Virtual Healthcare Solutions for Cardiac Rehabilitation: A Literature Review (Preprint)

2021 ◽  
Author(s):  
Keni Lee ◽  
Boris Breznen ◽  
Anastasia Ukhova ◽  
Friedrich Koehler ◽  
Seth S Martin
Keyword(s):  
Quality Of Life ◽  
Literature Review ◽  
Cardiac Rehabilitation ◽  
Systematic Reviews ◽  
Functional Capacity ◽  
Primary Outcome ◽  
Mobile Apps ◽  
Home Based ◽  
Wide Range

BACKGROUND In patients with cardiovascular disease, adherence to cardiac rehabilitation (CR) following a primary event has been demonstrated to improve overall health and quality of life, increase functional capacity, and decrease hospitalizations and mortality. Despite strong guideline recommendations, underutilization of CR remains a challenging problem in cardiovascular medicine, especially in underserved populations, who already have poorer health outcomes across a wide range of indicators. With the advent of new technologies such as wearable activity monitors (WAMs) or mobile apps running in smartphones and tablets (mHealth), healthcare professionals and researchers have looked at incorporating these and related technologies into novel home-based virtual CR programs to improve uptake and participation. OBJECTIVE This literature review summarizes the current state of the art in use of mHealth, WAMs, and other multi-component technologies deployed in support of home-based virtual CR. METHODS The methodology for this literature review was adapted from published guidance on methods for systematic literature reviews by Cochrane (Cochrane Handbook for Systematic Reviews of Interventions). Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. RESULTS The search identified a total of 2,094 records, of which 113 were eligible for qualitative analysis. A wide variety of virtual CR solutions were implemented in the 113 included studies, (1) multi-component interventions with multiple technologies integrated into a comprehensive CR solution in 48 studies (42.5%), (2) WAMs (e.g., Fitbit, Actigraph, Apple wristwatch) in 27 studies (23.9%), (3) web-based communications solutions and (4) mobile apps running on smartphones and tablets (mHealth), both in 19 studies (16.4%). Functional capacity was the most frequently reported aggregate primary outcome category (k=37, 32.7%), followed by user adherence/compliance (k=35, 31.0%), physical activity (k=27, 23.9%), and quality of life (k=14, 12.4%). Studies included in this review provided an overall mixed assessment of the efficacy of virtual CR in either attaining significant improvements over baseline, or in attaining significant improvements in outcomes compared with conventional hospital-based cardiac rehabilitation. Less than half of the included studies—47 out of 113 (41.6%)—reported a significant result for a primary outcome. A total of sixteen studies reported significant between-group improvements in primary outcomes of virtual CR vs. usual hospital-based CR; nine of these were studies utilizing multi-component interventions, six used mHealth and one reported on use of WAMs. CONCLUSIONS Efficacy outcomes with virtual CR sometimes, but not always, improve on the center-based CR outcomes, however, superior clinical efficacy may not necessarily be the only outcome of interest. The promise of virtual CR includes the potential for increased user adherence and longer-term patient engagement. If virtual CR solutions can improve adherence/compliance of cardiac patients, that would be a significant justification for using this technology.

scholarly journals Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Niramayee V. Prabhu ◽  
Arun G. Maiya ◽  
Nivedita S. Prabhu
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
Coronary Revascularization ◽  
Activity Levels ◽  
Home Based ◽  
Related Quality ◽  
Health Related

Background. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. These outcomes are paramount in predicting morbidity and mortality after these procedures. Cardiac rehabilitation (CR) focuses on incrementing cardiovascular endurance, exercise capacity, muscle strength, levels of physical activity, and quality of life through health education and lifestyle modification in post-coronary revascularization patients. Objective. To review the impact of cardiac rehabilitation on functional capacity, levels of physical activity, and health related quality of life in patients following coronary revascularization. Methods. A structured literature search in PubMed, Scopus, CINAHL, and ProQuest for studies focused on CR and its effects on functional capacity, physical activity, and quality of life after coronary revascularization. Results. A total of 2,010 studies were retrieved. Deduplication and eligibility screening included 190 studies after the application of filters. A sum of 21 studies were considered for this review. Most studies reported that exercise and physical activity programs were centre-based and home-based and via telerehabilitation. Treadmill and cycle ergometry training with callisthenics and flexibility exercises in phase 2 CR exhibited significant improvement in functional capacity and physical activity levels in patients after coronary revascularization procedures. Conclusion. Although centre-based supervised CR programs do improve functional capacity after coronary revascularization, home-based or telerehabilitation-based CR programs are feasible, improve patient compliance in improving physical activity, and thereby increase functional capacity. Patient education improves levels of physical activity, health related quality of life, and adherence to home- and centre-based CR programs.

scholarly journals Effect of mobile guided cardiac rehabilitation on quality of life – the EU-CaRE randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Houben ◽  
J.A Snoek ◽  
E Prescott ◽  
N Mikkelsen ◽  
A.E Van Der Velde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Control Group ◽  
Funding Source ◽  
Multi Centre Study ◽  
Old Patients ◽  
Home Based ◽  
Significant Difference

Abstract Background and purpose Although participation in cardiac rehabilitation (CR) improves quality of life (QoL), participation in CR, especially among elderly, is limited. We conducted this study to assess whether mobile home-based CR (mCR) increases QoL in elderly (≥65 years old) patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional CR. Methods It is designed as a randomised multi-centre study with two parallel arms. Randomisation assigned patients either to mCR or a control group. mCR Consisted of six months of home-based CR with telemonitoring and coaching. Control-group patients did not receive any form of CR throughout the study period. Quality of life was measured with the SF-36v2 questionnaire at 0, 6 and 12 months. Results A total of 179 patients were included in this study (90 control, 89 mCR). A flowchart of the trial is presented in Figure 1. Patients were predominantly male (81.1%). Baseline characteristics can be found in Table 1. Patients using mCR improved on physical QoL after 6 (p=0.026) and 12 (p=0.008) months. There was no difference on mental QoL for both groups (mCR 6 months p=0.563, 12 months p=0.945; control 6 months p=0.589, 12 months p=0.542). No difference existed in QoL between the mCR and control group (physical: 6 months p=0.070, 12 months p=0.150; mental: 6 months p=0.355, 12 months p=0.625). Conclusion Although there is no significant difference in QoL between the control and mCR group, mCR increases physical QoL after 6 and 12 months in elderly patients who decline participation in conventional CR. Therefore E-Health tools should be considered as an alternative for conventional CR when (elderly) patients decline to participate in conventional CR. Figure 1. Flow chart of all eligible patients Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme

scholarly journals Physical Activity and Sport for Acquired Brain Injury (PASABI): A Non-Randomized Controlled Trial

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 122
Author(s):  
Marta Pérez-Rodríguez ◽  
Saleky García-Gómez ◽  
Javier Coterón ◽  
Juan José García-Hernández ◽  
Javier Pérez-Tejero
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Brain Injury ◽  
Functional Capacity ◽  
Intervention Group ◽  
Chronic Phase ◽  
Acquired Brain Injury ◽  
Control Group ◽  
Wide Range

Background and objectives: Acquired brain injury (ABI) is the first cause of disability and physical activity (PA) is a key element in functional recovery and health-related quality of life (HRQoL) during the subacute and chronic phases. However, it is necessary to develop PA programs that respond to the heterogeneity and needs of this population. The aim of this study was to assess the effectiveness of a PA program on the HRQoL in this population. Materials and Methods: With regard to recruitment, after baseline evaluations, participants were assigned to either the intervention group (IG, n = 38) or the control group (CG, n = 35). Functional capacity, mood, quality of life and depression were measured pre- and post-intervention. The IG underwent the “Physical Activity and Sport for Acquired Brain Injury” (PASABI) program, which was designed to improve HRQoL (1-h sessions, two to four sessions/week for 18 weeks). The CG underwent a standard rehabilitation program without PA. Results: Results for the IG indicated significant differences and large effect sizes for the physical and mental dimensions of quality of life, as well as mood and functional capacity, indicating an increase in HRQoL. No significant differences were found for the CG across any variables. Conclusions: The PASABI program was feasible and beneficial for improving physiological and functionality variables in the IG. The wide range of the activities of the PASABI program allow its application to a large number of people with ABI, promoting health through PA, especially in the chronic phase.

scholarly journals Evaluating measures of quality of life in adult scoliosis: a protocol for a systematic review and narrative synthesis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
James E. Archer ◽  
Charles Baird ◽  
Adrian Gardner ◽  
Alison B. Rushton ◽  
Nicola R. Heneghan
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Outcome Measures ◽  
Study Design ◽  
Systematic Reviews ◽  
Primary Outcome ◽  
Adult Scoliosis ◽  
Measurement Properties ◽  
Narrative Synthesis

Abstract Background Adult scoliosis represents a distinct subgroup of scoliosis patients for whom the diagnosis can have a large impact on their health-related quality of life (HR-QOL). Therefore, HR-QOL patient-reported outcome measures (PROMs) are essential to assess disease progression and the impact of interventions. The objective of this systematic review is to evaluate the measurement properties of HR-QOL PROMs in adult scoliosis patients. Methods We will conduct a literature search, from their inception onwards, of multiple electronic databases including AMED, CINAHL, EMBASE, Medline, PsychINFO and PubMed. The searches will be performed in two stages. For both stages of the search, participants will be aged 18 and over with a diagnosis of scoliosis. The primary outcome of interest in the stage one searches will be studies which use PROMs to investigate HR-QOL as defined by the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy, the secondary outcome will be to assess the frequency of use of the various PROMs. In stage two, the primary outcome of interest will be studies which assess the measurement properties of the HR-QOL PROMs identified in stage one. No specific measurement property will be given priority. No planned secondary outcomes have been identified but will be reported if discovered. In stage one, the only restriction on study design will be the exclusion of systematic reviews. In Stage two the only restriction on study design will be the exclusion of full-text articles not available in the English language. Two reviewers will independently screen all citations and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or risk of bias) will be appraised using the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist. The overall strength of the body of evidence will then be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A narrative synthesis will be provided with information presented in the main text and tables to summarise and explain the characteristics and findings of the included studies. The narrative synthesis will explore the evidence for currently used PROMs in adult scoliosis patients and any areas that require further study. Discussion The review will help clinicians and researchers identify a HR-QOL PROM for use in patients with adult scoliosis. Findings from the review will be published and disseminated through a peer-reviewed journal and conference presentations. Systematic review registration This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), reference number: CRD42020219437

scholarly journals A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence

2010 ◽  
Vol 12 (2) ◽  
pp. 164-171 ◽  
Author(s):  
Ewa Piotrowicz ◽  
Rafał Baranowski ◽  
Maria Bilinska ◽  
Monika Stepnowska ◽  
Malgorzata Piotrowska ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
New Model ◽  
Home Based ◽  
Patients With Heart Failure

P6215Limited functional capacity and physical activity associated with patient withdrawals from cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Ding ◽  
M Gonzalez-Garcia ◽  
M Varnfield ◽  
A Krumins ◽  
Y Martin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Cardiac Rehabilitation ◽  
Functional Capacity ◽  
The Body ◽  
Analysis Of Covariance ◽  
Exact Test ◽  
Related Quality ◽  
Age And Sex

Abstract Background Cardiac rehabilitation (CR) assists patients with cardiovascular disease (CVD) in improving physical activity and effectively managing their health conditions. With numerous clinical benefits including reduced risks of mortality (by 25%) and all-cause hospitalizations (by 18% - 25%), CR has been strongly recommended by evidence-based clinical guidelines for secondary prevention of CVD. However, many CR participant withdraw and hence fail to fully benefit from their CR programme. To address this issue, knowledge on risk stratification of patients' characteristics to appropriate CR care pathways is important. Purpose The purpose of this study is to identify clinical baseline characteristics associated with patients who withdraw from a CR programme. Methods We retrospectively analysed patients who participated in the centre-based CR programmes of a research study in Queensland, Australia. The CR programmes provided structured sessions (training and education) once or twice a week for six weeks in community care centres. We compared the patients who withdrew from their CR programme (Group-W) with those who did not withdraw (or simply completion) (Group-C). Withdrawal was defined as discontinuing within the first four weeks of the CR programme. In the comparison, the one-way analysis of variance (ANOVA) and Fisher's exact test were used for analysing age and sex respectively. The analysis of covariance (ANCOVA) with an adjustment for age and sex was used for the body mass index (BMI), six-minute walk test (6WMT), and health-related quality of life (HeartQoL, ESC 2012), comprising physical (HeartQoL-Phy), emotional (HeartQoL-Emo), and global (HeartQoL-Glo) subscales. The study was approved by the Human Research Ethics Committee (Reference: HREC/16/QPAH/636). Results From Dec 2016 to Dec 2017, 600 outpatients with CVD were consented, and enrolled in the study. Seventy participants withdrew. Between the two groups (Group-W vs Group-C), no significant differences were found in age (64±12 years vs 65±10 years; p=0.4221), sex (Female, 31% vs 25%; p=0.2461) and BMI (30.5±6.2 vs 30.1±11.2; p=0.8211). The 6MWT distance was significantly lower in Group-W than Group-C (346±103 m vs 394±92 m; p=0.001). Significantly lower scores of HeartQoL-Phy (1.66±0.86 vs 1.93±0.74; p=0.0072) and HeartQoL-Glo scores (1.80±0.78 vs 2.02±0.67; p=0.0205) were found in Group-W. HeartQoL-Emo scores were lower in Group-W but the difference was not significant (2.19±0.73 vs 2.28±0.72; p=0.4550). Conclusions The levels of functional capacity measured by 6MWT and physical activity related quality of life were found to be significantly lower in withdrawal patients than those who completed their CR programme. The finding indicates that new care strategies, especially for patients with limited functional capacity and physical activity, are needed to improve the adherence and effectiveness of CR intervention in future studies. Acknowledgement/Funding CSIRO and Metro South Health

scholarly journals NEW MODEL OF HOME-BASED TELE-ECG-MONITORED CARDIAC REHABILITATION IN PATIENTS WITH HEART FAILURE: EFFECTIVENESS, QUALITY OF LIFE, SAFETY, AND ADHERENCE

2010 ◽  
Vol 55 (10) ◽  
pp. A29.E279
Author(s):  
Ewa Piotrowicz ◽  
Rafał Baranowski ◽  
Maria Bilińska ◽  
Monika Stepnowska ◽  
Małgorzata Piotrowska ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Life Safety ◽  
New Model ◽  
Home Based ◽  
Patients With Heart Failure

scholarly journals Exercise and Cognitive Training Intervention Improves Self-Care, Quality of Life and Functional Capacity in Persons With Heart Failure

2020 ◽  
pp. 073346482096433
Author(s):  
Rebecca A. Gary ◽  
Sudeshna Paul ◽  
Elizabeth Corwin ◽  
Brittany Butts ◽  
Andrew H. Miller ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Cognitive Training ◽  
Functional Capacity ◽  
Kansas City ◽  
Self Care ◽  
Optimal Dose ◽  
Care Quality ◽  
Home Based

This study evaluated a 12-week, home-based combined aerobic exercise (walking) and computerized cognitive training (EX/CCT) program on heart failure (HF) self-care behaviors (Self-care of HF Index [SCHFI]), disease specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity (6-minute walk distance) compared to exercise only (EX) or a usual care attention control (AC) stretching and flexibility program. Participants ( N = 69) were older, predominately female (54%) and African American (55%). There was significant improvement in self-care management, F(2, 13) = 5.7, p < .016; KCCQ physical limitation subscale, F(2, 52) = 3.4, p < .039; and functional capacity (336 ± 18 vs 388 ± 20 m, p < .05) among the EX/CCT participants. The underlying mechanisms that EX and CCT targets and the optimal dose that leads to improved outcomes are needed to design effective interventions for this rapidly growing population.

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