Effectiveness of technology-assisted cardiac rehabilitation: A systematic review and meta-analysis

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.