Web-based cardiac<b>RE</b>habilitatio<b>N</b>alternative for those declining or dropping out of conventional rehabilitation: results of the WREN feasibility randomised controlled trial

Houchen-Wolloff, Linzy; Gardiner, Nikki; Devi, Reena; Robertson, Noelle; Jolly, Kate; Marshall, Tom; Furze, Gill; Doherty, Patrick; Szczepura, Ala; Powell, John; Singh, Sally

doi:10.1136/openhrt-2018-000860

Cited by 22 publications

(20 citation statements)

References 36 publications

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“…However, the mean HADS anxiety scores were significantly higher in more depressive patients compared to the lower level depression group patients with comorbid depression (− 5.17 — 95% CI -5.47 to − 4.87). This difference is relatively high given that HADS is scored out of 21 and this has not been seen in the most recent CR randomised controlled trial REACH HF and a feasibility randomised controlled trial WREN [ 38 , 39 ]. In contrast to other studies, this paper investigated comorbid anxiety, which was prevalent in 52.4% of participants with higher level depressive symptoms, and this association was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation

Sever

Golder

Doherty

2018

BMC Cardiovasc Disord

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BackgroundThe literature suggests that comorbid depression, defined in this paper as a history of depression prior to a cardiovascular event, has an impact on later onset depression as well as constituting increased risk of mortality and adverse cardiac events. However, which factors are associated with depression, specifically in patients with comorbid depression, is unclear. Therefore, this paper investigates the factors associated with depression in patients with comorbid depression attending cardiac rehabilitation (CR).MethodsThis observational study used routinely collected data from the British Heart Foundation National Audit of Cardiac Rehabilitation for the time period between April 2012 and March 2017. CR participants with comorbid depression were selected as the study population. An independent t-test and chi-square test were used to compare the association between acute depression symptoms and baseline characteristics in this population.ResultsA total of 2715 CR patients with comorbid depression were analysed. Characteristics associated with acute depressive symptoms in patients with comorbid depression were found to be: young age (MD: 2.71, 95% CI 1.91, 3.50), increased number of comorbidities (MD: -0.50, 95% CI -0.66, − 0.34), increased weight (MD: -1.94, 95% CI -3.35, − 0.52), high BMI (MD: -1.94, 95% CI -3.35, − 0.52), HADS anxiety (MD: -5.17, 95% CI -5.47, − 4.87), comorbid anxiety (52.4%, p < 0.001), physical inactivity (150 min moderate physical activity a week and 75 min vigorous exercise a week; 27.5%, p < 0.001; 5.6%, p < 0.001 respectively), smoking (12.7%, p < 0.001), and being less likely to be partnered (63.6%, p < 0.001).ConclusionThe study demonstrated the association between a variety of clinical and socio-demographic factors and depression. The findings of the research indicated that, at CR baseline assessment, caution must be taken with patients with comorbid depression, specifically those with higher level depressive symptoms at the start of rehabilitation. Furthermore, their multi-comorbid condition must also be taken into account. Patients with higher depression symptoms and comorbid depression scored five points higher on the HADS anxiety scale in comparison to patients with lower level depression symptoms at the start of CR, which demonstrated that anxiety and depression are interrelated and present together.

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Section: Discussionmentioning

confidence: 99%

Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation

Sever

Golder

Doherty

2018

BMC Cardiovasc Disord

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“…This was successfully tested in patients who turned down face-to-face rehabilitation. 48 A systematic review concluded that home-based interventions attained similar outcomes to centrebased models. 49 Of note, broader NHS initiatives to more widely utilise digital healthcare interventions and telemedicine recognise growing internet utilisation and confidence among older patients.…”

Section: Mode Of Deliverymentioning

confidence: 99%

Prehabilitation

2019

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In this article, we review the evidence underpinning the broader prehabilitation concept and the target behavioural and lifestyle risk factors including their perioperative impact and evidence for prehabilitation intervention. We also identify principles for delivering prehabilitation in practice, alongside lessons for the perioperative setting from well-established allied interventions; cardiac and pulmonary rehabilitation.

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“…Data demonstrated that users' exercise capacity and HR-QoL improved after completing the programme (22).…”

Section: New Models Of Rehabilitationmentioning

confidence: 98%

“…As an example, “Activate Your Heart” is a well-established digital cardiac rehabilitation programme and was evaluated in several different locations. Data demonstrated that users' exercise capacity and HR-QoL improved after completing the programme ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Scalable modEls of Community rehAbilitation for Individuals Recovering From COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol—“SeaCole Cohort Evaluation”

Kelly

Innes

Holl

et al. 2021

Front. Public Health

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Introduction: High levels of physical, cognitive, and psychosocial impairments are anticipated for those recovering from the COVID-19. In the UK, ~50% of survivors will require additional rehabilitation. Despite this, there is currently no evidence-based guideline available in England and Wales that addresses the identification, timing and nature of effective interventions to manage the morbidity associated following COVID-19. It is now timely to accelerate the development and evaluation of a rehabilitation service to support patients and healthcare services. Nuffield Health have responded by configuring a scalable rehabilitation pathway addressing the immediate requirements for those recovering from COVID-19 in the community.Methods and Analysis: This long-term evaluation will examine the effectiveness of a 12-week community rehabilitation programme for COVID-19 patients who have been discharged following in-patient treatment. Consisting of two distinct 6-week phases; Phase 1 is an entirely remote service, delivered via digital applications. Phase 2 sees the same patients transition into a gym-based setting for supervised group-based rehabilitation. Trained rehabilitation specialists will coach patients across areas such as goal setting, exercise prescription, symptom management and emotional well-being. Outcomes will be collected at 0, 6, and 12 weeks and at 6- and 12-months. Primary outcome measures will assess changes in health-related quality of life (HR-QOL) and COVID-19 symptoms using EuroQol Five Dimension Five Level Version (EQ-5D-5L) and Dyspnea-12, respectively. Secondary outcome measures of the Duke Activity Status Questionnaire (DASI), 30 s sit to stand test, General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Patient Experience Questionnaire (PEQ) and Quality Adjusted Life Years (QALY) will allow for the evaluation of outcomes, mediators and moderators of outcome, and cost-effectiveness of treatment.Discussion: This evaluation will investigate the immediate and long-term impact, as well as the cost effectiveness of a blended rehabilitation programme for COVID-19 survivors. This evaluation will provide a founding contribution to the literature, evaluating one of the first programmes of this type in the UK. The evaluation has international relevance, with the potential to show how a new model of service provision can support health services in the wake of COVID-19.Trial Registration: Current Trials ISRCTN ISRCTN14707226Web: http://www.isrctn.com/ISRCTN14707226

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Web-based cardiacREhabilitatioNalternative for those declining or dropping out of conventional rehabilitation: results of the WREN feasibility randomised controlled trial

Cited by 22 publications

References 36 publications

Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation

Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation

Prehabilitation

Scalable modEls of Community rehAbilitation for Individuals Recovering From COVID:19 reLated illnEss: A Longitudinal Service Evaluation Protocol—“SeaCole Cohort Evaluation”

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