Less than 25% of eligible patients attend cardiac rehabilitation programs (CRP), with geographical proximity being a predominant barrier. Therefore, we undertook a pilot study to assess the feasibility and safety of using the Internet as a medium for delivery of an interactive "virtual" CRP (vCRP) to patients at a distance. Fifteen patients on the waiting list for a local hospital-based CRP were randomized to either an Internet-based vCRP or observational control. The vCRP consisted of on-line intake forms, one-on-one chat sessions with a nurse, dietitian, and exercise specialist, downloadable exercise heart rate monitoring, education and data monitoring of blood pressure, weight, and glucose. Participants were assessed for exercise capacity, risk factors, and lifestyle behaviors at baseline and at 12 weeks. Those in the vCRP logged onto the Internet-based CRP an average of 4.2 times per week. There were no adverse events in the vCRP participants. The vCRP group significantly improved their HDL-C, triglycerides, total cholesterol:HDL-C ratio, exercise capacity as assessed in metabolic equivalents, weekly physical activity, and exercise specific self-efficacy (p < 0.05). There were no significant improvements in the control group. Improvements in the vCRP group were similar to historical controls in a standard CRP. Feedback from exit interviews of the vCRP participants was unanimously positive. This Internet-based CRP resulted in clinically significant improvements in risk factors and exercise capacity similar to that of a standard CRP. The high user acceptance indicated that this program may have the potential to effectively manage patients who do not have access to traditional hospital-based CRP.
Medical care of complex patients may be delivered in a single combined specialty clinic as compared to multiple disease specific clinics without compromising patient care or important health outcomes, with demonstrable outpatient costs savings.
Overall, the STOP-D performs very well when compared with other longer and validated measures. The STOP-D is a 5-item self-report measure, which provides severity scores for: depression, anxiety, stress, anger, and poor social support. The STOP-D is self-administered and takes between 1 and 2 minutes to fill out, gives valid severity scores on 5 key areas of psychological distress (depression, anxiety, stress, anger, and poor social support), requires no scoring, and is free to use.
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