Utilization of Smartphone Apps for improving physical function capacity in Cardiac Patient Rehabilitation: A Systematic Review. (Preprint)

Mapping Intimacies ◽

10.2196/preprints.21906 ◽

2020 ◽

Author(s):

Yulan Liang ◽

Arpad Kelemen ◽

Arpad Kelemen

Keyword(s):

Systematic Review ◽

Cardiac Rehabilitation ◽

Real Time ◽

Clinical Outcomes ◽

Cardiac Patients ◽

Current Evidence ◽

Smartphone Apps ◽

Smartphone Applications ◽

Published Evidence ◽

Depth Analysis

UNSTRUCTURED Cardiac rehabilitation (CR) is an evidence-based approach for preventing secondary cardiac events. Smartphone applications are starting to be used in cardiac rehabilitation to give patients real time feedback on their health, connect them remotely with their medical team, reduce the cost of cardiac rehabilitation, and allow them to perform their rehabilitation at home. The usage of smartphone apps is becoming ubiquitous and has real potential in impacting patients in need of CR. Currently, the published evidence is not strong enough to confirm that the usage of smartphone apps with CR can substantially improve clinical outcomes for cardiac patients. This paper provides critical summaries of existing research studies with an in-depth analysis of not only individual studies, but also the larger patterns that have emerged with smartphone application usage in CR as well as their significance for practice change. Results from this systematic review reveal that smartphone apps being used in cardiac rehabilitation have better clinical outcomes related to exercise capacity if the app auto-records information or provides real-time feedback for the participant to see their progress, compared to apps that only educate and encourage usage while making the participant manually log CR activities. Current evidence in the literature suggests nonhomogeneous results for successful usage of smartphone applications in CR. More clinical trials are needed that implement smartphone apps with bio- sensing capabilities, which can automatically log results and send results out to providers on a real-time dashboard. Future smartphone app research can focus on incorporating the observed successful components related to CR in order to best support cardiac patients for better patient outcomes, quality improvement, and increased patient safety.

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The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease—A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10040773 ◽

2021 ◽

Vol 10 (4) ◽

pp. 773

Author(s):

Wei-Ting Wu ◽

Tsung-Min Lee ◽

Der-Sheng Han ◽

Ke-Vin Chang

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Clinical Manifestations ◽

Current Evidence ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

Spine Disease

The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.

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The Atrial Fibrillation Better Care (ABC) pathway in atrial fibrillation: a systematic review and meta-analysis of 285,000 patients

EP Europace ◽

10.1093/europace/euab116.290 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

GF Romiti ◽

D Pastori ◽

JM Rivera-Caravaca ◽

WY Ding ◽

YX Gue ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Clinical Outcomes ◽

Major Bleeding ◽

Meta Analysis ◽

Random Effect ◽

Significant Proportion ◽

Cardiovascular Death ◽

Current Evidence ◽

Meta Regression

Abstract Funding Acknowledgements Type of funding sources: None. Background The ‘Atrial Fibrillation Better Care’ (ABC) pathway has been recently proposed as a holistic approach for the comprehensive management of patients with Atrial Fibrillation (AF), standing on three main pillars: ‘A’ Avoid stroke (with Anticoagulants); ‘B’ Better symptom management; ‘C’ Cardiovascular and Comorbidity management. The ABC pathway is now recommended in several clinical guidelines, including the recent European Society of Cardiology (ESC) AF management guidelines. We performed a systematic review of the current evidence for use of the ABC pathway on clinical outcomes. Methods We performed a systematic review and meta-analysis according to PRISMA Guidelines. Pubmed and EMBASE were searched for studies reporting the prevalence of ABC pathway adherent management in AF patients, and its impact on clinical outcomes (all-cause death, cardiovascular death, stroke, and major bleeding). Metanalysis of odds ratio (OR) was performed with random-effect models; subgroup analysis and meta-regression were performed to account for heterogeneity; a CHA2DS2-VASc-stratified sensitivity analysis was also performed. Results Among 2862 records retrieved from the literature search, 8 studies were included. The pooled prevalence of ABC adherent management was 21% (95% confidence intervals (CI), 13-34%), with a high grade of heterogeneity; in a multivariable meta-regression model, adherence to each criteria of the ABC pathway explained most part of the heterogeneity (R2 = 98.9%). Patients treated according to the ABC pathway showed a lower risk of all-cause death (OR:0.42, 95%CI 0.31-0.56), cardiovascular death (OR:0.37, 95%CI 0.23-0.58), stroke (OR:0.55, 95%CI 0.37-0.82) and major bleeding (OR:0.69, 95%CI 0.51-0.94), with moderate heterogeneity. Meta-regressions showed that the increasing prevalence of diabetes mellitus, coronary artery disease, chronic heart failure and history of stroke were associated with a reduced effectiveness of the ABC pathway for all-cause and cardiovascular death; each comorbidity was able to explain a significant proportion of heterogeneity at univariate meta-regression. Conversely, longer follow-up time was associated with more effectiveness of the ABC pathway for all outcomes. Adherence to ABC pathway was associated with a progressively greater reduction of the all-cause death risk amongst patients with higher CHA2DS2-VASc scores; no difference in ABC pathway effectiveness was found across CHA2DS2-VASc strata for CV death and stroke occurrence. Conclusions Adherence to the ABC pathway was suboptimal, being adopted in 1 in every 5 patients. Adherence to the ABC pathway was associated with a reduction in the risk of major adverse outcomes. Our data supports extensive application of the ABC pathway for the management of AF. Abstract Figure.

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Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

Journal of Medical Internet Research ◽

10.2196/18636 ◽

2020 ◽

Vol 22 (6) ◽

pp. e18636 ◽

Cited By ~ 4

Author(s):

Jobbe P L Leenen ◽

Crista Leerentveld ◽

Joris D van Dijk ◽

Henderik L van Westreenen ◽

Lisette Schoonhoven ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Clinical Outcomes ◽

Health Care Professionals ◽

Continuous Monitoring ◽

Vital Signs ◽

Current Evidence ◽

Cochrane Central Register ◽

Wireless Devices

Background Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. Objective The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. Methods A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. Results In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. Conclusions Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.

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Are Clinical Outcomes Associated With Medication Regimen Complexity? A Systematic Review and Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/1060028019886846 ◽

2019 ◽

Vol 54 (4) ◽

pp. 301-313 ◽

Cited By ~ 4

Author(s):

Vanessa Alves-Conceição ◽

Kérilin Stancine Santos Rocha ◽

Fernanda Vilanova Nascimento Silva ◽

Rafaella de Oliveira Santos Silva ◽

Sabrina Cerqueira-Santos ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Clinical Outcomes ◽

Meta Analysis ◽

Case Control ◽

Current Evidence ◽

Medication Regimen ◽

Medication Regimen Complexity ◽

Complexity Index ◽

Regimen Complexity

Background: Current evidence of the influence of the medication regimen complexity (MRC) on the patients’ clinical outcomes are not conclusive. Objective: To systematically and analytically assess the association between MRC measured by the Medication Regimen Complexity Index (MRCI) and clinical outcomes. Methods: A search was carried out in the databases Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis, and Web of Science to identify studies evaluating the association between MRC and clinical outcomes that were published from January 1, 2004, to April 2, 2018. The search terms included outcome assessment, drug therapy, and medication regimen complexity index and their synonyms in different combinations for case-control and cohort studies that used the MRCI to measure MRC and related the MRCI with clinical outcomes. Odds ratios (ORs), hazard ratios (HRs), and mean differences (WMDs) were calculated, and heterogeneity was assessed using the I2 test. Results: A total of 12 studies met the eligibility criteria. The meta-analysis showed that MRC is associated with the following clinical outcomes: hospitalization (HR = 1.20; 95% CI = 1.14 to 1.27; I2 = 0%) in cohort studies, hospital readmissions (WMD = 7.72; 95% CI = 1.19 to 14.25; I2 = 84%) in case-control studies, and medication nonadherence (adjusted OR = 1.05; 95% CI = 1.02 to 1.07; I2 = 0%) in cohort studies. Conclusion and Relevance: This systematic review and meta-analysis gathered relevant scientific evidence and quantified the combined estimates to show the association of MRC with clinical outcomes: hospitalization, hospital readmission, and medication adherence.

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The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review

Hand ◽

10.1177/1558944717735945 ◽

2017 ◽

Vol 13 (5) ◽

pp. 509-515 ◽

Cited By ~ 4

Author(s):

Jessica L. Truong ◽

Chris Doherty ◽

Nina Suh

Keyword(s):

Systematic Review ◽

Socioeconomic Factors ◽

Clinical Outcomes ◽

Distal Radius ◽

Full Text ◽

Distal Radius Fractures ◽

Quality Analysis ◽

Current Evidence ◽

Radius Fractures ◽

Full Text Screening

Background: Socioeconomic factors are known to affect outcomes for both medical and surgical conditions. The purpose of this systematic review was to assess the current evidence regarding the effect of socioeconomic factors such as income, geographic location, educational level, and occupation on clinical outcomes after distal radius fractures. Methods: A systematic search strategy was performed to identify studies commenting on the effect of socioeconomic factors on clinical outcomes following open or closed distal radius fracture repair. Abstract and full-text screening was performed by 2 independent reviewers, and articles were evaluated by Structured Effectiveness Quality Evaluation Scale (SEQES). Treatment outcomes of interest included, but were not limited to, pain, function, range of motion, and grip strength. Results: There were 1745 studies that met our inclusion and exclusion criteria for abstract screening. Of these, 48 studies met our inclusion criteria for full-text screening and 20 studies met our criteria for quality analysis with the SEQES score. There were 3 studies of high quality, 16 of moderate quality, and 1 of low quality. Meta-analyses were not possible due to the variability in outcomes of interest across papers. Conclusions: Patient factors indicative of socioeconomic status are relevant predictors of functional outcome after distal radius fractures. There is currently limited evidence in this area of research, and further examination should be considered to improve outcomes from a patient and system standpoint.

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Current evidence for anesthesia management during endovascular stroke therapy: updated systematic review and meta-analysis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013916 ◽

2018 ◽

Vol 11 (2) ◽

pp. 107-113 ◽

Cited By ~ 4

Author(s):

Nitin Goyal ◽

Konark Malhotra ◽

Muhammad F Ishfaq ◽

Georgios Tsivgoulis ◽

Christopher Nickele ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Anesthetic Management ◽

Functional Independence ◽

Sensitivity Analyses ◽

Current Evidence ◽

Vessel Occlusion ◽

Random Effects Models ◽

Randomized Studies

IntroductionDebate continues about the optimal anesthetic management for patients undergoing endovascular treatment (ET) of acute ischemic stroke due to emergent large vessel occlusion.ObjectiveTo compare, using current evidence, the clinical outcomes and procedural characteristics among patients undergoing general anesthesia (GA) and local or monitored anesthesia (non-GA).MethodsWe performed a systematic review and meta-analysis of all available studies that involved the use of stent retrievers for ET (stentriever group). Additionally, we included studies that were published in 2015 and later, and compared the clinical outcomes among the studies using stentrievers or no stentrievers (pre-stentriever group). Outcome variables included functional independence (FI; modified Rankin Scale scores of 0–2), symptomatic hemorrhage, mortality, procedure duration, and vascular and respiratory complications. We calculated pooled odds ratios and 95% CIs using random-effects models.ResultsSixteen studies (three randomized controlled clinical trials (RCTs) and 13 non-randomized studies) were identified comprising 5836 patients. Although non-GA was associated with higher odds of 3-month FI (OR=1.57; 95% CI 1.17 to 2.10; P=0.003) and lower odds of 3-month mortality (OR=0.62; 95% CI 0.47 to 0.82; P=0.0006, substantial heterogeneity was noted across included trials. Sensitivity analyses of RCTs showed that non-GA was inversely associated with FI (OR=0.55; 95% CI 0.34 to 0.89; P=0.01; I2=15%), while no association was noted with mortality (OR=1.36; 95% CI 0.79 to 2.34; P=0.27; I2=0%).ConclusionOur updated meta-analysis demonstrates favorable results with non-GA, probably owing to inclusion of non-randomized studies. Recent single-center RCTs indicate that GA is associated with higher odds of FI at 3 months, while other outcomes are similar between the two groups.

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Using Smartphone Applications to Manage Chronic Conditions in Older Adults – A Review on Level of Evidence

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v5i4.347 ◽

2021 ◽

Vol 5 (4) ◽

pp. 381

Author(s):

Shaorin Tanira

Keyword(s):

Older Adults ◽

Mobile Phone ◽

Behaviour Change ◽

Health Monitoring ◽

Chronic Conditions ◽

Mobile Technologies ◽

Current Evidence ◽

Smartphone Apps ◽

Smartphone Applications ◽

Level Of Evidence

Background: From health monitoring to health education and from behaviour change to falls sensing and health alerts to the simple pleasure of communication and connectedness, the mobile technologies (smartphone applications) are changing the lives of older adults.Objective: To examine current evidence of use of smartphones by older adults for health purposes (including communication, education, and health monitoring), and understand gaps and challenges in order to inform the design of future systems given the ubiquity of mobile phone technology.Methods: MEDLINE, CINAHL and Google scholar databases were searched from October 2016 to January 2017. Keywords used include ‘smartphone apps’, ‘mobile phone’, ‘chronic disease’, ‘chronic condition’, ‘older adults’ and ‘elderly’. A total of 12 articles were selected for quality assessment and grading of evidence.Results: Twelve different articles were found and categorized into nine different clinical domains with specific health related interventions. Articles were focused on diabetes care (2 articles), followed by COPD (2 articles), heart disease (1 article), Alzheimer’s/dementia Care (2 articles), osteoarthritis and pain management (1 article), fall prevention (1 article), colon cancer (1 article), palliative care (1 article), chronic kidney disease (1 article). Areas of interest studied included feasibility, acceptability, functionality and thereby determining their effectiveness. There were many different clinical domains; however, most of the studies were pilot studies. Current work in using mobile phones for older adult use are spread across a variety of clinical domains. Findings from different studies indicate that the use of mobile phone interventions has the potential to support successful management of chronic conditions and health behaviour change in older adults.Conclusion: Perceived benefits and willingness to use the smartphone apps are high; however, technical training and cost are main concerns. A common problem with elderly users was their reluctance to press buttons due to the fear of breaking something which has been resolved by touch screen technology of the smartphones. However, the advanced user clicked around the screen until he found what he was looking for, while the others spent a lot of time observing the screen and trying to determine the correct step. Promotion of user-friendly apps are expected especially for older adults having a diminished physical and cognitive abilities.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 381-387

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Paediatric cardiac rehabilitation in congenital heart disease: a systematic review

Cardiology in the Young ◽

10.1017/s1047951111002010 ◽

2012 ◽

Vol 22 (3) ◽

pp. 241-250 ◽

Cited By ~ 41

Author(s):

Ana Ubeda Tikkanen ◽

Ainhoa Rodriguez Oyaga ◽

Olga Arroyo Riaño ◽

Enrique Maroto Álvaro ◽

Jonathan Rhodes

Keyword(s):

Systematic Review ◽

Congenital Heart Disease ◽

Heart Disease ◽

Cardiac Rehabilitation ◽

Congenital Heart ◽

Survival Rates ◽

Cardiopulmonary Exercise Testing ◽

Current Evidence ◽

Cardiac Rehabilitation Programme ◽

Complex Needs

AbstractBackgroundAdvances in medical and surgical care have contributed to an important increase in the survival rates of children with congenital heart disease. However, survivors often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac Rehabilitation Programmes have been extensively studied in adults with acquired heart disease. In contrast, studies of children with congenital heart disease have been few and of limited scope. We therefore undertook a systematic review of the literature on cardiac rehabilitation in children with congenital heart disease to systematically assess the current evidence regarding the use, efficacy, benefits, and risks associated with this therapy and to identify the components of a successful programme.MethodsWe included studies that incorporated a cardiac rehabilitation programme with an exercise training component published between January, 1981 and November, 2010 in patients under 18 years of age.ResultsA total of 16 clinical studies were found and were the focus of this review. Heterogeneous methodology and variable quality was observed. Aerobic and resistance training was the core component of most studies. Diverse variables were used to quantify outcomes. No adverse events were reported.ConclusionsCardiac Rehabilitation Programmes in the paediatric population are greatly underutilised, and clinical research on this promising form of therapy has been limited. Questions remain regarding the optimal structure and efficacy of the programmes. The complex needs of this unique population also mandate that additional outcome measures, beyond serial cardiopulmonary exercise testing, be identified and studied.

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