Evaluation of an mHealth-Based Adjunct to Outpatient Cardiac Rehabilitation

Abstract

A pilot study was conducted to determine if a smartphone-based adjunct to standard care could increase the completion rate of a cardiac rehabilitation program (CRP). Based on historical completion rates, 66 participants who were about to commence a hospital-based CRP were randomized so that half received three devices embedded with near-field communication, namely, a smartphone [pre-installed with an application (app) designed specifically for cardiac rehabilitation], portable blood pressure monitor, and weight scale while completing the CRP. The completion rate among participants who were randomized to the intervention group was 88%, compared to 67% in the control group ( = 0.038). This combined with the week-to-week frequency with which participants in the intervention group measured their blood pressure ( 5/week) demonstrated the ability of the intervention to increase the proportion of patients who completed the CRP. No significant differences were found between the treatment groups for the measurements taken at baseline and prior to discharge from the CRP. A statistically significant correlation ( = 0.472; = 0.013) was found between the average time participants walked each day (as estimated via the smartphone app) and participants' six minute walking distance (6MWD) before they were discharged from the CRP (a clinically validated measurement).

Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis

“…Del Rosario et al [ 33 ] randomized patients undergoing home-based or hospital-based CR for the first time to receive a sphygmomanometer and weighing scale that could transmit data via a mobile phone using near field communication technology as an adjunct to standard CR or standard CR alone. The authors noted an improvement in CR completion rates within the intervention arm (27/33, 88% vs 20/33, 67%; P =.04).…”

The effect of mobile applications for improving adherence in cardiac rehabilitation: a systematic review and meta-analysis

“…A total of four studies were evaluated in meta-analysis. The selected studies were from three different types: four randomized controlled trials/studies [25–27, 29], three non-controlled before-after studies [22–24] and one controlled before-after study [28]. When all studies were considered together, a total of 506 participants were evaluated.…”

“…2, the quality of four RCTs [25–27, 29] were summarized by using the Cochrane’s risk of bias table of Review Manager 5.2. Further, a total of four studies [25–27, 29] correctly reported the generation of random sequences and only one study [27] explicitly mentioned that the allocation was concealed. Participants were blinded in three of the selected studies [26, 27, 29].…”

“…Participants were blinded in three of the selected studies [26, 27, 29]. However, one study [25] could not be conducted with perfect blinding. Moreover, three studies [25, 27, 29] did not report whether the outcomes were affected due to the blindness of the participants and only one study [26] reported that the outcome was not affected at all by the lack of blindness.…”

“…Moreover, three studies [25, 27, 29] did not report whether the outcomes were affected due to the blindness of the participants and only one study [26] reported that the outcome was not affected at all by the lack of blindness. It was also documented that the integrity of the outcomes was low risk in two studies [25, 27], unclear in one study [29] and high risk in one study [26]. Additionally, for reporting bias, four studies [25–27, 29] were assessed as unclear on the presence of bias.

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