Abstract
BackgroundFace-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. However, these programs have low participation rates, especially among patients who live rural or remote. Hence, there is a need to develop OCR programs that provide an alternative to face-to-face contact such as by using the Internet. Only a very limited number of Internet-based OCR programs have been developed and evaluated. Therefore, the purpose of this study was to identify issues that are relevant to the development of an Internet-based OCR intervention.MethodsA three-round Delphi study among cardiac rehabilitation experts was conducted. In the first round, 43 experts outlined opinions they had on the development of an online ORC platform into an open-ended electronic questionnaire. In the second round, 42 experts completed a structured (five-point scale) electronic questionnaire based on first round results, in which they scored items on their relevance. In the third round, the same experts were asked to re-rate the same items after feedback was given about the group median relevance score to establish a level of consensus.ResultsAfter the third round, high consensus was reached in 120 of 162 (74%) questionnaire items, of which 93 (57% of 162 items) also had high relevance according to the experts. The results indicate that experts strongly agreed on desired website content, data obtained from the patient, and level of interaction with patients that should be part of an Internet-based OCR intervention.ConclusionThe high rates of consensus and relevance observed among cardiac rehabilitation experts are an indication that they perceived the development and implementation of an Internet-based ORC intervention as feasible, and as a valuable alternative to face-to-face programs. In many ways the experts indicated that an Internet-based ORC program should mimic a traditional face-to-face program, and emphasize the crucial role of the cardiac rehabilitation manager who interacts with patients from a distance. The present study revealed practical insights into how Internet OCR interventions should be designed and opens the door for the development of such an intervention to be subsequently examined in a longitudinal and experimental study.
Highlights
Face-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease
A strong improvement in level of consensus was observed between the second and third round of the study. This is comparable to what was found in other Delphi studies [33,39,40], and implies that experts strongly agreed about the desired website content, data obtained from the patient via the Internet, and level of interaction between patient and cardiac case manager that should be part of an Internet-based OCR intervention
Based on the knowledge and experience of experts in the field, this Delphi study revealed practical insights that are important in the development of an Internet-based OCR program
Summary
Face-to-face outpatient cardiac rehabilitation (OCR) programs are an important and effective component in the management of cardiovascular disease. These programs have low participation rates, especially among patients who live rural or remote. There is strong evidence that individuals who participate in an outpatient cardiac rehabilitation (OCR) program following hospital discharge ( called phase II rehabilitation) can significantly improve functional capacity, quality of life, social and psychological health, and provide a five-year survival advantage of up to 35% [5,7]. Studies have shown alarmingly low rates of enrolment and participation into phase II cardiac rehabilitation programs, with numbers ranging between 10% and 30% of eligible patients [5,11]. For Australia, participation rates for OCR programs range between 20% and 40% of completion, with significantly lower rates for patients from rural and remote areas [12,13]
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