scholarly journals Home-Based Cardiac Rehabilitation During COVID-19: A Qualitative Study

2021 ◽  
Author(s):  
Smitha Ganeshan ◽  
Crystal Tse ◽  
Alexis Beatty
Keyword(s):  
Cardiac Rehabilitation ◽  
Organizational Factors ◽  
Structured Interviews ◽  
Ongoing Research ◽  
Staff Members ◽  
Use Of Technology ◽  
Home Based ◽  
Mobile Phone Applications ◽  
Delivery Models

Abstract Background: Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity, and hospitalizations. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research.Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

scholarly journals A Qualitative Study of Home-Based and Hybrid Cardiac Rehabilitation During COVID-19

2021 ◽  
Author(s):  
Smitha Ganeshan ◽  
Crystal Tse ◽  
Alexis Beatty
Keyword(s):  
Cardiac Rehabilitation ◽  
Organizational Factors ◽  
Structured Interviews ◽  
Ongoing Research ◽  
Staff Members ◽  
Use Of Technology ◽  
Home Based ◽  
Mobile Phone Applications ◽  
Delivery Models

Abstract Background: Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications.Methods: Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research. Results: A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use.Conclusions: Individually tailored HBCR or hybrid CR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

Home-Based and Hybrid Cardiac Rehabilitation During COVID-19: A Qualitative Study (Preprint)

2021 ◽  
Author(s):  
Smitha Ganeshan ◽  
Crystal Tse ◽  
Alexis Beatty
Keyword(s):  
Cardiac Rehabilitation ◽  
Organizational Factors ◽  
Structured Interviews ◽  
Ongoing Research ◽  
Staff Members ◽  
Use Of Technology ◽  
Home Based ◽  
Mobile Phone Applications ◽  
Delivery Models

BACKGROUND Cardiac rehabilitation (CR) has been shown to reduce mortality, morbidity, and hospitalizations. Increasingly, digital tools have augmented the ease of delivering programs outside of the traditional rehabilitation center setting. Because of the need for distancing during the COVID-19 pandemic, many cardiac rehabilitation (CR) centers suspended in-person services and pivoted to home-based CR (HBCR). OBJECTIVE In this study, we qualitatively evaluated implementation of HBCR, which included weekly phone or video visits for individualized exercise plans, nutrition and health education counseling, wellness sessions, and optional mobile phone applications. METHODS Patient participants and staff members (physician, nurses, exercise physiologists, dietician, administrative staff) participated in semi-structured interviews. Two independent reviewers coded interview transcripts for emergent themes and pre-specified themes from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and the Consolidated Framework for Implementation Research. RESULTS A total of 12 patients and 7 staff were interviewed. Narrative descriptions highlighted the isolation, fear, and disruption of life activities during COVID-19. Key facilitators of the HBCR patient experience included strong relationships with staff who served as coaches and sources of accountability and the ability of HBCR to deliver an individually tailored experience within a patient’s home. Important organizational factors for implementation included leadership buy-in, culture of change, and support for staff. Though technology tools facilitated communication and accountability, not all participants embraced technology and some reported challenges with use. CONCLUSIONS Individually tailored HBCR can facilitate access for patients to participate outside of a CR center. Ongoing research is needed to understand the long-term outcomes of flexible delivery models that may include both in-person and remote visits, and the role of technology in these models.

scholarly journals COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients?

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Borges ◽  
M Lemos Pires ◽  
R Pinto ◽  
G De Sa ◽  
I Ricardo ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Cardiac Rehabilitation ◽  
Lean Mass ◽  
Lower Limb ◽  
Lower Limbs ◽  
Phase Iii ◽  
Face To Face ◽  
Home Based ◽  
Lower Limb Strength

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed. Purpose To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments. Methods 87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used. Results Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517). Conclusion After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.

Transitions in Technology Mediated Cardiac Rehabilitation and Self-management: A Qualitative Study using the Theoretical Domains Framework (Preprint)

2021 ◽  
Author(s):  
Shreya Tadas ◽  
Claudette Pretorius ◽  
Emma J. Foster ◽  
Trish Gorely ◽  
Stephen J. Leslie ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Self Management ◽  
Normal Life ◽  
Use Of Technology ◽  
Holistic Understanding ◽  
The Impact ◽  
Over Time

BACKGROUND An acute cardiac incident is a life changing event, often necessitating surgery. While surgery has high success rates, rehabilitation, behaviour change, and self-care are critical to long-term health. Recent systematic reviews highlight the potential of technology in this area, but significant shortcomings are also identified, particularly in regard to patient experience. OBJECTIVE To improve future systems this paper explores the experiences of cardiac patients during key phases post-hospitalisation: recuperation, initial rehabilitation and long term self-management. The key objective is to provide a holistic understanding of behavioural factors that impact people across these phases, understand how experiences evolve over time, and provide user-centred recommendations to improve the design of cardiac rehabilitation and self-management technologies. METHODS Semi-structured interviews were conducted with people who attended rehabilitation programs following hospitalisation for an acute cardiac event. Interviews were developed and data is analysed via the Theoretical Domains Framework (TDF), a pragmatic framework that synthesizes prior theories of behaviour change. RESULTS Three phases that arise post-hospitalisation are examined: recuperation, rehabilitation, and long-term self-management. Through these phases we describe the impact of key factors and important changes that occur in patients’ experiences over time, including: a desire for and redefinition of normal life; the need for different types of formal and informal knowledge; the benefits of safe-zoning and connectedness; and the need to recognise capability. The use of the TDF allows us to show how factors that influence behaviour evolve over time and identify potential sources of tension. CONCLUSIONS The paper provides empirically grounded recommendations for the design of technology-mediated cardiac rehabilitation and self-management systems. Key recommendations include the use of technology to support a normal life; leveraging social influences to extend participants’ sense of normality; the use of technology to provide a safe zone; the need to support both emotional and physical wellbeing; and a focus on recognizing capability and providing recommendations that are positive and reinforce this capability.

scholarly journals Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness?

2019 ◽  
Vol 27 (4) ◽  
pp. 367-377 ◽  
Author(s):  
Andrea Avila ◽  
Jomme Claes ◽  
Roselien Buys ◽  
May Azzawi ◽  
Luc Vanhees ◽  
...  
Keyword(s):  
Physical Activity ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Exercise Capacity ◽  
Phase Ii ◽  
Home Based ◽  
Artery Disease ◽  
One Year

Background Home-based interventions might facilitate the lifelong uptake of a physically active lifestyle following completion of a supervised phase II exercise-based cardiac rehabilitation. Yet, data on the long-term effectiveness of home-based exercise training on physical activity and exercise capacity are scarce. Objective The purpose of the TeleRehabilitation in Coronary Heart disease (TRiCH) study was to compare the long-term effects of a short home-based phase III exercise programme with telemonitoring guidance to a prolonged centre-based phase III programme in coronary artery disease patients. The primary outcome was exercise capacity. Secondary outcomes included physical activity behaviour, cardiovascular risk profile and health-related quality of life. Methods Ninety coronary artery disease patients (80 men) were randomly assigned to 3 months of home-based (30), centre-based (30) or a control group (30) on a 1:1:1 basis after completion of their phase II ambulatory cardiac rehabilitation programme. Outcome measures were assessed at discharge of the phase II programme and after one year. Results Eighty patients (72 (91%) men; mean age 62.6 years) completed the one-year follow-up measurements. Exercise capacity and secondary outcomes were preserved in all three groups ( Ptime > 0.05 for all), irrespective of the intervention ( Pinteraction > 0.05 for all). Eighty-five per cent of patients met the international guidelines for physical activity ( Ptime < 0.05). No interaction effect was found for physical activity. Conclusion Overall, exercise capacity remained stable during one year following phase II cardiac rehabilitation. Our home-based exercise intervention was as effective as centre-based and did not result in higher levels of exercise capacity and physical activity compared to the other two interventions. Trial registration ClinicalTrials.gov NCT02047942. https://clinicaltrials.gov/ct2/show/NCT02047942

An Investigation of the Usability Issues of Home-based Video Telemedicine Systems with Geriatric Patients

2016 ◽  
Vol 60 (1) ◽  
pp. 1804-1808 ◽  
Author(s):  
Shraddhaa Narasimha ◽  
Sruthy Agnisarman ◽  
Kapil Chalil Madathil ◽  
Anand K. Gramopadhye ◽  
Brandon Welch ◽  
...  
Keyword(s):  
Geriatric Patients ◽  
User Acceptance ◽  
Geriatric Population ◽  
Healthcare Needs ◽  
Use Of Technology ◽  
Home Based ◽  
Demographic Questionnaire ◽  
System Usability ◽  
Post Test

Telemedicine is the use of technology to provide and support healthcare when distance separates the clinical service and the patient. This system is rapidly replacing the conventional method of in-person clinical visits. More than seventy percent of the geriatric population is predicted to need long-term healthcare; telemedicine could potentially support their increased healthcare needs. However, for increased user acceptance, it is important to investigate the usability of telemedicine systems. This study aims to investigate the usability issues associated with geriatric patients using home-based video telemedicine systems. Four home-based video telemedicine systems were chosen for this study: (1) Doxy.me, (2) Polycom, (3) Vidyo and (4) VSee. Using a between-subjects experimental design, 20 participants were randomly assigned to one of these four conditions. They were asked to complete a demographic questionnaire, followed by the completion of representative tasks on the telemedicine platform. This is followed by a retrospective think-aloud session at the end of which, the participants completed a NASA-TLX workload survey, an IBM Computer System Usability Questionnaire (IBM-CSUQ), and a post-test subjective questionnaire. Issues faced by the participants include downloading application plug-ins, locating icons and the size of the icons.

Long-term functional outcomes after cardiac rehabilitation in older patients. Data from the Cardiac Rehabilitation in Advanced aGE: EXercise TRaining and Active follow-up (CR-AGE EXTRA) randomised study

2019 ◽  
Vol 26 (14) ◽  
pp. 1470-1478 ◽  
Author(s):  
Alessandra Pratesi ◽  
Samuele Baldasseroni ◽  
Costanza Burgisser ◽  
Francesco Orso ◽  
Riccardo Barucci ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Usual Care ◽  
Outcome Measures ◽  
Exercise Programme ◽  
Random Assignment ◽  
Cardiac Rehabilitation Programme ◽  
Randomised Study ◽  
Home Based

Aim Cardiac rehabilitation promotes functional recovery after cardiac events. Our study aimed at evaluating whether, compared to usual care, a home-based exercise programme with monthly reinforcement sessions adds long-term functional benefits to those obtained with cardiac rehabilitation in the elderly. Methods After a 4-week outpatient cardiac rehabilitation, 160 of 197 patients aged 75 years and older screened for eligibility with different indications for cardiac rehabilitation, were randomly assigned to a control (C) or an active treatment (T) group. During a 12-month follow-up, C patients received usual care, while T patients were prescribed a standardised set of home-based exercises with centre-based monthly reinforcements for the first 6 months. The main (peak oxygen consumption) and three secondary outcome measures (distance walked in 6 minutes, inferior limbs peak 90° Torque strength, health-related quality of life) were assessed at baseline, at random assignment and at 6 and 12-month follow-ups with the cardiopulmonary exercise test, 6-minute walking test, isokinetic dynamometer and the Short Form-36 questionnaire, respectively. Results Both C and T groups obtained a significant and similar improvement from baseline to the end of the 4-week cardiac rehabilitation programme in the three functional outcome measures. However, at univariable and age and gender-adjusted analysis of variance for repeated measures, changes from random assignment to 6 or 12-month follow-up in any outcome measure were similar in the C and T groups. Conclusion Results from this randomised study suggest that a home-based exercise programme with monthly reinforcements does not add any long-term functional benefit beyond those offered by a conventional, 4-week outpatient cardiac rehabilitation programme. Trial registration ClinicalTrial.gov Identifier: NCT00641134.

Different settings for cardiac rehabilitation

2020 ◽  
pp. 11-18
Author(s):  
Jean-Paul Schmid ◽  
Ugo Corrà
Keyword(s):  
Cardiac Rehabilitation ◽  
Health Related Quality ◽  
Clinical Events ◽  
Home Based ◽  
Related Quality ◽  
Health Related ◽  
Alternative Settings ◽  
The Impact

Cardiac rehabilitation (CR) has traditionally been viewed as a hospital-based intervention consisting of a multidisciplinary exercise-based programme, aimed at improving exercise capacity after an acute CV event or surgery and optimizing the CV risk profile. Because of various limitations on attendance at these programmes, in particular lack of availability or difficulties in accessibility, alternative settings for providing secondary preventive measures have been developed. Amongst them, home-based rehabilitation with or without telemonitoring has the potential to increase patient participation and support behavioural changes. This may be a reasonable option for selected clinically stable patients at low to moderate risk who are eligible for CR but cannot attend a traditional hospital- or centre-based CR programme. Although short-term improvements in functional capacity, health-related quality of life (HRQoL), and CV risk factor control are comparable in home-based and hospital- or centre-based CR, long-term studies of the impact of home-based CR on clinical events are still needed.

scholarly journals Role of smokers in the household and of cardiac rehabilitation in smoking behaviour after acute myocardial infarction

2005 ◽  
Vol 64 (2) ◽  
Author(s):  
Francesco Giallauria ◽  
Teresa Paragliola ◽  
Francesco Pilerci ◽  
Domenico Del Forno ◽  
Anna De Lorenzo ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Smoking Habit ◽  
Routine Care ◽  
Smoking Behaviour ◽  
Rehabilitation Program ◽  
Care Group ◽  
Behavioural Intervention ◽  
Home Based ◽  
Group A

Objects: This study aims to evaluate the influence of household smokers and of a prolonged, comprehensive home-based Cardiac Rehabilitation Program (CRP) on patient’s long term smoking behaviour after AMI. Methods: 164 male post-AMI patients, all smokers until the day of AMI, were subdivided into three groups: Group A (n=54): patients with recent AMI, discharged from hospital without enrolment in CRP; Group B (n=55): similar to Group A but enrolled in an 8 weeks hospital-based CRP and then discharged home with routine care; Group C (n=55) enrolled in an 8 weeks hospital-based CRP followed by a further 10 months of formal home-based CRP, with scheduled hospital follow-up visits. Results: Smoking resumption at 12 months was influenced by the presence of household smokers (HS): 38% of patients with HS resumed smoking compared to 27% of patients without HS (p &lt;0.01). Adherence to a CRP was inversely correlated to smoking resumption: there were fewer smoking patients at 12 months from AMI in Group C than in Groups A or B (11% in C vs. 29% and 55% in B and A, respectively, p &lt;0.001). Conclusions: Long term maintenance of CRP seems to be the best way to achieve a reduction of long term smoking habit and maintain adherence to prescription in patients after AMI. Counselling and behavioural intervention should also be extended to family members in order to maximize the benefit of secondary prevention.

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