ABSTRACT
Background: As COVID-19 pandemic continues, using technologies within cardiac rehabilitation facilitates access to care and reduces the frequency of direct contact with vulnerable cardiac patients. We aimed to assess the feasibility of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR) and preliminarily evaluate its effects on patients with coronary heart disease (CHD). Methods: Between February 2021 to May 2021, a total of 28 patients with CHD were recruited and randomised to receive a 12-week TecHCR programme (n = 14) or a 12-week conventional, centre-based programme (n = 14). The TecHCR group received three center-based, supervised exercise training sessions. Participants were instructed to wear a fitness tracker watch for exercise self-monitoring at home environment, and the exercise data were shared through a web-based application for remote monitoring by the intervener. Participants received six audio-visual educational videos via a messaging application and a weekly video/telephone call follow-up. Self- Efficacy for Exercise (ESE), Health Promoting Lifestyle Profile II (HPLP II), Hospital Anxiety and Depression Scale (HADS), exercise capacity and cardiovascular health outcomes were assessed at baseline and at 12th week on completion of the programme. Generalised estimating equations analysis was conducted to compare the outcomes between groups. Results: Out of 28 participants (56.46±12.98 years old;1 female), 67.9% had percutaneous coronary intervention and 28.6% had coronary bypass grafting surgery. Among 14 participants in the TecHCR group, three dropped out due to: 1) fear to attend face-to-face supervised exercise training during high daily COVID-19 cases;2) infected with COVID-19 and 3) found a job in overseas. Eleven participants in the TecHCR group attended all video/telephone call sessions, nine participants completed 3 supervised exercise training sessions and nine participants adhered to the weekly exercise recommendations. No treatment-related adverse events were reported. TecHCR was non-inferior to conventional, centre-based program on exercise self-efficacy, exercise capacity and cardiovascular health outcomes. TecHCR group showed significantly greater improvement in health-promoting behavior when compared with the control group (p =0.013) at post-intervention. Conclusion: This pilot study demonstrated the feasibility in recruitment and implementation of TecHCR as an alternative delivery mode and could enhance health-promoting behavior among patients with CHD. Implications: The TecHCR program provides accessible interventions to patients without frequent visits to the outpatient centre. A full-scale randomised controlled trial is needed to confirm the effectiveness of TecHCR.
ABSTRACT
Objectives: This review aims to examine the effectiveness of technologyassisted interventions in cardiac rehabilitation (CR), and to synthesise its delivery modes. Methods: Six electronic databases including CINALH Complete, Cochrane Library, PubMed, MEDLINE via OvidSP, British Nursing Index and PsycINFO were searched from 2010 to 2020. Randomised control trials that met the inclusion criteria were critically appraised by two independent reviewers using Revised Cochrane risk of bias tool for randomized trials (RoB2). Meta-analysis was conducted using Review Manager 5.3 for at least two studies reporting the same outcome parameter. Narrative synthesis was performed if there was a considerable heterogeneity (I2) with a significant p-value. Results: Nine trials with 1016 participants with coronary heart diseases in phase II cardiac rehabilitation (mean age between 54.9±9.6 and 62.68±11.95 years old, predominantly male (81.7%) were included. Technologyassisted CR interventions showed comparable effectiveness with traditional centre-based CR on modifiable coronary risk factors (systolic and diastolic blood pressure, and total cholesterol, all pooled results p>0.05), exercise capacity (peak VO2: SMD 0.13, 95% CI -0.10 to 0.35, p=0.28), psychological outcomes (anxiety: SMD 0.25, 95% CI -0.11 to 0.61, p=0.17 and depression: SMD 0.09, 95% CI -0.16 to 0.35, p=0.47). Narrative synthesis was conducted for adherence to CR. Inconsistent results were found among studies. The technology assisted CR interventions with web apps and wearable technology for self-monitoring were found to improve CR adherence when compared to traditional centre-based CR. Adverse events were self-reported, mostly were unrelated to technology-assisted CR interventions and the number of events was comparable between both groups. Conclusion: The technology-assisted interventions, incorporating smartphone and web apps, wearable physiological sensing devices, realtime video conferencing and secure messaging in home-based or hybrid CR, have demonstrated comparable effectiveness on patient outcomes as comparing with the traditional centre-based CR programs. Thus, it has opened up an array of opportunities for patient-professional coaching and monitoring while bridging geographical distances and physical contacts, especially during the current COVID-19 pandemic. There was lack of theory-based guided intervention in technology-assisted CR for enhancing self-efficacy, social support and behavioural change strategies, which may shed light on future studies.