TY - JOUR AU - Munce, Sarah PY - 2025/4/29 TI - The Importance of Telerehabilitation and Future Directions for the Field JO - JMIR Rehabil Assist Technol SP - e76153 VL - 12 KW - JMIR Rehabilitation and Assistive Technologies KW - telerehabilitation KW - assistive technologies KW - access KW - equity KW - personalized care UR - https://rehab.jmir.org/2025/1/e76153 UR - http://dx.doi.org/10.2196/76153 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/76153 ER - TY - JOUR AU - Yang, Li-Tan AU - Wu, Chi-Han AU - Lee, Jen-Kuang AU - Wang, Wei-Jyun AU - Chen, Ying-Hsien AU - Huang, Ching-Chang AU - Hung, Chi-Sheng AU - Chiang, Kuang-Chien AU - Ho, Yi-Lwun AU - Wu, Hui-Wen PY - 2025/4/23 TI - Effects of a Cloud-Based Synchronous Telehealth Program on Valvular Regurgitation Regression: Retrospective Study JO - J Med Internet Res SP - e68929 VL - 27 KW - mitral regurgitation KW - tricuspid regurgitation KW - telehealth KW - telemedicine KW - cardiac remodeling N2 - Background: Telemedicine has been associated with better cardiovascular outcomes, but its effects on the regression of mitral regurgitation (MR) and tricuspid regurgitation (TR) remain unknown. Objective: This study aimed to evaluate whether telemedicine could facilitate the regression of MR and TR compared to usual care and whether it was associated with better survival. Methods: This retrospective cohort study enrolled consecutive patients with moderate or greater MR or TR from 2010 through 2020, excluding those with concomitant aortic stenosis, aortic regurgitation, or mitral stenosis greater than mild severity. All patients underwent follow-up transthoracic echocardiography (TTE) at least 3 months apart. Patients receiving telehealth services for at least two weeks within 90 days of baseline TTE were categorized as the telehealth group; the remainder constituted the nontelehealth group. Telemedicine participants transmitted daily biometric data?blood pressure, pulse rate, blood glucose, electrocardiogram, and oxygen saturation?to a cloud-based platform for timely monitoring. Experienced case managers regularly contacted patients and initiated immediate action for concerning measurements. The primary endpoint was MR or TR regression from ?moderate to .05). Conclusions: RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. Trial Registration: ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793 UR - https://www.jmir.org/2024/1/e56480 UR - http://dx.doi.org/10.2196/56480 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56480 ER - TY - JOUR AU - Bilbrey, Tim AU - Martin, Jenny AU - Zhou, Wen AU - Bai, Changhao AU - Vaswani, Nitin AU - Shah, Rishab AU - Chokshi, Sara AU - Chen, Xi AU - Bhusri, Satjit AU - Niemi, Samantha AU - Meng, Hongdao AU - Lei, Zhen PY - 2024/10/1 TI - A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial JO - JMIR Mhealth Uhealth SP - e59098 VL - 12 KW - cardiac rehabilitation KW - telehealth KW - mHealth KW - digital health KW - exercise KW - quality of life KW - myocardial infarction KW - app KW - application KW - physical fitness KW - self-management KW - disease management N2 - Background: Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. Objective: We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. Methods: This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ?40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. Results: In total, 162 met the inclusion criteria and 75 (46.3%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49%; White: n=46, 61%). Heart failure was the most common diagnosis (37/75, 49%). In total, 62/75 (83%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81%) participants? performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95% CI 25.6-57.1). The average 12-Item Short-Form Health Survey?s physical and mental summary scores improved by 2.7 (SD 6.47) points (95% CI 1.1-4.3) and 2.2 (SD 9.09) points (95% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. Conclusions: The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. Trial Registration: ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500 UR - https://mhealth.jmir.org/2024/1/e59098 UR - http://dx.doi.org/10.2196/59098 UR - http://www.ncbi.nlm.nih.gov/pubmed/39150858 ID - info:doi/10.2196/59098 ER - TY - JOUR AU - Sun, Jia AU - Ma, Liang AU - Miao, Xiao AU - Sun, Hui AU - Zhu, SuSu AU - Zhang, Ran AU - Fan, LeLe AU - Hu, TingTing PY - 2024/8/26 TI - Current Status of Outcomes Reported by Patients With Stroke and an Analysis of Influencing Factors: Cross-Sectional Questionnaire Study JO - JMIR Form Res SP - e58330 VL - 8 KW - stroke KW - patient-reported outcomes KW - blood lipids KW - influence factor KW - correlation analysis KW - nursing care N2 - Background: Stroke is the leading cause of acquired disability and the second leading cause of death worldwide. Its rate of incidence, disability, mortality, and recurrence is high, and the patients experience various symptoms of discomfort, which not only affect their rehabilitation function but also reduce their ability to perform daily activities and their quality of life. Nowadays, with the improvement of China?s medical standards, patients are increasingly attentive to their quality of life and health status. However, diagnostic techniques and effective treatments for patients with stroke are still limited but urgently required. Objective: This study aimed to evaluate the quality of life during hospitalization using a stroke patient-reported outcomes (PROs) scale and additionally to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. Methods: This is a registry-based, retrospective observational cross-sectional study on patients with stroke. A convenient sampling method was used to select various indicators of patients. The Stroke-PRO scale was then used to assess patients? conditions across physical, psychological, social, and therapeutic domains. Multiple linear regression analysis was applied to identify factors influencing stroke PROs, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. Results: The mean Stroke-PRO score in this study was 4.09 (SD 0.29) points. By multiple linear regression analysis, residence, occupation, physical exercise, Barthel index, Braden scale, National Institutes of Health Stroke Scale scores at admission, and stroke type were the risk factors for reported outcomes of patients with stroke (P<.05). Correlation analysis showed that serum triglyceride, total cholesterol, and low-density lipoprotein were negatively correlated with Stroke-PRO scores in patients with stroke (P<.05), while high-density lipoprotein was positively correlated with patients with stroke (P<.05). The 95% CI was ?0.31 to ?0.03 for triglyceride, 0.17-0.44 for high-density lipoprotein, ?0.29 to ?0.01 for cholesterol, ?0.30 to ?0.02 for low-density lipoprotein, and ?0.12 to 0.16 for blood glucose. Conclusions: Patients with stroke have a low level of health, and their reported outcomes need to be improved. Accordingly, nursing staff should pay attention to the quality of life and blood lipid indexes of patients with stroke, actively assess their actual health status, and take early intervention measures to promote their recovery. UR - https://formative.jmir.org/2024/1/e58330 UR - http://dx.doi.org/10.2196/58330 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58330 ER - TY - JOUR AU - Cruz-Cobo, Celia AU - Bernal-Jiménez, Ángeles María AU - Calle, Germán AU - Gheorghe, Luciana Livia AU - Gutiérrez-Barrios, Alejandro AU - Cañadas, Dolores AU - Tur, A. Josep AU - Vázquez-García, Rafael AU - Santi-Cano, José María PY - 2024/7/25 TI - Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial JO - JMIR Mhealth Uhealth SP - e55421 VL - 12 KW - coronary event KW - coronary heart disease KW - eHealth KW - lifestyle KW - mHealth KW - mobile health N2 - Background: Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. Objective: This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. Methods: A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. Results: The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [?1/week]: 141/143, 97.9% vs 96/141, 68.1%; industrial pastries [<2/week]: 129/143, 89.6% vs 80/141, 56.8%; oily fish [?2/week]: 124/143, 86.1% vs 64/141, 41.4%; vegetables [?2/day]: 130/143, 90.3% vs 78/141, 55.3%; fruit [?2/day]: 128/143, 88.9% vs 85/141, 60.2%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points). Conclusions: With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising. Trial Registration: ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606 UR - https://mhealth.jmir.org/2024/1/e55421 UR - http://dx.doi.org/10.2196/55421 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55421 ER - TY - JOUR AU - Elf, Marie AU - Norin, Lizette AU - Meijering, Louise AU - Pessah-Rasmussen, Hélène AU - Suhonen, Riitta AU - Zingmark, Magnus AU - Kylén, Maya PY - 2024/7/23 TI - Rehabilitation at Home With the Development of a Sustainable Model Placing the Person?s Needs and Environment at Heart: Protocol for a Multimethod Project JO - JMIR Res Protoc SP - e56996 VL - 13 KW - co-design KW - early supported discharge KW - home KW - integrated care KW - life space mobility KW - multi-methods KW - physical environment KW - person-centered care KW - social environment KW - stroke rehabilitation N2 - Background: Each year, more than 1.5 million people in Europe have a stroke, and many experience disabilities leading to activity and participation restrictions. Home-based rehabilitation is the recommended approach for stroke rehabilitation, in line with the international shift to integrated care. Despite this, rehabilitation often focuses on the person?s physical functions, not the whole life situation and opportunities to live an active life. Given that rehabilitation today is often provided in the person?s home, there is a need to develop new models that consider the rehabilitation process as situated in the everyday living environment of persons with stroke. This project is grounded in experiences from our ongoing research, where we study the importance of the home environment for health and participation among persons with stroke, rehabilitated at home. This research has shown unmet needs, which lead to suboptimal rehabilitation outcomes. There is a need for studies on how to use environmental resources to optimize stroke rehabilitation in the home setting. Objective: The overarching objective of the project is to develop a new practice model for rehabilitation where the needs of the person are the starting point and where the environment is considered. Methods: The project will be conducted in partnership with persons with stroke, significant others, health care professionals, and care managers. Results from a literature review will form the base for interviews with the stakeholders, followed by co-designing workshops aiming to create a new practice model. Focus groups will be held to refine the outcome of the workshops to a practice model. Results: This 4-year project commenced in January 2023 and will continue until December 2026. The results of the literature review are, as of April 2024, currently being analyzed. The ethics application for the interviews and co-design phase was approved in October 2023 and data collection is ongoing during spring 2024. We aim to develop a practice model with stakeholders and refine it together with care managers and decision makers. The outcome is a new practice model and implementation plan, which will be achieved in autumn 2026. Conclusions: The project contributes with a prominent missing puzzle to optimize the rehabilitation process by adding a strong focus on user engagement combined with integrating different aspects of the environment. The goal is to improve quality of life and increase reintegration in society for the large group of people living with the aftermath of a stroke. By co-designing with multiple stakeholders, we expect the model to be feasible and sustainable. The knowledge from the project will also contribute to an increased awareness of the importance of the physical environment for sustainable health care. The findings will lay the foundation for future upscaling initiatives. International Registered Report Identifier (IRRID): DERR1-10.2196/56996 UR - https://www.researchprotocols.org/2024/1/e56996 UR - http://dx.doi.org/10.2196/56996 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56996 ER - TY - JOUR AU - Rony, Jahangir Rahat AU - Amir, Shajnush AU - Ahmed, Nova AU - Atiba, Samuelson AU - Verdezoto, Nervo AU - Sparkes, Valerie AU - Stawarz, Katarzyna PY - 2024/5/28 TI - Understanding the Sociocultural Challenges and Opportunities for Affordable Wearables to Support Poststroke Upper-Limb Rehabilitation: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e54699 VL - 11 KW - rehabilitation KW - wearables KW - upper-limb rehabilitation KW - user-centered design KW - qualitative KW - interviews KW - experiences KW - attitudes KW - perceptions KW - digital health KW - health technology KW - wearable KW - user centered design KW - design KW - home KW - stroke KW - recovery KW - affordable KW - low income KW - low resource KW - Bangladesh KW - physiotherapy N2 - Background: People who survive a stroke in many cases require upper-limb rehabilitation (ULR), which plays a vital role in stroke recovery practices. However, rehabilitation services in the Global South are often not affordable or easily accessible. For example, in Bangladesh, the access to and use of rehabilitation services is limited and influenced by cultural factors and patients? everyday lives. In addition, while wearable devices have been used to enhance ULR exercises to support self-directed home-based rehabilitation, this has primarily been applied in developed regions and is not common in many Global South countries due to potential costs and limited access to technology. Objective: Our goal was to better understand physiotherapists?, patients?, and caregivers? experiences of rehabilitation in Bangladesh, existing rehabilitation practices, and how they differ from the rehabilitation approach in the United Kingdom. Understanding these differences and experiences would help to identify opportunities and requirements for developing affordable wearable devices that could support ULR in home settings. Methods: We conducted an exploratory study with 14 participants representing key stakeholder groups. We interviewed physiotherapists and patients in Bangladesh to understand their approaches, rehabilitation experiences and challenges, and technology use in this context. We also interviewed UK physiotherapists to explore the similarities and differences between the 2 countries and identify specific contextual and design requirements for low-cost wearables for ULR. Overall, we remotely interviewed 8 physiotherapists (4 in the United Kingdom, 4 in Bangladesh), 3 ULR patients in Bangladesh, and 3 caregivers in Bangladesh. Participants were recruited through formal communications and personal contacts. Each interview was conducted via videoconference, except for 2 interviews, and audio was recorded with consent. A total of 10 hours of discussions were transcribed. The results were analyzed using thematic analysis. Results: We identified several sociocultural factors that affect ULR and should be taken into account when developing technologies for the home: the important role of family, who may influence the treatment based on social and cultural perceptions; the impact of gender norms and their influence on attitudes toward rehabilitation and physiotherapists; and differences in approach to rehabilitation between the United Kingdom and Bangladesh, with Bangladeshi physiotherapists focusing on individual movements that are necessary to build strength in the affected parts and their British counterparts favoring a more holistic approach. We propose practical considerations and design recommendations for developing ULR devices for low-resource settings. Conclusions: Our work shows that while it is possible to build a low-cost wearable device, the difficulty lies in addressing sociotechnical challenges. When developing new health technologies, it is imperative to not only understand how well they could fit into patients?, caregivers?, and physiotherapists? everyday lives, but also how they may influence any potential tensions concerning culture, religion, and the characteristics of the local health care system. UR - https://rehab.jmir.org/2024/1/e54699 UR - http://dx.doi.org/10.2196/54699 ID - info:doi/10.2196/54699 ER - TY - JOUR AU - Liliequist, E. Björn AU - Särnholm, Josefin AU - Skúladóttir, Helga AU - Ólafsdóttir, Eva AU - Ljótsson, Brjánn AU - Braunschweig, Frieder PY - 2024/5/7 TI - Cognitive Behavioral Therapy for Symptom Preoccupation Among Patients With Premature Ventricular Contractions: Nonrandomized Pretest-Posttest Study JO - JMIR Cardio SP - e53815 VL - 8 KW - premature ventricular contractions KW - quality of life KW - symptom preoccupation KW - cognitive behavioral therapy: CBT N2 - Background: Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired quality of life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL for patients with PVCs. Symptom preoccupation, involving cardiac-related fear, hypervigilance, and avoidance behavior, is associated with disability in other cardiac conditions and can be effectively targeted by cognitive behavioral therapy (CBT). Objective: The aim of this study was to evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs. Methods: Nineteen patients diagnosed with symptomatic idiopathic PVCs and symptom preoccupation underwent PVC-specific CBT over 10 weeks. The treatment was delivered by a licensed psychologist via videoconference in conjunction with online text-based information and homework assignments. The main components of the treatment were exposure to cardiac-related symptoms and reducing cardiac-related avoidance and control behavior. Self-rated measures were collected at baseline, post treatment, and at 3- and 6-month follow-ups. The primary outcome was PVC-specific QoL at posttreatment assessment measured with a PVC-adapted version of the Atrial Fibrillation Effects on Quality of Life questionnaire. Secondary measures included symptom preoccupation measured with the Cardiac Anxiety Questionnaire. PVC burden was evaluated with 5-day continuous electrocardiogram recordings at baseline, post treatment, and 6-month follow-up. Results: We observed large improvements in PVC-specific QoL (Cohen d=1.62, P<.001) and symptom preoccupation (Cohen d=1.73, P<.001) post treatment. These results were sustained at the 3- and 6-month follow-ups. PVC burden, as measured with 5-day continuous electrocardiogram, remained unchanged throughout follow-up. However, self-reported PVC symptoms were significantly lower at posttreatment assessment and at both the 3- and 6-month follow-ups. Reduction in symptom preoccupation had a statistically significant mediating effect of the intervention on PVC-specific QoL in an explorative mediation analysis. Conclusions: This uncontrolled pilot study shows preliminary promising results for PVC-specific CBT as a potentially effective treatment approach for patients with symptomatic idiopathic PVCs and symptom preoccupation. The substantial improvements in PVC-specific QoL and symptom preoccupation, along with the decreased self-reported PVC-related symptoms warrant further investigation in a larger randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT05087238; https://clinicaltrials.gov/study/NCT05087238 UR - https://cardio.jmir.org/2024/1/e53815 UR - http://dx.doi.org/10.2196/53815 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713500 ID - info:doi/10.2196/53815 ER - TY - JOUR AU - Chien, Cheng-Yu AU - Tsai, Shang-Li AU - Huang, Chien-Hsiung AU - Wang, Ming-Fang AU - Lin, Chi-Chun AU - Chen, Chen-Bin AU - Tsai, Li-Heng AU - Tseng, Hsiao-Jung AU - Huang, Yan-Bo AU - Ng, Chip-Jin PY - 2024/4/29 TI - Effectiveness of Blended Versus Traditional Refresher Training for Cardiopulmonary Resuscitation: Prospective Observational Study JO - JMIR Med Educ SP - e52230 VL - 10 KW - cardiopulmonary resuscitation KW - blended method KW - blended KW - hybrid KW - refresher KW - refreshers KW - teaching KW - instruction KW - observational KW - training KW - professional development KW - continuing education KW - retraining KW - traditional method KW - self-directed learning KW - resuscitation KW - CPR KW - emergency KW - rescue KW - life support KW - cardiac KW - cardiopulmonary N2 - Background: Generally, cardiopulmonary resuscitation (CPR) skills decline substantially over time. By combining web-based self-regulated learning with hands-on practice, blended training can be a time- and resource-efficient approach enabling individuals to acquire or refresh CPR skills at their convenience. However, few studies have evaluated the effectiveness of blended CPR refresher training compared with that of the traditional method. Objective: This study investigated and compared the effectiveness of traditional and blended CPR training through 6-month and 12-month refresher sessions with CPR ability indicators. Methods: This study recruited participants aged ?18 years from the Automated External Defibrillator Donation Project. The participants were divided into 4 groups based on the format of the CPR training and refresher training received: (1) initial traditional training (a 30-minute instructor-led, hands-on session) and 6-month traditional refresher training (Traditional6 group), (2) initial traditional training and 6-month blended refresher training (an 18-minute e-learning module; Mixed6 group), (3) initial traditional training and 12-month blended refresher training (Mixed12 group), and (4) initial blended training and 6-month blended refresher training (Blended6 group). CPR knowledge and performance were evaluated immediately after initial training. For each group, following initial training but before refresher training, a learning effectiveness assessment was conducted at 12 and 24 months. CPR knowledge was assessed using a written test with 15 multiple-choice questions, and CPR performance was assessed through an examiner-rated skill test and objectively through manikin feedback. A generalized estimating equation model was used to analyze changes in CPR ability indicators. Results: This study recruited 1163 participants (mean age 41.82, SD 11.6 years; n=725, 62.3% female), with 332 (28.5%), 270 (23.2%), 258 (22.2%), and 303 (26.1%) participants in the Mixed6, Traditional6, Mixed12, and Blended6 groups, respectively. No significant between-group difference was observed in knowledge acquisition after initial training (P=.23). All groups met the criteria for high-quality CPR skills (ie, average compression depth: 5-6 cm; average compression rate: 100-120 beats/min; chest recoil rate: >80%); however, a higher proportion (98/303, 32.3%) of participants receiving blended training initially demonstrated high-quality CPR skills. At 12 and 24 months, CPR skills had declined in all the groups, but the decline was significantly higher in the Mixed12 group, whereas the differences were not significant between the other groups. This finding indicates that frequent retraining can maintain high-quality CPR skills and that blended refresher training is as effective as traditional refresher training. Conclusions: Our findings indicate that 6-month refresher training sessions for CPR are more effective for maintaining high-quality CPR skills, and that as refreshers, self-learning e-modules are as effective as instructor-led sessions. Although the blended learning approach is cost and resource effective, factors such as participant demographics, training environment, and level of engagement must be considered to maximize the potential of this approach. Trial Registration: IGOGO NCT05659108; https://www.cgmh-igogo.tw UR - https://mededu.jmir.org/2024/1/e52230 UR - http://dx.doi.org/10.2196/52230 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683663 ID - info:doi/10.2196/52230 ER - TY - JOUR AU - Howdle, Charlotte AU - Wright, Alexander William James AU - Mant, Jonathan AU - De Simoni, Anna PY - 2024/4/16 TI - Factors Influencing Recovery From Pediatric Stroke Based on Discussions From a UK-Based Online Stroke Community: Qualitative Thematic Study JO - J Med Internet Res SP - e49409 VL - 26 KW - child KW - stroke KW - rehabilitation KW - barriers KW - facilitators KW - internet-based intervention KW - self-help group KW - thematic analysis N2 - Background: The incidence of stroke in children is low, and pediatric stroke rehabilitation services are less developed than adult ones. Survivors of pediatric stroke have a long poststroke life expectancy and therefore have the potential to experience impairments from their stroke for many years. However, there are relatively few studies characterizing these impairments and what factors facilitate or counteract recovery. Objective: This study aims to characterize the main barriers to and facilitators of recovery from pediatric stroke. A secondary aim was to explore whether these factors last into adulthood, whether they change, or if new factors impacting recovery emerge in adulthood. Methods: We performed a qualitative thematic analysis based on posts from a population of participants from a UK-based online stroke community, active between 2004 and 2011. The analysis focused on users who talked about their experiences with pediatric stroke, as identified by a previous study. The posts were read by 3 authors, and factors influencing recovery from pediatric stroke were mapped into 4 areas: medical, physical, emotional, and social. Factors influencing recovery were divided into short-term and long-term factors. Results: There were 425 posts relating to 52 survivors of pediatric stroke. Some survivors of stroke posted for themselves, while others were talked about by a third party (mostly parents; 31/35, 89% mothers). In total, 79% (41/52) of survivors of stroke were aged ?18 years and 21% (11/52) were aged >18 years at the time of posting. Medical factors included comorbidities as a barrier to recovery. Medical interventions, such as speech and language therapy and physiotherapy, were also deemed useful. Exercise, particularly swimming, was deemed a facilitator. Among physical factors, fatigue and chronic pain could persist decades after a stroke, with both reported as a barrier to feeling fully recovered. Tiredness could worsen existing stroke-related impairments. Other long-standing impairments were memory loss, confusion, and dizziness. Among emotional factors, fear and uncertainty were short-term barriers, while positivity was a major facilitator in both short- and long-term recovery. Anxiety, grief, and behavioral problems hindered recovery. The social barriers were loneliness, exclusion, and hidden disabilities not being acknowledged by third parties. A good support network and third-party support facilitated recovery. Educational services were important in reintegrating survivors into society. Participants reported that worrying about losing financial support, such as disability allowances, and difficulties in obtaining travel insurance and driving licenses impacted recovery. Conclusions: The lived experience of survivors of pediatric stroke includes long-term hidden disabilities and barriers to rehabilitation. These are present in different settings, such as health care, schools, workplaces, and driving centers. Greater awareness of these issues by relevant professional groups may help ameliorate them. UR - https://www.jmir.org/2024/1/e49409 UR - http://dx.doi.org/10.2196/49409 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625726 ID - info:doi/10.2196/49409 ER - TY - JOUR AU - Regan, Wherley Elizabeth AU - Toto, Pamela AU - Brach, Jennifer PY - 2024/4/11 TI - A Community Needs Assessment and Implementation Planning for a Community Exercise Program for Survivors of Stroke: Protocol for a Pilot Hybrid Type I Clinical Effectiveness and Implementation Study JO - JMIR Res Protoc SP - e55432 VL - 13 KW - community participatory research KW - need assessment KW - exercise KW - survivors of stroke KW - community KW - community need KW - exercise program KW - stroke KW - physical activity KW - PA KW - mobility impairments KW - impairment KW - mobility KW - health decline KW - group activity KW - group exercise N2 - Background: Physical activity and exercise are important aspects of maintaining health. People with mobility impairments, including survivors of stroke, are less likely to exercise and at greater risk of developing or worsening chronic health conditions. Increasing accessible, desired options for exercise may address the gap in available physical activity programs, provide an opportunity for continued services after rehabilitation, and cultivate social connections for people after stroke and others with mobility impairments. Existing evidence-based community programs for people after stroke target cardiovascular endurance, mobility, walking ability, balance, and education. While much is known about the effectiveness of these programs, it is important to understand the local environment as implementation and sustainment strategies are context-specific. Objective: This study protocol aims to evaluate community needs and resources for exercise for adults living with mobility impairments with initial emphasis on survivors of stroke in Richland County, South Carolina. Results will inform a hybrid type I effectiveness and implementation pilot of an evidence-based group exercise program for survivors of stroke. Methods: The exploration and preparation phases of the EPIS (Exploration, Preparation, Implementation, and Sustainment) implementation model guide the study. A community needs assessment will evaluate the needs and desires of survivors of stroke through qualitative semistructured interviews with survivors of stroke, rehabilitation professionals, and fitness trainers serving people with mobility impairments. Additional data will be collected from survivors of stroke through a survey. Fitness center sites will be assessed through interviews and the Accessibility Instrument Measuring Fitness and Recreation Environments inventory. Qualitative data will be evaluated using content analysis and supported by mean survey results. Data will be categorized by the community (outer context), potential participants (outer context), and fitness center (inner context) and evaluate needs, resources, barriers, and facilitators. Results will inform evidence-based exercise program selection, adaptations, and specific local implementation strategies to influence success. Pilot outcome measures for participants (clinical effectiveness), process, and program delivery levels will be identified. An implementation logic model for interventions will be created to reflect the design elements for the pilot and their complex interactions. Results: The study was reviewed by the institutional review board and exempt approved on December 19, 2023. The study data collection began in January 2024 and is projected to be completed in June 2024. A total of 17 participants have been interviewed as of manuscript submission. Results are expected to be published in early 2025. Conclusions: Performing a needs assessment before implementing it in the community allows for early identification of complex relationships and preplanning to address problems that cannot be anticipated in controlled effectiveness research. Evaluation and preparation prior to implementation of a community exercise program enhance the potential to be successful, valued, and sustained in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/55432 UR - https://www.researchprotocols.org/2024/1/e55432 UR - http://dx.doi.org/10.2196/55432 UR - http://www.ncbi.nlm.nih.gov/pubmed/38603776 ID - info:doi/10.2196/55432 ER - TY - JOUR AU - Short, E. Camille AU - Rawstorn, C. Jonathan AU - Jones, L. Tamara AU - Edbrooke, Lara AU - Hayes, C. Sandra AU - Maddison, Ralph AU - Nightingale, Sophie AU - Ismail, Hilmy AU - De Boer, Richard AU - Hegi-Johnson, Fiona AU - Sverdlov, L. Aaron AU - Bell, Robyn AU - Halligan, Irene AU - Denehy, Linda PY - 2024/4/5 TI - Evaluating a Remotely Delivered Cardio-Oncology Rehabilitation Intervention for Patients With Breast Cancer (REMOTE-COR-B): Protocol for a Single-Arm Feasibility Trial JO - JMIR Res Protoc SP - e53301 VL - 13 KW - breast cancer survivor KW - breast cancer KW - cancer survivor KW - cancer KW - cardiac rehabilitation KW - cardiac KW - cardiotoxicity KW - cardiovascular disease KW - digital health KW - efficacy KW - exercise KW - feasibility KW - fitness KW - rehabilitation intervention KW - rehabilitation KW - safety N2 - Background: Exercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. Objective: This study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. Methods: We will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). Results: Recruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. Conclusions: The REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/53301 UR - https://www.researchprotocols.org/2024/1/e53301 UR - http://dx.doi.org/10.2196/53301 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578682 ID - info:doi/10.2196/53301 ER - TY - JOUR AU - Park, G. Linda AU - Chi, Serena AU - Pitsenbarger, Susan AU - Johnson, K. Julene AU - Shah, J. Amit AU - Elnaggar, Abdelaziz AU - von Oppenfeld, Julia AU - Cho, Evan AU - Harzand, Arash AU - Whooley, A. Mary PY - 2024/3/14 TI - Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study JO - JMIR Cardio SP - e54823 VL - 8 KW - cardiac rehabilitation KW - cardiac rehab KW - COVID-19 KW - digital health KW - digital technology KW - physical activity KW - physical activity maintenance KW - social media KW - older adults KW - pandemic KW - social distancing KW - technology KW - wearables KW - CR KW - exercise KW - cardiovascular disease KW - gerontology KW - geriatric KW - geriatrics KW - hospital KW - medical facility KW - California KW - interview KW - thematic analysis KW - anxiety N2 - Background: Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. Objective: This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. Methods: We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. Results: In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants? feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. Conclusions: Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR. UR - https://cardio.jmir.org/2024/1/e54823 UR - http://dx.doi.org/10.2196/54823 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483450 ID - info:doi/10.2196/54823 ER - TY - JOUR AU - Misra, Satish AU - Niazi, Karen AU - Swayampakala, Kamala AU - Blackmon, Amanda AU - Lang, Melissa AU - Davenport, Elizabeth AU - Saxonhouse, Sherry AU - Fedor, John AU - Powell, Brian AU - Thompson, Joseph AU - Holshouser, John AU - Mehta, Rohit PY - 2023/12/14 TI - Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study JO - JMIR Cardio SP - e49345 VL - 7 KW - atrial fibrillation KW - behavior modification KW - cardiac rehabilitation KW - catheter ablation KW - exercise KW - remote exercise supervision KW - weight loss N2 - Background: Risk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. Objective: This study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. Methods: A total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. Results: The median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [?75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. Conclusions: An asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort. UR - https://cardio.jmir.org/2023/1/e49345 UR - http://dx.doi.org/10.2196/49345 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096021 ID - info:doi/10.2196/49345 ER - TY - JOUR AU - Patterson, Kacie AU - Davey, Rachel AU - Keegan, Richard AU - Niyonsenga, Theo AU - Mohanty, Itismita AU - Bowen, Sarah AU - Regan, Elizabeth AU - Lander, Michelle AU - van Berlo, Sander AU - Freene, Nicole PY - 2023/10/3 TI - Testing the Effect of a Smartphone App on Hospital Admissions and Sedentary Behavior in Cardiac Rehabilitation Participants: ToDo-CR Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e48229 VL - 11 KW - mobile health KW - secondary prevention KW - cardiovascular disease KW - sedentary behavior KW - hospital admissions KW - cost-effectiveness KW - mobile phone N2 - Background: People with coronary heart disease are at an increased risk of morbidity and mortality even if they attend cardiac rehabilitation. High sedentary behavior levels potentially contribute to this morbidity. Smartphone apps may be feasible to facilitate sedentary behavior reductions and lead to reduced health care use. Objective: We aimed to test the effect of a sedentary behavior change smartphone app (Vire app and ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12 months. Methods: A multicenter, randomized controlled trial was conducted with 120 participants recruited from 3 cardiac rehabilitation programs. Participants were randomized 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and ToDo-CR program (intervention) or usual care (control). The primary outcome was nonelective hospital admissions and ED presentations over 12 months. Secondary outcomes including accelerometer-measured sedentary behavior, BMI, waist circumference, and quality of life were recorded at baseline and 6 and 12 months. Logistic regression models were used to analyze the primary outcome, and linear mixed-effects models were used to analyze secondary outcomes. Data on intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICERs) were calculated. Results: Participants were, on average, aged 62 (SD 10) years, and the majority were male (93/120, 77.5%). The intervention group were more likely to experience all-cause (odds ratio [OR] 1.54, 95% CI 0.58-4.10; P=.39) and cardiac-related (OR 3.26, 95% CI 0.84-12.55; P=.09) hospital admissions and ED presentations (OR 2.07, 95% CI 0.89-4.77; P=.09) than the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12 months (Aus $252.40 vs Aus $859.38; P=.24; a currency exchange rate of Aus $1=US $0.69 is applicable). There were no significant between-group differences in sedentary behavior minutes per day over 12 months, although the intervention group completed 22 minutes less than the control group (95% CI ?22.80 to 66.69; P=.33; Cohen d=0.21). The intervention group had a lower BMI (?=1.62; P=.05), waist circumference (?=5.81; P=.01), waist-to-hip ratio (?=.03, P=.03), and quality of life (?=3.30; P=.05) than the control group. The intervention was more effective but more costly in reducing sedentary behavior (ICER Aus $351.77) and anxiety (ICER Aus $10,987.71) at 12 months. The intervention was also more effective yet costly in increasing quality of life (ICER Aus $93,395.50) at 12 months. Conclusions: The Vire app and ToDo-CR program was not an outcome-effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation compared with usual care. Smartphone apps that target sedentary behavior alone may not be an effective solution for cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001223123; https://australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619001223123 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-040479 UR - https://mhealth.jmir.org/2023/1/e48229 UR - http://dx.doi.org/10.2196/48229 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788043 ID - info:doi/10.2196/48229 ER - TY - JOUR AU - Duran, T. Andrea AU - Keener-DeNoia, Adrianna AU - Stavrolakes, Kimberly AU - Fraser, Adina AU - Blanco, V. Luis AU - Fleisch, Emily AU - Pieszchata, Nicole AU - Cannone, Diane AU - Keys McKay, Charles AU - Whittman, Emma AU - Edmondson, Donald AU - Shelton, C. Rachel AU - Moise, Nathalie PY - 2023/7/13 TI - Applying User-Centered Design and Implementation Science to the Early-Stage Development of a Telehealth-Enhanced Hybrid Cardiac Rehabilitation Program: Quality Improvement Study JO - JMIR Form Res SP - e47264 VL - 7 KW - user-centered design KW - implementation science KW - cardiac rehabilitation KW - telemedicine KW - remote patient monitoring KW - behavioral intervention development KW - hybrid N2 - Background: Cardiac rehabilitation (CR) is an evidence-based intervention that improves event-free survival in patients with cardiac conditions, yet <27% of all eligible patients use CR in the United States. CR is traditionally delivered in clinic-based settings where implementation barriers abound. Innovative nontraditional program designs and strategies are needed to support widespread CR uptake. Objective: This study aimed to demonstrate how user-centered design (UCD) and implementation science (IS) principles and methods can be integrated into the early-stage development of nontraditional CR interventions. Methods: As part of a NewYork-Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we combined UCD and IS principles and methods to design a novel home- and clinic-based telehealth-enhanced hybrid CR (THCR) program. We co-designed this program with multilevel stakeholders using an iterative 3-step UCD process to identify user and contextual barriers and facilitators to CR uptake (using semistructured interviews and contextual inquiry [step 1]), design an intervention prototype that targets contextual and user factors and emulates the evidence-based practice (through design workshops and journey mapping [step 2]), and review and refine the prototype (according to real-world usability testing and feedback [step 3]). The UCD process was informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research. Results: At step 1, we conducted semistructured interviews with 9 provider- and system-level stakeholders (female: n=6, 67%) at 3 geographically diverse academic medical centers, which revealed behavioral (eg, self-efficacy and knowledge) and contextual (eg, social distancing guidelines, physical space, staffing, and reimbursement) barriers to uptake; hybrid delivery was a key facilitator. Step 2 involved conducting 20 design workshops and 3 journey-mapping sessions with multidisciplinary NYPH stakeholders (eg, digital health team, CR clinicians, and creative director) where we identified key design elements (eg, mix of clinic- and home-based CR and synchronous remote patient monitoring), yielding an initial THCR prototype that leveraged NYPH?s telehealth infrastructure. At step 3, we conducted usability testing with 2 CR clinicians (both female) administering home-based sessions to 3 CR patients (female: n=1, 33%), which revealed usability themes (eg, ease of using remote patient monitoring devices or a telehealth platform, technology disruptions, and confidence in using the telehealth platform to safely monitor patients) and design solutions (eg, onboarding sessions, safety surveys, and fully supervised remote sessions) to be included in the final THCR prototype. Conclusions: Combining UCD and IS methods while engaging multidisciplinary stakeholders in an iterative process yielded a theory-informed THCR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process and guidance for incorporating UCD and IS principles and methods into the early-stage development of a nontraditional CR intervention. The feasibility, acceptability, appropriateness, and usability of the final THCR prototype is being evaluated in an ongoing study. UR - https://formative.jmir.org/2023/1/e47264 UR - http://dx.doi.org/10.2196/47264 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440285 ID - info:doi/10.2196/47264 ER - TY - JOUR AU - Herren, Tara AU - Fivaz, Loris AU - Dufeil, Eva AU - Golay, Eric AU - Braun, Ely AU - Straub, Emilie AU - Nidegger, Philippe AU - Grosgurin, Olivier AU - Gartner, Andrea Birgit AU - Suppan, Mélanie AU - Suppan, Laurent PY - 2023/6/27 TI - Development of a Pilot Introductory Advanced Cardiovascular Resuscitation Course for Senior Medical Students in Switzerland: Student-Driven Implementation Study JO - Interact J Med Res SP - e46075 VL - 12 KW - advanced cardiovascular life support KW - undergraduate medical education KW - cardiopulmonary resuscitation KW - CPR KW - medical education KW - resuscitation KW - web-based questionnaire KW - collaborative design KW - implementation KW - medical course KW - curriculum KW - student KW - life support KW - training KW - cardiac arrest KW - medical student N2 - Background: Cardiac arrest is the most time-critical emergency medical students and junior physicians may face in their personal or professional life. However, many studies have shown that most of them lack the necessary knowledge and skills to efficiently perform resuscitation. This could be related to the fact that advanced cardiovascular resuscitation courses are not always part of the undergraduate medical curriculum. Objective: The aim of this study was to describe the development, pilot implementation, and assessment of an advanced cardiovascular resuscitation course designed to enable senior medical students to manage the initial resuscitation phase in case of cardiac arrest. Methods: An introductory advanced cardiovascular resuscitation course was developed on the initiative of fifth-year medical students, in collaboration with the prehospital emergency medical service team of the Geneva University Hospitals. The 60 slots available to the 157 members of the fifth-year promotion of the University of Geneva Faculty of Medicine were filled in less than 8 hours. This unexpected success prompted the creation of a first questionnaire, which was sent to all fifth-year students to determine the overall proportion of students interested in attending an advanced cardiovascular resuscitation course. This questionnaire was also used to assess basic life support education and experience among course participants. A postcourse questionnaire was used to gather feedback regarding the course and to assess student confidence regarding the resuscitation skills they had been taught. Results: Out of 157 fifth-year medical students, 73 (46%) completed the first questionnaire. Most thought that the current curriculum did not provide them with enough knowledge and skills regarding resuscitation and 85% (62/73) wished to attend an introductory advanced cardiovascular resuscitation course. All the participants who would have wanted to follow the full Advanced Cardiovascular Life Support course before graduating were set back by its cost (10/10, 100%). Of the 60 students who had registered for the training sessions, 56 (93%) actually attended. The postcourse questionnaire was completed by 42 (87%) students (out of 48 who had registered on the platform). They unanimously answered that an advanced cardiovascular resuscitation course should be part of the standard curriculum. Conclusions: This study demonstrates the interest of senior medical students in an advanced cardiovascular resuscitation course and their willingness to see such a course integrated as a part of their regular curriculum. UR - https://www.i-jmr.org/2023/1/e46075 UR - http://dx.doi.org/10.2196/46075 UR - http://www.ncbi.nlm.nih.gov/pubmed/37231610 ID - info:doi/10.2196/46075 ER - TY - JOUR AU - Siegmund, Anne Lee AU - Bena, F. James AU - Morrison, L. Shannon PY - 2023/6/15 TI - Cardiac Rehabilitation Facebook Intervention: Feasibility Randomized Controlled Trial JO - JMIR Cardio SP - e46828 VL - 7 KW - cardiac rehabilitation KW - motivation KW - exercise KW - social media KW - cardiology KW - adherence KW - physical activity KW - satisfaction KW - rehabilitation KW - Facebook KW - peer support N2 - Background: The adherence to cardiac rehabilitation is low. Social media has been used to improve motivation and cardiac rehabilitation completion, but the authors did not find Facebook interventions for these purposes in the literature. Objective: The purpose of this study was to determine the feasibility of the Cardiac Rehabilitation Facebook Intervention (Chat) for affecting changes in exercise motivation and need satisfaction and adherence to cardiac rehabilitation. Methods: The Behavioral Regulation in Exercise Questionnaire-3 and Psychological Need Satisfaction for Exercise were used to measure motivation and need satisfaction (competence, autonomy, and relatedness) before and after the Chat intervention. To support need satisfaction, the intervention included educational posts, supportive posts, and interaction with peers. The feasibility measures included recruitment, engagement, and acceptability. Groups were compared using analysis of variance and Kruskal-Wallis tests. Paired t tests were used to assess motivation and need satisfaction change, and Pearson or Spearman correlations were used for continuous variables. Results: A total of 32 participants were lost to follow-up and 22 were included in the analysis. Higher motivation at intake (relative autonomy index 0.53, 95% CI 0.14-0.78; P=.01) and change in need satisfaction-autonomy (relative autonomy index 0.61, 95% CI 0.09-0.87; P=.02) were associated with more completed sessions. No between-group differences were found. Engagement included ?likes? (n=210) and ?hits? (n=157). For acceptability, mean scores on a 1 (not at all) to 5 (quite a bit) Likert scale for feeling supported and in touch with providers were 4.6 and 4.4, respectively. Conclusions: Acceptability of the Chat group was high; however, intervention feasibility could not be determined due to the small sample size. Those with greater motivation at intake completed more sessions, indicating its importance in cardiac rehabilitation completion. Despite challenges with recruitment and engagement, important lessons were learned. Trial Registration: ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7554 UR - https://cardio.jmir.org/2023/1/e46828 UR - http://dx.doi.org/10.2196/46828 UR - http://www.ncbi.nlm.nih.gov/pubmed/37318865 ID - info:doi/10.2196/46828 ER - TY - JOUR AU - Oclaman, May Janah AU - Murray, L. Michelle AU - Grandis, J. Donald AU - Beatty, L. Alexis PY - 2023/5/15 TI - The Association Between Mobile App Use and Change in Functional Capacity Among Cardiac Rehabilitation Participants: Cohort Study JO - JMIR Cardio SP - e44433 VL - 7 KW - cardiac rehabilitation KW - mobile application KW - functional capacity KW - blood pressure KW - telemedicine KW - mHealth KW - telehealth assessment KW - e-health KW - youth KW - adolescence KW - EHR KW - electronic health record N2 - Background: Cardiac rehabilitation (CR) is underused in the United States and globally, with participation disparities across gender, socioeconomic status, race, and ethnicities. The pandemic led to greater adoption of telehealth CR and mobile app use. Objective: Our primary objective was to estimate the association between CR mobile app use and change in functional capacity from enrollment to completion in patients participating in a CR program that offered in-person, hybrid, and telehealth CR. Our secondary objectives were to study the association between mobile app use and changes in blood pressure (BP) or program completion. Methods: We conducted a retrospective cohort study of participants enrolled in CR at an urban CR program in the United States. Participants were English speaking, at least 18 years of age, participated in the program between May 22, 2020, and May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by number of exercise logs, vitals logs, and education material views. The primary outcome was change in functional capacity, measured by change in 6-minute walk distance (6MWD) from enrollment to completion. The secondary outcome was change in BP from enrollment to completion. We estimated associations using multivariable linear or logistic regression models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for CR referral. Results: A total of 107 participants (mean age 62.9, SD 13.02 years; 90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) meter increase in 6MWD between enrollment and completion (P<.001). From enrollment to completion, participants with an elevated BP at baseline (?130/80 mmHg) experienced a significant decrease in BP (systolic BP ?11.5 mmHg; P=.002 and diastolic BP ?7.7 mmHg; P=.003). We found no significant association between total app interactions and change in 6MWD (coefficient ?0.03, 95% CI ?0.1 to 0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI ?0.03 to 0.03; P=.87 and diastolic coefficient ?0.005, 95% CI ?0.03 to 0.02; P=.65). There was no significant association between total exercise logs and change in 6MWD (coefficient 0.1, 95% CI ?0.3 to 0.4; P=.57) or total BP logs and change in BP (systolic coefficient ?0.02, 95% CI ?0.1 to 0.06; P=.63 and diastolic coefficient ?0.02, 95% CI ?0.09 to 0.04; P=.50). There was no significant association between total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 0.99-1.01; P=.44). Conclusions: CR mobile app use as part of an in-person, hybrid, or telehealth CR program was not associated with greater improvement in functional capacity or BP or with program completion. UR - https://cardio.jmir.org/2023/1/e44433 UR - http://dx.doi.org/10.2196/44433 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184917 ID - info:doi/10.2196/44433 ER - TY - JOUR AU - Lahtio, Heli AU - Heinonen, Ari AU - Paajanen, Teemu AU - Sjögren, Tuulikki PY - 2023/4/12 TI - The Added Value of Remote Technology in Cardiac Rehabilitation on Physical Function, Anthropometrics, and Quality of Life: Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e42455 VL - 25 KW - weight loss KW - cardiac rehabilitation KW - remote technology KW - physical function KW - 6-minute walk test KW - overweight KW - obesity KW - body mass KW - BMI KW - waist circumference KW - quality of life KW - QoL KW - mobile phone N2 - Background: Cardiovascular diseases (CVDs) cause most deaths globally and can reduce quality of life (QoL) of rehabilitees with cardiac disease. The risk factors of CVDs are physical inactivity and increased BMI. With physical activity, it is possible to prevent CVDs, improve QoL, and help maintain a healthy body mass. Current literature shows the possibilities of digitalization and advanced technology in supporting independent self-rehabilitation. However, the interpretation of the results is complicated owing to the studies? high heterogeneity. In addition, the added value of this technology has not been studied well, especially in cardiac rehabilitation. Objective: We aimed to examine the effectiveness of added remote technology in cardiac rehabilitation on physical function, anthropometrics, and QoL in rehabilitees with CVD compared with conventional rehabilitation. Methods: Rehabilitees were cluster randomized into 3 remote technology intervention groups (n=29) and 3 reference groups (n=30). The reference group received conventional cardiac rehabilitation, and the remote technology intervention group received conventional cardiac rehabilitation with added remote technology, namely, the Movendos mCoach app and Fitbit charge accelerometer. The 12 months of rehabilitation consisted of three 5-day in-rehabilitation periods in the rehabilitation center. Between these periods were two 6-month self-rehabilitation periods. Outcome measurements included the 6-minute walk test, body mass, BMI, waist circumference, and World Health Organization QoL-BREF questionnaire at baseline and at 6 and 12 months. Between-group differences were assessed using 2-tailed t tests and Mann-Whitney U test. Within-group differences were analyzed using a paired samples t test or Wilcoxon signed-rank test. Results: Overall, 59 rehabilitees aged 41 to 66 years (mean age 60, SD 6 years; n=48, 81% men) were included in the study. Decrement in waist circumference (6 months: 1.6 cm; P=.04; 12 months: 3 cm; P<.001) and increment in self-assessed QoL were greater (environmental factors: 0.5; P=.02) in the remote technology intervention group than the reference group. Both groups achieved statistically significant improvements in the 6-minute walk test in both time frames (P=.01-.03). Additionally, the remote technology intervention group achieved statistically significant changes in the environmental domain at 0-6 months (P=.03) and waist circumference at both time frames (P=.01), and reference group achieve statistically significant changes in waist circumference at 0-6 months (P=.02). Conclusions: Remote cardiac rehabilitation added value to conventional cardiac rehabilitation in terms of waist circumference and QoL. The results were clinically small, but the findings suggest that adding remote technology to cardiac rehabilitation may increase beneficial health outcomes. There was some level of systematic error during rehabilitation intervention, and the sample size was relatively small. Therefore, care must be taken when generalizing the study results beyond the target population. To confirm assumptions of the added value of remote technology in rehabilitation interventions, more studies involving different rehabilitees with cardiac disease are required. Trial Registration: ISRCTN Registry ISRCTN61225589; https://www.isrctn.com/ISRCTN61225589 UR - https://www.jmir.org/2023/1/e42455 UR - http://dx.doi.org/10.2196/42455 UR - http://www.ncbi.nlm.nih.gov/pubmed/37043264 ID - info:doi/10.2196/42455 ER - TY - JOUR AU - Yu, Tianzhuo AU - Xu, Haiyan AU - Sui, Xin AU - Zhang, Xin AU - Pang, Yue AU - Yu, Tianyue AU - Lian, Xiaoqian AU - Zeng, Ting AU - Wu, Yuejin AU - Leng, Xin AU - Li, Feng PY - 2023/3/29 TI - Effectiveness of eHealth Interventions on Moderate-to-Vigorous Intensity Physical Activity Among Patients in Cardiac Rehabilitation: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e42845 VL - 25 KW - cardiac rehabilitation KW - cardiorespiratory fitness KW - cardiovascular diseases KW - exercise KW - physical activity KW - heart disease risk factors KW - meta-analysis KW - systematic review KW - eHealth KW - telemedicine N2 - Background: Cardiac rehabilitation is a class IA recommendation for patients with cardiovascular diseases. Physical activity is the core component and core competency of a cardiac rehabilitation program. However, many patients with cardiovascular diseases are failing to meet cardiac rehabilitation guidelines that recommend moderate-to-vigorous intensity physical activity. Objective: The major objective of this study was to review the evidence of the effectiveness of eHealth interventions in increasing moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. The secondary objective was to examine the effectiveness of eHealth interventions in improving cardiovascular-related outcomes, that is, cardiorespiratory fitness, waist circumference, and systolic blood pressure. Methods: A comprehensive search strategy was developed, and a systematic search of 4 electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) was conducted for papers published from the start of the creation of the database until November 27, 2022. Experimental studies reporting on eHealth interventions designed to increase moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation were included. Multiple unblinded reviewers determined the study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Collaboration Tool for randomized controlled trials and the Cochrane Effective Practice and Organization of Care group methods for nonrandomized controlled trials. A random-effect model was used to provide the summary measures of effect (ie, standardized mean difference and 95% CI). All statistical analyses were performed using Stata 17. Results: We screened 3636 studies, but only 29 studies were included in the final review, of which 18 were included in the meta-analysis. The meta-analysis demonstrated that eHealth interventions improved moderate-to-vigorous intensity physical activity (standardized mean difference=0.18, 95% CI 0.07-0.28; P=.001) and vigorous-intensity physical activity (standardized mean difference=0.2, 95% CI 0.00-0.39; P=.048) but did not improve moderate-intensity physical activity (standardized mean difference=0.19, 95% CI ?0.12 to 0.51; P=.23). No changes were observed in the cardiovascular-related outcomes. Post hoc subgroup analyses identified that wearable-based, web-based, and communication-based eHealth intervention delivery methods were effective. Conclusions: eHealth interventions are effective at increasing minutes per week of moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. There was no difference in the effectiveness of the major eHealth intervention delivery methods, thereby providing evidence that in the future, health care professionals and researchers can personalize convenient and affordable interventions tailored to patient characteristics and needs to eliminate the inconvenience of visiting center-based cardiac rehabilitation programs during the COVID-19 pandemic and to provide better support for home-based maintenance of cardiac rehabilitation. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021278029; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278029 UR - https://www.jmir.org/2023/1/e42845 UR - http://dx.doi.org/10.2196/42845 UR - http://www.ncbi.nlm.nih.gov/pubmed/36989017 ID - info:doi/10.2196/42845 ER - TY - JOUR AU - Bente, E. Britt AU - Wentzel, Jobke AU - Schepers, Celina AU - Breeman, D. Linda AU - Janssen, R. Veronica AU - Pieterse, E. Marcel AU - Evers, M. Andrea W. AU - van Gemert-Pijnen, Lisette PY - 2023/3/24 TI - Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study JO - JMIR Cardio SP - e43781 VL - 7 KW - patient needs KW - health behavior KW - lifestyle support KW - user-centered design KW - implementation KW - evaluation KW - cardiovascular disease KW - app KW - web-based platform KW - intervention N2 - Background: eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients? needs, it is necessary to account for these changes in needs and contexts of use. Objective: This study aimed to identify and monitor patients? needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: ?How do novice and more advanced users experience an online health management platform?? ?What user expectations support or hinder the adoption of an online health management platform, from a user perspective?? and ?How does actual usage relate to user experiences and adoption?? Methods: A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. Results: After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. Conclusions: Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients? needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology. UR - https://cardio.jmir.org/2023/1/e43781 UR - http://dx.doi.org/10.2196/43781 UR - http://www.ncbi.nlm.nih.gov/pubmed/36961491 ID - info:doi/10.2196/43781 ER - TY - JOUR AU - Han, Dong AU - Ding, Y. Eric AU - Cho, Chaeho AU - Jung, Haewook AU - Dickson, L. Emily AU - Mohagheghian, Fahimeh AU - Peitzsch, G. Andrew AU - DiMezza, Danielle AU - Tran, Khanh-Van AU - McManus, D. David AU - Chon, H. Ki PY - 2023/2/13 TI - A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study JO - JMIR Cardio SP - e41691 VL - 7 KW - atrial fibrillation KW - stroke KW - smartwatch app KW - smartphone apps KW - wearable devices KW - user experience KW - older adults KW - mobile phone N2 - Background: The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. Objective: This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. Methods: The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. Results: We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64%) endorsed that the smartwatch app is ?easy to use.? For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. Conclusions: This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system?s usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. Trial Registration: ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394 International Registered Report Identifier (IRRID): RR2-10.1016/j.cvdhj.2021.07.002 UR - https://cardio.jmir.org/2023/1/e41691 UR - http://dx.doi.org/10.2196/41691 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780211 ID - info:doi/10.2196/41691 ER - TY - JOUR AU - Giggins, M. Oonagh AU - Doyle, Julie AU - Smith, Suzanne AU - Vavasour, Grainne AU - Moran, Orla AU - Gavin, Shane AU - Sojan, Nisanth AU - Boyle, Gordon PY - 2023/2/10 TI - Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study JO - JMIR Cardio SP - e40283 VL - 7 KW - cardiac rehabilitation KW - exercise KW - coronary heart disease KW - CHD KW - coronary KW - cardiovascular KW - virtual rehabilitation KW - remote rehabilitation KW - digital health KW - heart KW - rehabilitation KW - cardiac KW - digital platform KW - digital KW - intervention KW - program KW - physical activity KW - fitness N2 - Background: Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR. Objective: We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre?Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program. Methods: In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed. Results: In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F1,14=.026; P=.87) nor effect for time (F1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study. Conclusions: This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supported with digital self-monitoring, is feasible and may be considered for individuals less likely to participate in traditional center-based programs. International Registered Report Identifier (IRRID): RR2-10.2196/31855 UR - https://cardio.jmir.org/2023/1/e40283 UR - http://dx.doi.org/10.2196/40283 UR - http://www.ncbi.nlm.nih.gov/pubmed/36763453 ID - info:doi/10.2196/40283 ER - TY - JOUR AU - Nabutovsky, Irene AU - Breitner, Daniel AU - Heller, Alexis AU - Scheinowitz, Mickey AU - Klempfner, Yarin AU - Klempfner, Robert PY - 2022/11/16 TI - The First National Program of Remote Cardiac Rehabilitation in Israel?Goal Achievements, Adherence, and Responsiveness in Older Adult Patients: Retrospective Analysis JO - JMIR Cardio SP - e36947 VL - 6 IS - 2 KW - remote cardiac rehabilitation KW - mobile application KW - adherence KW - elderly patients KW - telehealth KW - telemedicine KW - cardiology KW - smartwatch KW - wearable KW - patient monitoring N2 - Background: Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative Israeli national program in the field of telecardiology. RCR is included in the Israeli health coverage for all citizens. It is generally accepted that telemedicine programs better apply to younger patients because it is thought that they are more technologically literate than are older patients. It has also previously been thought that older patients have difficulty using technology-based programs and attaining program goals. Objective: The objectives of this study were as follows: to study patterns of physical activity, goal achievement, and improvement in functional capacity among patients undergoing RCR over 65 years old compared to those of younger patients; and to identify predictors of better adherence with the RCR program. Methods: A retrospective study of patients post?myocardial infarction were enrolled in a 6-month RCR program. The activity of the patients was monitored using a smartwatch. The data were collected and analyzed by a special telemedicine platform. RCR program goals were as follows: 150 minutes of aerobic activity per week, 120 minutes of the activity in the target heart rate recommended by the exercise physiologist, and 8000 steps per day. Models were created to evaluate variables predicting adherence with the program. Results: Out of 306 patients, 80 were older adults (mean age 70 years, SD 3.4 years). At the end of the program, there was a significant improvement in the functional capacity of all patients (P=.002). Specifically, the older adult group improved from a mean 8.1 (SD 2.8) to 11.2 (SD 12.6). The metabolic equivalents of task (METs) and final MET results were similar among older and younger patients. During the entire program period, the older adult group showed better achievement of program goals compared to younger patients (P=.03). Additionally, we found that younger patient age is an independent predictor of early dropout from the program and completion of program goals (P=.045); younger patients were more likely to experience early program dropout and to complete fewer program goals. Conclusions: Older adult patients demonstrated better compliance and achievement of the goals of the remote rehabilitation program in comparison with younger patients. We found that older age is not a limitation but rather a predictor of better RCR program compliance and program goal achievement. UR - https://cardio.jmir.org/2022/2/e36947 UR - http://dx.doi.org/10.2196/36947 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383410 ID - info:doi/10.2196/36947 ER - TY - JOUR AU - Gutenberg, Johanna AU - Kulnik, Tino Stefan AU - Niebauer, Josef AU - Crutzen, Rik PY - 2022/9/7 TI - Determinants of Physical Activity in the Cardiac Population: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e39188 VL - 11 IS - 9 KW - behavior change KW - cardiac rehabilitation KW - cardiovascular disease KW - determinants KW - heart healthy KW - physical activity KW - protocol KW - secondary prevention KW - systematic review KW - cardiac disease KW - heart disease KW - clinician KW - health care worker KW - health intervention KW - decision-making KW - health promotion N2 - Background: Lack of physical activity is a critical contributing risk factor to cardiovascular disease. Hence, regular physical activity is a mainstay in the primary and secondary prevention of cardiovascular disease. Despite the extensive promotion of physical activity in both primary and secondary prevention programs, including cardiac rehabilitation, physical activity levels in the cardiac population remain low. Therefore, it is crucial to understand critical determinants that influence physical activity behavior. Objective: This study aims to deliver a systematic review of studies with collated observational data exploring the association between determinants and physical activity behavior in the target population. These new insights inform the design of future interventions targeted at lasting heart-healthy physical activity behavior in the cardiac population. Methods: Primary studies with observational quantitative data on determinants and their association with physical activity behavior in the cardiac population will be included. Information on relevant primary studies will be retrieved from various databases, including Embase, CINAHL, MEDLINE, PsycInfo, and Web of Science Core Collection. Six reviewers will independently double-screen articles. Studies will be selected according to the prespecified inclusion and exclusion criteria. Data will be extracted and entered into suitable worksheets. The US-based National Heart, Lung, and Blood Institute?s Study Quality Assessment Tool for Observational Studies will be used to assess the quality of all eligible primary studies. The results will be presented in a descriptive and narrative synthesis. If the type and quality of data are suitable, meta-analyses will be conducted. Study reporting will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Results: Data collection started in September 2020, and the literature search was updated in July 2021. Data synthesis is ongoing, and the literature search will be updated in October 2022. Conclusions: This review will be valuable to relevant stakeholders, including clinicians and health care professionals, intervention developers, and decision makers in health care. It lays a comprehensive foundation for understanding the determinants of physical activity to inform the design of secondary prevention interventions relevant to the cardiac population. Trial Registration: PROSPERO CRD42020206637; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206637 International Registered Report Identifier (IRRID): RR1-10.2196/39188 UR - https://www.researchprotocols.org/2022/9/e39188 UR - http://dx.doi.org/10.2196/39188 UR - http://www.ncbi.nlm.nih.gov/pubmed/36069762 ID - info:doi/10.2196/39188 ER - TY - JOUR AU - Brocki, Cristina Barbara AU - Andreasen, Jesper Jan AU - Aaroe, Jens AU - Andreasen, Jane AU - Thorup, Brun Charlotte PY - 2022/4/26 TI - Exercise-Based Real-time Telerehabilitation for Older Adult Patients Recently Discharged After Transcatheter Aortic Valve Implantation: Mixed Methods Feasibility Study JO - JMIR Rehabil Assist Technol SP - e34819 VL - 9 IS - 2 KW - telerehabilitation KW - transcatheter aortic valve implantation KW - cardiac surgery KW - cardiac rehabilitation KW - exercise training KW - older adults KW - tablet N2 - Background: The use of telehealth technology to improve functional recovery following transcatheter aortic valve implantation (TAVI) has not been investigated. Objective: In this study, we aimed to examine the feasibility of exercise-based cardiac telerehabilitation after TAVI. Methods: This was a single-center, prospective, nonrandomized study using a mixed methods approach. Data collection included testing, researchers? observations, logbooks, and individual patient interviews, which were analyzed using a content analysis approach. The intervention lasted 3 weeks and consisted of home-based web-based exercise training, an activity tracker, a TAVI information website, and 1 web-based session with a nurse. Results: Of the initially included 13 patients, 5 (40%) completed the study and were interviewed; the median age was 82 (range 74-84) years, and the sample comprised 3 men and 2 women. Easy access to supervised exercise training at home with real-time feedback and use of the activity tracker to count daily steps were emphasized by the patients who completed the intervention. Reasons for patients not completing the program included poor data coverage, participants? limited information technology skills, and a lack of functionality in the systems used. No adverse events were reported. Conclusions: Exercise-based telerehabilitation for older people after TAVI, in the population as included in this study, and delivered as a web-based intervention, does not seem feasible, as 60% (8/13) of patients did not complete the study. Those completing the intervention highly appreciated the real-time feedback during the web-based training sessions. Future studies should address aspects that support retention rates and enhance patients? information technology skills. UR - https://rehab.jmir.org/2022/2/e34819 UR - http://dx.doi.org/10.2196/34819 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471263 ID - info:doi/10.2196/34819 ER - TY - JOUR AU - Ögmundsdóttir Michelsen, Halldóra AU - Sjölin, Ingela AU - Bäck, Maria AU - Gonzalez Garcia, Manuel AU - Olsson, Anneli AU - Sandberg, Camilla AU - Schiopu, Alexandru AU - Leósdóttir, Margrét PY - 2022/3/31 TI - Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial JO - J Med Internet Res SP - e25224 VL - 24 IS - 3 KW - eHealth KW - cardiac rehabilitation KW - cardiovascular KW - mobile device app KW - risk factors KW - web-based application KW - mobile phone N2 - Background: Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. Objective: This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). Methods: All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. Results: There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic ?27.7 vs ?16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic ?25.3 vs ?16.4 mm Hg; P=.02, and diastolic ?13.4 vs ?9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25. Conclusions: Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation. Trial Registration: ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3118-1 UR - https://www.jmir.org/2022/3/e25224 UR - http://dx.doi.org/10.2196/25224 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357316 ID - info:doi/10.2196/25224 ER - TY - JOUR AU - Lunde, Pernille AU - Bye, Asta AU - Bruusgaard, Anette Kari AU - Hellem, Elisabet AU - Nilsson, Blakstad Birgitta PY - 2022/3/23 TI - Patients? Experiences of Using a Smartphone App After Cardiac Rehabilitation: Qualitative Study JO - JMIR Hum Factors SP - e34294 VL - 9 IS - 1 KW - mHealth KW - mobile health KW - cardiac rehabilitation KW - mobile phone app KW - smartphone KW - lifestyle N2 - Background: Exercise-based cardiac rehabilitation (CR) is a crucial part of the treatment of patients with cardiac diseases, and adherence to healthy behavior is a prerequisite to improve long-term prognosis. Unfortunately, adherence to healthy behavior adapted in CR is challenging for many cardiac patients in the long term. Recently, we demonstrated that follow-up conducted via an app for 1 year significantly improved adherence to healthy behavior after CR. To increase the knowledge and understanding of mobile Health (mHealth) interventions that can promote acceptance and adherence, qualitative research investigating patients? experiences with these interventions is warranted. Objective: The aim was to investigate patient experiences with individualized long-term follow-up conducted via an app for 1 year and their thoughts about what features promoted adherence to healthy behavior after CR. The purpose was to increase the understanding of significant findings previously reported and to guide future development of similar interventions in the field of adherence. Methods: A qualitative study with individual interviews was conducted from November 2018 to May 2019. A thematic interview guide was used when conducting the semistructured in-depth interviews. The interviews were audio recorded and transcribed successively during the period in which the interviews were conducted. Texts were managed and systematized by NVivo. Interviews were analyzed by qualitative content analysis. Codes and themes were inductively developed. Results: Ten patients who had participated in a randomized controlled trial evaluating the effect of follow-up conducted via an app on adherence to healthy behavior after CR were included. The median patient age was 65 years (range 46-72 years), and both genders were represented. The analysis resulted in the following 4 themes describing the patients? experiences: (1) The person behind the app is crucial for motivation and adherence; (2) The app as a commitment; (3) The app as a path to independence; and (4) Suggestions for improvements. Features experienced as beneficial to promote adherence were individualized feedback and the use of goal setting. The significance of the person behind the app (the supervisor) who provided individualized feedback was a consistent finding. This person seemed to promote motivation in general and to enable other known behavioral change techniques. Conclusions: The person behind the app (the supervisor) seems to be one of the most significant success factors in promoting adherence to healthy behavior after CR. This indicates that a health care provider must actively participate in a patient?s process of adherence to healthy behavior, even when using interventions, including an app. Future development of interventions in the field of adherence should strive to create tools that enable an ongoing collaborative relationship between the patient and the health care provider. The follow-up should be based on the patient?s own goals, and individualized feedback should be provided. UR - https://humanfactors.jmir.org/2022/1/e34294 UR - http://dx.doi.org/10.2196/34294 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319476 ID - info:doi/10.2196/34294 ER - TY - JOUR AU - Sawa, Ryuichi AU - Saitoh, Masakazu AU - Morisawa, Tomoyuki AU - Takahashi, Tetsuya AU - Morimoto, Yuh AU - Kagiyama, Nobuyuki AU - Kasai, Takatoshi AU - Dinesen, Birthe AU - Daida, Hiroyuki PY - 2022/3/18 TI - The Potential Application of Commercially Available Active Video Games to Cardiac Rehabilitation: Scoping Review JO - JMIR Serious Games SP - e31974 VL - 10 IS - 1 KW - active video game KW - cardiac rehabilitation KW - physical exercise KW - rehabilitation KW - serious games KW - CVD KW - AVG KW - cardiovascular disease KW - exercise KW - safety KW - adherence N2 - Background: Commercially available active video games (AVGs) have recently been used for rehabilitation in some specific patient populations but rarely in those with cardiovascular disease (CVD). Commercially available AVGs are designed to increase motivation for continuous play, which could be applicable to the long-term cardiac rehabilitation process. Objective: The objective of this scoping review was to assess the effectiveness of AVG-induced physical exercise, safety management, and patient adherence by applying commercially available AVGs to cardiac rehabilitation. Methods: Four databases (CINAHL, MEDLINE, PubMed, and SPORTDiscus) were searched for all years up to August 12, 2020. Articles were retained if they were written in English, included patients with CVD who were aged 18 years or older, and used AVGs as part of a physical exercise program. The included studies were then evaluated from the viewpoints of effectiveness as physical exercise, safety, and adherence management. Results: Among 120 nonduplicate articles reviewed, 5 (4.2%) were eligible for inclusion, of which 3 (2.5%) were reported by the same research group. The AVG consoles used were Xbox Kinect and Nintendo Wii, and sports-related programs were adopted for the intervention. No adverse cardiac events occurred in the identified studies, and dropout rates tended to be low. Conclusions: AVGs appear to be safe and feasible for promoting an active lifestyle in patients with CVD. However, the effectiveness of AVGs alone as a therapeutic exercise to improve physical function may be limited. UR - https://games.jmir.org/2022/1/e31974 UR - http://dx.doi.org/10.2196/31974 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302503 ID - info:doi/10.2196/31974 ER - TY - JOUR AU - Dodson, A. John AU - Schoenthaler, Antoinette AU - Sweeney, Greg AU - Fonceva, Ana AU - Pierre, Alicia AU - Whiteson, Jonathan AU - George, Barbara AU - Marzo, Kevin AU - Drewes, Wendy AU - Rerisi, Elizabeth AU - Mathew, Reena AU - Aljayyousi, Haneen AU - Chaudhry, I. Sarwat AU - Hajduk, M. Alexandra AU - Gill, M. Thomas AU - Estrin, Deborah AU - Kovell, Lara AU - Jennings, A. Lee AU - Adhikari, Samrachana PY - 2022/3/3 TI - Rehabilitation Using Mobile Health for Older Adults With Ischemic Heart Disease in the Home Setting (RESILIENT): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e32163 VL - 11 IS - 3 KW - mobile health KW - cardiac rehabilitation KW - clinical trial KW - rehabilitation KW - cardiology KW - heart disease KW - ambulatory care KW - mHealth KW - health outcomes KW - older adults N2 - Background: Participation in ambulatory cardiac rehabilitation remains low, especially among older adults. Although mobile health cardiac rehabilitation (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments may limit older adults? uptake, and efficacy data are currently lacking. Objective: This study aims to describe the design of the rehabilitation using mobile health for older adults with ischemic heart disease in the home setting (RESILIENT) trial. Methods: RESILIENT is a multicenter randomized clinical trial that is enrolling patients aged ?65 years with ischemic heart disease in a 3:1 ratio to either an intervention (mHealth-CR) or control (usual care) arm, with a target sample size of 400 participants. mHealth-CR consists of a commercially available mobile health software platform coupled with weekly exercise therapist sessions to review progress and set new activity goals. The primary outcome is a change in functional mobility (6-minute walk distance), which is measured at baseline and 3 months. Secondary outcomes are health status, goal attainment, hospital readmission, and mortality. Among intervention participants, engagement with the mHealth-CR platform will be analyzed to understand the characteristics that determine different patterns of use (eg, persistent high engagement and declining engagement). Results: As of December 2021, the RESILIENT trial had enrolled 116 participants. Enrollment is projected to continue until October 2023. The trial results are expected to be reported in 2024. Conclusions: The RESILIENT trial will generate important evidence about the efficacy of mHealth-CR among older adults in multiple domains and characteristics that determine the sustained use of mHealth-CR. These findings will help design future precision medicine approaches to mobile health implementation in older adults. This knowledge is especially important in light of the COVID-19 pandemic that has shifted much of health care to a remote, internet-based setting. Trial Registration: ClinicalTrials.gov NCT03978130; https://clinicaltrials.gov/ct2/show/NCT03978130 International Registered Report Identifier (IRRID): DERR1-10.2196/32163 UR - https://www.researchprotocols.org/2022/3/e32163 UR - http://dx.doi.org/10.2196/32163 UR - http://www.ncbi.nlm.nih.gov/pubmed/35238793 ID - info:doi/10.2196/32163 ER - TY - JOUR AU - Rivers, T. John AU - Smith, Carla AU - Smith, Ian AU - Cameron, James PY - 2022/1/17 TI - The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study JO - JMIR Cardio SP - e24174 VL - 6 IS - 1 KW - cardiac rehabilitation KW - digital health KW - smartphone app KW - Cardihab KW - participation rates KW - rehabilitation KW - cardiology KW - heart KW - app KW - barrier N2 - Background: Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective: We evaluated the impact on CR participation rates associated with the addition of the option of mobile app?based CR (Cardihab) for patients declining conventional CR. Methods: A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results: CR participation improved from 21% (95% CI 14%-30%) to 63% (95% CI 53%-71%) with the addition of the app (P<.001). Approximately 25% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions: Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake. UR - https://cardio.jmir.org/2022/1/e24174 UR - http://dx.doi.org/10.2196/24174 UR - http://www.ncbi.nlm.nih.gov/pubmed/35037891 ID - info:doi/10.2196/24174 ER - TY - JOUR AU - Ramachandran, Joann Hadassah AU - Jiang, Ying AU - Teo, Claire Jun Yi AU - Yeo, Joo Tee AU - Wang, Wenru PY - 2022/1/7 TI - Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review JO - J Med Internet Res SP - e34657 VL - 24 IS - 1 KW - technology acceptance KW - coronary heart disease KW - home-based KW - telerehabilitation KW - web-based KW - mobile application KW - acceptance KW - heart KW - rehabilitation KW - app KW - review KW - evaluation KW - cardiac KW - cardiology KW - perspective KW - usability KW - acceptability N2 - Background: An understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature. Objective: We aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients? perspectives on its usability, utility, acceptability, acceptance, and external variables. Methods: We searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken. Results: The search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors. Conclusions: Home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians. UR - https://www.jmir.org/2022/1/e34657 UR - http://dx.doi.org/10.2196/34657 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994711 ID - info:doi/10.2196/34657 ER - TY - JOUR AU - Lairez, Olivier AU - Blanchard, Virginie AU - Balardy, Laurent AU - Vardon-Bounes, Fanny AU - Cazalbou, Stéphanie AU - Ruiz, Stéphanie AU - Collot, Samia AU - Houard, Valérie AU - Rolland, Yves AU - Conil, Jean-Marie AU - Minville, Vincent PY - 2022/1/6 TI - COCARDE Study?Cardiac Imaging Phenotype in Patients With COVID-19: Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e24931 VL - 11 IS - 1 KW - COVID-19 KW - SARS-CoV-2 KW - cardiac imaging KW - echocardiography KW - cardiac MRI KW - hyperinflammation KW - inflammation N2 - Background: The effects of SARS-CoV-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-CoV-2 is driven by hyperinflammation, and the effects of SARS-CoV-2 on the myocardium may be significant. This study proposes to use bedside observations and biomarkers to characterize the association of COVID-19 with myocardial injury. Objective: The aim of the study is to describe the myocardial function and its evolution over time in patients infected with SARS-CoV-2 and to investigate the link between inflammation and cardiac injury. Methods: This prospective, monocentric, observational study enrolled 150 patients with suspected or confirmed SARS-CoV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted to the intensive care unit (ICU), regular cardiologic ward, and geriatric ward of our tertiary university hospital were included during the pandemic period. Blood sampling, electrocardiography, echocardiography, and morphometric and demographic data were prospectively collected. Results: A total of 100 patients were included. The final enrolment day was March 31, 2020, with first report of results at the end of the first quarter of 2021. The first echocardiographic results at admission of 31 patients of the COCARDE-ICU substudy population show that biological myocardial injury in COVID-19 has low functional impact on left ventricular systolic function. Conclusions: A better understanding of the effects of COVID-19 on myocardial function and its link with inflammation would improve patient follow-up and care. Trial Registration: Clinicaltrials.gov NCT04358952; https://clinicaltrials.gov/ct2/show/NCT04358952 International Registered Report Identifier (IRRID): DERR1-10.2196/24931 UR - https://www.researchprotocols.org/2022/1/e24931 UR - http://dx.doi.org/10.2196/24931 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751159 ID - info:doi/10.2196/24931 ER - TY - JOUR AU - Rogerson, C. Michelle AU - Jackson, C. Alun AU - Navaratnam, S. Hema AU - Le Grande, R. Michael AU - Higgins, O. Rosemary AU - Clarke, Joanne AU - Murphy, M. Barbara PY - 2021/12/23 TI - Getting ?Back on Track? After a Cardiac Event: Protocol for a Randomized Controlled Trial of a Web-Based Self-management Program JO - JMIR Res Protoc SP - e34534 VL - 10 IS - 12 KW - coronary heart disease KW - heart disease KW - coronary KW - cardiovascular KW - prevention KW - RCT KW - randomized control trial KW - secondary prevention KW - self-management KW - online KW - randomised controlled trial KW - health behaviours KW - health behaviour KW - health behavior KW - depression KW - cognitive behaviour therapy KW - motivational interviewing N2 - Background: After a cardiac event, a large majority of patients with cardiac conditions do not achieve recommended behavior change targets for secondary prevention. Mental health issues can also impact the ability to engage in health behavior change. There is a need for innovative, flexible, and theory-driven eHealth programs, which include evidence-based strategies to assist patients with cardiac conditions with their recovery, especially in behavioral and emotional self-management. Objective: The aim of this study is to determine the short- and longer-term behavioral and emotional well-being outcomes of the Back on Track web-based self-management program. In addition, this study will test whether there is enhanced benefit of providing one-on-one telephone support from a trained lifestyle counselor, over and above benefit obtained through completing the web-based program alone. Methods: People who have experienced a cardiac event in the previous 12 months and have access to the internet will be eligible for this study (N=120). Participants will be randomly assigned to one of the two study conditions: either ?self-directed? completion of the Back on Track program (without assistance) or ?supported? completion of the Back on Track program (additional 2 telephone sessions with a lifestyle counselor). All participants will have access to the web-based Back on Track program for 2 months. Telephone sessions with the supported arm participants will occur at approximately 2 and 6 weeks post enrollment. Measures will be assessed at baseline, and then 2 and 6 months later. Outcome measures assessed at all 3 timepoints include dietary intake, physical activity and sitting time, smoking status, anxiety and depression, stage of change, and self-efficacy in relation to behavioral and emotional self-management, quality of life, and self-rated health and well-being. A demographic questionnaire will be included at baseline only and program acceptability at 2 months only. Results: Recruitment began in May 2020 and concluded in August 2021. Data collection for the 6-month follow-up will be completed by February 2022, and data analysis and publication of results will be completed by June 2022. A total of 122 participants were enrolled in this study. Conclusions: The Back on Track trial will enable us to quantify the behavioral and emotional improvements obtained and maintained for patients with cardiac conditions and, in particular, to compare two modes of delivery: (1) fully self-directed delivery and (2) supported by a lifestyle counselor. We anticipate that the web-based Back on Track program will assist patients in their recovery and self-management after an acute event, and represents an effective, flexible, and easily accessible adjunct to center-based rehabilitation programs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000102976; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378920&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/34534 UR - https://www.researchprotocols.org/2021/12/e34534 UR - http://dx.doi.org/10.2196/34534 UR - http://www.ncbi.nlm.nih.gov/pubmed/34941550 ID - info:doi/10.2196/34534 ER - TY - JOUR AU - Choi, Yeon Jah AU - Kim, Bak Ji AU - Lee, Sunki AU - Lee, Seo-Joon AU - Shin, Eon Seung AU - Park, Hyun Se AU - Park, Jin Eun AU - Kim, Woohyeun AU - Na, Oh Jin AU - Choi, Ung Cheol AU - Rha, Seung-Woon AU - Park, Gyu Chang AU - Seo, Seog Hong AU - Ahn, Jeonghoon AU - Jeong, Hyun-Ghang AU - Kim, Ju Eung PY - 2021/12/7 TI - A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study JO - JMIR Med Inform SP - e23285 VL - 9 IS - 12 KW - cardiac rehabilitation KW - smartphone app KW - coronary heart disease N2 - Background: Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective: This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods: The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results: The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions: We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research. UR - https://medinform.jmir.org/2021/12/e23285 UR - http://dx.doi.org/10.2196/23285 UR - http://www.ncbi.nlm.nih.gov/pubmed/34878987 ID - info:doi/10.2196/23285 ER - TY - JOUR AU - Herkert, Cyrille AU - Graat-Verboom, Lidwien AU - Gilsing-Fernhout, Judith AU - Schols, Manon AU - Kemps, Clemens Hareld Marijn PY - 2021/11/9 TI - Home-Based Exercise Program for Patients With Combined Advanced Chronic Cardiac and Pulmonary Diseases: Exploratory Study JO - JMIR Form Res SP - e28634 VL - 5 IS - 11 KW - home-based exercise KW - cardiac diseases KW - pulmonary diseases KW - comorbidities KW - elderly N2 - Background: As chronic cardiac and pulmonary diseases often coexist, there is a need for combined physical home-based rehabilitation programs, specifically addressing older patients with advanced disease stages. Objective: The primary aim of this study is to evaluate the completion and adherence rates of an 8-week, home-based exercise program for patients with advanced cardiopulmonary disease. The secondary end points include patient satisfaction; adverse events; and program efficacy in terms of change in functional capacity, level of dyspnea, and health-related quality of life. Methods: The participants received a goal-oriented, home-based exercise program, and they used a wrist-worn activity tracker to record their exercise sessions. Activity tracker data were made visible on a digital platform, which was also equipped with several other features such as short instruction videos on how to perform specific exercises. The participants received weekly coaching by a physiotherapist and an occupational therapist through video communication. Results: In all, 10 patients with advanced combined cardiopulmonary disease participated (median age 71, IQR 63-75 years), and 50% (5/10) were men. Of the 10 participants, 9 (90%) completed the 8-week program. Median adherence to the exercise prescription was 75% (IQR 37%-88%), but it declined significantly when the program was divided into 2-week periods (first 2 weeks: 86%, IQR 51%-100%, and final 2 weeks: 57%, IQR 8%-75%; P=.03). The participants were highly satisfied with the program (Client Satisfaction Questionnaire: median score 29, IQR 26-32, and Purpose-Designed Questionnaire: median score 103, IQR 92-108); however, of the 9 participants, 4 (44%) experienced technical issues. The Patient-Specific Complaints Instrument scores declined, indicating functional improvement (from median 7.5, IQR 6.1-8.9, to median 5.7, IQR 3.8-6.7; P=.01). Other program efficacy metrics showed a trend toward improvement. Conclusions: Home-based cardiopulmonary telerehabilitation for patients with severe combined cardiopulmonary disease is feasible in terms of high completion and satisfaction rates. Nevertheless, a decrease in adherence during the program was observed, and some of the participants reported difficulties with the technology, indicating the importance of the integration of behavior change techniques, using appropriate technology. Trial Registration: Netherlands Trial Register NL9182; https://www.trialregister.nl/trial/9182 UR - https://formative.jmir.org/2021/11/e28634 UR - http://dx.doi.org/10.2196/28634 UR - http://www.ncbi.nlm.nih.gov/pubmed/34751655 ID - info:doi/10.2196/28634 ER - TY - JOUR AU - Anttila, Marjo-Riitta AU - Soderlund, Anne AU - Paajanen, Teemu AU - Kivistö, Heikki AU - Kokko, Katja AU - Sjögren, Tuulikki PY - 2021/11/3 TI - Biopsychosocial Profiles of Patients With Cardiac Disease in Remote Rehabilitation Processes: Mixed Methods Grounded Theory Approach JO - JMIR Rehabil Assist Technol SP - e16864 VL - 8 IS - 4 KW - coronary disease KW - experience KW - biopsychosocial model KW - digital cardiac rehabilitation KW - mixed methods grounded theory KW - web-based program KW - physical activity KW - self-efficacy KW - quality of life N2 - Background: Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): feeling outsider, being uninterested, reflecting benefit, and enthusiastic using. Objective: This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation. Methods: Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a t test, or nonparametric tests?Mann?Whitney and Kruskal?Wallis tests?to compare the 4 e-usage groups?feeling outsider, being uninterested, reflecting benefit, and enthusiastic using?in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory. Results: The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; P=.03) and lower for physical fitness (MD ?0.72; 95% CI ?1.4 to ?0.06; P=.03) in the being uninterested group than in the enthusiastic using group. The feeling outsider group had lower physical fitness (MD ?55.8; 95% CI ?110.7 to ?0.92; P=.047) than the enthusiastic using group. For psychosocial variables, such as the degree of self-determination in exercise (MD ?7.3; 95% CI ?13.5 to ?1.1; P=.02), the being uninterested group had lower values than the enthusiastic using group. Social variables such as performing guided tasks in the program (P=.03) and communicating via messages (P=.03) were lower in the feeling outsider group than in the enthusiastic using group. The feeling outsider and being uninterested groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the being uninterested group were interested in tracking their physical activity. The reflecting benefit and enthusiastic using groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the enthusiastic using group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as building self-awareness, increasing engagement, maintaining a healthy lifestyle balance, and strengthening self-confidence. Conclusions: The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles. UR - https://rehab.jmir.org/2021/4/e16864 UR - http://dx.doi.org/10.2196/16864 UR - http://www.ncbi.nlm.nih.gov/pubmed/34730548 ID - info:doi/10.2196/16864 ER - TY - JOUR AU - Skov Schacksen, Cathrine AU - Henneberg, Celina Nanna AU - Muthulingam, Anajan Janusiya AU - Morimoto, Yuh AU - Sawa, Ryuichi AU - Saitoh, Masakazu AU - Morisawa, Tomoyuki AU - Kagiyama, Nobuyuki AU - Takahashi, Tetsuya AU - Kasai, Takatoshi AU - Daida, Hiroyuki AU - Refsgaard, Jens AU - Hollingdal, Malene AU - Dinesen, Birthe PY - 2021/11/1 TI - Effects of Telerehabilitation Interventions on Heart Failure Management (2015-2020): Scoping Review JO - JMIR Rehabil Assist Technol SP - e29714 VL - 8 IS - 4 KW - heart failure KW - telerehabilitation KW - quality of life KW - physical capacity KW - depression KW - anxiety KW - telehealth KW - rehabilitation KW - cardiac rehabilitation KW - cardiovascular disease KW - CVD KW - mental health KW - adherence N2 - Background: Heart failure is one of the world?s most frequently diagnosed cardiovascular diseases. An important element of heart failure management is cardiac rehabilitation, the goal of which is to improve patients? recovery, functional capacity, psychosocial well-being, and health-related quality of life. Patients in cardiac rehabilitation may lack sufficient motivation or may feel that the rehabilitation process does not meet their individual needs. One solution to these challenges is the use of telerehabilitation. Although telerehabilitation has been available for several years, it has only recently begun to be utilized in heart failure studies. Especially within the past 5 years, we now have several studies focusing on the effectiveness of telerehabilitation for heart failure management, all with varying results. Based on a review of these studies, this paper offers an assessment of the effectiveness of telerehabilitation as applied to heart failure management. Objective: The aim of this scoping review was to assess the effects of telerehabilitation in the management of heart failure by systematically reviewing the available scientific literature within the period from January 1, 2015, to December 31, 2020. Methods: The literature search was carried out using PubMed and EMBASE. After duplicates were removed, 77 articles were screened and 12 articles were subsequently reviewed. The review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews) guidelines. As measures of the effectiveness of telerehabilitation, the following outcomes were used: patients? quality of life, physical capacity, depression or anxiety, and adherence to the intervention. Results: A total of 12 articles were included in this review. In reviewing the effects of telerehabilitation for patients with heart failure, it was found that 4 out of 6 randomized controlled trials (RCTs), a single prospective study, and 4 out of 5 reviews reported increased quality of life for patients. For physical capacity, 4 RCTs and 3 systematic reviews revealed increased physical capacity. Depression or depressive symptoms were reported as being reduced in 1 of the 6 RCTs and in 2 of the 5 reviews. Anxiety or anxiety-related symptoms were reported as reduced in only 1 review. High adherence to the telerehabilitation program was reported in 4 RCTs and 4 reviews. It should be mentioned that some of the reviewed articles described the same studies although they employed different outcome measures. Conclusions: It was found that there is a tendency toward improvement in patients? quality of life and physical capacity when telerehabilitation was used in heart failure management. The outcome measures of depression, anxiety, and adherence to the intervention were found to be positive. Additional research is needed to determine more precise and robust effects of telerehabilitation. UR - https://rehab.jmir.org/2021/4/e29714 UR - http://dx.doi.org/10.2196/29714 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723827 ID - info:doi/10.2196/29714 ER - TY - JOUR AU - Tadas, Shreya AU - Pretorius, Claudette AU - Foster, J. Emma AU - Gorely, Trish AU - Leslie, J. Stephen AU - Coyle, David PY - 2021/10/14 TI - Transitions in Technology-Mediated Cardiac Rehabilitation and Self-management: Qualitative Study Using the Theoretical Domains Framework JO - JMIR Cardio SP - e30428 VL - 5 IS - 2 KW - cardiac rehabilitation KW - self-management KW - self-care KW - behavioral change KW - Theoretical Domains Framework KW - qualitative methods KW - mobile phone N2 - Background: An acute cardiac incident is a life-changing event that often necessitates surgery. Although surgery has high success rates, rehabilitation, behavioral changes, and self-care are critical to long-term health. Recent systematic reviews have highlighted the potential of technology in this area; however, significant shortcomings have also been identified, particularly with regard to patient experience. Objective: This study aims to improve future systems and to explore the experiences of cardiac patients during key phases after hospitalization: recuperation, initial rehabilitation, and long-term self-management. The key objective is to provide a holistic understanding of behavioral factors that impact people across these phases, understand how experiences evolve over time, and provide user-centered recommendations to improve the design of cardiac rehabilitation and self-management technologies. Methods: Semistructured interviews were conducted with people who attended rehabilitation programs following hospitalization for acute cardiac events. Interviews were developed and data were analyzed via the Theoretical Domains Framework, a pragmatic framework that synthesizes prior theories of behavioral change. Results: Three phases that arise posthospitalization were examined, namely, recuperation, rehabilitation, and long-term self-management. Through these phases, we describe the impact of key factors and important changes that occur in patients? experiences over time, including the desire for and redefinition of normal life, the need for different types of formal and informal knowledge, the benefits of safe zoning and connectedness, and the need to recognize capability. The use of the Theoretical Domains Framework allows us to show how factors that influence behavior evolve over time and to identify potential sources of tension. Conclusions: This study provides empirically grounded recommendations for the design of technology-mediated cardiac rehabilitation and self-management systems. Key recommendations include the use of technology to support a normal life, leveraging social influences to extend participants? sense of normality, the use of technology to provide a safe zone, the need to support both emotional and physical well-being, and a focus on recognizing capability and providing recommendations that are positive and reinforce this capability. UR - https://cardio.jmir.org/2021/2/e30428 UR - http://dx.doi.org/10.2196/30428 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647892 ID - info:doi/10.2196/30428 ER - TY - JOUR AU - Giggins, M. Oonagh AU - Doyle, Julie AU - Smith, Suzanne AU - Moran, Orla AU - Gavin, Shane AU - Sojan, Nisanth AU - Boyle, Gordon PY - 2021/10/7 TI - Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial JO - JMIR Res Protoc SP - e31855 VL - 10 IS - 10 KW - cardiac rehabilitation KW - exercise KW - cardiovascular disease KW - virtual rehabilitation KW - digital health KW - self-management KW - pilot study KW - platform KW - feasibility N2 - Background: Exercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. Objective: The aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering ? Cardiac Rehabilitation (ECME-CR) platform. Methods: A convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. Results: Participant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. Conclusions: This pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID): PRR1-10.2196/31855 UR - https://www.researchprotocols.org/2021/10/e31855 UR - http://dx.doi.org/10.2196/31855 UR - http://www.ncbi.nlm.nih.gov/pubmed/34617908 ID - info:doi/10.2196/31855 ER - TY - JOUR AU - Itoh, Hidetaka AU - Amiya, Eisuke AU - Narita, Koichi AU - Shimbo, Mai AU - Taya, Masanobu AU - Komuro, Issei AU - Hasegawa, Takashi AU - Makita, Shigeru AU - Kimura, Yutaka PY - 2021/10/4 TI - Efficacy and Safety of Remote Cardiac Rehabilitation in the Recovery Phase of Cardiovascular Diseases: Protocol for a Multicenter, Nonrandomized, Single-Arm, Interventional Trial JO - JMIR Res Protoc SP - e30725 VL - 10 IS - 10 KW - cardiac rehabilitation KW - remote system KW - e-learning KW - exercise capacity KW - rehabilitation KW - cardiovascular disease KW - monitoring system KW - disease prevention KW - cardiology N2 - Background: Conventional group-based outpatient cardiac rehabilitation through monitoring and center-based approaches for patients in the recovery phase has shown strong evidence for the prevention of cardiovascular diseases. However, there are some cases in which maintaining attendance of center-based cardiac rehabilitation is difficult. Objective: This study aims to ascertain the safety and efficacy of remote cardiac rehabilitation (RCR) in the recovery phase in patients with cardiovascular disease. Methods: Patients satisfying the study criteria will be recruited from multiple institutions (approximately 30) across Japan. In total, 75 patients (approximately 2 or 3 patients from each institution) are proposed to be recruited. Patients enrolled in the RCR group will be lent devices necessary for RCR (including calibrated ergometers and tablets). Patients will perform anaerobic exercise at home using ergometer for 30-40 minutes at least 3 times weekly. During exercise, an instructor will monitor the patient in real time (using interactive video tools and monitoring tools for various vital data). Moreover, educational instructions will be given 3 times weekly using e-learning methods. Results: The primary endpoint is the peak oxygen uptake 2-3 months from the start of exercise or 6-min walk test. The extracted data will be compared between RCR patients and controls without RCR. Conclusions: The establishment of the system of RCR proposed in this study will lead to the development of more extensive applications, which have been insufficient through conventional interventions. Trial Registration: University Hospital Medical Information Network?Clinical Trials Registry UMIN?CTR UMIN000042942; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048983 International Registered Report Identifier (IRRID): DERR1-10.2196/30725 UR - https://www.researchprotocols.org/2021/10/e30725 UR - http://dx.doi.org/10.2196/30725 UR - http://www.ncbi.nlm.nih.gov/pubmed/34407925 ID - info:doi/10.2196/30725 ER - TY - JOUR AU - Choi, Michael AU - Raeside, Rebecca AU - Hyun, Karice AU - Partridge, R. Stephanie AU - Thiagalingam, Aravinda AU - Redfern, Julie PY - 2021/9/20 TI - Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment JO - J Med Internet Res SP - e26224 VL - 23 IS - 9 KW - mHealth KW - cardiovascular disease KW - respiratory disease KW - visual communication KW - lifestyle change KW - consumer preferences KW - secondary prevention KW - rehabilitation KW - persuasive health technology N2 - Background: Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective: This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods: A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results: There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions: A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs. UR - https://www.jmir.org/2021/9/e26224 UR - http://dx.doi.org/10.2196/26224 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542413 ID - info:doi/10.2196/26224 ER - TY - JOUR AU - Tuttle, Katherine AU - Kelemen, Arpad AU - Liang, Yulan PY - 2021/9/17 TI - Use of Smartphone Apps for Improving Physical Function Capacity in Cardiac Patient Rehabilitation: Systematic Review JO - JMIRx Med SP - e21906 VL - 2 IS - 3 KW - cardiac rehabilitation KW - physical capacity KW - exercise KW - smartphone apps N2 - Background: Cardiac rehabilitation (CR) is an evidence-based approach for preventing secondary cardiac events. Smartphone apps are starting to be used in CR to give patients real-time feedback on their health, connect them remotely with their medical team, and allow them to perform their rehabilitation at home. The use of smartphone apps is becoming omnipresent and has real potential in impacting patients in need of CR. Objective: This paper provides critical examinations and summaries of existing research studies with an in-depth analysis of not only the individual studies but also the larger patterns that have emerged with smartphone apps in CR as well as their significance for practice change. Methods: A systematic review was conducted through broad database searches that focused on evaluating randomized controlled trials, in compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) expectations. A total of 43 articles were evaluated, and 6 were chosen for this review. The dates of the articles ranged from 2014-2020, and the studies focused on the population of cardiac outpatients who needed CR after suffering a cardiac event, with interventions using a smartphone that incorporated the CR standards of the American Heart Association. The outcomes measured were directed at focusing on improved exercise function capacity, valued at a significance level of P<.05, for improved 6-minute walk test (6MWT) and peak oxygen uptake (PVO2) results. Results: In the evaluated articles, the results were inconsistent for significant positive effects of CR smartphone apps on cardiac patients? physical function capacity in terms of the 6MWT and PVO2 when using a smartphone app to aid in CR. Conclusions: Because evidence in the literature suggests nonhomogeneous results for successful use of smartphone apps in CR, it is crucial to investigate the potential reasons for this inconsistency. An important observation from this systematic review is that smartphone apps used in CR have better clinical outcomes related to physical function capacity if the app automatically records information or provides real-time feedback to participants about their progress, compared to apps that only educate and encourage use while requiring the participant to manually log their CR activities. Additional factors to consider during these studies include the starting health of the patients, the sample sizes, and the specific components of CR that the smartphone apps are using. Overall, more clinical trials are needed that implement smartphone apps with these factors in mind, while placing stronger emphasis on using biosensing capabilities that can automatically log results and send them to providers on a real-time dashboard. UR - https://med.jmirx.org/2021/3/e21906 UR - http://dx.doi.org/10.2196/21906 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725554 ID - info:doi/10.2196/21906 ER - TY - JOUR AU - Elnaggar, Abdelaziz AU - von Oppenfeld, Julia AU - Whooley, A. Mary AU - Merek, Stephanie AU - Park, G. Linda PY - 2021/9/2 TI - Applying Mobile Technology to Sustain Physical Activity After Completion of Cardiac Rehabilitation: Acceptability Study JO - JMIR Hum Factors SP - e25356 VL - 8 IS - 3 KW - physical activity KW - cardiac rehabilitation KW - digital health KW - mobile app KW - wearable device, mHealth KW - mobile phone N2 - Background: Many patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion. Objective: This study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion. Methods: We used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews. Results: Our sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback. Conclusions: By applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults. UR - https://humanfactors.jmir.org/2021/3/e25356 UR - http://dx.doi.org/10.2196/25356 UR - http://www.ncbi.nlm.nih.gov/pubmed/34473064 ID - info:doi/10.2196/25356 ER - TY - JOUR AU - de Buisonjé, David AU - Van der Geer, Jessica AU - Keesman, Mike AU - Van der Vaart, Roos AU - Reijnders, Thomas AU - Wentzel, Jobke AU - Kemps, Hareld AU - Kraaijenhagen, Roderik AU - Janssen, Veronica AU - Evers, Andrea PY - 2021/8/30 TI - Financial Incentives for Healthy Living for Patients With Cardiac Disease From the Perspective of Health Care Professionals: Interview Study JO - JMIR Cardio SP - e27867 VL - 5 IS - 2 KW - financial incentives KW - material rewards KW - healthy lifestyle KW - cardiovascular disease KW - cardiac rehabilitation KW - CVD N2 - Background: A promising new approach to support lifestyle changes in patients with cardiovascular disease (CVD) is the use of financial incentives. Although financial incentives have proven to be effective, their implementation remains controversial, and ethical objections have been raised. It is unknown whether health care professionals (HCPs) involved in CVD care find it acceptable to provide financial incentives to patients with CVD as support for lifestyle change. Objective: This study aims to investigate HCPs? perspectives on using financial incentives to support healthy living for patients with CVD. More specifically, we aim to provide insight into attitudes toward using financial incentives as well as obstacles and facilitators of implementing financial incentives in current CVD care. Methods: A total of 16 semistructured, in-depth, face-to-face interviews were conducted with Dutch HCPs involved in supporting patients with CVD with lifestyle changes. The topics discussed were attitudes toward an incentive system, obstacles to using an incentive system, and possible solutions to facilitate the use of an incentive system. Results: HCPs perceived an incentive system for healthy living for patients with CVD as possibly effective and showed generally high acceptance. However, there were concerns related to focusing too much on the extrinsic aspects of lifestyle change, disengagement when rewards are insignificant, paternalization and threatening autonomy, and low digital literacy in the target group. According to HCPs, solutions to mitigate these concerns included emphasizing intrinsic aspects of healthy living while giving extrinsic rewards, integrating social aspects to increase engagement, supporting autonomy by allowing freedom of choice in rewards, and aiming for a target group that can work with the necessary technology. Conclusions: This study mapped perspectives of Dutch HCPs and showed that attitudes are predominantly positive, provided that contextual factors, design, and target groups are accurately considered. Concerns about digital literacy in the target group are novel findings that warrant further investigation. Follow-up research is needed to validate these insights among patients with CVD. UR - https://cardio.jmir.org/2021/2/e27867 UR - http://dx.doi.org/10.2196/27867 UR - http://www.ncbi.nlm.nih.gov/pubmed/34459748 ID - info:doi/10.2196/27867 ER - TY - JOUR AU - Snyder, Natalie AU - Wilson, Ria AU - Finch, Lian AU - Gallant, Brooklyn AU - Landa, Chris AU - Frankel, Daniel AU - Brooks, Dina AU - Packham, Tara AU - Oliveira, Ana PY - 2021/7/26 TI - The Role of Occupational Therapy in Pulmonary Rehabilitation Programs: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e30244 VL - 10 IS - 7 KW - chronic respiratory disease KW - COPD KW - lung diseases KW - occupational therapy KW - pulmonary rehabilitation program N2 - Background: Chronic respiratory diseases are highly prevalent and compromise an individual?s ability to perform activities of daily living (ADLs) and participate in meaningful life roles. Pulmonary rehabilitation (PR) is a well-established intervention aimed at restoring an individual?s exercise capacity and improving their ability to complete their ADLs. Occupational therapists help individuals engage in meaningful ?occupations,? improving their health and well-being. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs. However, the benefits of adding OT to PR programs have been sparsely reported in the literature and the role of OT in PR has never been synthesized or reported in national and international guidelines. Objective: The aim of this review is to explore the role of OT in PR programs, the current guideline recommendations for the inclusion of OT in PR programs, the estimated prevalence of OT in PR programs, and the reported or anticipated effects of OT interventions in PR programs. Methods: The review will be conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews. A comprehensive search will be undertaken in the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, and CINAHL (EBSCO) to identify and retrieve relevant literature published in English, French, or Portuguese. Gray literature on international OT association websites will also be identified, including position statements and guidelines relevant to PR programs. All literature published since the establishment of the effectiveness of PR for chronic respiratory disease in 1994 that explores OT in PR programs for these patients will be included. Search results will be exported to Covidence for title, abstract, and full-text screening by two independent reviewers. Data will be extracted by two independent reviewers using a pilot-tested template including the following: the number of PR programs including OT (specifically from surveys), the purpose of the study, the study design, patient characteristics, respiratory conditions included, PR components, OT role, outcomes, and results. Findings will be presented using a narrative summary, supplemented by figures and/or tables. Key themes will be displayed in an infographic or schematic. Results: The study was initiated in January 2021 and registered with the Open Science Framework (OSF) in February 2021, prior to title and abstract screening. Data collection and analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022. Conclusions: The results of this scoping review will help health care professionals improve patient care by broadening their understanding and awareness of the role of OT in PR programs. This role clarification may help to inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient outcomes. Trial Registration: OSF Registries ZH63W; https://osf.io/zh63w International Registered Report Identifier (IRRID): DERR1-10.2196/30244 UR - https://www.researchprotocols.org/2021/7/e30244 UR - http://dx.doi.org/10.2196/30244 UR - http://www.ncbi.nlm.nih.gov/pubmed/34309572 ID - info:doi/10.2196/30244 ER - TY - JOUR AU - Dinesen, Birthe AU - Dam Gade, Josefine AU - Skov Schacksen, Cathrine AU - Spindler, Helle AU - Eie Albertsen, Andi AU - Dittmann, Lars AU - Jochumsen, Mads AU - Svenstrup Møller, Dorthe PY - 2021/7/19 TI - The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses JO - JMIR Cardio SP - e27321 VL - 5 IS - 2 KW - atrial fibrillation KW - cardiac rehabilitation KW - telerehabilitation KW - patient education N2 - Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients? perspectives. Secondary outcomes were the development of patients? knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient?TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437. UR - https://cardio.jmir.org/2021/2/e27321 UR - http://dx.doi.org/10.2196/27321 UR - http://www.ncbi.nlm.nih.gov/pubmed/34279239 ID - info:doi/10.2196/27321 ER - TY - JOUR AU - Ding, Y. Eric AU - Erskine, Nathaniel AU - Stut, Wim AU - McManus, D. David AU - Peterson, Amy AU - Wang, Ziyue AU - Escobar Valle, Jorge AU - Albuquerque, Daniella AU - Alonso, Alvaro AU - Botkin, F. Naomi AU - Pack, R. Quinn PY - 2021/7/8 TI - MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study JO - JMIR Hum Factors SP - e18130 VL - 8 IS - 3 KW - cardiac rehabilitation KW - telerehabilitation KW - health watch KW - mHealth KW - exercise N2 - Background: Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction. Objective: In this pilot study, we aimed to developed and assess the feasibility of delivering a health watch?informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation. Methods: We enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life. Results: Of 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100). Conclusions: This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch?based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation. UR - https://humanfactors.jmir.org/2021/3/e18130 UR - http://dx.doi.org/10.2196/18130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255660 ID - info:doi/10.2196/18130 ER - TY - JOUR AU - Hakala, Sanna AU - Kivistö, Heikki AU - Paajanen, Teemu AU - Kankainen, Annaliisa AU - Anttila, Marjo-Riitta AU - Heinonen, Ari AU - Sjögren, Tuulikki PY - 2021/6/18 TI - Effectiveness of Distance Technology in Promoting Physical Activity in Cardiovascular Disease Rehabilitation: Cluster Randomized Controlled Trial, A Pilot Study JO - JMIR Rehabil Assist Technol SP - e20299 VL - 8 IS - 2 KW - cardiac rehabilitation KW - rehabilitation KW - cardiovascular diseases KW - technology KW - exercise KW - randomized controlled trial KW - clinical trial N2 - Background: Physical activity is beneficial for cardiovascular rehabilitation. Digitalization suggests using technology in the promotion of physical activity and lifestyle changes. The effectiveness of distance technology interventions has previously been found to be similar to that of conventional treatment, but the added value of the technology has not been frequently studied. Objective: The aim of this pilot study was to investigate whether additional distance technology intervention is more effective in promoting physical activity than non-technology?based treatment in 12 months of cardiac rehabilitation. Methods: The cardiovascular disease rehabilitation intervention consisted of three 5-day inpatient periods in a rehabilitation center and two 6-month self-exercise periods at home in between. Participants were recruited from among cardiac patients who attended the rehabilitation program and were cluster-randomized into unblinded groups: conventional rehabilitation control clusters (n=3) and similar rehabilitation with additional distance technology experimental group clusters (n=3). Experimental groups used Fitbit Charge HR for self-monitoring, and they set goals and reported their activity using Movendos mCoach, through which they received monthly automated and in-person feedback. Physical activity outcomes for all participants were measured using the Fitbit Zip accelerometer and the International Physical Activity Questionnaire. Results: During the first 6 months, the experimental group (n=29) engaged in light physical activity more often than the control group (n=30; mean difference [MD] 324.2 minutes per week, 95% CI 77.4 to 571.0; P=.01). There were no group differences in the duration of moderate to vigorous physical activity (MD 12.6 minutes per week, 95% CI ?90.5 to 115.7; P=.82) or steps per day (MD 1084.0, 95% CI ?585.0 to 2752.9; P=.20). During the following 6 months, no differences between the groups were observed in light physical activity (MD ?87.9 minutes per week, 95% CI ?379.2 to 203.3; P=.54), moderate to vigorous physical activity (MD 70.9 minutes per week, 95% CI ?75.7 to 217.6; P=.33), or steps per day (MD 867.1, 95% CI ?2099.6 to 3833.9; P=.55). Conclusions: The use of additional distance technology increased the duration of light physical activity at the beginning of cardiac rehabilitation (for the first 6 months), but statistically significant differences were not observed between the two groups for moderate or vigorous physical activity or steps per day for both 6-month self-exercise periods. Trial Registration: ISRCTN Registry ISRCTN61225589; https://doi.org/10.1186/ISRCTN61225589 UR - https://rehab.jmir.org/2021/2/e20299 UR - http://dx.doi.org/10.2196/20299 UR - http://www.ncbi.nlm.nih.gov/pubmed/34142970 ID - info:doi/10.2196/20299 ER - TY - JOUR AU - Maddison, Ralph AU - Jiang, Yannan AU - Stewart, Ralph AU - Scott, Tony AU - Kerr, Andrew AU - Whittaker, Robyn AU - Benatar, Jocelyn AU - Rolleston, Anna AU - Estabrooks, Paul AU - Dale, Leila PY - 2021/6/9 TI - An Intervention to Improve Medication Adherence in People With Heart Disease (Text4HeartII): Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e24952 VL - 9 IS - 6 KW - cardiovascular disease KW - self-management KW - text messaging KW - risk factors N2 - Background: Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease. Objective: This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks. Methods: A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks. Results: Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing recordswere available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups. Conclusions: Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2468-z UR - https://mhealth.jmir.org/2021/6/e24952 UR - http://dx.doi.org/10.2196/24952 UR - http://www.ncbi.nlm.nih.gov/pubmed/34106081 ID - info:doi/10.2196/24952 ER - TY - JOUR AU - Lou, Weiqun Vivian AU - Tang, Man Jennifer Yee AU - Lau, Kai Gary Kui AU - Lum, Sang Terry Yat AU - Fong, Kenneth AU - Ko, Tung Rachel Wai AU - Cheng, Man Clio Yuen AU - Fu, Yinqi Joyce AU - Chow, Lun Eddie Siu AU - Chu, Kwok Angus Chun AU - Hui, Elsie AU - Ng, Ling Winnie Wing AU - Chan, Wai Felix Hon AU - Luk, C. C. AU - Kwok, K. T. PY - 2021/5/28 TI - Effectiveness of a Two-Tier Family-Oriented Intervention in Enhancing the Family Functioning and Care Capacity of the Family Caregivers of Stroke Survivors: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e16703 VL - 10 IS - 5 KW - two-tier family-oriented intervention KW - family functioning KW - family caregivers KW - stroke survivors KW - randomized controlled trial N2 - Background: Stroke has profound impacts on families. Often, family members, including stroke survivors and the person who takes up the role of the primary caregiver, would encounter demands on finances, rehabilitation arrangement, and even conflicts. Hence, a family-oriented intervention is expected to enable families to rebuild internal and external resources to achieve optimal rehabilitation and community reintegration. Objective: This study aims to describe a design of a two-tier family-oriented care management intervention for enhancing the family functioning and care capacity of the caregivers of stroke survivors. Methods: The two-tier care management intervention was guided by a standardized protocol conducted by trained professional care managers (first tier) with the support of trained volunteers (second tier), which lasted for 8-12 weeks. Participants were recruited through collaborating hospitals according to inclusion and exclusion criteria. In order to examine the effectiveness and cost-effectiveness of the two-tier care management intervention, a two-arm randomization multicenter study was designed, including an active comparison group, which was guided by a standardized protocol conducted by trained volunteers. Dyadic participants, including both stroke survivors and their primary caregivers for both groups, were invited to participate in a questionnaire survey using standardized and purposefully developed measures 3 times: before the intervention, immediately after the intervention, and 2 months after the intervention. The primary outcome was family functioning measured by the Family Role Performance Scale and Family Assessment Device-General Functioning Scale. The secondary outcomes included caregiving burden, depressive symptoms, care management strategies, and the incremental cost-effectiveness ratio. Results: Recruitment began in January 2017 and was completed at the end of April 2019. Data collection was completed at the end of March 2020. As of March 2020, enrollment has been completed (n=264 stroke caregivers). A total of 200 participants completed the baseline questionnaires. We aim to publish the results by mid-2021. Conclusions: This study successfully developed a two-tier care management protocol that aims to enhance the family functioning of the caregivers of stroke survivors. Guided by a standardized protocol, this family-oriented two-tier intervention protocol was found to be feasible among Chinese families. Trial Registration: ClinicalTrials.gov NCT03034330; https://ichgcp.net/clinical-trials-registry/NCT03034330 International Registered Report Identifier (IRRID): RR1-10.2196/16703 UR - https://www.researchprotocols.org/2021/5/e16703 UR - http://dx.doi.org/10.2196/16703 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047707 ID - info:doi/10.2196/16703 ER - TY - JOUR AU - Gao, Yang AU - Zhong, D. Linda L. AU - Quach, Binh AU - Davies, Bruce AU - Ash, I. Garrett AU - Lin, Zhi-Xiu AU - Feng, Yibin AU - Lau, M. Benson W. AU - Wagner, D. Peter AU - Yang, Xian AU - Guo, Yike AU - Jia, Wei AU - Bian, Zhaoxiang AU - Baker, S. Julien PY - 2021/5/26 TI - COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study JO - JMIR Res Protoc SP - e25556 VL - 10 IS - 5 KW - COVID-19 KW - rehabilitation KW - cardiorespiratory exercise KW - Chinese medicine N2 - Background: Recent studies have revealed that many discharged patients with COVID-19 experience ongoing symptoms months later. Rehabilitation interventions can help address the consequences of COVID-19, including medical, physical, cognitive, and psychological problems. To our knowledge, no studies have investigated the effects of rehabilitation following discharge from hospital for patients with COVID-19. Objective: The specific aims of this project are to investigate the effects of a 12-week exercise program on pulmonary fibrosis in patients recovering from COVID-19. A further aim will be to examine how Chinese herbal medicines as well as the gut microbiome and its metabolites regulate immune function and possibly autoimmune deficiency in the rehabilitation process. Methods: In this triple-blinded, randomized, parallel-group, controlled clinical trial, we will recruit adult patients with COVID-19 who have been discharged from hospital in Hong Kong and are experiencing impaired lung function and pulmonary function. A total of 172 eligible patients will be randomized into four equal groups: (1) cardiorespiratory exercise plus Chinese herbal medicines group, (2) cardiorespiratory exercise only group, (3) Chinese herbal medicines only group, and (4) waiting list group (in which participants will receive Chinese herbal medicines after 24 weeks). These treatments will be administered for 12 weeks, with a 12-week follow-up period. Primary outcomes include dyspnea, fatigue, lung function, pulmonary function, blood oxygen levels, immune function, blood coagulation, and related blood biochemistry. Measurements will be recorded prior to initiating the above treatments and repeated at the 13th and 25th weeks of the study. The primary analysis is aimed at comparing the outcomes between groups throughout the study period with an ? level of .05 (two-tailed). Results: The trial has been approved by the university ethics committee following the Declaration of Helsinki (approval number: REC/19-20/0504) in 2020. The trial has been recruiting patients. The data collection will be completed in 24 months, from January 1, 2021, to December 31, 2022. Conclusions: Given that COVID-19 and its sequelae would persist in human populations, important findings from this study would provide valuable insights into the mechanisms and processes of COVID-19 rehabilitation. Trial Registration: ClinicalTrials.gov NCT04572360; https://clinicaltrials.gov/ct2/show/NCT04572360 International Registered Report Identifier (IRRID): PRR1-10.2196/25556 UR - https://www.researchprotocols.org/2021/5/e25556 UR - http://dx.doi.org/10.2196/25556 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970864 ID - info:doi/10.2196/25556 ER - TY - JOUR AU - Humphries, Monica Sophia AU - Wallert, John AU - Norlund, Fredrika AU - Wallin, Emma AU - Burell, Gunilla AU - von Essen, Louise AU - Held, Claes AU - Olsson, Gustaf Erik Martin PY - 2021/5/24 TI - Internet-Based Cognitive Behavioral Therapy for Patients Reporting Symptoms of Anxiety and Depression After Myocardial Infarction: U-CARE Heart Randomized Controlled Trial Twelve-Month Follow-up JO - J Med Internet Res SP - e25465 VL - 23 IS - 5 KW - myocardial infarction KW - iCBT KW - psychological treatment KW - cardiovascular health KW - cognitive behavior therapy KW - internet KW - cardiovascular KW - infarction KW - treatment KW - anxiety KW - depression N2 - Background: The U-CARE Heart trial was one of the first randomized controlled trials to evaluate the effect of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety or depression for patients with a recent myocardial infarction. While the effects of internet-based cognitive behavioral therapy on Hospital Anxiety and Depression Scale (HADS) scores at 14 weeks postbaseline were not significant, in this study, we investigated possible long-term effects of treatment. Objective: The aim of this study was to evaluate the long-term effectiveness of internet-based cognitive behavioral therapy on self-reported symptoms of anxiety and depression in patients 12 months after a myocardial infarction and to explore subsequent occurrences of cardiovascular disease events. Methods: Shortly after acute myocardial infarction, 239 patients (33% female, mean age 59.6 years) reporting mild-to-moderate symptoms of anxiety or depression were randomized to 14 weeks of therapist-guided internet-based cognitive behavioral therapy (n=117) or treatment as usual (n=122). Data from national registries were used to explore group differences in clinical outcomes such as cardiovascular disease and cardiovascular-related mortality for a follow-up period of up to 5 years: group differences in HADS total score 1 year post?myocardial infarction, the primary outcome, was analyzed using multiple linear regression. Secondary outcomes, such as HADS anxiety and depression subscales and the Cardiac Anxiety Questionnaire total score (CAQ), which measures heart-focused anxiety, were analyzed in the same way. Multiple imputation was used to account for missing data, and a pooled treatment effect was estimated. Adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) for data pertaining to registry outcomes. Results: Both groups reported lower HADS total scores 1 year after myocardial infarction than those at baseline. HADS total scores were not significantly different between the treatment and control groups 1 year after myocardial infarction (?=?1.14, 95% CI ?2.73 to 0.45, P=.16). CAQ was the only measure improved significantly by internet-based cognitive behavioral therapy when compared with treatment as usual (?=?2.58, 95% CI ?4.75 to ?0.42, P=.02) before adjusting for multiple comparisons. The composite outcome of nonfatal cardiovascular events and cardiovascular-related mortality did not differ between groups but was numerically higher in the internet-based cognitive behavioral therapy group, who were at slightly greater risk (HR 1.8, 95% CI 0.96 to 3.4, P=.07). Adjusting for previous myocardial infarction and diabetes attenuated this estimate (HR 1.5, 95% CI 0.8 to 2.8, P=.25). Conclusions: Internet-based cognitive behavioral therapy was not superior in reducing self-reported symptoms of depression or anxiety compared to treatment as usual at the 1-year follow-up after myocardial infarction. A reduction in cardiac-related anxiety was observed but was not significant after adjusting for multiple comparisons. There was no difference in risk of cardiovascular events between the treatment groups. Low treatment adherence, which might have affected treatment engagement and outcomes, should be considered when interpreting these results. Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-015-0689-y UR - https://www.jmir.org/2021/5/e25465 UR - http://dx.doi.org/10.2196/25465 UR - http://www.ncbi.nlm.nih.gov/pubmed/34028358 ID - info:doi/10.2196/25465 ER - TY - JOUR AU - Litrownik, Daniel AU - Gilliam, A. Elizabeth AU - Wayne, M. Peter AU - Richardson, R. Caroline AU - Kadri, Reema AU - Rist, M. Pamela AU - Moy, L. Marilyn AU - Yeh, Y. Gloria PY - 2021/4/29 TI - Development of a Novel Intervention (Mindful Steps) to Promote Long-Term Walking Behavior in Chronic Cardiopulmonary Disease: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e27826 VL - 10 IS - 4 KW - mind?body exercise KW - internet-mediated intervention KW - behavior change KW - physical activity KW - COPD KW - heart failure N2 - Background: Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind?body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. Objective: This study aims to develop a novel multimodal mind?body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind?body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. Methods: In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind?body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind?body exercise classes, an educational website, online mind?body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. Results: The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. Conclusions: Through the integration of components from a web-based physical activity intervention and mind?body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. Trial Registration: ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780 International Registered Report Identifier (IRRID): DERR1-10.2196/27826 UR - https://www.researchprotocols.org/2021/4/e27826 UR - http://dx.doi.org/10.2196/27826 UR - http://www.ncbi.nlm.nih.gov/pubmed/33913819 ID - info:doi/10.2196/27826 ER - TY - JOUR AU - Park, G. Linda AU - Elnaggar, Abdelaziz AU - Lee, J. Sei AU - Merek, Stephanie AU - Hoffmann, J. Thomas AU - Von Oppenfeld, Julia AU - Ignacio, Nerissa AU - Whooley, A. Mary PY - 2021/4/16 TI - Mobile Health Intervention Promoting Physical Activity in Adults Post Cardiac Rehabilitation: Pilot Randomized Controlled Trial JO - JMIR Form Res SP - e20468 VL - 5 IS - 4 KW - physical activity KW - cardiac rehabilitation KW - digital health KW - mobile app KW - wearable device KW - mHealth N2 - Background: Cardiac rehabilitation (CR) is an exercise-based program prescribed after cardiac events associated with improved physical, mental, and social functioning; however, many patients return to a sedentary lifestyle leading to deteriorating functional capacity after discharge from CR. Physical activity (PA) is critical to avoid recurrence of cardiac events and mortality and maintain functional capacity. Leveraging mobile health (mHealth) strategies to increase adherence to PA is a promising approach. Based on the social cognitive theory, we sought to determine whether mHealth strategies (Movn mobile app for self-monitoring, supportive push-through messages, and wearable activity tracker) would improve PA and functional capacity over 2 months. Objective: The objectives of this pilot randomized controlled trial were to examine preliminary effects of an mHealth intervention on group differences in PA and functional capacity and group differences in depression and self-efficacy to maintain exercise after CR. Methods: During the final week of outpatient CR, patients were randomized 1:1 to the intervention group or usual care. The intervention group downloaded the Movn mobile app, received supportive push-through messages on motivation and educational messages related to cardiovascular disease (CVD) management 3 times per week, and wore a Charge 2 (Fitbit Inc) activity tracker to track step counts. Participants in the usual care group wore a pedometer and recorded their daily steps in a diary. Data from the 6-minute walk test (6MWT) and self-reported questionnaires were collected at baseline and 2 months. Results: We recruited 60 patients from 2 CR sites at a community hospital in Northern California. The mean age was 68.0 (SD 9.3) years, and 23% (14/60) were female; retention rate was 85% (51/60). Our results from 51 patients who completed follow-up showed the intervention group had a statistically significant higher mean daily step count compared with the control (8860 vs 6633; P=.02). There was no difference between groups for the 6MWT, depression, or self-efficacy to maintain exercise. Conclusions: This intervention addresses a major public health initiative to examine the potential for mobile health strategies to promote PA in patients with CVD. Our technology-based pilot mHealth intervention provides promising results on a pragmatic and contemporary approach to promote PA by increasing daily step counts after completing CR. Trial Registration: ClinicalTrials.gov NCT03446313; https://clinicaltrials.gov/ct2/show/NCT03446313 UR - https://formative.jmir.org/2021/4/e20468 UR - http://dx.doi.org/10.2196/20468 UR - http://www.ncbi.nlm.nih.gov/pubmed/33861204 ID - info:doi/10.2196/20468 ER - TY - JOUR AU - Gulick, Victoria AU - Graves, Daniel AU - Ames, Shannon AU - Krishnamani, Parimala Pavitra PY - 2021/4/15 TI - Effect of a Virtual Reality?Enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial JO - J Med Internet Res SP - e23882 VL - 23 IS - 4 KW - virtual reality KW - VR KW - cardiac rehabilitation KW - patient experience KW - patient education KW - outpatient therapy KW - exercise N2 - Background: Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients? lack of understanding of the importance of their care and a lack of motivation to maintain attendance. Objective: This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions. Methods: New CR patients were enrolled and randomized on a rolling basis to either the control group or intervention group. Intervention patients completed their time on the treadmill with VR walking trails, which included audio-recorded education, whereas control patients completed the standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing 6-minute walk test improvement. In addition, secondary outcomes of patients? cardiac knowledge and satisfaction were assessed via a computer-based questionnaire; patient adherence to the recommended number of sessions was also monitored. Cardiac knowledge assessment included a prerehabilitation education quiz, and the same quiz was repeated at patients? final visit and again at the 2-month follow-up. The satisfaction questionnaire was completed at the final visit. Results: Between January 2018 and May 2019, 72 patients were enrolled?41 in the intervention group and 31 in the control group. On the basis of the results of the prerehabilitation and postrehabilitation 6-minute walk test, no significant differences were observed between the intervention and control groups (P=.64). No statistical differences were observed between groups in terms of education (P=.86) or satisfaction (P=.32) at any time point. The control group had statistically more favorable rates of attendance, as determined by the risk group comparison (P=.02) and the comparison of the rates for completing the minimum number of sessions (P=.046), but no correlation was observed between the study group and reasons for ending treatment. Conclusions: Although no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, the qualitative information suggests that patients may have indeed enjoyed their experience with VR, even though quantitative satisfaction data did not capture this. Further considerations for how and when VR should be applied to CR are suggested in this paper. Trial Registration: ClinicalTrials.gov NCT03945201; https://clinicaltrials.gov/ct2/show/NCT03945201 UR - https://www.jmir.org/2021/4/e23882 UR - http://dx.doi.org/10.2196/23882 UR - http://www.ncbi.nlm.nih.gov/pubmed/33856355 ID - info:doi/10.2196/23882 ER - TY - JOUR AU - Akinosun, Samuel Adewale AU - Polson, Rob AU - Diaz - Skeete, Yohanca AU - De Kock, Hendrikus Johannes AU - Carragher, Lucia AU - Leslie, Stephen AU - Grindle, Mark AU - Gorely, Trish PY - 2021/3/3 TI - Digital Technology Interventions for Risk Factor Modification in Patients With Cardiovascular Disease: Systematic Review and Meta-analysis JO - JMIR Mhealth Uhealth SP - e21061 VL - 9 IS - 3 KW - digital technologies KW - mHealth KW - eHealth KW - risk factors KW - cardiovascular diseases KW - telehealth KW - cardiac rehabilitation KW - behavior KW - systematic review KW - meta-analysis KW - mobile phone N2 - Background: Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. Objective: The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. Methods: This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. Results: Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at ?0.29 [?0.44, ?0.15], P<.001; high-density lipoprotein SMD at ?0.09 [?0.19, 0.00], P=.05; low-density lipoprotein SMD at ?0.18 [?0.33, ?0.04], P=.01; physical activity (PA) SMD at 0.23 [0.11, 0.36], P<.001; physical inactivity (sedentary) RR at 0.54 [0.39, 0.75], P<.001; and diet (food intake) RR at 0.79 [0.66, 0.94], P=.007. Initial effect estimates showed no significant benefit in body mass index (BMI) MD at ?0.37 [?1.20, 0.46], P=.38; diastolic blood pressure (BP) SMD at ?0.06 [?0.20, 0.08], P=.43; systolic BP SMD at ?0.03 [?0.18, 0.13], P=.74; Hemoglobin A1C blood sugar (HbA1c) RR at 1.04 [0.40, 2.70], P=.94; alcohol intake SMD at ?0.16 [?1.43, 1.10], P=.80; smoking RR at 0.87 [0.67, 1.13], P=.30; and medication adherence RR at 1.10 [1.00, 1.22], P=.06. Conclusions: Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c). UR - https://mhealth.jmir.org/2021/3/e21061 UR - http://dx.doi.org/10.2196/21061 UR - http://www.ncbi.nlm.nih.gov/pubmed/33656444 ID - info:doi/10.2196/21061 ER - TY - JOUR AU - Wongvibulsin, Shannon AU - Habeos, E. Evagelia AU - Huynh, P. Pauline AU - Xun, Helen AU - Shan, Rongzi AU - Porosnicu Rodriguez, A. Kori AU - Wang, Jane AU - Gandapur, K. Yousuf AU - Osuji, Ngozi AU - Shah, M. Lochan AU - Spaulding, M. Erin AU - Hung, George AU - Knowles, Kellen AU - Yang, E. William AU - Marvel, A. Francoise AU - Levin, Eleanor AU - Maron, J. David AU - Gordon, F. Neil AU - Martin, S. Seth PY - 2021/2/8 TI - Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review JO - J Med Internet Res SP - e18773 VL - 23 IS - 2 KW - cardiac rehabilitation KW - telemedicine KW - digital technologies KW - mHealth KW - mobile phone N2 - Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective: The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods: Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results: Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions: Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions. UR - https://www.jmir.org/2021/2/e18773 UR - http://dx.doi.org/10.2196/18773 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555259 ID - info:doi/10.2196/18773 ER - TY - JOUR AU - Gade, Dam Josefine AU - Spindler, Helle AU - Hollingdal, Malene AU - Refsgaard, Jens AU - Dittmann, Lars AU - Frost, Lars AU - Mahboubi, Kiomars AU - Dinesen, Birthe PY - 2020/11/30 TI - Predictors of Walking Activity in Patients With Systolic Heart Failure Equipped With a Step Counter: Randomized Controlled Trial JO - JMIR Biomed Eng SP - e20776 VL - 5 IS - 1 KW - heart failure KW - cardiovascular rehabilitation KW - step counters KW - physical activity KW - telerehabilitation N2 - Background: Physical activity has been shown to decrease cardiovascular mortality and morbidity. Walking, a simple physical activity which is an integral part of daily life, is a feasible and safe activity for patients with heart failure (HF). A step counter, measuring daily walking activity, might be a motivational factor for increased activity. Objective: The aim of this study was to examine the association between walking activity and demographical and clinical data of patients with HF, and whether these associations could be used as predictors of walking activity. Methods: A total of 65 patients with HF from the Future Patient Telerehabilitation (FPT) program were included in this study. The patients monitored their daily activity using a Fitbit step counter for 1 year. This monitoring allowed for continuous and safe data transmission of self-monitored activity data. Results: A higher walking activity was associated with younger age, lower New York Heart Association (NYHA) classification, and higher ejection fraction (EF). There was a statistically significant correlation between the number of daily steps and NYHA classification at baseline (P=.01), between the increase in daily steps and EF at baseline (P<.001), and between the increase in daily steps and improvement in EF (P=.005). The patients? demographic, clinical, and activity data could predict 81% of the variation in daily steps. Conclusions: This study demonstrated an association between demographic, clinical, and activity data for patients with HF that could predict daily steps. A step counter can thus be a useful tool to help patients monitor their own physical activity. Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918 International Registered Report Identifier (IRRID): RR2-10.2196/14517 UR - http://biomedeng.jmir.org/2020/1/e20776/ UR - http://dx.doi.org/10.2196/20776 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/20776 ER - TY - JOUR AU - Subedi, Narayan AU - Rawstorn, C. Jonathan AU - Gao, Lan AU - Koorts, Harriet AU - Maddison, Ralph PY - 2020/11/27 TI - Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review JO - JMIR Mhealth Uhealth SP - e17957 VL - 8 IS - 11 KW - heart diseases KW - cardiac rehabilitation KW - telerehabilitation KW - implementation science KW - smartphone KW - systematic review N2 - Background: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. Objective: This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. Methods: MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. Results: No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Conclusions: Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124254 UR - http://mhealth.jmir.org/2020/11/e17957/ UR - http://dx.doi.org/10.2196/17957 UR - http://www.ncbi.nlm.nih.gov/pubmed/33245286 ID - info:doi/10.2196/17957 ER - TY - JOUR AU - Tadas, Shreya AU - Coyle, David PY - 2020/11/11 TI - Barriers to and Facilitators of Technology in Cardiac Rehabilitation and Self-Management: Systematic Qualitative Grounded Theory Review JO - J Med Internet Res SP - e18025 VL - 22 IS - 11 KW - telemedicine KW - cardiovascular diseases KW - self-management KW - self-care KW - systematic review KW - grounded theory KW - mobile phone N2 - Background: Dealing with cardiovascular disease is challenging, and people often struggle to follow rehabilitation and self-management programs. Several systematic reviews have explored quantitative evidence on the potential of digital interventions to support cardiac rehabilitation (CR) and self-management. However, although promising, evidence regarding the effectiveness and uptake of existing interventions is mixed. This paper takes a different but complementary approach, focusing on qualitative data related to people?s experiences of technology in this space. Objective: Through a qualitative approach, this review aims to engage more directly with people?s experiences of technology that supports CR and self-management. The primary objective of this paper is to provide answers to the following research question: What are the primary barriers to and facilitators and trends of digital interventions to support CR and self-management? This question is addressed by synthesizing evidence from both medical and computer science literature. Given the strong evidence from the field of human-computer interaction that user-centered and iterative design methods increase the success of digital health interventions, we also assess the degree to which user-centered and iterative methods have been applied in previous work. Methods: A grounded theory literature review of articles from the following major electronic databases was conducted: ACM Digital Library, PsycINFO, Scopus, and PubMed. Papers published in the last 10 years, 2009 to 2019, were considered, and a systematic search with predefined keywords was conducted. Papers were screened against predefined inclusion and exclusion criteria. Comparative and in-depth analysis of the extracted qualitative data was carried out through 3 levels of iterative coding and concept development. Results: A total of 4282 articles were identified in the initial search. After screening, 61 articles remained, which were both qualitative and quantitative studies and met our inclusion criteria for technology use and health condition. Of the 61 articles, 16 qualitative articles were included in the final analysis. Key factors that acted as barriers and facilitators were background knowledge and in-the-moment understanding, personal responsibility and social connectedness, and the need to support engagement while avoiding overburdening people. Although some studies applied user-centered methods, only 6 involved users throughout the design process. There was limited evidence of studies applying iterative approaches. Conclusions: The use of technology is acceptable to many people undergoing CR and self-management. Although background knowledge is an important facilitator, technology should also support greater ongoing and in-the-moment understanding. Connectedness is valuable, but to avoid becoming a barrier, technology must also respect and enable individual responsibility. Personalization and gamification can also act as facilitators of engagement, but care must be taken to avoid overburdening people. Further application of user-centered and iterative methods represents a significant opportunity in this space. UR - http://www.jmir.org/2020/11/e18025/ UR - http://dx.doi.org/10.2196/18025 UR - http://www.ncbi.nlm.nih.gov/pubmed/33174847 ID - info:doi/10.2196/18025 ER - TY - JOUR AU - Freene, Nicole AU - van Berlo, Sander AU - McManus, Margaret AU - Mair, Tarryn AU - Davey, Rachel PY - 2020/11/3 TI - A Behavioral Change Smartphone App and Program (ToDo-CR) to Decrease Sedentary Behavior in Cardiac Rehabilitation Participants: Prospective Feasibility Cohort Study JO - JMIR Form Res SP - e17359 VL - 4 IS - 11 KW - mHealth KW - eHealth KW - sedentary behavior KW - cardiac rehabilitation KW - mobile phone N2 - Background: Cardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior. Objective: This study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants. Methods: Using a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do?s). Do?s were delivered via the app, with participants receiving 14 to 19 Do?s during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure. Results: Between January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P<.001). Participants were, on average, aged 54 (SD 13) years, mostly male (17/20, 85%), and working (12/20, 67%). At 6 weeks, 95% (19/20) of participants were assessed, and 60% (12/20) of participants were assessed at 16 weeks. Participants were relatively satisfied with the usability of the app (UTAUT2 questionnaire). Overall, participants spent 11 to 12 hours per day sitting. There was a medium effect size (Cohen d=0.54) for the reduction in sedentary behavior (minutes per day) over 16 weeks. Conclusions: The use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app. UR - https://formative.jmir.org/2020/11/e17359 UR - http://dx.doi.org/10.2196/17359 UR - http://www.ncbi.nlm.nih.gov/pubmed/33141091 ID - info:doi/10.2196/17359 ER - TY - JOUR AU - Ferguson, Caleb AU - Inglis, C. Sally AU - Breen, P. Paul AU - Gargiulo, D. Gaetano AU - Byiers, Victoria AU - Macdonald, S. Peter AU - Hickman, D. Louise PY - 2020/6/18 TI - Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study JO - JMIR Aging SP - e17299 VL - 3 IS - 1 KW - technology KW - arrhythmia KW - monitoring KW - older people KW - cardiology KW - qualitative KW - wearable N2 - Background: New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. Objective: This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Methods: A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes. Results: Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, ?the ideal device.? Conclusions: There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care. UR - http://aging.jmir.org/2020/1/e17299/ UR - http://dx.doi.org/10.2196/17299 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554377 ID - info:doi/10.2196/17299 ER - TY - JOUR AU - De Cannière, Hélène AU - Smeets, P. Christophe J. AU - Schoutteten, Melanie AU - Varon, Carolina AU - Van Hoof, Chris AU - Van Huffel, Sabine AU - Groenendaal, Willemijn AU - Vandervoort, Pieter PY - 2020/5/20 TI - Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study JO - J Med Internet Res SP - e17326 VL - 22 IS - 5 KW - wearables KW - sensor KW - 6MWT KW - rehabilitation KW - cardiovascular N2 - Background: Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. Objective: The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. Methods: A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. Results: All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HRpeak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HRrec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HRrec1: P<.001, HRrec2: P<.001, HRrec3: P<.001, HRrec4: P<.001, and HRrec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients? cardiac responses. Conclusions: This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome. UR - http://www.jmir.org/2020/5/e17326/ UR - http://dx.doi.org/10.2196/17326 UR - http://www.ncbi.nlm.nih.gov/pubmed/32432552 ID - info:doi/10.2196/17326 ER - TY - JOUR AU - Widmer, Jay R. AU - Senecal, Conor AU - Allison, G. Thomas AU - Lopez-Jimenez, Francisco AU - Lerman, O. Lilach AU - Lerman, Amir PY - 2020/2/26 TI - Dose-Response Effect of a Digital Health Intervention During Cardiac Rehabilitation: Subanalysis of Randomized Controlled Trial JO - J Med Internet Res SP - e13055 VL - 22 IS - 2 KW - cardiovascular prevention KW - secondary prevention KW - online KW - digital health interventions N2 - Background: Previous data have validated the benefit of digital health interventions (DHIs) on weight loss in patients following acute coronary syndrome entering cardiac rehabilitation (CR). Objective: The primary purpose of this study was to test the hypothesis that increased DHI use, as measured by individual log-ins, is associated with improved weight loss. Secondary analyses evaluated the association between log-ins and activity within the platform and exercise, dietary, and medication adherence. Methods: We obtained DHI data including active days, total log-ins, tasks completed, educational modules reviewed, medication adherence, and nonmonetary incentive points earned in patients undergoing standard CR following acute coronary syndrome. Linear regression followed by multivariable models were used to evaluate associations between DHI log-ins and weight loss or dietary adherence. Results: Participants (n=61) were 79% male (48/61) with mean age of 61.0 (SD 9.7) years. We found a significant positive association of total log-ins during CR with weight loss (r2=.10, P=.03). Educational modules viewed (r2=.11, P=.009) and tasks completed (r2=.10, P=.01) were positively significantly associated with weight loss, yet total log-ins were not significantly associated with differences in dietary adherence (r2=.05, P=.12) or improvements in minutes of exercise per week (r2=.03, P=.36). Conclusions: These data extend our previous findings and demonstrate increased DHI log-ins portend improved weight loss in patients undergoing CR after acute coronary syndrome. DHI adherence can potentially be monitored and used as a tool to selectively encourage patients to adhere to secondary prevention lifestyle modifications. Trial Registration: ClinicalTrials.gov (NCT01883050); https://clinicaltrials.gov/ct2/show/NCT01883050 UR - http://www.jmir.org/2020/2/e13055/ UR - http://dx.doi.org/10.2196/13055 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130116 ID - info:doi/10.2196/13055 ER - TY - JOUR AU - Claes, Jomme AU - Cornelissen, Véronique AU - McDermott, Clare AU - Moyna, Niall AU - Pattyn, Nele AU - Cornelis, Nils AU - Gallagher, Anne AU - McCormack, Ciara AU - Newton, Helen AU - Gillain, Alexandra AU - Budts, Werner AU - Goetschalckx, Kaatje AU - Woods, Catherine AU - Moran, Kieran AU - Buys, Roselien PY - 2020/2/4 TI - Feasibility, Acceptability, and Clinical Effectiveness of a Technology-Enabled Cardiac Rehabilitation Platform (Physical Activity Toward Health-I): Randomized Controlled Trial JO - J Med Internet Res SP - e14221 VL - 22 IS - 2 KW - cardiac rehabilitation KW - physical activity KW - technology KW - eHealth N2 - Background: Cardiac rehabilitation (CR) is highly effective as secondary prevention for cardiovascular diseases (CVDs). Uptake of CR remains suboptimal (30% of eligible patients), and long-term adherence to a physically active lifestyle is even lower. Innovative strategies are needed to counteract this phenomenon. Objective: The Physical Activity Toward Health (PATHway) system was developed to provide a comprehensive, remotely monitored, home-based CR program for CVD patients. The PATHway-I study aimed to investigate its feasibility and clinical efficacy during phase III CR. Methods: Participants were randomized on a 1:1 basis to the PATHway (PW) intervention group or usual care (UC) control group in a single-blind, multicenter, randomized controlled pilot trial. Outcomes were assessed at completion of phase II CR and 6-month follow-up. The primary outcome was physical activity (PA; Actigraph GT9X link). Secondary outcomes included measures of physical fitness, modifiable cardiovascular risk factors, endothelial function, intima-media thickness of the common carotid artery, and quality of life. System usability and patients? experiences were evaluated only in PW. A mixed-model analysis of variance with Bonferroni adjustment was used to analyze between-group effects over time. Missing values were handled by means of an intention-to-treat analysis. Statistical significance was set at a 2-sided alpha level of .05. Data are reported as mean (SD). Results: A convenience sample of 120 CVD patients (mean 61.4 years, SD 13.5 years; 22 women) was included. The PATHway system was deployed in the homes of 60 participants. System use decreased over time and system usability was average with a score of 65.7 (SD 19.7; range 5-100). Moderate-to-vigorous intensity PA increased in PW (PW: 127 [SD 58] min to 141 [SD 69] min, UC: 146 [SD 66] min to 143 [SD 71] min; Pinteraction=.04; effect size of 0.42), while diastolic blood pressure (PW: 79 [SD 11] mmHg to 79 [SD 10] mmHg, UC: 78 [SD 9] mmHg to 83 [SD 10] mmHg; Pinteraction=.004; effect size of ?0.49) and cardiovascular risk score (PW: 15.9% [SD 10.4%] to 15.5% [SD 10.5%], UC: 14.5 [SD 9.7%] to 15.7% [SD 10.9%]; Pinteraction=.004; effect size of ?0.36) remained constant, but deteriorated in UC. Conclusions: This pilot study demonstrated the feasibility and acceptability of a technology-enabled, remotely monitored, home-based CR program. Although clinical effectiveness was demonstrated, several challenges were identified that could influence the adoption of PATHway. Trial Registration: ClinicalTrials.gov NCT02717806; https://clinicaltrials.gov/ct2/show/NCT02717806 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-016781 UR - https://www.jmir.org/2020/2/e14221 UR - http://dx.doi.org/10.2196/14221 UR - http://www.ncbi.nlm.nih.gov/pubmed/32014842 ID - info:doi/10.2196/14221 ER - TY - JOUR AU - Peute, Linda AU - Scheeve, Thom AU - Jaspers, Monique PY - 2020/1/30 TI - Classification and Regression Tree and Computer Adaptive Testing in Cardiac Rehabilitation: Instrument Validation Study JO - J Med Internet Res SP - e12509 VL - 22 IS - 1 KW - psychometrics KW - computing methodologies KW - mHealth KW - internet KW - cardiac rehabilitation KW - needs assessment N2 - Background: There is a need for shorter-length assessments that capture patient questionnaire data while attaining high data quality without an undue response burden on patients. Computerized adaptive testing (CAT) and classification and regression tree (CART) methods have the potential to meet these needs and can offer attractive options to shorten questionnaire lengths. Objective: The objective of this study was to test whether CAT or CART was best suited to reduce the number of questionnaire items in multiple domains (eg, anxiety, depression, quality of life, and social support) used for a needs assessment procedure (NAP) within the field of cardiac rehabilitation (CR) without the loss of data quality. Methods: NAP data of 2837 CR patients from a multicenter Cardiac Rehabilitation Decision Support System (CARDSS) Web-based program was used. Patients used a Web-based portal, MyCARDSS, to provide their data. CAT and CART were assessed based on their performances in shortening the NAP procedure and in terms of sensitivity and specificity. Results: With CAT and CART, an overall reduction of 36% and 72% of NAP questionnaire length, respectively, was achieved, with a mean sensitivity and specificity of 0.765 and 0.817 for CAT, 0.777 and 0.877 for classification trees, and 0.743 and 0.40 for regression trees, respectively. Conclusions: Both CAT and CART can be used to shorten the questionnaires of the NAP used within the field of CR. CART, however, showed the best performance, with a twice as large overall decrease in the number of questionnaire items of the NAP compared to CAT and the highest sensitivity and specificity. To our knowledge, our study is the first to assess the differences in performance between CAT and CART for shortening questionnaire lengths. Future research should consider administering varied assessments of patients over time to monitor their progress in multiple domains. For CR professionals, CART integrated with MyCARDSS would provide a feedback loop that informs the rehabilitation progress of their patients by providing real-time patient measurements. UR - https://www.jmir.org/2020/1/e12509 UR - http://dx.doi.org/10.2196/12509 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012065 ID - info:doi/10.2196/12509 ER - TY - JOUR AU - Lima, Paula Ana AU - Nascimento, Oliveira Isabella AU - Oliveira, A. Anne Caroline AU - Martins, S. Thiago Henrique AU - Pereira, Gomes Danielle A. AU - Britto, Rodrigues Raquel PY - 2019/11/7 TI - Home-Based Cardiac Rehabilitation in Brazil?s Public Health Care: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e13901 VL - 8 IS - 11 KW - cardiac rehabilitation KW - coronary disease KW - exercise N2 - Background: Coronary artery disease (CAD) is among the main causes of hospitalization and death worldwide, therefore, the implementation of programs to reduce its impact is necessary. Supervised cardiac rehabilitation has been shown to have positive effects on CAD control. However, there are barriers to patient participation in the traditional, face-to-face cardiac rehabilitation programs, mainly in low-resource environments. Objective: This study aimed to verify patient compliance to a home-based cardiac rehabilitation program, which includes unsupervised health education and physical exercises, guided by telephone. Moreover, we compare this new method to the traditional supervised cardiac rehabilitation offered in most hospital centers. Methods: We present here a two-arm, single-blinded, and randomized controlled design protocol, which compares the traditional cardiac rehabilitation (CenterRehab) with the home-based cardiac rehabilitation (Home-Based) in 72 patients affected by CAD. The primary outcome is the compliance to the cardiac rehabilitation sessions. The secondary outcomes (to evaluate effectiveness) include measurable variables such as functional capacity, CAD risk factors (blood pressure, waist circumference, glycemic, cholesterol levels, depressive symptoms, and the level of physical activity), the patient?s quality of life, the disease knowledge, and the morbidity rate. Parameters such as the program cost and the usability will also be evaluated. The programs will last 12 weeks, with a total of 60 rehabilitation and 6 educational sessions. Patients of the CenterRehab program will participate in 24 supervised sessions and 36 home sessions, while the patients of the Home-Based program will participate in 2 supervised sessions and 58 home sessions, guided by telephone. After the 12-week period all participants will be recommended to continue practicing physical exercises at home or at a community center, and they will be invited for re-evaluation after 3 months. The outcomes will be evaluated at baseline, and after 3 and 6 months. Results: Participants are currently being recruited for the trial. Data collection is anticipated to be completed by October 2019. Conclusions: This is the first study in Brazil comparing the traditional cardiac rehabilitation approach with a novel, home-based protocol that uses an accessible and low-cost technology. If positive results are obtained, the study will contribute to establish a new and viable model of cardiac rehabilitation. Trial Registration: ClinicalTrials.gov NCT03605992; https://clinicaltrials.gov/ct2/show/NCT03605992 International Registered Report Identifier (IRRID): DERR1-10.2196/13901 UR - https://www.researchprotocols.org/2019/11/e13901 UR - http://dx.doi.org/10.2196/13901 UR - http://www.ncbi.nlm.nih.gov/pubmed/31697246 ID - info:doi/10.2196/13901 ER - TY - JOUR AU - Lunde, Pernille AU - Nilsson, Blakstad Birgitta AU - Bergland, Astrid AU - Bye, Asta PY - 2019/4/19 TI - Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study JO - JMIR Form Res SP - e12679 VL - 3 IS - 2 KW - mHealth KW - eHealth KW - mobile phone app KW - cardiac rehabilitation N2 - Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients? adherence to a heart-healthy lifestyle after CR. Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results: In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field. UR - http://formative.jmir.org/2019/2/e12679/ UR - http://dx.doi.org/10.2196/12679 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066684 ID - info:doi/10.2196/12679 ER - TY - JOUR AU - Choi, G. Brian AU - Dhawan, Tania AU - Metzger, Kelli AU - Marshall, Lorraine AU - Akbar, Awdah AU - Jain, Tushina AU - Young, A. Heather AU - Katz, J. Richard PY - 2019/04/23 TI - Image-Based Mobile System for Dietary Management in an American Cardiology Population: Pilot Randomized Controlled Trial to Assess the Efficacy of Dietary Coaching Delivered via a Smartphone App Versus Traditional Counseling JO - JMIR Mhealth Uhealth SP - e10755 VL - 7 IS - 4 KW - Mediterranean diet KW - telemedicine KW - cardiovascular disease KW - randomized controlled trial N2 - Background: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease. Objective: This study aimed to test the hypothesis that asynchronous dietary counseling supplied through a custom smartphone app results in better adherence to a Mediterranean diet in a non-Mediterranean population than traditional standard-of-care (SOC) counseling. Methods: In total, 100 patients presenting to the cardiology clinic of an academic medical center were randomized to either the SOC or smartphone app-based experimental (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietitian. Participants in EXP received a custom smartphone app that reinforced the Mediterranean diet, whereas participants in SOC received 2 additional sessions of in-person dietary counseling with the registered dietitian?30 min at 1 month and 30 min at 3 months. Preexisting knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score (MDS) instrument. Baseline height, weight, blood pressure (BP), and laboratory biomarkers were collected. At 1, 3, and 6 months, participants presented for a follow-up appointment to assess compliance to the Mediterranean diet using the MDS as well as a patient satisfaction survey, BP, and weight. Repeat laboratory biomarkers were performed at 3 and 6 months. Results: Enrolled participants had a mean age with SE of 56.6 (SD 1.7) for SOC and 57.2 (SD 1.8) for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with regard to BP, lipid parameters, hemoglobin A1c, or C-reactive protein (CRP). Participants in EXP achieved a significantly greater weight loss on average of 3.3 pounds versus 3.1 pounds for participants in SOC, P=.04. Adherence to the Mediterranean diet increased significantly over time for both groups (P<.001), but there was no significant difference between groups (P=.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as the MDS ?9) increased significantly over time (P<.001)?from 18.4% to 57.1% for SOC and 27.5% to 64.7% for EXP; however, there was no significant difference between the groups. Conclusions: Both traditional SOC counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling. Trial Registration: ClinicalTrials.gov NCT03897426;https://clinicaltrials.gov/ct2/show/NCT03897426 UR - https://mhealth.jmir.org/2019/4/e10755/ UR - http://dx.doi.org/10.2196/10755 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012860 ID - info:doi/10.2196/10755 ER - TY - JOUR AU - Dinesen, Birthe AU - Nielsen, Gitte AU - Andreasen, Jesper Jan AU - Spindler, Helle PY - 2019/04/15 TI - Integration of Rehabilitation Activities Into Everyday Life Through Telerehabilitation: Qualitative Study of Cardiac Patients and Their Partners JO - J Med Internet Res SP - e13281 VL - 21 IS - 4 KW - telerehabilitation KW - heart diseases KW - social media KW - qualitative study N2 - Background: Implementation of cardiac rehabilitation has not been optimal, with patient participation rates below 50%. Factors that contribute to cardiac patients? lack of participation in rehabilitation programs are patient motivation, logistical difficulties in getting to the rehabilitation facilities, lack of psychosocial elements, and individualization of activities in the rehabilitation programs. Telerehabilitation has been proposed as a new way to address the challenge of engaging and motivating cardiac patients and their partners to participate in rehabilitation. Objective: The aim of this study was to explore the experiences of cardiac patients and their partners of participating in the Teledialog Telerehabilitation Program (TTP). The Teledialog program consisted of a digital rehabilitation plan, transmission of health data from patient?s home to hospital and health care center, and an interactive Web portal with information and training videos. Methods: This case study used a theoretical approach combining the ?community of practice? approach and self-determination theory. A triangulation of data collection techniques was used, including documents, participant observation (72 hours), and qualitative interviews with cardiac patients and their partners enrolled in the telerehabilitation group. A total of 14 cardiac patients, 12 patient spouses/partners, and 1 son participated in the study. The participants were interviewed at enrollment in the telerehabilitation program and after 12 weeks of participation in the program. Interview data were analyzed using NVivo 11.0. Results: Patients and their partners found the Web portal ActiveHeart.dk and the electronic rehabilitation (e-rehabilitation) plan to be helpful tools for health education, coordinating rehabilitation goals, creating an overview of the data, and ensuring continuity in the rehabilitation process. The patients felt that the TTP treated them as individuals, gave them a sense of autonomy, and provided enhanced relatedness to health care professionals and partners and a sense of competence as active participants in their own rehabilitation process. Some patients missed being part of a community of practice with other cardiac patients and did not use the Web forum. Patients? partners found that the telerehabilitation program gave them a sense of security and helped them balance their involvement as a partner to the patient and not push the patient too hard. Conclusions: Cardiac patients and their partners found telerehabilitation technologies a useful digital toolbox in the rehabilitation process. Telerehabilitation motivated the patients to integrate rehabilitation activities into their work schedule and everyday life and made them feel like unique individuals. Participating in the Teledialog Telerehabilitation Program might not be a suitable strategy for all cardiac patients. Being a patient?s partner in the telerehabilitation program was associated with a heightened sense of security, navigation between active involvement in the rehabilitation process, being an equal partner, and not pushing the patient too hard. UR - http://www.jmir.org/2019/4/e13281/ UR - http://dx.doi.org/10.2196/13281 UR - http://www.ncbi.nlm.nih.gov/pubmed/30985284 ID - info:doi/10.2196/13281 ER - TY - JOUR AU - Fitze, P. Daniel AU - Franchi, Martino AU - Popp, L. Werner AU - Ruoss, Severin AU - Catuogno, Silvio AU - Camenisch, Karin AU - Lehmann, Debora AU - Schmied, M. Christian AU - Niederseer, David AU - Frey, O. Walter AU - Flück, Martin PY - 2019/03/27 TI - Concentric and Eccentric Pedaling-Type Interval Exercise on a Soft Robot for Stable Coronary Artery Disease Patients: Toward a Personalized Protocol JO - JMIR Res Protoc SP - e10970 VL - 8 IS - 3 KW - cardiovascular rehabilitation KW - concentric and eccentric exercise KW - high-intensity interval training KW - muscle oxygen saturation KW - near-infrared spectroscopy KW - peak oxygen uptake KW - ramp test KW - skeletal muscle power KW - soft robot N2 - Background: Cardiovascular diseases are the leading causes of death worldwide, and coronary artery disease (CAD) is one of the most common causes of death in Europe. Leading cardiac societies recommend exercise as an integral part of cardiovascular rehabilitation because it reduces the morbidity and mortality of patients with CAD. Continuous low-intensity exercise using shortening muscle actions (concentric, CON) is a common training modality during cardiovascular rehabilitation. However, a growing clinical interest has been recently developed in high-intensity interval training (HIIT) for stable patients with CAD. Exercise performed with lengthening muscle actions (eccentric, ECC) could be tolerated better by patients with CAD as they can be performed with higher loads and lower metabolic cost than CON exercise. Objective: We developed a clinical protocol on a soft robot to compare cardiovascular and muscle effects of repeated and work-matched CON versus ECC pedaling-type interval exercise between patients with CAD during cardiovascular rehabilitation. This study aims to ascertain whether the developed training protocols affect peak oxygen uptake (VO2peak), peak aerobic power output (Ppeak), and parameters of muscle oxygen saturation (SmO2) during exercise, and anaerobic muscle power. Methods: We will randomize 20-30 subjects to either the CON or ECC group. Both groups will perform a ramp test to exhaustion before and after the training period to measure cardiovascular parameters and SmO2. Moreover, the aerobic skeletal muscle power (Ppeak) is measured weekly during the 8-week training period using a simulated squat jump and a counter movement jump on the soft robot and used to adjust the training load. The pedaling-type interval exercise on the soft robot is performed involving either CON or ECC muscle actions. The soft robotic device being used is a closed kinetic chain, force-controlled interactive training, and testing device for the lower extremities, which consists of two independent pedals and free footplates that are operated by pneumatic artificial muscles. Results: The first patients with CAD, who completed the training, showed protocol-specific improvements, reflecting, in part, the lower aerobic training status of the patient completing the CON protocol. Rehabilitation under the CON protocol, more than under the ECC protocol, improved cardiovascular parameters, that is, VO2peak (+26% vs ?6%), and Ppeak (+20% vs 0%), and exaggerated muscle deoxygenation during the ramp test (248% vs 49%). Conversely, markers of metabolic stress and recovery from the exhaustive ramp test improved more after the ECC than the CON protocol, that is, peak blood lactate (?9% vs +20%) and peak SmO2 (+7% vs ?7%). Anaerobic muscle power only improved after the CON protocol (+18% vs ?15%). Conclusions: This study indicates the potential of the implemented CON and ECC protocols of pedaling-type interval exercise to improve oxygen metabolism of exercised muscle groups while maintaining or even increasing the Ppeak. The ECC training protocol seemingly provided a lower cardiovascular stimulus in patients with CAD while specifically enhancing the reoxygenation and blood lactate clearance in recruited muscle groups during recovery from exercise. Trial Registration: ClinicalTrials.gov NCT02845063; https://clinicaltrials.gov/ct2/show/NCT02845063 UR - https://www.researchprotocols.org/2019/3/e10970/ UR - http://dx.doi.org/10.2196/10970 UR - http://www.ncbi.nlm.nih.gov/pubmed/30916659 ID - info:doi/10.2196/10970 ER - TY - JOUR AU - Anttila, Marjo-Riitta AU - Kivistö, Heikki AU - Piirainen, Arja AU - Kokko, Katja AU - Malinen, Anita AU - Pekkonen, Mika AU - Sjögren, Tuulikki PY - 2019/02/07 TI - Cardiac Rehabilitees? Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach JO - J Med Internet Res SP - e10985 VL - 21 IS - 2 KW - coronary disease KW - rehabilitees? experience KW - focus group KW - qualitative study KW - grounded theory KW - remote rehabilitation KW - e-health KW - e-rehabilitation KW - telerehabilitation KW - secondary prevention N2 - Background: Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees? perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation. Objective: This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees? experiences and attitudes toward technology before 12 months of remote rehabilitation. Methods: Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser?s mode of the grounded theory approach. Results: The result of the study was an ?identifying e-usage? experience category, which refers to the rehabilitees? notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees? technology experience. These subcategories are ?feeling outsider,? ?being uninterested,? ?reflecting benefit,? and ?enthusiastic using.? All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation. Conclusions: The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education. Trial Registration: ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD) UR - http://www.jmir.org/2019/2/e10985/ UR - http://dx.doi.org/10.2196/10985 UR - http://www.ncbi.nlm.nih.gov/pubmed/30730298 ID - info:doi/10.2196/10985 ER - TY - JOUR AU - Thijs, Isabeau AU - Fresiello, Libera AU - Oosterlinck, Wouter AU - Sinnaeve, Peter AU - Rega, Filip PY - 2019/01/31 TI - Assessment of Physical Activity by Wearable Technology During Rehabilitation After Cardiac Surgery: Explorative Prospective Monocentric Observational Cohort Study JO - JMIR Mhealth Uhealth SP - e9865 VL - 7 IS - 1 KW - fitness trackers KW - coronary artery bypass KW - cardiac surgery KW - cardiac rehabilitation KW - postoperative care KW - wearable KW - physical activity KW - exercise N2 - Background: Wearable technology is finding its way into clinical practice. Physical activity describes patients? functional status after cardiac surgery and can be monitored remotely by using dedicated trackers. Objective: The aim of this study was to compare the progress of physical activity in cardiac rehabilitation by using wearable fitness trackers in patients undergoing coronary artery bypass surgery by either the conventional off-pump coronary artery bypass (OPCAB) or the robotically assisted minimally invasive coronary artery bypass (RA-MIDCAB). We hypothesized faster recovery of physical activity after RA-MIDCAB in the first weeks after discharge as compared to OPCAB. Methods: Patients undergoing RA-MIDCAB or OPCAB were included in the study. Each patient received a Fitbit Charge HR (Fitbit Inc, San Francisco, CA) physical activity tracker following discharge. Rehabilitation progress was assessed by measuring the number of steps and physical activity level daily. The physical activity level was calculated as energy expenditure divided by the basic metabolic rate. Results: A total of 10 RA-MIDCAB patients with a median age of 68 (min, 55; max, 83) years and 12 OPCAB patients with a median age of 69 (min, 50; max, 82) years were included. Baseline characteristics were comparable except for body mass index (RA-MIDCAB: 26 kg/m²; min, 22; max, 28 versus OPCAB: 29 kg/m²; min, 27; max, 33; P<.001). Intubation time (P<.05) was significantly lower in the RA-MIDCAB group. A clear trend, although not statistically significant, was observed towards a higher number of steps in RA-MIDCAB patients in the first week following discharge. Conclusions: RA-MIDCAB patients have an advantage in recovery in the first weeks of revalidation, which is reflected by the number of steps and physical activity level measured by the Fitbit Charge HR, as compared to OPCAB patients. However, unsupervised assessment of daily physical activity varied widely and could have consequences with regard to the use of these trackers as research tools. UR - http://mhealth.jmir.org/2019/1/e9865/ UR - http://dx.doi.org/10.2196/mhealth.9865 UR - http://www.ncbi.nlm.nih.gov/pubmed/30702433 ID - info:doi/10.2196/mhealth.9865 ER - TY - JOUR AU - Duan, Ping Yan AU - Liang, Wei AU - Guo, Lan AU - Wienert, Julian AU - Si, Yan Gang AU - Lippke, Sonia PY - 2018/11/19 TI - Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial JO - J Med Internet Res SP - e12052 VL - 20 IS - 11 KW - eHealth KW - physical activity KW - diet KW - cardiac rehabilitation KW - health resources N2 - Background: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention. Objective: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression). Methods: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016. Results: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, ?2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely. Conclusions: Patients? psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge. Trial Registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1) UR - http://www.jmir.org/2018/11/e12052/ UR - http://dx.doi.org/10.2196/12052 UR - http://www.ncbi.nlm.nih.gov/pubmed/30455167 ID - info:doi/10.2196/12052 ER - TY - JOUR AU - Dinesen, Birthe AU - Spindler, Helle PY - 2018/11/19 TI - The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study JO - JMIR Rehabil Assist Technol SP - e10758 VL - 5 IS - 2 KW - telerehabilitation KW - heart diseases KW - workflow KW - cooperation KW - professional practice KW - community of practice N2 - Background: Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. Objective: This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. Methods: Theories of networks between organizations, the sociology of professions, and the ?community of practice? approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. Results: The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. Conclusions: The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. Trial Registration: ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb) UR - http://rehab.jmir.org/2018/2/e10758/ UR - http://dx.doi.org/10.2196/10758 UR - http://www.ncbi.nlm.nih.gov/pubmed/30455168 ID - info:doi/10.2196/10758 ER - TY - JOUR AU - Thornton, Louise AU - Kay-Lambkin, Frances AU - Tebbutt, Bree AU - Hanstock, L. Tanya AU - Baker, L. Amanda PY - 2018/10/1 TI - A Mobile Phone?Based Healthy Lifestyle Monitoring Tool for People With Mental Health Problems (MyHealthPA): Development and Pilot Testing JO - JMIR Cardio SP - e10228 VL - 2 IS - 2 KW - telemedicine KW - mental health KW - cardiovascular diseases KW - mhealth KW - smartphone KW - mobile phone N2 - Background: People with mental health disorders live, on average, 20 years less than those without, often because of poor physical health including cardiovascular disease (CVD). Evidence-based interventions are required to reduce this lifespan gap. Objective: This study aimed to develop, test, and evaluate a mobile phone?based lifestyle program (MyHealthPA) to help people with mental health problems improve key health risk behaviors and reduce their risk of CVD. Methods: The development of MyHealthPA occurred in 3 stages: (1) scoping of the literature, (2) a survey (n=251) among people with and without the experience of mental health problems, and (3) program development informed by stages 1 and 2. A small pilot trial among young people with and without mental health disorders was also conducted. Participants completed a baseline assessment and were given access to the MyHealthPA program for a period of 8 weeks. They were then asked to complete an end-of-treatment assessment and a follow-up assessment 1 month later. Results: In the study, 28 young people aged 19 to 25 years were recruited to the pilot trial. Of these, 12 (12/28, 43%) had been previously diagnosed with a mental illness. Overall, 12 participants (12/28, 43%) completed the end-of-treatment assessment and 6 (6/28, 21%) completed the follow-up assessment. Small improvements in fruit and vegetable consumption, level of physical activity, alcohol use, and mood were found between baseline and end of treatment and follow-up, particularly among people with experience of mental health issues. Most participants (history of mental illness: 4/7, 57%; no history of mental illness: 3/5, 60%) reported the program had above average usability; however, only 29% (2/7, no history of mental illness) to 40% (2/5, history of mental illness) of participants reported that they would like to use the program frequently and would recommend it to other young people. Participants also identified a number of ways in which the program could be improved. Conclusions: This study describes the formative research and process of planning that formed the development of MyHealthPA and the evidence base underpinning the approach. The MyHealthPA program represents an innovative approach to CVD risk reduction among people with mental health problems. MyHealthPA appears to be an acceptable, easy-to-use, and potentially effective mHealth intervention to assist young people with mental illness to monitor risk factors for CVD. However, ways in which the program could be improved for future testing and dissemination were identified and discussed. UR - http://cardio.jmir.org/2018/2/e10228/ UR - http://dx.doi.org/10.2196/10228 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758772 ID - info:doi/10.2196/10228 ER - TY - JOUR AU - Zhang, Ling AU - Ding, Ding AU - Neubeck, Lis AU - Gallagher, Patrick AU - Paull, Glenn AU - Gao, Yan AU - Gallagher, Robyn PY - 2018/06/26 TI - Mobile Technology Utilization Among Patients From Diverse Cultural and Linguistic Backgrounds Attending Cardiac Rehabilitation in Australia: Descriptive, Case-Matched Comparative Study JO - JMIR Cardio SP - e13 VL - 2 IS - 1 KW - cultural and linguistic diverse KW - cardiac rehabilitation KW - technology KW - mobile technology KW - information technology N2 - Background: Barriers to attending cardiac rehabilitation (CR), including cultural and linguistic differences, may be addressed by recent technological developments. However, the feasibility of using these approaches in culturally and linguistically diverse patients is yet to be determined. Objective: This study aims to assess the use of mobile technologies and features, as well as confidence in utilization across patients speaking different languages at home (ie, English, Mandarin Chinese, and a language other than English and Mandarin [other]) and are both eligible and physically suitable for CR. In addition, the study aims to determine the sociodemographic correlates of the mobile technology/feature use, including language spoken at home in the three groups mentioned above. Methods: This is a descriptive, case matched, comparative study. Age and gender-matched patients speaking English, Mandarin and other languages (n=30/group) eligible for CR were surveyed for their mobile technology and mobile feature use. Results: ?Participants had a mean age of 66.7 years (SD 13, n=90, range 46-95), with 53.3% (48/90) male. The majority (82/90, 91.1%) used at least one technology device, with 87.8% (79/90) using mobile devices, the most common being smartphones (57/90, 63.3%), tablets (28/90, 31.1%), and text/voice-only phones (24/90, 26.7%). More English-speaking participants used computers than Mandarin or ?other? language speaking participants (P=.003 and .02) and were more confident in doing so compared to Mandarin-speaking participants (P=.003). More Mandarin-speaking participants used smartphones compared with ?other? language speaking participants (P=.03). Most commonly used mobile features were voice calls (77/82, 93.9%), text message (54/82, 65.9%), the internet (39/82, 47.6%), email (36/82, 43.9%), and videoconferencing (Skype or FaceTime [WeChat or QQ] 35/82, 42.7%). Less Mandarin-speaking participants used emails (P=.001) and social media (P=.007) than English-speaking participants. Speaking Mandarin was independently associated with using smartphone, emails, and accessing the web-based medication information (OR 7.238, 95% CI 1.262-41.522; P=.03, OR 0.089, 95% CI 0.016-0.490; P=.006 and OR 0.191, 95% CI 0.037-0.984; P=.05). Conclusions: This study reveals a high usage of mobile technology among CR patients and provides further insights into differences in the technology use across CALD patients in Australia. The findings of this study may inform the design and implementation of future technology-based CR. UR - http://cardio.jmir.org/2018/1/e13/ UR - http://dx.doi.org/10.2196/cardio.9424 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758767 ID - info:doi/10.2196/cardio.9424 ER - TY - JOUR AU - Habibovi?, Mirela AU - Broers, Eva AU - Piera-Jimenez, Jordi AU - Wetzels, Mart AU - Ayoola, Idowu AU - Denollet, Johan AU - Widdershoven, Jos PY - 2018/02/08 TI - Enhancing Lifestyle Change in Cardiac Patients Through the Do CHANGE System (?Do Cardiac Health: Advanced New Generation Ecosystem?): Randomized Controlled Trial Protocol JO - JMIR Res Protoc SP - e40 VL - 7 IS - 2 KW - cardiac health KW - lifestyle KW - behavior change KW - eHealth KW - mHealth N2 - Background: Promoting a healthy lifestyle (eg, physical activity, healthy diet) is crucial for the primary and secondary prevention of cardiac disease in order to decrease disease burden and mortality. Objective: The current trial aims to evaluate the effectiveness of the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) service, which is developed to assist cardiac patients in adopting a healthy lifestyle and improving their quality of life. Methods: Cardiac patients (ie, people who have been diagnosed with heart failure, coronary artery disease, and/or hypertension) will be recruited at three pilot sites (Badalona Serveis Assistencials, Badalona, Spain [N=75]; Buddhist Tzu Chi Dalin General Hospital, Dalin, Taiwan [N=100] and Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands [N=75]). Patients will be assisted by the Do Something Different (DSD) program to change their unhealthy habits and/or lifestyle. DSD has been developed to increase behavioral flexibility and subsequently adopt new (healthier) habits. In addition, patients? progress will be monitored with a number of (newly developed) devices (eg, Fitbit, Beddit, COOKiT, FLUiT), which will be integrated in one application. Results: The Do CHANGE trial will provide us with new insights regarding the effectiveness of the proposed intervention in different cultural settings. In addition, it will give insight into what works for whom and why. Conclusions: The Do CHANGE service integrates new technologies into a behavior change intervention in order to change the unhealthy lifestyles of cardiac patients. The program is expected to facilitate long-term, sustainable behavioral change. Trial Registration: Clinicaltrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305 (Archived by WebCite at http://www.webcitation.org/6wfWHvuyU). UR - http://www.researchprotocols.org/2018/2/e40/ UR - http://dx.doi.org/10.2196/resprot.8406 UR - http://www.ncbi.nlm.nih.gov/pubmed/29422454 ID - info:doi/10.2196/resprot.8406 ER - TY - JOUR AU - Beatty, L. Alexis AU - Magnusson, L. Sara AU - Fortney, C. John AU - Sayre, G. George AU - Whooley, A. Mary PY - 2018/01/15 TI - VA FitHeart, a Mobile App for Cardiac Rehabilitation: Usability Study JO - JMIR Hum Factors SP - e3 VL - 5 IS - 1 KW - cardiac rehabilitation KW - mobile applications KW - exercise therapy KW - exercise KW - rehabilitation research KW - telemedicine KW - habits KW - qualitative research N2 - Background: Cardiac rehabilitation (CR) improves outcomes for patients with ischemic heart disease or heart failure but is underused. New strategies to improve access to and engagement in CR are needed. There is considerable interest in technology-facilitated home CR. However, little is known about patient acceptance and use of mobile technology for CR. Objective: The aim of this study was to develop a mobile app for technology-facilitated home CR and seek to determine its usability. Methods: We recruited patients eligible for CR who had access to a mobile phone, tablet, or computer with Internet access. The mobile app includes physical activity goal setting, logs for tracking physical activity and health metrics (eg, weight, blood pressure, and mood), health education, reminders, and feedback. Study staff demonstrated the mobile app to participants in person and then observed participants completing prespecified tasks with the mobile app. Participants completed the System Usability Scale (SUS, 0-100), rated likelihood to use the mobile app (0-100), questionnaires on mobile app use, and participated in a semistructured interview. The Unified Theory of Acceptance and Use of Technology and the Theory of Planned Behavior informed the analysis. On the basis of participant feedback, we made iterative revisions to the mobile app between users. Results: We conducted usability testing in 13 participants. The first version of the mobile app was used by the first 5 participants, and revised versions were used by the final 8 participants. From the first version to revised versions, task completion success rate improved from 44% (11/25 tasks) to 78% (31/40 tasks; P=.05), SUS improved from 54 to 76 (P=.04; scale 0-100, with 100 being the best usability), and self-reported likelihood of use remained high at 76 and 87 (P=.30; scale 0-100, with 100 being the highest likelihood). In interviews, patients expressed interest in tracking health measures (?I think it?ll be good to track my exercise and to see what I?m doing?), a desire for introductory training (?Initially, training with a technical person, instead of me relying on myself?), and an expectation for sharing data with providers (?It would also be helpful to share with my doctor, it just being a matter of clicking a button and sharing it with my doctor?). Conclusions: With participant feedback and iterative revisions, we significantly improved the usability of a mobile app for CR. Patient expectations for using a mobile app for CR include tracking health metrics, introductory training, and sharing data with providers. Iterative mixed-method evaluation may be useful for improving the usability of health technology. UR - http://humanfactors.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/humanfactors.8017 UR - http://www.ncbi.nlm.nih.gov/pubmed/29335235 ID - info:doi/10.2196/humanfactors.8017 ER - TY - JOUR AU - Gallagher, Robyn AU - Roach, Kellie AU - Sadler, Leonie AU - Glinatsis, Helen AU - Belshaw, Julie AU - Kirkness, Ann AU - Zhang, Ling AU - Gallagher, Patrick AU - Paull, Glenn AU - Gao, Yan AU - Partridge, Ruth Stephanie AU - Parker, Helen AU - Neubeck, Lis PY - 2017/10/24 TI - Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study JO - JMIR Mhealth Uhealth SP - e161 VL - 5 IS - 10 KW - mobile phone KW - cell phone KW - digital divide KW - cardiac rehabilitation KW - cardiovascular disease N2 - Background: Emerging evidence indicates mobile technology?based strategies may improve access to secondary prevention and reduce risk factors in cardiac patients. However, little is known about cardiac patients? use of mobile technology, particularly for health reasons and whether the usage varies across patient demographics. Objective: This study aimed to describe cardiac patients? use of mobile technology and to determine variations between age groups after adjusting for education, employment, and confidence with using mobile technology. Methods: Cardiac patients eligible for attending cardiac rehabilitation were recruited from 9 hospital and community sites across metropolitan and rural settings in New South Wales, Australia. Participants completed a survey on the use of mobile technology devices, features used, confidence with using mobile technology, willingness and interest in learning, and health-related use. Results: The sample (N=282) had a mean age of 66.5 (standard deviation [SD] 10.6) years, 71.9% (203/282) were male, and 79.0% (223/282) lived in a metropolitan area. The most common diagnoses were percutaneous coronary intervention (33.3%, 94/282) and myocardial infarction (22.7%, 64/282). The majority (91.1%, 257/282) used at least one type of technology device, 70.9% (200/282) used mobile technology (mobile phone/tablet), and 31.9% (90/282) used all types. Technology was used by 54.6% (154/282) for health purposes, most often to access information on health conditions (41.4%, 117/282) and medications (34.8%, 98/282). Age had an important independent association with the use of mobile technology after adjusting for education, employment, and confidence. The youngest group (<56 years) was over 4 times more likely to use any mobile technology than the oldest (>69 years) age group (odds ratio [OR] 4.45, 95% CI 1.46-13.55), 5 times more likely to use mobile apps (OR 5.00, 95% CI 2.01-12.44), and 3 times more likely to use technology for health-related reasons (OR 3.31, 95% CI 1.34-8.18). Compared with the older group, the middle age group (56-69 years) was more than twice as likely to use any mobile technology (OR 2.42, 95% CI 1.27-4.59) and mobile technology for health-related purposes (OR 1.92, 95% CI 1.04-3.53). Participants who had completed high school were twice as likely to use mobile technology (OR 2.62, 95% CI 1.45-4.70), mobile apps (OR 2.05, 95% CI 1.09-3.84), and mobile technology for health-related reasons (OR 5.09, 95% CI 2.89-8.95) than those who had not completed high school. Associations were also present between participants living in metropolitan areas and mobile technology use (OR 1.07, 95% CI 1.07-4.24) and employment and mobile app use (OR 2.72, 95% CI 1.44-5.140). Conclusions: Mobile technology offers an important opportunity to improve access to secondary prevention for cardiac patients, particularly when modified to suit subgroups. High levels of mobile technology use and health motivation need to be harnessed for secondary prevention. UR - http://mhealth.jmir.org/2017/10/e161/ UR - http://dx.doi.org/10.2196/mhealth.8352 UR - http://www.ncbi.nlm.nih.gov/pubmed/29066425 ID - info:doi/10.2196/mhealth.8352 ER - TY - JOUR AU - Partridge, R. Stephanie AU - Grunseit, C. Anne AU - Gallagher, Patrick AU - Freeman, Becky AU - O'Hara, J. Blythe AU - Neubeck, Lis AU - Due, Sarah AU - Paull, Glenn AU - Ding, Ding AU - Bauman, Adrian AU - Phongsavan, Philayrath AU - Roach, Kellie AU - Sadler, Leonie AU - Glinatsis, Helen AU - Gallagher, Robyn PY - 2017/09/15 TI - Cardiac Patients? Experiences and Perceptions of Social Media: Mixed-Methods Study JO - J Med Internet Res SP - e323 VL - 19 IS - 9 KW - cardiovascular disease KW - cardiac rehabilitation KW - qualitative research KW - secondary prevention KW - social media N2 - Background: Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults provides an opportunity to reach patients who are eligible for cardiac rehabilitation but unable to attend traditional face-to-face groups. However, there is a paucity of research on cardiac patients? experiences and perspectives on using social media to support their health. Objective: The aim of this study was to describe cardiac rehabilitation patients? experiences in using social media in general and their perspective on using social media, particularly Facebook, to support their cardiac health and secondary prevention efforts. Methods: A mixed-methods study was undertaken among cardiac rehabilitation patients in both urban and rural areas. First, this study included a survey (n=284) on social media use and capability. Second, six focus group interviews were conducted with current Facebook users (n=18) to elucidate Facebook experience and perspectives. Results: Social media use was low (28.0%, 79/282) but more common in participants who were under 70 years of age, employed, and had completed high school. Social media users accessed Web-based information on general health issues (65%, 51/79), medications (56%, 44/79), and heart health (43%, 34/79). Participants were motivated to invest time in using Facebook for ?keeping in touch? with family and friends and to be informed by expert cardiac health professionals and fellow cardiac participants if given the opportunity. It appeared that participants who had a higher level of Facebook capability (understanding of features and the consequences of their use and efficiency in use) spent more time on Facebook and reported higher levels of ?liking,? commenting, or sharing posts. Furthermore, higher Facebook capability appeared to increase a participants? willingness to participate in a cardiac Facebook support group. More capable users were more receptive to the use of Facebook for cardiac rehabilitation and more likely to express interest in providing peer support. Recommended features for a cardiac rehabilitation Facebook group included a closed group, expert cardiac professional involvement, provision of cardiac health information, and ensuring trustworthiness of the group. Conclusions: Cardiac health professionals have an opportunity to capitalize on cardiac patients? motivations and social media, mostly Facebook, as well as the capability for supporting cardiac rehabilitation and secondary prevention. Participants? favored purposeful time spent on Facebook and their cardiac health provides such a purpose for a Facebook intervention. The study results will inform the development of a Facebook intervention for secondary prevention of cardiovascular disease. UR - http://www.jmir.org/2017/9/e323/ UR - http://dx.doi.org/10.2196/jmir.8081 UR - http://www.ncbi.nlm.nih.gov/pubmed/28916507 ID - info:doi/10.2196/jmir.8081 ER - TY - JOUR AU - Cossette, Sylvie AU - Côté, José AU - Rouleau, Geneviève AU - Robitaille, Marie AU - Heppell, Sonia AU - Mailhot, Tanya AU - Fontaine, Guillaume AU - Cournoyer, Catherine AU - Gagnon, Marie-Pierre AU - Gallani, Maria-Cecilia AU - Tanguay, Jean-Francois AU - Dupuis, Jocelyn AU - Nigam, Anil AU - Guertin, Marie-Claude PY - 2017/09/06 TI - A Web-Based Tailored Intervention to Support Illness Management in Patients With an Acute Coronary Syndrome: Pilot Study JO - JMIR Cardio SP - e4 VL - 1 IS - 2 KW - nursing informatics KW - health behavior KW - self-care KW - acute coronary syndrome KW - pilot study N2 - Background: Illness management after an acute coronary syndrome (ACS) is crucial to prevent cardiac complications, to foster participation in a cardiac rehabilitation (CR) program, and to optimize recovery. Web-based tailored interventions have the potential to provide individualized information and counseling to optimize patient?s illness management after hospital discharge. Objective: We aimed to assess the feasibility and acceptability of a Web-based tailored intervention (TAVIE@COEUR) designed to improve illness management in patients hospitalized for an ACS. Illness management outcomes were operationalized by self-care, medication adherence, anxiety management, cardiac risk factors reduction, and enrollment in a CR program. Methods: This posttest pilot study was conducted with one group (N=30) of patients hospitalized for an ACS on the coronary care unit of a tertiary cardiology center. TAVIE@COEUR comprises three Web-based sessions, with a duration ranging from 10 to 45 min and is structured around an algorithm to allow the tailoring of the intervention to different pathways according to patients? responses to questions. TAVIE@COEUR includes 90 pages, 85 videos, and 47 PDF documents divided across session 1 (S1), session 2 (S2), and session 3 (S3). These sessions concern self-care and self-observation skills related to medication-taking (S1), emotional control and problem-solving skills (S2), and social skills and interacting with health professionals (S3). Throughout the videos, a virtual nurse (providing the intervention virtually) guides the participants in the acquisition of self-care skills. Patients completed S1 of TAVIE@COEUR before hospital discharge and were asked to complete S2 and S3 within 2 weeks after discharge. Feasibility indicators were extracted from the TAVIE@COEUR system. Data regarding acceptability (satisfaction and appreciation of the platform) and preliminary effect (self-care, medication adherence, anxiety management, risk factor reduction, and CR enrollment) were assessed through questionnaires at 1 month following discharge. Preliminary effect was assessed by comparing baseline and 1-month illness management variables. Results: Of the 30 participants, 20 completed S1, 10 completed S2, and 5 completed S3. Good acceptability scores were observed for ease of navigation (mean=3.58, standard deviation [SD]=0.70; scale=0-4), ease of understanding (mean=3.46, SD=0.63; scale=0-4), and applicability (mean=3.55, SD=0.74; scale=0-4). The lowest acceptability scores were observed for information tailoring (mean=2.93, SD=0.68; scale=0-4) and individual relevance (mean=2.56, SD=0.96; scale=0-4). With regard to preliminary effect, we observed an overall self-care at 1 month following discharge score higher than at baseline (mean at 1 month=54.07, SD=3.99 vs mean at baseline=49.09, SD=6.92; scale-0-60). Conclusions: Although participants reported general satisfaction and appreciation of TAVIE@COEUR, acceptability and feasibility results show the need for further development of the Web-based intervention to enhance its tailoring before undertaking a full-fledged randomized controlled trial. This may be accomplished by optimizing the adaptability of TAVIE@COEUR to patients? knowledge, needs, interests, individual capabilities, and emotional and cognitive responses during session completion. UR - http://cardio.jmir.org/2017/2/e4/ UR - http://dx.doi.org/10.2196/cardio.7342 UR - http://www.ncbi.nlm.nih.gov/pubmed/31758758 ID - info:doi/10.2196/cardio.7342 ER - TY - JOUR AU - Siegmund, Anne Lee AU - Ahmed, M. Haitham AU - Crawford, Todd Michael AU - Bena, Frank James PY - 2017/08/18 TI - Feasibility of a Facebook Intervention for Exercise Motivation and Cardiac Rehabilitation Adherence: Study Protocol JO - JMIR Res Protoc SP - e162 VL - 6 IS - 8 KW - cardiac rehabilitation KW - social media KW - adherence KW - motivation KW - Facebook KW - Self-Determination Theory KW - Behavioral Regulation in Exercise Questionnaire-3 KW - BREQ-3 KW - Psychological Need Satisfaction in Exercise scale N2 - Background: While cardiac rehabilitation has been shown to be effective at improving coronary heart disease (CHD), participation is generally poor. Attempts to increase uptake and adherence often fail. Use of a Facebook intervention for this population may be a unique opportunity to support self-determined motivation and affect adherence. Objective: To evaluate the impact of a Facebook intervention on motivation for exercise and adherence to cardiac rehabilitation in patients with CHD during a 12-week, Phase II cardiac rehabilitation program. Methods: A prospective, randomized controlled pilot study, grounded in Self-Determination Theory, will be conducted. Participants will be recruited from inpatient, or the intake visit to outpatient, cardiac rehabilitation, and then randomly assigned to the intervention or comparison group. Participants in the intervention group will take part in a private Facebook group. Weekly posts will be designed to support self-determined motivation, measured at baseline and postcardiac rehabilitation by the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3). The Psychological Need Satisfaction for Exercise (PNSE) scale will measure fulfillment of needs that affect motivation. Participants in the comparison group will be given the same materials, but these will be supplied via handouts and email. The number of sessions attended will be tallied and analyzed using t tests. Overall motivation will be evaluated using analysis of covariance (ANCOVA) models. Multivariate analysis of variance models will be used to evaluate differences in the change across motivation subtypes. If significant, ANCOVA models for each subtype will be fit. ANCOVA models will be used to compare changes in needs satisfaction, overall and separately among the three subscales, between groups. Engagement in the Facebook group will be measured by number of ?likes? and self-report of weekly visits to the group. Results: This project was funded in July 2017 and recruitment is currently underway. The recruitment goal is 60 cardiac rehabilitation patients. Data collection is anticipated to be complete by July 2018. Conclusions: This pilot study will be the first to examine the effect of a Facebook intervention on patient adherence and motivation for exercise in a cardiac rehabilitation setting. Engagement in the Facebook group and participation in the study will help to determine the feasibility of using Facebook to affect adherence and motivation in cardiac rehabilitation patients, potentially improving outcomes through the use of a unique intervention. Trial Registration: ClinicalTrials.gov NCT02971813; https://clinicaltrials.gov/ct2/show/NCT02971813 (Archived by WebCite at http://www.webcitation.org/6sRsz8Zpa) UR - http://www.researchprotocols.org/2017/8/e162/ UR - http://dx.doi.org/10.2196/resprot.7554 UR - http://www.ncbi.nlm.nih.gov/pubmed/28821473 ID - info:doi/10.2196/resprot.7554 ER -