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Li Z, Guo K, Yang Y, Shuai Y, Fan R, Li Y, DU J, Niu J, Yang K. Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study. Eur J Phys Rehabil Med 2024; 60:361-372. [PMID: 38345568 DOI: 10.23736/s1973-9087.23.08165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management. EVIDENCE ACQUISITION A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.
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Affiliation(s)
- Zijun Li
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ke Guo
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongqi Yang
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yuxi Shuai
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Rui Fan
- First Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Yanfei Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
| | - Jiawei DU
- Second Clinical Medical College, University of Lanzhou, Lanzhou, China
| | - Junqiang Niu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
- First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China -
- Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China
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Khan MN, Altalbe A, Naseer F, Awais Q. Telehealth-Enabled In-Home Elbow Rehabilitation for Brachial Plexus Injuries Using Deep-Reinforcement-Learning-Assisted Telepresence Robots. Sensors (Basel) 2024; 24:1273. [PMID: 38400431 PMCID: PMC10892919 DOI: 10.3390/s24041273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
Due to damage to the network of nerves that regulate the muscles and feeling in the shoulder, arm, and forearm, brachial plexus injuries (BPIs) are known to significantly reduce the function and quality of life of affected persons. According to the World Health Organization (WHO), a considerable share of global disability-adjusted life years (DALYs) is attributable to upper limb injuries, including BPIs. Telehealth can improve access concerns for patients with BPIs, particularly in lower-middle-income nations. This study used deep reinforcement learning (DRL)-assisted telepresence robots, specifically the deep deterministic policy gradient (DDPG) algorithm, to provide in-home elbow rehabilitation with elbow flexion exercises for BPI patients. The telepresence robots were used for a six-month deployment period, and DDPG drove the DRL architecture to maximize patient-centric exercises with its robotic arm. Compared to conventional rehabilitation techniques, patients demonstrated an average increase of 4.7% in force exertion and a 5.2% improvement in range of motion (ROM) with the assistance of the telepresence robot arm. According to the findings of this study, telepresence robots are a valuable and practical method for BPI patients' at-home rehabilitation. This technology paves the way for further research and development in telerehabilitation and can be crucial in addressing broader physical rehabilitation challenges.
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Affiliation(s)
- Muhammad Nasir Khan
- Electrical Engineering Department, Government College University Lahore, Lahore 54000, Pakistan
| | - Ali Altalbe
- Department of Computer Engineering, Prince Sattam bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Faculty of Computing and Information Technology, King Abdulaziz University, P.O. Box 80210, Jeddah 21589, Saudi Arabia
| | - Fawad Naseer
- Computer Science and Software Engineering Department, Beaconhouse International College, Faisalabad 38000, Pakistan;
| | - Qasim Awais
- Electrical Engineering Department, Fatima Jinnah Women University, Rawalpindi 46000, Pakistan;
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Zhang P, Niu C, Zhang L, Lai H, Liu B, Lv D, Zhuang R, Liu Y, Xiao D, Ma L, Li M. The impact of the time factors on the exercise-based cardiac rehabilitation outcomes of the patients with acute myocardial infarction after percutaneous coronary intervention: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:35. [PMID: 38184523 PMCID: PMC10771662 DOI: 10.1186/s12872-023-03692-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/24/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cardiac rehabilitation (CR) has been demonstrated to improve outcomes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). However, the optimal CR initiation time and duration remain to be determined. This study aimed to explore the impact of the time factors on the CR outcomes in AMI patients who received PCI by the method of meta-regression analysis. METHODS We searched five databases (PubMed, Embase, Cochrane Library, Web of Science and Google scholar) up to October 31, 2023. Meta-regression analysis was utilized to explore the impact of the time factors on the effect sizes. Subgroups with more than 3 studies were used for meta-regression analysis. RESULTS Our analysis included 16 studies and a total of 1810 patients. The meta-regression analysis revealed that the initiation time and duration of CR had no significant impact on the occurrence of arrhythmia, coronary artery restenosis and angina pectoris. The initiation time and duration of CR also had no significant impact on the changes in left ventricular ejection fraction (LVEF, starting time: estimate = 0.160, p = 0.130; intervention time: estimate = 0.017, p = 0.149), left ventricular end-diastolic volume (LVEDV, starting time: estimate = - 0.191, p = 0.732; intervention time: estimate = - 0.033, p = 0.160), left ventricular end-systolic volume (LVESV, starting time: estimate = - 0.301, p = 0.464; intervention time: estimate = 0.015, p = 0.368) and 6-minute walk test (6MWT, starting time: estimate = - 0.108, p = 0.467; intervention time: estimate = 0.019, p = 0.116). CONCLUSION Implementation of CR following PCI in patients with AMI is beneficial. However, in AMI patients, there is no significant difference in the improvement of CR outcomes based on different CR starting times within 1 month after PCI or different durations of the CR programs. It indicates that it is feasible for patients with AMI to commence CR within 1 month after PCI and continue long-term CR, but the time factors which impact CR are intricate and further clinical research is still needed to determine the optimal initiation time and duration of CR.
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Affiliation(s)
- Peiyu Zhang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chaofeng Niu
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lijing Zhang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Haixia Lai
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Birong Liu
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Diyang Lv
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Rui Zhuang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Liu
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Di Xiao
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Liyong Ma
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Meng Li
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, Kaihoi B, Kopecky S, Krogman A, Leth S, Malik S, Marsteller J, Mathews L, Scales R, Schulte P, Shultz A, Taylor B, Thomas R, Wong N, Olson T. Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial. J Am Heart Assoc 2023; 12:e030883. [PMID: 38014699 PMCID: PMC10727355 DOI: 10.1161/jaha.123.030883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
- Center for Health Equity and Community Engagement ResearchMayo ClinicRochesterMN
| | - Helayna Abraham
- Department of Internal MedicineMayo Clinic College of MedicineRochesterMN
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Melvin Echols
- Department of Cardiovascular MedicineMorehouse School of MedicineAtlantaGA
| | - Michael Hall
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Karen Hodgman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Brian Kaihoi
- Global Products and ServicesMayo Clinic Center for InnovationRochesterMN
| | - Stephen Kopecky
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Ashton Krogman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shawn Leth
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shaista Malik
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Jill Marsteller
- Center for Health Services and Outcomes ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lena Mathews
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Robert Scales
- Department of Cardiovascular MedicineMayo Clinic College of MedicinePhoenixAZ
| | - Phillip Schulte
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Adam Shultz
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Bryan Taylor
- Department of Cardiovascular MedicineMayo Clinic College of MedicineJacksonvilleFL
| | - Randal Thomas
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Nathan Wong
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Thomas Olson
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
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Chimura M, Koba S, Sakata Y, Ise T, Miura H, Murai R, Suzuki H, Maekawa E, Kida K, Matsuo K, Kondo H, Takabayashi K, Fujimoto W, Tamura Y, Imai S, Miura SI, Origuchi H, Goda A, Saita R, Kikuchi A, Taniguchi T. Evaluation of the efficacy and safety of an integrated telerehabilitation platform for home-based cardiac REHABilitation in patients with heart failure (E-REHAB): protocol for a randomised controlled trial. BMJ Open 2023; 13:e073846. [PMID: 37620273 PMCID: PMC10450078 DOI: 10.1136/bmjopen-2023-073846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is strongly recommended as a medical treatment to improve the prognosis and quality of life of patients with heart failure (HF); however, participation rates in CR are low compared with other evidence-based treatments. One reason for this is the geographical distance between patients' homes and hospitals. To address this issue, we developed an integrated telerehabilitation platform, RH-01, for home-based CR. We hypothesised that using the RH-01 platform for home-based CR would demonstrate non-inferiority compared with traditional centre-based CR. METHODS AND ANALYSIS The E-REHAB trial aims to evaluate the efficacy and safety of RH-01 for home-based CR compared with traditional centre-based CR for patients with HF. This clinical trial will be conducted under a prospective, randomised, controlled and non-inferiority design with a primary focus on HF patients. Further, to assess the generalisability of the results in HF to other cardiovascular disease (CVD), the study will also include patients with other CVDs. The trial will enrol 108 patients with HF and 20 patients with other CVD. Eligible HF patients will be randomly assigned to either traditional centre-based CR or home-based CR in a 1:1 fashion. Patients with other CVDs will not be randomised, as safety assessment will be the primary focus. The intervention group will receive a 12-week programme conducted two or three times per week consisting of a remotely supervised home-based CR programme using RH-01, while the control group will receive a traditional centre-based CR programme. The primary endpoint of this trial is change in 6 min walk distance. ETHICS AND DISSEMINATION The conduct of the study has been approved by an institutional review board at each participating site, and all patients will provide written informed consent before entry. The report of the study will be disseminated via scientific fora, including peer-reviewed publications and presentations at conferences. TRIAL REGISTRATION NUMBER jRCT:2052200064.
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Affiliation(s)
- Misato Chimura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinji Koba
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Suzuki
- Department of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keisuke Kida
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Koki Matsuo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | | | | | - Wataru Fujimoto
- Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Yuichi Tamura
- Department of Cardiology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shunsuke Imai
- Department of Cardiology, Shinrakuen Hospital, Niigata, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hideki Origuchi
- Department of Cardiology, Japan Community Hearlthcare Organization, Kyushu Hospital, Kitakyushu, Japan
| | - Akiko Goda
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center, Nishinomiya, Japan
| | - Ryotaro Saita
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
- Remohab Inc, Osaka, Japan
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