Telerehabilitation Programs Research Articles

Home-based tele-rehabilitation versus hospital-based outpatient rehabilitation for pain and function after initial total knee arthroplasty: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to compare the effectiveness of home-based tele-rehabilitation programs with hospital-based rehabilitation programs in improving pain and function at various time points (≤6 weeks, ≤14 weeks, and ≤ 52 weeks) following the initial total knee arthroplasty. This study used PRISMA and AMSTAR reporting guidelines. We systematically searched 5 databases (PubMed, Embase, Web of Science, Cochrane Library, and Medline) to identify randomized controlled trials published from January 1, 2019, to January 1, 2023. The primary outcomes were pain, knee injury and osteoarthritis outcome score, and mobility (knee range of motion). We included 9 studies involving 1944 patients. Low-quality evidence showed hospital-based rehabilitation was better than home-based tele-rehabilitation in knee injury and osteoarthritis outcome score (mean difference [MD], -2.62; 95% confidence interval [CI], -4.65 to -0.58; P = .01) at ≤ 14 weeks after total knee arthroplasty. Based on low-quality evidence, home-based tele-rehabilitation was better than hospital-based rehabilitation in knee range of motion (MD, 2.00; 95% CI, 0.60 to 3.40; P = .005). There was no significant difference between hospital-based rehabilitation and home-based tele-rehabilitation in knee pain at ≤ 6 weeks (MD, 0.18; 95% CI, -0.07 to 0.42; P = .16), 14 weeks (MD, 0.12; 95% CI, -0.26 to 0.49; P = .54), and ≤ 52 weeks (MD, 0.16; 95% CI, -0.11 to 0.43; P = .24). Home-based tele-rehabilitation and hospital-based rehabilitation programs showed comparable long-term outcomes in pain, mobility, physical function, and patient-reported health status after primary total knee arthroplasty. Considering the economic costs, home-based tele-rehabilitation programs are recommended as a viable alternative to hospital-based rehabilitation programs.

Investigating the Telerehabilitation With Aims to Improve Lower Extremity Recovery Poststroke Program: A Feasibility Study.

The purpose of this study was to examine the feasibility of a progressive virtual exercise and self-management intervention, the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke program (TRAIL), in individuals with stroke. A single group pre-post study design was used. Thirty-two participants were recruited who were aged 19years or older, had a stroke within 18months of the beginning of the study, had hemiparesis of the lower extremity, and were able to tolerate 50minutes of activity. Participants completed TRAIL, a synchronous exercise and self-management program delivered via videoconferencing. Participants received 8 telerehabilitation sessions over 4weeks that were 60 to 90minutes, with a trained physical therapist in a ≤2 to 1 participant-to-therapist ratio. Feasibility indicators in the areas of process (recruitment and retention rates, perceived satisfaction), resources (treatment fidelity and adherence, participant and assessor burden, therapist burden), management (equipment, processing time), and scientific indicators (safety, treatment response, treatment effect) were collected throughout the study using a priori criteria for success. The treatment effect was examined on the Timed "Up & Go" test, the virtual Fugl-Meyer Lower Extremity Assessment, the 30-Second Sit-to-Stand Test, the Functional Reach, the Tandem Stand, the Activities-Specific Balance Confidence Scale, the Stroke Impact Scale, and the Goal Attainment Scale. Forty-seven individuals were screened, of which 32 (78% male; median age of 64.5years) were included for the study from 5 sites across Canada. Nine feasibility indicators met our study-specific threshold criteria for success: retention rate (0 dropouts), perceived satisfaction, treatment fidelity, adherence, therapist burden, equipment, and safety. In terms of treatment response and effect, improvements were observed in Timed "Up & Go" test (Cohen d= 0.57); Fugl-Meyer Lower Extremity Assessment (d= 0.76); 30-Second Sit-to-Stand Test (d= 0.89); and Goal Attainment Scale (d= 0.95). The delivery of TRAIL, a lower extremity stroke rehabilitation program using videoconferencing technology, is feasible and appears to have positive influences on mobility, lower extremity impairment, strength, and goal attainment. Community-based telerehabilitation programs, such as TRAIL, could extend the continuum of care during the transition back to community postdischarge or during global disruptions, such as Coronavirus Disease 2019 (COVID-19). Delivery of synchronous lower extremity rehabilitation via videoconferencing to community-dwelling stroke survivors is feasible.

Effectiveness of Different Telerehabilitation Strategies on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review and Meta-Analysis.

Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also brings a serious economic burden to society. However, it is difficult for patients with knee OA to access rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies for the improvement of knee OA, but the effect of different telerehabilitation strategies on knee OA is not clear. The aim of this systematic review and meta-analysis was to identify telerehabilitation strategies attributing to the improvement of pain and physical function outcomes in patients with knee OA. We reviewed and analyzed telerehabilitation strategies from randomized controlled trials (RCTs) comparing telerehabilitation with conventional treatment or usual care. For each strategy, we examined whether RCTs that applied the telerehabilitation strategy resulted in a significant improvement in pain or physical function compared with conventional treatment or usual care. We included 6 RCTs (n=734) incorporating 8 different telerehabilitation strategies. The duration of the interventions ranged from 1 to 48 weeks, and sample sizes ranged from 20 to 350 patients. The results showed that RCTs that provided telerehabilitation were found to be more effective than conventional treatments for improving pain (P=.003; standardized mean difference [SMD] -0.21, 95% CI -0.35 to -0.07), but not physical function (P=.24; SMD -0.09, 95% CI -0.25 to 0.06). Furthermore, this systematic review and meta-analysis indicated that there is no significant correlation between different telerehabilitation strategies and the pain and physical function of patients with knee OA. This systematic review and meta-analysis showed that telerehabilitation programs could relieve pain but not improve physical function for patients with knee OA. These results indicated that telerehabilitation is beneficial for the implementation of home rehabilitation exercises for patients with knee OA, thereby reducing the economic burden of health. However, there were limitations in terms of the number of search results and the number of studies that were eligible for this review and meta-analysis. Therefore, the results need to be interpreted with caution, and more high-quality studies with large samples are needed to focus on the long-term outcomes of telerehabilitation for patients with knee OA to address this limitation.

Acceptability of a Balance Rehabilitation Program Delivered via a Tele‐Remote Platform Among a Thai MCI Cohort

AbstractBackgroundPatients with mild cognitive impairment can have a decline in overall motor function and balance which are more severe than the normal older adult population. Balance rehabilitation should be offered consistently to maximize its effect. Telerehabilitation programs are emerging as a possible solution for customized balance exercises for older adults at home.However, the acceptability of such programs among cognitive decline cohorts should be explored. Modification may be needed to tailor to the need of this population. We conducted a public involvement and engagement session with the MCI cohort according to the user‐centred design approach to gather feedback from the cohort to better improve the platform to suit the cognitive decline of older adults' needs, especially in ASIAN culture.MethodTwenty MCI and carer volunteers from the memory clinic were invited to attend the session. The augmented reality equipment, sensors and telerehabilitation platform were shown to the group. Their opinions and feedback about the system were collected.ResultVolunteers were keen to adopt new technology. The user experience and system usability were collected along with additional feedback from the cohort to ease the use of the platform for the cognitively impaired population.ConclusionThe volunteer feedback promoted the customization of the platform to be more user‐friendly. Balance rehabilitation programs delivered via tele‐remote platform at home can be a potential solution among the MCI population in ASIA.

Telerehabilitasi pada Penyakit Paru Obstruktif Kronik

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Pulmonary rehabilitation is an essential component of COPD management and can be delivered through telerehabilitation programs. COPD telerehabilitation consists of exercise testing and training that can be performed at home with supervision from a physiotherapist or remotely using a smartphone application. Exercise training includes cardiorespiratory endurance, resistance, flexibility, and respiratory muscle training. COPD telerehabilitation is effective in improving exercise tolerance, reducing the incidence of acute exacerbations, and improving patients’ quality of life.

A Pulmonary Telerehabilitation Program Improves Exercise Capacity and Quality of Life in Young Females Post-COVID-19 Patients.

To examine the impact of telerehabilitation training on exercise capacity, lung function, and health-related quality of life (HRQOL) in comparison to no rehabilitation for post-COVID-19 symptoms in adult females. A randomized controlled trial of 48 females after mild to moderate COVID-19 survival were equally and randomly assigned to one of two groups: intervention group or control group. Three sessions per week for 6 weeks of a telerehabilitation program provided via a smartphone to the intervention group. Spirometry was used to quantify lung function, a 6-minute walk test (6MWT) measured in meters to measure exercise capacity, and the Short Form Health Survey-36 was used to assess HRQOL. After treatment, there was no statistically significant difference in forced vital capacity (FVC) or forced expiratory volume in 1 second (FEV1) between groups (p>0.05), but the 6MWT of the intervention group increased significantly more than that of the control group (p=0.001). The percent of change in 6MWT for the intervention group and control group was 14.22% and 4.21%, respectively. After therapy, the intervention group's HRQOL significantly improved when compared to the control group's (p=0.001). This study showed that a telerehabilitation programs improved exercise capacity and HRQOL in young females post-COVID-19 compared to no rehabilitation.

Exploring attitudes of people with chronic conditions towards telerehabilitation: A qualitative study

Abstract Background Patient attitudes towards telerehabilitation have been explored in condition-specific cohorts. However, less is known about how patients perceive generic group telerehabilitation programmes for a range of chronic conditions. The aim of this research is to explore the attitudes of people with a range of chronic health conditions towards group-based telerehabilitation, and the acceptability of generic telerehabilitation programmes. Methods We conducted a qualitative research study using semi-structured focus groups via videoconferencing software. A purposive sample of 18 people with chronic health complaints including cardiorespiratory, neurological and musculoskeletal conditions were recruited. The sample included both those who had (n = 11), and had not (n = 7), previously engaged in telerehabilitation programmes. An online questionnaire collected demographic information and data regarding previous telerehabilitation participation and preferences. Focus groups were conducted via videoconferencing, in accordance with the Consolidated Criteria for Reporting Qualitative Research Checklist, and analysed using thematic analysis following Braun and Clarke's methodology. Findings were triangulated with quantitative questionnaire data. Results Four focus groups were conducted including participants with chronic cardiorespiratory (n = 8), neurological (n = 6) and musculoskeletal (n = 4) conditions. Three themes were identified regarding telerehabilitation: 1. Benefits and Facilitators 2. Challenges and Barriers, and 3. Preferences Conclusion(s) Telerehabilitation is convenient for people with chronic conditions, however, concerns exist regarding technology and the limitations of this healthcare delivery method. The role of telerehabilitation is valued, and future programmes should acknowledge patient preferences including a hybrid model of care, exercise and educational content, social interaction, and synchronous components. Key messages • Patients value the role of telerehabilitation in the future as an adjunct to traditional in-person rehabilitation, not as a replacement. • The acceptability of a generic telerehabilitation programme for a group of people with a range of chronic conditions remains unclear, and may differ between groups.

In person versus remote cognitive rehabilitation in patients with subjective cognitive decline or neurocognitive disorders: what factors drive patient's preference?

To date, there is still a lack of consensus for identifying the ideal candidate for cognitive telerehabilitation (TR). The main goal of the present study is to identify the factors associated to the preference for either TR or in-person cognitive training (CT) programs in older adults at risk of dementia or with early cognitive impairment. A sample of 56 participants with subjective cognitive decline or neurocognitive disorders eligible for CT were enrolled at the Dementia Research Center and Neurorehabilitation Unit of IRCCS Mondino Foundation. All individuals underwent a baseline assessment to capture their complete profile, including cognitive reserve and lifestyle habits, sociodemographic characteristics, cognitive functioning, and mental health. Patients were then asked their preference for TR or in-person CT, before being randomized to either treatment as per protocol procedures. Statistical analyses included explorative descriptive approach, logistic regression, and non-parametric models to explore the overall contribution of each variable. The two (TR and in-person) preference groups were similar for cognitive functioning and mental health status. Socio-demographic and lifestyle profiles seem to be the most important factors to influence the preference in terms of the area under the curve (AUC) of the models. The two preference groups differed in terms of socio-demographic characteristics (e.g., level of technological skills, age, and distance from the clinic). Furthermore, participants who selected the TR modality of CT had significantly higher levels of cognitive reserve and adopted more protective lifestyle habits (e.g., regular physical activity, Mediterranean diet) when compared to those who preferred in-person CT. These findings highlight that the preference to receive CT delivered by TR or in person is a complex issue and is influenced by a variety of factors, mostly related to lifestyle habits and sociodemographic characteristics. Availability of profiles of patients that may be more attracted to one or the other modality of TR may help promote shared decision-making to enhance patient experience and outcomes.

Patient-clinician digital health interventions for the hip fracture population: a scoping review

IntroductionOlder adults with hip fracture often require extensive post-surgery care across multiple sectors, making follow-up care even more important to ensure an ideal recovery. With the increased adoption of technology, patient-clinician digital health interventions can potentially improve post-surgery outcomes of hip fracture patients by helping them and their caregivers better understand the various aspects of their care, post-hip fracture surgery. The purpose of this study was to examine the available literature on the impact of hip fracture-specific, patient-clinician digital health interventions on patient outcomes and health care delivery processes. We also aimed to identify the barriers and enablers to the uptake and implementation of these technologies and to provide strategies for improved use of these digital health interventions.MethodsWe conducted a scoping review following the six stages of Arksey and O’Malley’s framework and following the PRISMA-ScR reporting format. Searches were conducted in five databases. In addition to hand searching for relevant studies from the references of all included studies, we also conducted a grey literature search to identify relevant primary studies. Screening of titles and abstracts as well as full texts were performed independently by two reviewers. Two reviewers also performed the data extraction of the included studies.ResultsAfter screening 3,638 records, 20 articles met the criteria and 1 article was identified through hand searching. Various patient-clinician digital health interventions were described including telehealth /telerehabilitation programs (n = 6), care transition /follow-up interventions (n = 5), online resources (n = 2), and wearable devices /sensor monitoring (n = 1). Outcomes were varied and included functional status, gait/mobility, quality of life, psychological factors, satisfaction, survival/complications, caregiver outcomes, compliance, technology-user interactions, and feedback on the use of the digital health interventions. For clinicians, a key barrier to the use of the digital health interventions was the acceptability of the technology. However, the usefulness of the digital health intervention by clinicians was seen as both a barrier and an enabler. For patients and caregivers, all the themes were seen as both a barrier and an enabler depending on the study. These themes included: 1) availability and access, 2) usability, 3) knowledge and skills, 4) acceptability, and 5) usefulness of the digital health intervention.ConclusionMany behavioural factors affect the use of patient-clinician digital health interventions. However, a specific attention should be focused on the acceptability of the technology by the clinicians to encourage uptake of the digital health interventions. The results of this scoping review can help to better understand the factors that may be targeted to increase the use of these technologies by clinicians, patients, and caregivers.

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review

Objective To explore the extent and type of evidence in relation to group-based cardiac telerehabilitation interventions and health outcomes in coronary artery disease patients. Data sources A literature search was conducted in August 2022 and July 2023 in databases including PubMed, CINAHL, Scopus and PsycINFO. The search process followed the scoping review methodology guided by the Joanna Briggs Institute for scoping reviews. Methods The inclusion criteria were a peer-reviewed journal article published in English between 1 January 2017 and 15 August 2022 and updated to cover until 15 July 2023 concerning group-based cardiac telerehabilitation in adult coronary artery disease patients. All group-based cardiac telerehabilitation interventions and health outcome types were charted and summarized. Results The researcher screened a total of 2089 articles, of which 22 were retained with a total of 1596 participants. Group-based cardiac telerehabilitation interventions were particularly useful for patients with multi-faceted technological applications and social support. The patients received guidance regarding cardiovascular disease risk factors. Physical fitness, psychological complaints and quality of life were often measured outcomes in the included studies. Conclusions This scoping review indicates the success of various rehabilitation interventions utilizing different technologies for coronary patients. Coronary patients were guided in making lifestyle changes, and positive findings were observed in the health outcomes measured after the telerehabilitation intervention. The findings of this review can provide valuable guidance for developing and evaluating sustainable group-based cardiac telerehabilitation programs that aim to benefit coronary patients.

Exploring attitudes of people with chronic health conditions towards the use of group-based telerehabilitation: A qualitative study

Objective The study explores the attitudes of people with chronic health conditions towards the use of group-based telerehabilitation. Design A qualitative research study. Setting The setting involved semi-structured focus groups via videoconferencing software. Participants A purposive sample of 18 people with chronic health conditions including cardiorespiratory, neurological and musculoskeletal conditions was recruited via national patient advocacy and support groups in Ireland and clinical contacts. The sample included both those who had, and had not, previously engaged in telerehabilitation programmes. Procedures An online questionnaire collected demographic information and data regarding previous telerehabilitation participation and telerehabilitation preferences. Focus groups were conducted using videoconferencing software, in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist, and analysed using thematic analysis following Braun and Clarke's methodology. Findings were triangulated with quantitative questionnaire data. Results Four focus groups were conducted including participants with chronic cardiorespiratory (n = 8), neurological (n = 6) and musculoskeletal (n = 4) conditions. Three themes were identified regarding telerehabilitation: (a) benefits and facilitators (including convenience, increased service accessibility, social connection and technological support), (b) challenges and barriers (including technological access and literacy, limited ‘hands-on’ therapy, safety concerns and social limitations), and (c) preferences (regarding mode of delivery, content, duration and generic programmes for mixed-condition groups). Conclusions Telerehabilitation is convenient for people with chronic conditions; however, concerns exist regarding the use of technology and the limitations of this healthcare delivery method. The role of telerehabilitation is valued, and future programmes should acknowledge patient preferences including a hybrid model of care, exercise and educational content, social interaction and synchronous components.

Is asynchronous telerehabilitation equal to synchronous telerehabilitation in COVID-19 survivors with classes 4-6?

The first aim of this study was to compare synchronous and asynchronous telerehabilitation programs in COVID-19 survivors with classes 4-6 and determine the more appropriate telerehabilitation approach. Thirty-six COVID-19 survivors with class 4-6 severity were randomly divided into two groups. Telerehabilitation programs were an 8-week exercise program that comprised pulmonary, aerobic, and strengthening exercises. Patients were assessed at the baseline, post-treatment, and follow-up for the incremental shuttle walk test (ISWT), short physical performance battery (SPPB), health-related quality of life (HRQoL) and hospital anxiety and depression scale (HADS). The overall mean age of the study population was 54.06 (SD 10.50), and 15 (46.8%) were male. There were no significant differences between the two groups in any of the demographics and clinical characteristics at the baseline (p > 0.05), except for physical function (p < 0.05). There was a significant improvement in exercise capacity (p < 0.001) and lower extremity function (p < 0.01) within both groups in the short term and long term. There was a significant improvement in some subparameters of quality of life in both groups. As the synchronous group's short-term and long-term psychological status improved significantly, the asynchronous group's short-term psychological status improved significantly (p < 0.05). Telerehabilitation programs had similar effects, and only synchronous telerehabilitation outperformed asynchronous telerehabilitation in terms of physical function, role-emotional, and long-term anxiety. Asynchronous telerehabilitation was as effective as synchronous telerehabilitation in developing clinical and functional parameters when properly planned and implemented.

Longer-Term Effects of Cardiac Telerehabilitation on Patients With Coronary Artery Disease: Systematic Review and Meta-Analysis.

Cardiac telerehabilitation offers a flexible and accessible model for patients with coronary artery disease (CAD), effectively transforming the traditional cardiac rehabilitation (CR) approach. This systematic review and meta-analysis aimed to evaluate the long-term effectiveness of cardiac telerehabilitation. We searched randomized controlled trials (RCTs) in 7 electronic databases: PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, the China National Knowledge Infrastructure, and WANFANG. The primary outcome focused on cardiopulmonary fitness. For secondary outcomes, we examined cardiovascular risk factors (blood pressure, BMI, and serum lipids), psychological scales of depression and anxiety, quality of life (QoL), cardiac telerehabilitation adherence, and adverse events. In total, 10 RCTs fulfilled the predefined criteria, which were reviewed in our meta-analysis. The results showed that after cardiac telerehabilitation, there was a significant difference in the improvement in long-term peak oxygen uptake compared to center-based CR (mean difference [MD] 1.61, 95% CI 0.38-2.85, P=.01), particularly after 6-month rehabilitation training (MD 1.87, 95% CI 0.34-3.39, P=.02). The pooled effect size of the meta-analysis indicated that there were no significant differences in the reduction in cardiovascular risk factor control. There was also no practical demonstration of anxiety scores or depression scores. However, cardiac telerehabilitation demonstrated an improvement in the long-term QoL of patients (MD 0.92, 95% CI 0.06-1.78, P=.04). In addition, the study reported a high completion rate (80%) for cardiac telerehabilitation interventions. The incidence of adverse events was also low during long-term follow-up. Cardiac telerehabilitation proves to be more effective in improving cardiopulmonary fitness and QoL during the long-term follow-up for patients with CAD. Our study highlights monitoring-enabled and patient-centered telerehabilitation programs, which play a vital role in the recovery and development of CAD and in the long-term prognosis of patients.

A Systematic Review of Telemedicine-Driven Pulmonary Rehabilitation after the Acute Phase of COVID-19.

The acute phase of COVID-19 often leaves patients with persistent pulmonary deficits. Pulmonary Rehabilitation (PR) has been recommended as an essential part of post-acute COVID-19 management. In light of the global pandemic, telerehabilitation has been increasingly employed to deliver PR. This systematic review aimed to evaluate the effectiveness of telemedicine-driven PR in patients recovering from the acute phase of COVID-19, assessing variations in telerehabilitation practices and identifying the degree of change in mental health, physical health, quality of life, and lung function. A systematic search was conducted across PubMed, Web of Science, Cochrane, and Scopus up until April 2023. Studies focusing on telerehabilitation in PR for post-acute COVID-19 patients with outcomes including pulmonary function, exercise capacity, and quality of life were included after careful assessment of this study's protocol. The selection process involved careful scrutiny of abstracts and full texts, and the quality assessment was performed using the National Heart, Lung, and Blood Institute (NHLBI) tool. Seven studies, published between 2021 and 2022, involving a total of 412 patients, were included. The evaluated telerehabilitation programs stretched between 4 and 10 weeks, involving a mobile app or video connection with the patient, integrating a mix of aerobic and resistance training, breathing exercises, functional activities, and muscle strengthening. Findings revealed that telemedicine-driven PR significantly improved physical health, measured by the step test score (73 vs. 71), 6MWD (30.2 vs. 17.1) and BPAQ, mental health evaluated by SF-12 (6.15 vs. 4.17) and PHQ-4, quality of life measured by the SF-12 (7.81 vs. 3.84), SGRQ (31.5 vs. 16.9), and CAT scores, and some parameters of pulmonary function in post-acute COVID-19 patients (mMRC, STST, and MVV). This review substantiates the potential of telemedicine-driven PR to improve various health outcomes in post-acute COVID-19 patients. The findings underscore the importance of integrating telerehabilitation into the management of post-acute COVID-19 and call for further exploration of its long-term effects, cost-effectiveness, and best practices.

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

BackgroundTraditional cardiac rehabilitation programs are centre-based and clinically supervised, with their safety and effectiveness well established. Notwithstanding the established benefits, cardiac rehabilitation remains underutilised. A possible alternative would be a hybrid approach where both centre-based and tele-based methods are combined to deliver cardiac rehabilitation to eligible patients. The objective of this study was to determine the long-term cost-effectiveness of a hybrid cardiac telerehabilitation and if it should be recommended to be implemented in the Australian context.MethodsFollowing a comprehensive literature search, we chose the Telerehab III trial intervention that investigated the effectiveness of a long-term hybrid cardiac telerehabilitation program. We developed a decision analytic model to estimate the cost-effectiveness of the Telerehab III trial using a Markov process. The model included stable cardiac disease and hospitalisation health states and simulations were run using one-month cycles over a five-year time horizon. The threshold for cost-effectiveness was set at $AU 28,000 per quality-adjusted life-year (QALY). For the base analysis, we assumed that 80% completed the programme. We tested the robustness of the results using probabilistic sensitivity and scenario analyses.ResultsTelerehab III intervention was more effective but more costly and was not cost-effective, at a threshold of $28,000 per QALY. For every 1,000 patients who undergo cardiac rehabilitation, employing the telerehabilitation intervention would cost $650,000 more, and 5.7 QALYs would be gained, over five years, compared to current practice. Under probabilistic sensitivity analysis, the intervention was cost-effective in only 18% of simulations. Similarly, if the intervention compliance was increased to 90%, it was still unlikely to be cost-effective.ConclusionHybrid cardiac telerehabilitation is highly unlikely to be cost-effective compared to the current practice in Australia. Exploration of alternative models of delivering cardiac telerehabilitation is still required. The results presented in this study are useful for policymakers wanting to make informed decisions about investment in hybrid cardiac telerehabilitation programs.

Predicting Adherence to Home-Based Cardiac Rehabilitation with Data-Driven Methods

Cardiac rehabilitation (CR) focuses on the improvement of health or the prevention of further disease progression after an event. Despite the documented benefits of CR programs, the participation remains suboptimal. Home-based CR programs have been proposed to improve uptake and adherence. The goal of this study was to apply an end-to-end methodology including machine learning techniques to predict the 6-month adherence of cardiovascular disease (CVD) patients to a home-based telemonitoring CR program, combining patients’ clinical information with their actual program participation during a short familiarization phase. Fifty CVD patients participated in such a program for 6 months, enabling personalized guidance during a phase III CR study. Clinical, fitness, and psychological data were measured at baseline, whereas actual adherence, in terms of weekly exercise session duration and patient heart rate, was measured using wearables. Hierarchical clustering was used to identify different groups based on (1) patients’ clinical baseline characteristics, (2) exercise adherence during the familiarization phase, and (3) the whole program adherence, whereas the output of the clustering was determined using repetitive decision trees (DTs) and random forest (RF) techniques to predict long-term adherence. Finally, for each cluster of patients, network analysis was applied to discover correlations of their characteristics that link to adherence. Based on baseline characteristics, patients were clustered into three groups, with differences in behavior and risk factors, whereas adherent, non-adherent, and transient adherent patients were identified during the familiarization phase. Regarding the prediction of long-term adherence, the most common DT showed higher performance compared with RF (precision: 80.2 ± 19.5% and 71.8 ± 25.8%, recall: 94.5 ± 14.5% and 71.8 ± 25.8% for DT and RF accordingly). The analysis of the DT rules and the analysis of the feature importance of the RF model highlighted the significance of non-adherence during the familiarization phase, as well as that of the baseline characteristics to predict future adherence. Network analysis revealed different relationships in different clusters of patients and the interplay between their behavioral characteristics. In conclusion, the main novelty of this study is the application of machine learning techniques combining patient characteristics before the start of the home-based CR programs with data during a short familiarization phase, which can predict long-term adherence with high accuracy. The data used in this study are available through connected health technologies and standard measurements in CR; thus, the proposed methodology can be generalized to other telerehabilitation programs and help healthcare providers to improve patient-tailored enrolment strategies and resource allocation.

Patients' Perceptions of Exercise-Based Cardiac Telerehabilitation after a Myocardial Infarction-A Qualitative Study.

To be able to design telerehabilitation programs targeting the needs and preferences of end-users, patients' in-depth perspectives are needed. To date, such studies are lacking and, therefore, the aim of the present study was to describe patients' perceptions of performing exercise-based cardiac telerehabilitation after a myocardial infarction (MI). Individual semi-structured interviews were performed with 15 patients (3 women, median age 69 years) after an MI who had participated in exercise-based cardiac telerehabilitation for three months. The interviews were transcribed verbatim and analyzed with inductive content analysis. An overall theme was defined as "Cardiac telerehabilitation-a new alternative for exercising that is easily accessible and up to date". Four categories, including "The important role of a physical therapist with expert knowledge", "Prerequisites playing an important role in the willingness to participate", "Making exercise accessible and adjustable" and "Inspiring future exercise", and 15 subcategories were identified. Understanding the patient's perspective is an important key to further improving and successfully implementing exercise-based cardiac telerehabilitation, as an alternative or adjunct to traditional, centre-based programs. The findings can serve to improve patient-physiotherapist interactions and to inform important aspects related to exercise, technology and a sense of security from an exercise-based cardiac telerehabilitation program.

Effectiveness of telerehabilitation and home-based falls prevention programs for community-dwelling older adults: a systematic review and meta-analysis protocol

IntroductionFalls among older adults are associated with adverse sequelae including fractures, chronic pain and disability, which can lead to loss of independence and increased risks of nursing home admissions. The...

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundRecent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI.MethodsWe performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients.ResultsAll studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD − 0.25, 95%CI − 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD − 2.88, 95%CI − 5.19 to − 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol.ConclusionThis systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.

Telerehabilitation-based exercises with or without transcranial direct current stimulation for pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke: A multi-arm parallel-group randomized controlled trial study protocol

BackgroundCognitive impairments, pain, and motor dysfunction are daunting challenges for stroke survivors, clinicians, and caregivers during rehabilitation programmes. There is a dearth of studies investigating the effectiveness of combining neurodevelopmental technique telerehabilitation-based exercises with transcranial direct current stimulation (tDCS) for stroke survivors with mild cognitive impairments post-stroke. ObjectivesThe primary aim of this study is to investigate and compare the effects of Telerehabilitation-Based Exercises with or without Transcranial Direct Current Stimulation (tDCS) on pain, motor and cognitive function in older adults with mild cognitive impairments post-stroke. MethodsA multi-arm parallel-group (three groups) randomized controlled trial study involving a minimum of 87 participants (29 per group) will be conducted. Participants will be randomized into either telerehabilitation programmes with tDCS, telerehabilitation programmes alone or conventional physiotherapy programmes. All participants will be treated 3 times weekly for 8 weeks (45 min of intervention per session). DiscussionThe findings in this study are expected to guide the provision of effective and affordable rehabilitation for stroke survivors with mild cognitive impairment.