Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial.

BACKGROUND: The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM: To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN: Single-blind randomized control trial. SETTING: A university hospital. POPULATION: Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS: The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS: 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS: CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT: Home-CR can contribute to overcome participants' barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.

Duke Activity Status Index em Doenças Cardiovasculares: Validação de Tradução em Português / Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Fundamentos: O Duke Activity Status Index (DASI) avalia a capacidade funcional de pacientes com doença cardiovascular (DCV), mas não há versão validada em português para doenças cardiovasculares. Objetivos: Traduzir e adaptar culturalmente o DASI para o idioma português do Brasil, e verificar suas propriedades psicométricas na avaliação da capacidade funcional de pacientes com doenças cardiovasculares. Métodos: O DASI foi traduzido para o português, verificado pela retrotradução para o inglês e avaliado por um comitê de especialistas. A versão pré-teste foi avaliada pela primeira vez em 30 indivíduos. As propriedades psicométricas e a correlação com o teste de esforço foram verificadas em um segundo grupo de 67 indivíduos. Uma análise fatorial exploratória foi realizada em todos os 97 pacientes para verificar a validade de construto do DASI. Resultados: O coeficiente de correlação intraclasse para a confiabilidade teste-reteste foi de 0,87 e para a confiabilidade entre avaliadores foi de 0,84. O alfa de Cronbach para consistência interna foi de 0,93. A validade concorrente foi verificada por correlações positivas significativas de pontuações do DASI com o VO2 max (r = 0,51, p < 0,001). A análise fatorial mostrou dois fatores que explicaram 54% da variância total, com o fator 1 responsável por 40 % da variância. A aplicação do DASI requer entre um e três minutos e meio por paciente. Conclusão: A versão brasileira do DASI parece ser um instrumento válido, confiável, rápido e fácil de administrar para avaliar a capacidade funcional em pacientes com doenças cardiovasculares. .

Background: The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD. Objectives: To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD. Methods: The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI. Results: The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach's α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO2max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient. Conclusions: The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD. .

Duke Activity Status Index for cardiovascular diseases: validation of the Portuguese translation.

BACKGROUND: The Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD. OBJECTIVES: To translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD. METHODS: The DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI. RESULTS: The intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach's α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO2max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient. CONCLUSIONS: The Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.