 95% CI -3.52 to -0.26; P=.02). These findings suggest that digital exercise therapy provides immediate benefits for both pain and physical function in patients with OA, with sustained improvements in physical function observed during follow-up, though pain relief may not persist long term.

CONCLUSIONS

Digital exercise therapy can alleviate the pain and improve the physical function in patients with OA and can be used as an auxiliary means in the rehabilitation treatment of OA. It provides great convenience for patients with OA who need long-term treatment, allowing them to exercise at home for rehabilitation training.

TRIAL REGISTRATION

PROSPERO CRD42023484819; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023484819.

Facilitators and barriers in managing older chronic heart failure patients in community health care centers: a qualitative study of medical personnel's perspectives using the socio-ecological model

Background

Community health care centers (CHCs) plays a crucial role in ensuring timely diagnosis and effective management of congestive chronic heart failure (CHF) in older patients. Understanding the current status of CHF management in CHCs can therefore be effective in reducing the disease burden of CHF.

Objectives

This study evaluates the current state of CHF services in community healthcare facilities and identifies key facilitators and obstacles faced by medical personnel in China.

Methods

This interpretive study applied the social ecological model (SEM) and used a semi-structured interview guide for data collection. Each interview lasted 45-60 min. Thematic analysis was used to analyze the data.

Results

This study involved 30 participants. Facilitators and barriers were identified within the five domains of the SEM. (1) Individual level: medical staff lack knowledge and experience in CHF management while patients' need for greater health education. (2) Interpersonal level: insufficient support from the patients' family and lack of trust in CHCs and staff. (3) Organizational level: inadequate medical knowledge and training programs for medical staff, shortage of medical staff and limited teamwork and few health promotion channels. (4) Community level: Lack of regular screening and follow-up, medical equipment and an information technology-assisted monitoring system. (5) Public policy level: lack of policy support, funding subsidies, national guidelines adapted to the local context and low medical insurance reimbursement rate.

Conclusion

There are many impediments to chronic disease management in the community, so it is vital to improve public understanding of CHF, as well as to improve the quality of community health equipment and services, to improve reciprocal referral mechanisms between hospitals and the community, and to develop policies on chronic disease management for CHF.

The Status of Medication Literacy in Young Patients With Hypertension and Its Relationship With Medication Adherence

BACKGROUND

Previous investigators have shown that low levels of ML were associated with poor medication adherence, but few have explored this relationship in young patients with hypertension.

OBJECTIVE

In this study, our objective was to analyze the current state of ML in young Chinese patients with hypertension and determine its relationship with medication adherence.

METHODS

This was a prospective observational study using data from young patients with hypertension in Jiangsu Province, China. Sociodemographic data, ML, and medication adherence of participants were obtained. We used logistic regression and mediation effect analysis to explore the relationship between relevant dimensions of ML and medication adherence.

RESULTS

A total of 171 participants were enrolled, aged 18 to 45 years, who had a median total ML score of 37.0 (score range: 20-51) and median scores of each subdimension of 10.0 for medication knowledge, 9.0 for medication attitude, 6.0 for medication skill, and 13.0 for medication behavior. After a 3-month follow-up, 46.8% of the participants still demonstrated poor medication adherence, with scores below 6 points. Medication attitude (odds ratio [OR], 1.196; 95% confidence interval, 1.041-1.373) and medication behavior (OR, 1.279; 95% confidence interval, 1.069-1.531) were associated with improved medication adherence. Medication behavior partially mediated the relationship between medication attitude and medication adherence with a mediating effect value of 10.9%.

CONCLUSIONS

Young patients with hypertension have poor ML and medication adherence. Medication literacy scores for medication attitude and medication behavior contributed to medication adherence, whereas medication behavior mediated the relationship between medication attitude and medication adherence. More detailed education on medication needs to be implemented to enhance ML.

Engineering Integrated Care Expansion and Innovation: Drawing upon Nursing Leadership

In the United States (US), a longstanding solution to the unmet need for mental health treatment is integrated behavioral health care (IBH). Within a primary care model, problems are identified and treatment combines care for physical, mental and substance use disorders. Treatments are delivered through the collaboration of primary and behavioral health providers. According to US federal billing guidelines, in one integrated model, the Collaborative Care Model (CoCM), the psychiatric consultant must be a medical professional trained in psychiatry and capable of prescribing medications, i.e., either a psychiatrist, Psychiatric Mental Health Nurse Practitioner (PMHNP) or Physician Assistant. The development of integrated care has been slow for particular vulnerable populations, in part due to the lack of psychiatric consultants. PMHNPs are increasingly taking on the role of psychiatric consultants on CoCM teams and creating nurse-led IBH models for underserved populations. In this paper, eight such models are discussed along with implementation challenges and the strategies used to address them. Nurse leaders have the capacity to enhance and expand integrated care, particularly for underserved populations, through the optimal utilization of care teams, expanding measured outcomes, and developing measures for team-based effectiveness. Future directions are proposed that will accelerate this PMHNP-led expansion of IBH.

Impact of COVID-19 on door-to-wire time in ST-segment elevation myocardial infarction treatment: the role of digital communication

INTRODUCTION

ST-segment elevation myocardial infarction (STEMI) is a life-threatening cardiovascular emergency necessitating rapid reperfusion. During the COVID-19 pandemic, healthcare providers faced the challenge of ensuring timely STEMI interventions while managing the risk of viral transmission in hospitals. This study aims to analyze changes in the door-to-wire (D-to-W) time for STEMI treatment across three pandemic phases-early pre-epidemic phase (Group C), initial lockdown phase (Group A), and intermediate normalization phase (Group B). It also examines the impact of digital communication tools, collectively referred to as "InterNet+" (e.g., Twitter, WeChat), on treatment processes.

METHODS

Based on data of 630 STEMI patients treated in Chest Pain Center in a particular hospital in China from 2019 to 2020, changes in D-to-W time in different groups are measured. Time intervals in STEMI treatment process are also predicted by Bayesian statistics approach. The study investigated the influence of InterNet+ utilization before and after the pandemic through a questionnaire-based assessment.

RESULTS

For transfer-non-emergency- treatment, the time from first-electrocardiogram to preliminary-diagnosis in Group-A is significantly longer than that in Groups-B and -C (p = 0.004, p = 0.004); the time from decision-on-intervention to catheterization-room-activation in Group-A and -B is significantly longer than that in Group-C (p = 0.003, p < 0.001). For transfer-emergency- treatment, the time from first-medical-contact to arterial-puncture in Group-A and -B is remarkably shorter than that in Group-C (p = 0.006). Meanwhile, Bayesian method performs well in forecasting time intervals, so it can provide effective assistance for STEMI treatment. The findings from the questionnaire indicated that physicians perceived a significant association between the optimal management of STEMI and an increased frequency of InterNet+ tool usage following the pandemic (p = 0.019).

CONCLUSIONS

The treatment and management of STEMI patients have been in dilemmas and various time intervals of D-to-W are inevitably prolonged during the COVID-19 pandemic. The implementation of InterNet + tools proved essential for minimizing delays in D-to-W and FMC-to-W times, offering a valuable strategy for enhancing STEMI care amid ongoing pandemic challenges.

CLINICAL TRIAL NUMBER

Not applicable.

Cost-Effectiveness of Telerehabilitation Compared to Traditional In-Person Rehabilitation: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the cost-effectiveness of telerehabilitation compared to traditional in-person rehabilitation. A comprehensive search of PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid databases identified 14 eligible studies. The analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, assessing economic outcomes using incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs). Findings indicate that telerehabilitation was cost-effective in three out of 14 studies included in the cost-effectiveness analysis. The mean ICER for telerehabilitation compared to traditional rehabilitation varied, with a probability of cost-effectiveness reaching 90% at a willingness-to-pay (WTP) threshold of $30,000 per QALY. However, at a WTP threshold of $0, the probability of cost-effectiveness remained low, suggesting that telerehabilitation does not always dominate in cost-effectiveness analyses. The study highlights the potential of telerehabilitation to provide similar or improved health outcomes compared to traditional rehabilitation while reducing travel costs and enhancing patient access. Increased patient satisfaction, reduced hospital readmissions, and improved adherence to rehabilitation protocols contributed to the economic benefits observed. However, methodological heterogeneity across studies remains a limitation. Given the growing adoption of digital health technologies, telerehabilitation presents a viable and economically efficient alternative to in-person rehabilitation. Policymakers should consider integrating telerehabilitation into routine healthcare services, particularly in resource-constrained settings, to optimize cost-effectiveness and enhance accessibility. Further research should focus on standardizing cost-effectiveness evaluation methods to strengthen evidence for large-scale implementation.

The feasibility and effectiveness of telecare consultations in a nurse-led post-acute stroke clinic

BACKGROUND

Telecare may provide an alternative to maintaining post-acute stroke care services in making benefit to both the providers and the stroke survivors, although study is needed to investigate its feasibility and effectiveness in integrating this innovative delivery mode into a routine.

OBJECTIVES

The objectives of this study are to assess the feasibility and effectiveness of telecare consultations in a nurse-led post-acute stroke clinic.

METHODS

A pre- and post-test one group quasi-experimental design was adopted. Subjects were recruited in the clinic and received three secondary stroke care consultations in 3 months via telecare from stroke nurses. Data were collected at pre- and post-intervention. A Wilcoxon signed-rank test was used to compare the two time-points for differences in effectiveness.

RESULTS

Ninety-two stroke survivors participated. The drop-out rate was 27%. The majority perceived the programme as time-friendly and cost-saving and as alleviating their health-related worries. At the 3-month follow-up, notable improvements were observed in the activities of daily living and the strength domain of stroke-specific quality of life.

CONCLUSIONS

Integrating telecare consultations within nurse-led stroke clinics is a feasible and acceptable strategy for monitoring the health and fostering the self-care abilities of individuals following their discharge from hospital after an acute stroke episode.

A review on the homecare management of pre-term babies

Adequate home care is essential for improving health outcomes in preterm babies while supporting parents and caregivers. Therefore, it is of interest to review known data on homecare approaches, including telehealth, feeding plans, kangaroo care and caregiver education. Known data shows benefits in feeding, developmental progress and maternal mental health, but limitations such as varied methodologies, short follow-up periods and bias risks constrain the conclusions. Hence, future studies should address these gaps through high-quality controlled studies, standardized outcomes and long-term family observations.

Effect of Simple Swallowing Training Program on Early Oropharyngeal Dysphagia in Community-Dwelling Older Adults: A Randomized Controlled Study

OBJECTIVES

Oropharyngeal dysphagia (OD) in community-dwelling older adults continues to be a challenge due to its insidious onset. This study developed a simple swallowing training program (SSTP) to address these issues and conducted a randomized controlled trial to explore its effect on swallowing function and quality of life.

DESIGN

Two-arm randomized controlled trial.

SETTING

AND PARTICIPANTS: A total of 248 community-dwelling older adults with OD from were included in 2024 and randomly divided into intervention and control groups.

METHODS

The SSTP was developed through expert consultation. A total of 248 community-dwelling older adults with OD were included in 2024 and randomly divided into intervention and control groups. The intervention group underwent the SSTP twice daily for 21 days, with weekends off, and the control group participants did light physical activities by themselves. The primary outcome was the Gugging Swallowing Screen (GUSS), and the secondary outcomes were the Eating Assessment Tool-10 (EAT-10), Swallowing Quality of Life questionnaire (SWAL-QoL), maximum tongue pressure, masticatory ability, bite force, and meal duration. Assessments were conducted on days 1 and 21, while meal duration was assessed every 3 days for lunch.

RESULTS

Twenty-seven participants withdrew halfway. There were no significant differences in baseline assessments (P > .05). There were significant between-group and interactive effects in the GUSS [(19.07 ± 1.38) vs (17.28 ± 2.17), Fbetween-group = 6.893, Pbetween-group = .009, Finteractive = 59.504, Pinteractive<.001], EAT-10 {[4.00 (3.00, 5.00)] vs [9.00 (7.00, 10.00)], zbetween-group = -3.502, Pbetween-group<.001; zinteractive = -6.252, Pinteractive<.001}, SWAL-QoL {[166.00 (163.00, 171.50)] vs [154.00 (150.00, 158.00)], zbetween-group = 2.681, Pbetween-group = .007; zinteractive = 5.475, Pinteractive<.001}, maximum tongue pressure {[33.10 (26.48, 36.86)] vs [28.85 (19.21, 35.77)], zbetween-group = 3.377, Pbetween-group = .001; zinteractive = -6.208, Pinteractive<.001}, masticatory ability {[176.92 (133.10, 212.91) vs [163.33 (116.66, 189.32)], zbetween-group = 4.801, Pbetween-group<.001; zinteractive = 6.979, Pinteractive<.001}. Between-group, time, and interactive effects were significant in the meal duration [(23.39 ± 4.32) vs (27.64 ± 5.63), Fbetween-group = 8.692, Pbetween-group = .004, Ftime = 138.683, Ptime< 0.001, Pinteractive = 73.196, Pinteractive<.001].

CONCLUSIONS AND IMPLICATIONS

The SSTP can effectively improve early OD and swallowing-related quality of life in community-dwelling older adults.

Effectiveness and Feasibility of Digital Pulmonary Rehabilitation in Patients Undergoing Lung Cancer Surgery: Systematic Review and Meta-Analysis

BACKGROUND

Pulmonary rehabilitation (PR) has been shown to effectively support postsurgical recovery in patients with lung cancer (LC) at various stages. While digital PR programs offer a potential solution to traditional challenges, such as time and space constraints, their efficacy and feasibility for patients undergoing LC surgery remain unclear.

OBJECTIVE

This systematic review aims to assess the feasibility and effectiveness of digital PR programs for individuals undergoing LC surgery.

METHODS

A systematic review was conducted, retrieving data from 6 English and 4 Chinese databases from their inception to January 1, 2024. References in related studies were also manually reviewed. The primary outcomes assessed were physical capacity, lung function, and the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were compliance, hospital stay, chest tube duration, anxiety, depression, and quality of life. Where applicable, recruitment and withdrawal rates were also evaluated. Meta-analysis and descriptive analysis were used to assess the outcomes.

RESULTS

A total of 5 randomized controlled trials and 6 quasi-experimental studies (n=1063) were included, with 4 studies being included in the meta-analyses. Our meta-analyses revealed that digital PR reduced the decline in 6-minute walk distance (6-MWD) by an average of 15 m compared with routine PR programs from admission to discharge, demonstrating a clinically significant improvement in physical capacity (mean difference -15.00, 95% CI -25.65 to -4.34, P=.006). Additionally, digital PR was associated with a reduction (26/58, 45%) in the likelihood of PPCs (risk ratio 0.45, 95% CI 0.30-0.66, P<.001) and a reduction of 1.53 days in chest tube duration (mean difference -1.53, 95% CI -2.95 to -0.12, P=.03), without a statistically significant effect on postoperative hospital stay (mean difference -1.42, 95% CI -3.45 to 0.62, P=.17). Descriptive analyses suggested that digital PR has the potential to improve knowledge, lung function, quality of life, and self-efficacy, while reducing depression and anxiety. Notably, digital PR was found to be a safe, feasible, and acceptable supplementary intervention. Despite challenges with low recruitment, digital PR enhanced exercise compliance, increased patient satisfaction, and lowered dropout rates.

CONCLUSIONS

This systematic review is the first comprehensive analysis to suggest that digital PR is a safe, feasible, acceptable, and effective intervention for promoting recovery in patients with LC after surgery. Digital PR has the potential to be a valuable supplement, expanding access to traditional PR programs. Future research should prioritize the development of interactive and inclusive digital solutions tailored to diverse age groups and educational backgrounds. Rigorous studies, including large-scale, high-quality randomized controlled trials with detailed protocols and robust methodologies, are needed to assess the short-, medium-, and long-term efficacy of digital PR, ensuring reproducibility in future research.

TRIAL REGISTRATION

PROSPERO CRD42023430271; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=430271.

Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway

BACKGROUND

The COVID-19 pandemic sent shock waves through societies, economies, and health systems of Member States in the WHO European Region and beyond. During the pandemic, most countries transitioned from a slow to a rapid adoption of telehealth solutions, to accommodate the public health and social measures introduced to mitigate the spread of the disease. As countries shift to a post-pandemic world, the question remains whether telehealth's importance as a mode of care provision in Europe continues to be significant.

OBJECTIVE

This paper aims to present, synthesize, and interpret results from the Telehealth Programmes section of the 2022 WHO Survey on Digital Health (2022 WHO/Europe DH Survey). We specifically analyze the implementation and use of teleradiology, telemedicine, and telepsychiatry. Norwegian telehealth experiences will be used to illustrate survey findings, and we discuss some of the relevant barriers and facilitators that impact the use of telehealth services.

METHODS

The survey tool was revised from the 2015 WHO Global Survey on eHealth, updated to reflect recent progress and policy priorities.The 2022 WHO/Europe DH Survey was conducted by WHO and circulated to Member States in its European Region from April to October 2022.

RESULTS

The data analysis revealed that teleradiology, telemedicine, and telepsychiatry are the telehealth services most commonly used in the WHO European Region in 2022. Funding remains the most significant barrier to the implementation of telehealth in the Region, followed by infrastructure and capacity/human resources. The survey results highlighted in this study are presented in the following sections: (1) telehealth strategies and financing, (2) telehealth programmes and services offered by Member States of the WHO European Region, (3) barriers to implementing telehealth services, and (4) monitoring and evaluation of telehealth.

CONCLUSION

Based on WHO's 2022 survey, the use of telehealth in the WHO European Region is on the rise. However, merely having telehealth in place is not sufficient for its successful and sustained use for care provision. Responses also uncovered regional differences and barriers that need to be overcome. Successful implementation and scaling of telehealth requires rethinking the design of health and social care systems to create robust, trustworthy, and person-centred digital health and care services.

Comparing Telerehabilitation and Home-based Exercise for Shoulder Disorders: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to quantitatively compare the effects of telerehabilitation and home-based exercise for shoulder disorders.

DATA SOURCES

We conducted a search for eligible studies in PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE databases following Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

STUDY SELECTION

Independent reviewers selected randomized controlled trials that compared the effects of telerehabilitation and home-based exercise in individuals with shoulder disorders.

DATA EXTRACTION

Two reviewers independently conducted data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool.

DATA SYNTHESIS

A total of 7 studies with 508 participants were included. Compared with home-based exercise, telerehabilitation showed superior improvements in range of motion (flexion: standardized mean difference [SMD] 0.35, 95% confidence interval [CI] 0.14 to 0.56; abduction: SMD 0.37, 95% CI 0.16 to 0.58; external rotation: SMD 0.43, 95% CI 0.22 to 0.64; internal rotation: SMD 0.33, 95% CI 0.08 to 0.58), functional outcomes (Shoulder Pain and Disability Index: SMD -0.37, 95% CI -0.61 to -0.12; shortened Disabilities of the Arm, Shoulder and Hand questionnaire: mean difference [MD] -4.51, 95% CI -8.70 to -0.32), and quality of life (EuroQol Five Dimensions Questionnaire: MD 0.04, 95% CI 0.01 to 0.07). Telerehabilitation was not different from home-based exercise in terms of pain relief (SMD -0.19, 95% CI -0.60 to 0.23). Subgroup analysis demonstrated that telerehabilitation provided significant pain relief when sustained for over 12 weeks (SMD -0.46, 95% CI -0.81 to -0.11).

CONCLUSIONS

Telerehabilitation is more effective than home-based exercise in improving range of motion, functional outcomes, and quality of life for patients with shoulder disorders. Telerehabilitation significantly outperforms home-based exercise in relieving pain when continued for over 12 weeks.

Characterization of Telecare Conversations on Lifestyle Management and Their Relation to Health Care Utilization for Patients with Heart Failure: Mixed Methods Study

BACKGROUND

Telehealth interventions where providers offer support and coaching to patients with chronic conditions such as heart failure (HF) and type 2 diabetes mellitus (T2DM) are effective in improving health outcomes. However, the understanding of the content and structure of these interactions and how they relate to health care utilization remains incomplete.

OBJECTIVE

This study aimed to characterize the content and structure of telecare conversations on lifestyle management for patients with HF and investigate how these conversations relate to health care utilization.

METHODS

We leveraged real-world data from 50 patients with HF enrolled in a postdischarge telehealth program, with the primary intervention comprising a series of telephone calls from nurse telecarers over a 12-month period. For the full cohort, we transcribed 729 English-language calls and annotated conversation topics. For a subcohort (25 patients with both HF and T2DM), we annotated lifestyle management content with fine-grained dialogue acts describing typical conversational structures. For each patient, we identified calls with unusually high ratios of utterances on lifestyle management as lifestyle-focused calls. We further extracted structured data for inpatient admissions from 6 months before to 6 months after the intervention period. First, to understand conversational structures and content of lifestyle-focused calls, we compared the number of utterances, dialogue acts, and symptom attributes in lifestyle-focused calls to those in calls containing but not focused on lifestyle management. Second, to understand the perspectives of nurse telecarers on these calls, we conducted an expert evaluation where 2 nurse telecarers judged levels of concern and follow-up actions for lifestyle-focused and other calls (not focused on lifestyle management content). Finally, we assessed how the number of lifestyle-focused calls relates to the number of admissions, and to the average length of stay per admission.

RESULTS

In comparative analyses, lifestyle-focused calls had significantly fewer utterances (P=.01) and more dialogue acts (Padj=.005) than calls containing but not focused on lifestyle management. Lifestyle-focused calls did not contain deeper discussions on clinical symptoms. These findings indicate that lifestyle-focused calls entail short, intense discussions with greater emphasis on understanding patient experience and coaching than on clinical content. In the expert evaluation, nurse telecarers identified 24.2% (29/120) of calls assessed as concerning enough for follow-up. For these 29 calls, nurse telecarers were more attuned to concerns about symptoms and vitals (19/29, 65.5%) than lifestyle management concerns (4/29, 13.8%). The number of lifestyle-focused calls a patient had was modestly (but not significantly) associated with a lower average length of stay for inpatient admissions (Spearman ρ=-0.30; Padj=.06), but not with the number of admissions (Spearman ρ=-0.03; Padj=.84).

CONCLUSIONS

Our approach and findings offer novel perspectives on the content, structure, and clinical associations of telehealth conversations on lifestyle management for patients with HF. Hence, our study could inform ways to enhance telehealth programs for self-care management in chronic conditions.

The effects of mHealth in geriatric rehabilitation on health status: A systematic review

BACKGROUND

Geriatric rehabilitation positively influences health outcomes in older adults after acute events. Integrating mobile health (mHealth) technologies with geriatric rehabilitation may further improve outcomes by increasing therapy time and independence, potentially enhancing functional recovery. Previous reviews have highlighted positive outcomes but also the need for further investigation of populations receiving geriatric rehabilitation.

OBJECTIVE

Our main objective was to assess the effects of mHealth applications on the health status of older adults after acute events. A secondary objective was to examine the structure and process elements reported in these studies.

METHODS

Systematic review, including studies from 2010 to January 2024. Studies were eligible if they involved older adults' post-acute care and used mHealth interventions, measured health outcomes and compared intervention and control groups. The adjusted Donabedian Structure-Process-Outcome (SPO) framework was used to present reported intervention processes and structures.

RESULTS

After initial and secondary screenings of the literature, a total of nine studies reporting 26 health outcomes were included. mHealth interventions ranged from mobile apps to wearables to web platforms. While most outcomes showed improvement in both the intervention and control groups, a majority favored the intervention groups. Reporting of integration into daily practice was minimal.

CONCLUSION

While mHealth shows positive effects on health status in geriatric rehabilitation, the variability in outcomes and methodologies among studies, along with a generally high risk of bias, suggest cautious interpretation. Standardized measurement approaches and co-created interventions are needed to enhance successful uptake into blended care and keep geriatric rehabilitation accessible and affordable.

The effect of consultations performed by specialised nurses or advanced nurse practitioners on patient and organisational outcomes in patients with complex health conditions: An umbrella review

BACKGROUND

Policymakers and researchers often suggest that nurses may play a crucial role in addressing the evolving needs of patients with complex conditions, by taking on advanced roles and providing nursing consultations. Nursing consultations vary widely across settings and countries, and their activities range from complementing to substituting traditional physician-led consultations or usual care.

OBJECTIVE

This study was aimed at describing the effects of nursing consultations with patients with complex conditions in any setting on patient outcomes (quality of life, physical status, psychosocial health, health behaviour, medication adherence, mortality, anthropometric and physiological outcomes, and patient satisfaction) and organisational outcomes (health resource use and costs).

DESIGN

Umbrella review.

METHODS

We followed the Joanna Briggs Institute method for umbrella reviews. We searched PubMed, Embase, Cochrane Database of Systematic Reviews and CINAHL to identify relevant articles published in English, Dutch, French, Spanish or German between January 2013 and February 2023. We included systematic literature reviews, with or without meta-analyses, that included randomised controlled trials conducted in high-income countries. Reviews were eligible if they pertained to consultations led by specialised nurses or advanced nurse practitioners. Article selection, data extraction and quality appraisal were performed independently by at least two reviewers.

RESULTS

We included 50 systematic reviews based on 473 unique trials. For all patient outcomes, nursing consultations achieved effects at least equivalent to those of physician-led consultations or usual care (i.e., non-inferiority). For quality of life, health behaviour, medication adherence, mortality and patient satisfaction, more than half the meta-analyses found statistically significant effects in favour of nursing consultations (i.e., superiority). Cost results must be interpreted with caution, because very few and heterogeneous cost-related data were extracted, and the methodological quality of the cost analyses was questionable. Narrative syntheses confirmed the overall conclusions of the meta-analyses.

CONCLUSIONS

The effects of nursing consultations on patients with complex health conditions across healthcare settings appear to be at least similar to physician-led consultations or usual care. Nursing consultations appear to be more effective than physician-led consultations or usual care in terms of quality of life, health behaviour, mortality, patient satisfaction and medication adherence. Further analysis of the primary data is necessary to determine the patient populations and settings in which nursing consultations are most effective. Moderate study quality, diversity amongst and within systematic reviews, and quality of reporting hamper the strength of the findings.

Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis

BACKGROUND

Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation.

OBJECTIVE

To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation.

DESIGN

Systematic review and network meta-analysis.

METHODS

We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643).

RESULTS

This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence.

CONCLUSIONS

Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.

Innovation Support Reduces Quiet Quitting and Improves Innovative Behavior and Innovation Outputs among Nurses in Greece

BACKGROUND

Innovation is a crucial issue in healthcare services since it can affect job-related variables such as productivity, satisfaction, and burnout. The aim of our study was to examine the impact of innovation support on quiet quitting, innovative behavior, and innovation outputs among nurses.

METHODS

We conducted a cross-sectional study in Greece during April 2024. We employed a convenience sample of nurses. We followed the reporting of observational studies in epidemiology (STROBE). We used the following instruments: (a) the innovation support inventory (ISI) to measure innovation support; (b) the quiet quitting scale (QQS) to measure quiet quitting; (c) the innovative behavior inventory (IBI) to measure innovative behavior; and (d) the innovation outputs (IO) scale to measure innovation outputs. Our study questionnaire was anonymous, and nurses gave their informed consent to participate. The Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of Athens, approved our study protocol, while we followed the guidelines of the Declaration of Helsinki.

RESULTS

Our study population included 328 nurses with a mean age of 42.3 years (standard deviation: 9.7). Among them, 89.9% were females. Our multivariable analysis identified a negative relationship between innovation support and quiet quitting. Moreover, we found that managerial support and cultural support improved several aspects of innovative behavior, such as idea generation, idea search, idea communication, implementation starting activities, involving others, and overcoming obstacles. Additionally, managerial support improved innovation outputs.

CONCLUSIONS

Our findings suggested the positive impact of innovation support on quiet quitting, innovative behavior, and innovation outputs among nurses. Organizations and nurses' managers should establish an innovative working environment to improve nurses' passion, motives, and productivity.

Adopting a nurse-led model of care to advance whole-person health and health equity within Medicaid

BACKGROUND

Medicaid payment reforms and delivery model innovations are needed to fully transform U.S. healthcare structuring and provision.

PURPOSE

To synthesize nurse-led models of care and their implications for improving health care access, quality, and reducing costs for Medicaid recipients.

METHODS

A critical review of the literature regarding nurse-led models and implications for addressing social determinants of health (SDOH), adopting population health approaches, managing complex care, and integrating behavioral and physical health care within Medicaid.

DISCUSSION

Three interrelated findings emerged (a) investing in dynamic nurse-led models is important for mitigating SDOH and adopting value-based care, (b) regulations preventing nurses from practicing at the fullest extent of their training and licensure limit clinical impact and value, and (c) directed payments can establish value-based expectations for Medicaid managed care.

CONCLUSION

Adoption of a nurse-led model of care has the potential to advance the goals of reducing inequity and promoting whole-person health within Medicaid and nationally.

The effects of telerehabilitation on physiological function and disease symptom for patients with chronic respiratory disease: a systematic review and meta-analysis

OBJECTIVE

To compare the impact of telerehabilitation versus conventional rehabilitation on the recovery outcomes of patients with chronic respiratory disease (CRD).

METHODS

The Cochrane Library, MEDLINE, Web of Science and Embase were searched to collect randomized controlled trials (RCTs) on telerehabilitation for the rehabilitation of patients with chronic respiratory system diseases since the establishment of the database to November 14, 2023. Two researchers independently screened the literature and extracted valid data according to the inclusion criteria. The quality assessment of included studies was conducted individually by using the RoB 2(Risk of Bias 2) tool, followed by meta-analysis using RevMan5.3 software.

RESULTS

Based on inclusion and exclusion criteria, 21 RCTs were included, comprising 3030 participants, with 1509 in the telerehabilitation group and 1521 in the conventional rehabilitation group. Meta-analysis results indicated that compared to conventional rehabilitation, video conference-based telerehabilitation demonstrated significant improvements in short-term (≤ 6 months) outcomes, including 6-min walk distance (6MWD) (MD = 7.52, 95% CI: 2.09, 12.94), modified Medical Research Council Dyspnea Scale (mMRC) (MD = -0.29, 95% CI: -0.41, -0.18), COPD assessment test (CAT) (MD = -1.77, 95% CI: -3.52, -0.02), HADS (MD = -0.44, 95% CI: -0.86, -0.03), and St. George's Respiratory Questionnaire (SGRQ's) activity, impact, and symptom scores. In the long term (> 6 months), although improvements persisted in 6WMD [MD = 12.89, 95% CI (-0.37, 26.14)], mMRC [MD = -0.38, 95% CI (-0.56, -0.21)], CAT [MD = -1.39, 95% CI (-3.83, 1.05)], Hospital anxiety and depression scale (HADS) [MD = -0.34, 95% CI (-0.66, -0.03)], and SGRQ's Activity, Impact, and Symptom scores between intervention and control groups, statistically significant differences were observed only for mMRC and HADS. Without considering time factors, the intervention group exhibited some improvement in FEV1% predicted and the forced expiratory volume in the first one second (FEV1)/ forced vital capacity (FVC) (%) without statistical significance compared to the control group.

CONCLUSION

Telerehabilitation therapy demonstrates short-term benefits in enhancing patients' daily activity capacity, improving respiratory function, and enhancing mental health status, thereby improving patients' quality of life. However, further high-quality, large-sample RCTs are required to ascertain its long-term effectiveness conclusively.

TRIAL REGISTRATION

This study protocol was approved and registered in PROSPERO: CRD 42024509154.

Effects of Peer- or Professional-Led Support in Enhancing Adherence to Wearable Monitoring Devices Among Community-Dwelling Older Adults: Systematic Review of Randomized Controlled Trials

BACKGROUND

Despite the well-documented health benefits associated with wearable monitoring devices (WMDs), adherence among community-dwelling older adults remains low. By providing guidance on the purpose and benefits of using WMDs, facilitating goal-setting aligned with the device's features, promoting comprehension of the health data captured by the device, and assisting in overcoming technological challenges, peers and health care professionals can potentially enhance older adults' adherence to WMDs. However, the effectiveness of such support mechanisms in promoting adherence to WMDs among older adults remains poorly understood.

OBJECTIVE

The aims of this systematic review were to examine the effects of peer- or professional-led intervention programs designed to improve adherence to WMDs among community-dwelling older adults and to identify the intervention components that may positively influence the effects of the intervention.

METHODS

We conducted a comprehensive search across 7 electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, EMBASE, PsycINFO, British Nursing Index, Web of Science, and CINAHL) to identify articles published between January 1, 2010, and June 26, 2023. We specifically targeted randomized controlled trials that examined the impact of peer- or professional-led interventions on enhancing adherence to WMDs among individuals aged 60 years and older residing in the community. Two independent reviewers extracted data from the included studies and assessed the potential risk of bias in accordance with the Cochrane Risk of Bias tool for randomized trials, version 2.

RESULTS

A total of 10,511 studies were identified through the database search. Eventually, we included 3 randomized controlled trials involving 154 community-dwelling older adults. The participants had a mean age of 65 years. Our review revealed that increasing awareness of being monitored and implementing the SystemCHANGE approach, a habit change tool focusing on personal goals and feedback, were effective strategies for enhancing adherence to WMDs among older adults. All of the included studies exhibited a low risk of bias.

CONCLUSIONS

By collaboratively designing specific goals related to WMDs with health care professionals, including nurses and physicians, older adults exhibited a higher likelihood of adhering to the prescribed use of WMDs. These goal-setting tools provided a framework for structure and motivation, facilitating the seamless integration of WMDs into their daily routines. Researchers should prioritize interventions that target awareness and goal-setting as effective approaches to enhance adherence to WMDs among older adults, thereby maximizing the realization of associated health benefits.

Chronic illness trajectory-based nursing intervention improves the self-care abilities of patients with inflammatory bowel disease

OBJECTIVE

To explore the effects of chronic illness trajectory model (CITM)-based nursing interventions on anxiety, depression, quality of life, medication adherence, and dietary compliance among patients with inflammatory bowel disease (IBD).

METHODS

A retrospective analysis was performed on 112 IBD patients admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from January to December 2023. Patients were divided into two groups: a control group (n=62) receiving routine nursing care, and an observation group (n=50) receiving CITM-based nursing care. Assessments of anxiety, depression, self-care ability, daily living ability, and symptom severity were conducted before and after the intervention.

RESULTS

Post-intervention, the observation group demonstrated significantly higher quality of life scores at 1 and 3 months compared to the control group (both P<0.05). Additionally, the observation group showed improved medication adherence and lower symptom scores, with significant differences (both P<0.05). Anxiety and depression levels were also significantly reduced in the observation group compared to the control group (both P<0.05).

CONCLUSION

CITM-based nursing intervention significantly enhances self-care abilities, quality of life, and compliance with medication and dietary regimens in IBD patients. Furthermore, it effectively alleviates anxiety and depression, supporting comprehensive management of this chronic disease.

Mobile Health System for Meeting Health Information Needs in Patients With Head and Neck Cancer Undergoing Radiotherapy: Development and Feasibility Study

Patients with head and neck cancer undergoing radiotherapy encounter physical and psychosocial challenges, indicating unmet needs. Mobile health technology can potentially support patients. This single-armed feasibility study included 30 patients with head and neck cancer undergoing radiotherapy. Patients were asked to use the Health Enjoy System, a mobile health support system that provides a disease-related resource for 1 week. We assessed the usability of the system and its limited efficacy in meeting patients' health information needs. The result showed that the system was well received by patients and effectively met their health information needs. They also reported free comments on the system's content, backend maintenance, and user engagement. This study supplies a foundation for further research to explore the potential benefits of the Health Enjoy System in supporting patients with head and neck cancer.

Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear.

OBJECTIVE

We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR.

METHODS

This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low.

CONCLUSIONS

The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR.

TRIAL REGISTRATION

PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.

Awareness and associated factors of venous thromboembolism in breast cancer surgical patients: a cross-sectional study

BACKGROUND

Venous thromboembolism (VTE) is a major complication of breast cancer surgical patients. Assessing VTE awareness enables medical staff to tailor educational programs that improve patient self-management and reduce VTE risk. Therefore, this study aimed to assess VTE awareness among breast cancer surgical patients and identify factors influencing their awareness level.

METHODS

A multicenter cross-sectional study was conducted on breast cancer patients scheduled for surgery from May 2023 to November 2023. Data were collected using a general information form and a validated self-assessment questionnaire on VTE awareness for breast cancer surgical patients. Univariate analysis and multiple linear regression analysis were used to analyze the data.

RESULTS

Of 1969 patients included, the term awareness rates for deep vein thrombosis and pulmonary embolism were 42.5% and 26.1%, respectively. Information about VTE was primarily obtained from doctors (30.4%), nurses (24.0%), and social media (23.3%). The overall average VTE awareness score was 1.55 ± 0.53, with the dimension of VTE preventive measures scoring highest, and VTE clinical symptoms/signs scoring lowest. Multivariate analysis identified education level, personal VTE history, chemotherapy and surgical history, and the hospital's regional location as significant factors associated with VTE awareness level (p < 0.05).

CONCLUSION

This study highlights a critical need for improved VTE awareness among breast cancer surgical patients, particularly regarding clinical symptoms/signs. Health education programs are recommended especially tailored for patients with lower education levels, no history of VTE, or without prior surgery or chemotherapy, to improve their understanding of VTE.

Effects of a nurse-led eHealth programme on functional outcomes and quality of life of patients with stroke: a pooled analysis of randomized controlled trials

BACKGROUND

Stroke remains a leading cause of disability worldwide. Nurse-led eHealth programs have emerged as a potentially effective strategy to improve functional outcomes and quality of life in stroke survivors. However, the variability of study designs and outcomes measured across trials necessitates a pooled analysis to comprehensively assess the efficacy of these interventions. This protocol outlines the methodology for a pooled analysis that aims to synthesize evidence from randomized controlled trials (RCTs) evaluating nurse-led eHealth interventions for stroke patients.

METHODS AND ANALYSIS

This pooled analysis will be conducted according to the PRISMA guidelines. We will include RCTs that evaluate nurse-led eHealth programs and report on functional outcomes or quality of life in stroke patients. Comprehensive searches of electronic databases including Pubmed, EMBASE, the Cochrane Library, CINAHL, and PsycINFO will be conducted with a predefined search strategy. Study selection will involve screening titles and abstracts, followed by full-text review using explicit inclusion and exclusion criteria. Data extraction will be undertaken independently by two reviewers. The risk of bias will be assessed through the Cochrane Risk of Bias tool. Additionally, the quality of evidence for each outcome will be evaluated using the GRADE approach. Meta-analyses will be performed using random-effects models, and heterogeneity will be quantified using the I2 statistic. Subgroup and sensitivity analyses will explore potential sources of heterogeneity.

DISCUSSION AND CONCLUSIONS

This pooled analysis is poised to provide a nuanced understanding of the effectiveness of nurse-led eHealth programs in stroke rehabilitation, leveraging a thorough methodological framework and GRADE tool to ensure robustness and reliability of evidence. The investigation anticipates diverse improvements in patient outcomes, underscoring the potential of personalized, accessible eHealth interventions to enhance patient engagement and treatment adherence. Despite the challenges posed by the heterogeneity of interventions and rapid technological advancements, the findings stand to influence clinical pathways by integrating eHealth into standard care, if substantiated by the evidence. Our study's depth and methodological rigor possess the potential to initiate changes in healthcare policy, advocating for the adoption of eHealth and subsequent investigations into its cost-efficiency. Ultimately, we aim to contribute rich, evidence-based insights into the burgeoning field of digital health, offering a foundational assessment of its applications in stroke care. Our data is expected to have a lasting impact, not only guiding immediate clinical decisions but also shaping the trajectory of future healthcare strategies in stroke recovery.

SYSTEMATIC REVIEW REGISTRATION

Identifier (CRD42024520100: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=520100).

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

BACKGROUND

Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services.

METHODS

We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022.

RESULTS

Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 - 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 - 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 - 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers.

CONCLUSIONS

The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

Effects of Telerehabilitation on Pain and Disability in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis

(1) Background: This systematic review and meta-analysis explores the effectiveness of telerehabilitation in patients suffering from chronic neck pain, specifically on pain and disability. The research delves into an area of growing significance within the realm of healthcare, aiming to understand the impact of digital interventions on the rehabilitation process for individuals with prolonged neck pain. (2) Methods: The comprehensive review encompasses a wide array of studies evaluating the collective outcomes of numerous trials focused on telerehabilitation strategies. In this systematic review, PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched to identify studies on telerehabilitation's impact on pain. (3) Results: Eight studies met the inclusion criteria. Using the Downs and Black quality assessment, three studies were classified as good and five as fair. The authors identify specific modalities within telerehabilitation, such as remote exercise programs and virtual consultations, that contribute significantly to positive patient outcomes. Meta-analysis indicated a significant overall effect of telerehabilitation on pain reduction (MD = -1.27; 95% CI = -2.06; -0.47; p = 0.002). These findings support telerehabilitation's efficacy in pain management. (4) Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of telerehabilitation as an effective and accessible means of managing chronic neck pain, offering valuable insights for both healthcare practitioners and policymakers in advancing patient-centered care.

Improving post-acute stroke follow-up care by adopting telecare consultations in a nurse-led clinic: Study protocol of a hybrid implementation-effectiveness trial

AIM

To evaluate the clinical effectiveness and implementation strategies of telecare consultations in post-stroke nurse-led clinics.

BACKGROUND

Telecare consultations could be an alternative to conventional in-person consultations and improve continuity of care for stroke survivors following their discharge from hospital. Previous studies utilizing telecare consultations only focused on testing their clinical effectiveness on stroke survivors; the appropriateness and feasibility of adopting this new delivery modality in a real-world setting were not examined.

DESIGN

A Type II hybrid effectiveness-implementation design will be adopted.

METHODS

Eligible stroke survivor participants will be randomly assigned to the intervention group (telecare consultation) or control group (usual in-person clinic consultation). Both groups will receive the same nursing intervention but delivered through different channels. The Reach, Effectiveness, Adoption, Implementation, Maintenance framework will be used to evaluate the clinical effectiveness and implementation outcomes. The primary outcome is the non-inferiority of the degree of disability between the two groups at 3 months into the intervention and at 3 months post-intervention. The paper complies with the SPIRIT guidelines for study protocols adapted for designing and reporting parallel group randomized trials.

CONCLUSION

The findings of this study will provide key insights into the processes for implementing and adopting telecare consultations into long-term services for post-stroke patients.

IMPACT

This study contributes to the translation of telecare consultations for stroke survivors into real-life settings. If effective, this program may provide guidance for expanding telecare consultations to other post-stroke nurse-led clinics or to patients with other chronic diseases.

TRIAL REGISTRATION

This study has been registered at clinicaltrials.gov (identifier: NCT05183672). Registered on 10 January 2022.

Nurse-led intervention in the management of patients with cardiovascular diseases: a brief literature review

Coronary artery disease (CAD) is one among the major causes of mortality in patients all around the globe. It has been reported by the World Health Organization (WHO) that approximately 80% of cardiovascular diseases could be prevented through lifestyle modifications. Management of CAD involves the prevention and control of cardiovascular risk factors, invasive and non-invasive treatments including coronary revascularizations, adherence to proper medications and regular outpatient follow-ups. Nurse-led clinics were intended to mainly provide supportive, educational, preventive measures and psychological support to the patients, which were completely different from therapeutic clinics. Our review focuses on the involvement and implication of nurses in the primary and secondary prevention and management of cardiovascular diseases. Nurses have a vital role in Interventional cardiology. They also have major roles during the management of cardiac complications including congestive heart failure, atrial fibrillation and heart transplantation. Today, the implementation of a nurse-led tele-consultation strategy is also gaining positive views. Therefore, a nurse-led intervention for the management of patients with cardiovascular diseases should be implemented in clinical practice. Based on advances in therapy, more research should be carried out to further investigate the effect of nurse-led clinics during the long-term treatment and management of patients with cardiovascular diseases.

The role of community nurse in the implementation of health policy for the elderly in Thailand

In the implementation of the policy for the elderly, the nurses who have the competency to pull out their potential power to continue living with several stakeholders' support are required to provide care in the community. Community nurse in Thailand has the responsibility to deliver adequate medical care and also social care for the elderly. The study aimed to identify the role of community nurse in the implementation of Thai health policy for the elderly. Codes regarding the role of community nurse in the implementation of Thai health policy for the elderly were extracted from descriptive data interviewed with 15 policy implementors in Thailand. The codes were categorized by similarities using thematic analysis. The role of community nurse was 16 categories and 102 codes out of factors promoting implementation of Thai health policy for the elderly, with 27 categories and 416 codes. The main roles were Coordination, Service delivery, and Monitoring and evaluation, composing seven categories and 45 codes, eight categories and 51 codes, and one category and six codes, respectively. It was conspicuous in coordination mechanisms, especially between the organizations and disciplines in providing Primary Health Care. Both health promotion activities and medical treatment were crucial roles for community nurses. The role of community nurse was one of promoting factors of Thai health policy for the elderly. The community nurse acts as a lubricant between the hospital and the community, which means that the community nurse implements seamless service delivery for the elderly integrating medical care and welfare.

Community-based group rehabilitation program for stroke patients with dysphagia on quality of life, depression symptoms, and swallowing function: a randomized controlled trial

BACKGROUND

Community-based exercise programs have demonstrated potential for implementation in older adults; however, it remains imperative to ascertain whether this strategy will yield comparable benefit in stroke patients with dysphagia.

METHODS

This was a single blinded, randomized, matched pairs clinical trial. Sixty-four stroke patients with dysphagia were recruited from patients who had been discharged the Rehabilitation Department of the Third Affiliated Hospital of Sun Yat-sen University. A single blinded, randomized and controlled trial was conducted. Participants were randomly assigned to either the intervention group (n = 32) or the control group (n = 32). Patients in the intervention group received health education followed by swallowing function training in community public spaces for 5 days every week over an eight-week period (60 minutes per day). Patients in the control group received swallowing rehabilitation training, and booster educational information about dysphagia, as well as instructions on how to improve quality of life. Swallowing function (Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA)), depressive symptoms (Geriatric Depression Scale-15), and quality of life (Swallowing-Quality of Life, SWAL-QOL) were assessed before and after all the treatment.

RESULTS

Before treatment, the two groups did not differ statistically. After the intervention, the swallowing function (SSA and FOIS) showed a significant improvement in both groups (All p < 0.001). But there was no significant difference in Functional Oral Intake Scale change between groups (P = 0.479). Compared with the control group, the intervention group had a significant improvement in depressive symptoms (P = 0.002), with a greater reduction in the number of depressed patients (13 to 6).The control group showed no significant improvements in depressive symptoms or a reduction in the number of depressed patients before and after treatment (P = 0.265, 14 to 12). The Swallowing-Quality of Life scores showed significant improvement in both the intervention and control group (P < 0.001). Specifically within Swallowing-Quality of Life sub-domains, greater changes were observed in symptoms and frequency (P < 0.001), communication (P = 0.012), and sleep (P = 0.006) for participants in the intervention group. And the cost-effectiveness of group rehabilitation surpasses that of rehabilitation training.

CONCLUSION

Community-based group rehabilitation program is more effective than traditional treatment in improving patients' depressive symptoms and quality of life, as well as being more cost-effective.

The Efficacy of Internet-Based Interventions in Family-Centered Empowerment Among Children with Chronic Diseases: A Mixed-Methods Systematic Review

Background

The incidence of chronic diseases in children is increasing worldwide, which can disrupt the quality of life. Family empowerment (FE) is one approach to strengthen family care among children with chronic diseases. In addition, internet has the potential in healthcare service interventions for families.

Purpose

This study aimed to determine the efficacy of internet-based family empowerment interventions among children with chronic diseases.

Methods

The study used a mixed-methods systematic review. A literature review was conducted following PRISMA guidelines using the PubMed, Scopus, ScienceDirect, and CINAHL databases. We used the PCC framework: chronic diseases (Population), family empowerment (Concept), and internet-based intervention (Context). Studies were eligible if published between 2013 and 2023, full-text, original study design, and focused on family empowerment in children with chronic diseases. Studies would be excluded if they were not in English or if the population was adults. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018. The study analysis used Sequential Explanatory Synthesis, which is a quantitative study (QUAN) synthesis followed by a qualitative study (QUAL) synthesis, then integrated using the QUAL data transformation technique.

Results

We highlight the quantitative study findings that an internet-based family empowerment intervention positively impacted family members' ability to care for children with chronic diseases with a mean Family Empowerment Scale (FES) total score of 4.13. We analyzed six study and identified four themes regarding efficacy of internet-based interventions in empowering families with children with chronic diseases: knowledge; availability of resources and time-saving; connectedness and communication; and family management and self-confidence.

Conclusion

Our study highlights that online-based interventions in family empowerment positively impact enhancing all domains of empowerment. This findings suggest that internet-based family interventions need to be adopted to fulfill the care needs of children with chronic diseases sustainably.

Outcomes of a risk assessment and management program using telecare consultation among patients with diabetes mellitus in general out-patient clinic: a hybrid effectiveness-implementation study protocol

Diabetes Mellitus (DM) is a chronic disease characterized by abnormally uncontrolled high blood glucose level. The Risk Assessment and Management Program (RAMP) in Hong Kong has been providing long-term face-to-face follow-up to DM patients in the government out-patient clinics since 2009. However, under the current outbreak of COVID-19, these face-to-face consultations were ceased over and over again to lower the risk of disease transmission. With the advancement in technology, the recent emergence of telecare has provided an alternative to replace the conventional consultations in the clinics. Its clinical effectiveness on DM patients has also been supported by numerous studies. Yet, there is only a paucity of literatures discussing the practicality of such implementation design in the real-world settings. This study aims at studying both the effectiveness and implementation outcomes of telecare in Hong Kong DM patients. It adopts a type 2 hybrid effectiveness-implementation design. It will be conducted in seven government out-patient clinics in Hong Kong. The subjects will be randomly assigned to an intervention group or a control group when they 1) are aged 18 or above, 2) have a confirmed diagnosis of diabetes, and 3) are having regular follow-up appointment in the clinic. Subjects in the intervention group will receive a 84-week Risk Assessment and Management Program (RAMP) in an alternate telecare and face-to-face consultations mode, while the control group will receive the same program but in usual face-to-face consultation mode. RE-AIM is employed as the implementation and effectiveness outcome evaluation framework. The primary outcome measure will be HbA1c. Data will be collected pre-intervention (T1), 42-week (T2), and 84-week (T3). The study will provide effectiveness-implementation assessment of telecare mode for DM patients in Hong Kong, as an alternative or in addition to conventional face-to-face consultations. It also aimed to provide insights for the future adoption in a broader health care setting.

Feasibility and Acceptability of Community-Based Telehealth to Prevent Long-Term Care Readmission

Background

Transitioning to community living after long-term care requires multiple complex individualized interventions to prevent readmission. The current focus of home and community-based services (HCBS) is on increasing consumer engagement and individualizing care. Telehealth interventions provide additional services without the burden of face-to-face encounters and have yet to be evaluated for feasibility and acceptability in rural HCBS.

Methods

West Virginia Bureau for Medical Services and West Virginia University implemented and evaluated a telehealth intervention with 26 Aged and Disabled Waiver or Traumatic Brain Injury Waiver participants who were transitioning back into their communities from a long-term care facility. Feasibility was assessed through recruitment process, fidelity to planned intervention, number of people eligible for participation, number of individuals enrolling in the intervention, enrollment process, completed enrollment, engagement in the intervention, number of weeks participating in the intervention, type of devices provided, attrition, and fidelity to original intervention. Satisfaction with services was used as a marker of acceptability for both participants and providers.

Results

Half (n = 12) of the enrolled population completed the full 24-week telehealth monitoring period and modification of the original intervention was necessary for most. Provider and participant satisfaction was high. Recruitment and enrollment may have been affected by COVID-19.

Conclusion

Future implementation will continue to track recruitment and retention efforts. Individualized care plans, demonstration and practice with equipment, family or direct-care worker presence, and live technical support through the phone are needed. Primary care provider and in-home direct-care worker satisfaction workflow planning and evaluation are required.

Effect of a telecare-based intervention on stress levels in informal caregivers of older adults: protocol for a randomized controlled trial

Significance

Due to caregiving commitments, caregivers of older adults may not have the time to make use of the onsite community services available to them during the day. With the support of advanced technology, telecare could be a convenient and easily accessible channel for providing individualized caregiving advice to caregivers.

Objective

The aim of the study is to describe a research protocol that highlights the development of a telecare-based intervention program for reducing stress levels in informal caregivers of community-dwelling older adults.

Methods

It is a randomized controlled trial. The study is supported by two community centers. The study participants will be randomly assigned to either the telecare-based intervention group or the control group. The former will receive a 3-month program comprised of three components: online nurse case management supported by a health and social care team, an online resource center, and a discussion forum. The latter will receive the usual services that provided by the community centers. Data will be collected at two time points - pre-intervention (T1) and post-intervention (T2). The primary outcome is stress levels, while secondary outcomes include self-efficacy, depression levels, quality of life, and caregiving burden.

Discussion

Besides taking care of one or more older adults, informal caregivers have to deal with work, chores, and take care of their children. This study will add valuable information to the knowledge gap on whether telecare-based interventions with the support of an integrated health-social team can alleviate the stress levels of informal caregivers of community-dwelling older adults. If successful, policymakers and healthcare professionals should consider incorporating telecare modalities in a primary health setting for informal caregivers to correspond with them, to relieve their caregiving stress and promote a healthy life.

Clinical trial registration

https://www.clinicaltrials.gov/, NCT05636982.

Engagement, Advance Care Planning, and Hospice Use in a Telephonic Nurse-Led Palliative Care Program for Persons Living with Advanced Cancer

Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for patients with advanced cancer as part of a larger randomized trial. Patients 50 years and older with metastatic solid tumors were recruited from 18 EDs and randomized to receive nursing calls focused on ACP, symptom management, and care coordination or specialty outpatient palliative care (ClinicialTrials.gov: NCT03325985). One hundred and five (50%) graduated from the 6-month program, 54 (26%) died or enrolled in hospice, 40 (19%) were lost to follow-up, and 19 (9%) withdrew prior to program completion. In a Cox proportional hazard regression, withdrawn subjects were more likely to be white and have a low symptom burden compared to those who did not withdraw. Two hundred eighteen persons living with advanced cancer were enrolled in the nursing arm, and 182 of those (83%) completed some ACP. Of the subjects who died, 43/54 (80%) enrolled in hospice. Our program demonstrated high rates of engagement, ACP, and hospice enrollment. Enrolling subjects with a high symptom burden may result in even greater program engagement.

Factors associated with the perceptions of eHealth technology of Chinese nurses and nursing students

AIM

The current study sought to assess the perceptions of eHealth technology of nurses and nursing students in China and to examine the association between these perceptions and demographic factors.

BACKGROUND

Despite the increasing use of eHealth technologies in China and across the globe, the perceptions of practicing and student nurses remain minimally explored. Findings from such an inquiry can potentially inform actions and policies to improve the uptake of eHealth technologies among Chinese nurses.

DESIGN

This was a cross-sectional study with a real-time online survey.

METHODS

A convenience sample of 1338 nurses and nursing students from Mainland China participated in the study. Their perceptions of eHealth technology were collected using the Chinese version of the Perceptions of eHealth Technology Scale. The Kruskal-Wallis test and multiple linear regression analysis were used to examine the relationship between demographic variables (age group, gender, occupation, education level, position and clinical experience) and perceptions of eHealth technology. All study procedures adhered to the STROBE guidelines.

RESULTS

Most participants were aged between 20 and 29 (55.8%). Nearly half (42.5%) were frontline clinical nursing staff, some were nursing students (36.2%), academic nursing staff (12.3%) and clinical nursing management staff (9.0%). Regardless of the differences in their demographic characteristics, the participants had higher mean scores in "Perception of eHealth applications" and lower mean scores in "Knowledge of eHealth technology". Participants with doctoral degree had a higher mean total score and higher sub-scale scores in knowledge of eHealth technology, perception of the advantages of eHealth technology and perception of eHealth applications; and the lowest scores in perception of the disadvantages of eHealth technology and perception of eHealth applications. Occupation, position and clinical experience were found to be the demographic characteristics associated with eHealth perceptions, before adjusting for age and gender. Education level was associated with eHealth perceptions regardless of adjustment.

CONCLUSION

Overall, participants had higher scores on perceptions of eHealth applications but lower scores on knowledge of eHealth technology. Considering the association between education and all subscales and overall scores, it may be essential to implement continuing professional education for nurses to improve their knowledge of eHealth applications. Encouragement to use available eHealth digital technologies may also be helpful to improve perceptions of eHealth.

The feasibility and effectiveness of telecare consultations in nurse-led post-acute stroke clinics: A study protocol

Background

Globally, nurse-led post-acute stroke clinics have been developed to provide secondary care services to stroke survivors. Although synthesized evidence supports the idea that the secondary prevention services delivered by nurses in these clinics can improve the functional ability of stroke survivors and reduce their readmission rates, long travel and waiting times, high costs, and the pandemic have limited the utilization of such clinics. Telecare consultations are a new modality for expanding public access to healthcare services, although how it can be applied in nurse-led clinics has not been reported.

Objective

The aim of this study is to determine the feasibility and effects of telecare consultations in nurse-led post-acute stroke clinics.

Methods

The study adopts a quasi-experimental design. The participants will receive three secondary stroke care consultations in 3 months provided via telecare by experienced advanced practice nurses. The outcome measures include feasibility (reasons for refusing to participate and for dropping-out, the attitudes and satisfaction of both the advanced practice nurses and their patients towards the programme), and preliminary effectiveness (degree of disability after stroke, activities of daily living, instrumental activities of daily living, health-related quality of life, depression) outcomes. Data will be collected at pre-(T1) and post-(T2) intervention.

Conclusions

The findings of this study may help facilitate the implementation of telecare consultations in a nurse-led post-acute stroke clinic, which may benefit the stroke survivors who are having mobility restrictions from accessing customary healthcare services and may protect them from being exposed to the infectious risk.