eHealth for maintenance cardiovascular rehabilitation: a systematic review and meta-analysis

Abstract

Aims To provide a quantitative analysis of eHealth-supported interventions on health outcomes in cardiovascular rehabilitation (CR) maintenance (phase III) in patients with coronary artery disease (CAD) and to identify effective behavioral change techniques (BCTs). Methods A systematic review was conducted (PubMed, CINAHL, MEDLINE, Web of Science) to summarize and synthesize the effects of eHealth in phase III maintenance on health outcomes including physical activity (PA) and exercise capacity, quality of life (QoL), mental health, self-efficacy, clinical variables, and events/rehospitalization. A meta-analysis following the Cochrane Collaboration guidelines using Review Manager (RevMan5.4) was performed. Analyses were conducted differentiating between short-term (≤6 months) and medium/long-term effects (>6 months). BCTs were defined based on the described intervention and coded according to the BCT handbook. Results Fourteen eligible studies (1,497 patients) were included. eHealth significantly promoted PA (SMD = 0.35; 95%CI 0.02­–0.70; p = 0.04) and exercise capacity after 6 months (SMD = 0.29; 95%CI 0.05–0.52; p = 0.02) compared to usual care. QoL was higher with eHealth compared to care as usual (SMD = 0.17; 95%CI 0.02–0.32; p = 0.02). Systolic blood pressure decreased after 6 months with eHealth compared to care as usual (SMD = -0.20; 95%CI -0.40–0,00; p = 0.046). There was substantial heterogeneity in the adapted BCTs and type of intervention. Mapping of BCTs revealed that self-monitoring of behavior and/or goal setting, as well as feedback on behavior were most frequently included. Conclusion eHealth in phase III CR is effective in stimulating PA and improving exercise capacity in patients with CAD, while increasing QoL and decreasing systolic blood pressure. Currently, data of eHealth effects on morbidity, mortality, and clinical outcomes are scarce and should be investigated in future studies. PROSPERO, CRD42020203578.

The state-of-the-art of eHealth self-management interventions for people with Chronic Obstructive Pulmonary Disease: a scoping review

“…This may simultaneously be valuable for informing future eHealth self-management initiatives as they can take into account these theories, techniques and processes in their developments. When looking at the literature, the lack of reporting on underlying theories was also prevalent in the review of Heimer et al (2023) [134] in which only three of the included studies reported speci c BCTs. Also, other studies encountered the problem of low reporting on BCTs, Hardeman et al (2008) [135] and Lorencatto et al (2013) [136] concluded that fewer than half of the planned BCTs were speci ed in the later published article.…”

Making it transparent: A worked example of articulating programme theory for a digital health application using Intervention Mapping

“…For example, in a recent systematic review of 14 randomised controlled trials (1497 patients), digital health interventions showed positive effects for promoting PA following completion of a cardiac rehabilitation programme (pooled effect size assessed as standardised mean difference (SMD) = 0.35; 95% confidence interval (CI) 0.02–0.70; p = 0.04). 9 Moreover, several systematic reviews support patient safety of digital health interventions in cardiac rehabilitation, for example the studies by Wongvibulsin et al 10 and Antoniou et al 11 However, it is notable that digital health interventions for CVD secondary prevention are typically very heterogeneous – including building blocks such as websites, text messages, wearable sensing devices, smartphone apps and virtual reality programmes – and little information is available on their underlying programme theory; that is, what intervention components are expected to lead to which changes. 9 This runs contrary to methodological recommendations and reporting guidelines for behaviour change interventions, such as the United Kingdom Medical Research Council's framework for developing and evaluating complex interventions, 12 the Template for Intervention Description and Replication (TIDieR) checklist, 13 the Workgroup for Intervention Development and Evaluation Research (WIDER) 14 and others.…”