Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation

Brouwers, R. W. M.; Exel, Henk J. van; Hal, J M C van; Jørstad, Harald T; Kluiver, Ed P de; Kraaijenhagen, Roderik A.; Kuijpers, Petra; Linde, M. R. van der; Spee, Ruud F.; Sunamura, Madoka; Uszko-Lencer, Nicole H.M.K.; Vromen, Tom; Wittekoek, M. E.; Kemps, Hareld

doi:10.1007/s12471-020-01432-y

Cited by 66 publications

(58 citation statements)

References 51 publications

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“…Taken together our results support that telerehabilitation is a viable alternative or supplement to conventional rehabilitation, as it supports patient motivation. As such, our results are in line with the general consensus in the literature stating that TR is a well-accepted, safe, and effective alternative or supplement to CR ( Anderson et al, 2017 ; Brouwers et al, 2020 ; Frederix et al, 2015 ; Piotrowicz, 2017 ; Spindler et al, 2019 ).…”

Section: Discussionsupporting

confidence: 90%

“…Telerehabilitation (TR) is increasingly adopted as a means to overcome some of these barriers ( Brouwers et al, 2020 ; Knudsen et al, 2019 ). TR entails the delivery of rehabilitation via information and communication technologies over distance ( Brennan et al, 2010 ), and is used increasingly on a global scale, especially so during the COVID-19 pandemic.…”

mentioning

confidence: 99%

“…TR entails the delivery of rehabilitation via information and communication technologies over distance ( Brennan et al, 2010 ), and is used increasingly on a global scale, especially so during the COVID-19 pandemic. Although studies are few, they all indicate that TR is effective, either as a stand-alone strategy, or combined with conventional rehabilitation (CR) ( Anderson et al, 2017 ; Brouwers et al, 2020 ; Frederix et al, 2015 ; Spindler et al, 2019 ). A recent review suggests that TR for patients with HF is well-accepted, safe, effective, and with high adherence ( Piotrowicz, 2017 ).…”

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confidence: 99%

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Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial

Spindler

Hollingdal²,

Refsgaard³

et al. 2021

Int J Telerehab

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Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation and addresses some of the barriers for participating in rehabilitation identified in the literature.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial

Spindler

Hollingdal²,

Refsgaard³

et al. 2021

Int J Telerehab

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“…TR is defined as rehabilitation using information and communication technologies for delivery of rehabilitation activities [13]. Reviews describing TR in cardiac patients highlight the findings that TR has been shown to be as effective as conventional rehabilitation [14,15]. A review of the literature showed no studies of TR programs for AF patients that included monitoring parameters such as electrocardiography (ECG), steps, sleep, blood pressure, pulse, and weight.…”

Section: Introductionmentioning

confidence: 99%

The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses

Dinesen¹,

Gade²,

Schacksen³

et al. 2021

JMIR Cardio

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Background Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. Objective The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. Methods This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients’ perspectives. Secondary outcomes were the development of patients’ knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. Results Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. Conclusions Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient–TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. Trial Registration ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437.

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“…The review article by Brouwers et al. in this issue outlines the numerous advantages of CTR [ 6 ]. As the authors point out, an initial centre-based introduction and evaluation appears appropriate, from both a safety and a psychological standpoint.…”

mentioning

confidence: 99%

Cardiac rehabilitation and telemedicine (and COVID-19)

Peters

2020

Neth Heart J

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Cardiac rehabilitation (CR) programmes reduce morbidity and mortality in cardiac patients, with effect sizes that are comparable to those of antiplatelet, lipid-lowering or blood pressure-lowering therapy. In addition, participation in CR programmes increases quality of life [1]. Current guidelines indicate a class 1A recommendation for CR [2,3].However, only a minority of cardiac patients participate in these programmes. This is related to limited capacity, to low referral rates (particularly in patients with chronic cardiac conditions) and to patient factors that include age, socioeconomic status and practical issues such as geographical distance [4]. Dropout from CR programmes is mainly related to these same factors. Dropout is associated with unfavourable outcomes, as reported by Sunamura et al. in this issue [5]. Premature termination of the CR programme represents a loss of benefits, a waste of resources and a waste of the limited capacity for CR. Patients who do complete a centre-based CR programme are commonly not offered follow-up coaching and support. Most programmes are limited to a duration of 12 weeks, after which a loss of effect on risk profiles and exercise capacity is to be expected.Cardiac telerehabilitation (CTR) has the potential to overcome several of the barriers and limitations of the current centre-based CR. Patient volumes may be significantly greater, travel issues (including costs and pollution) are avoided, coaching and support can be

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Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation

Cited by 66 publications

References 51 publications

Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial

Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial

The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses

Cardiac rehabilitation and telemedicine (and COVID-19)

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