- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04738383
Feasibility and Acceptance of Changes in Medical Supervision of Exercise Groups in Cardiac Rehabilitation
Exercise groups are a form of rehabilitation sport that is offered to cardiac patients (e.g. after a heart attack) in long-term rehabilitation. In Germany, the constant presence of a physician is mandatory. In order to meet the increasing demand for heart groups, the present study implements emergency care during the heart group sessions with three alternatives: paramedics, physician-on-call or specially trained instructors.
In the present study the investigators compare these alternatives (three experimental conditions) with the conventional way (control condition). Perceived safety, trust, acceptance and organisational feasibility are the main outcomes of the study. The methods used are questionnaires to the participants, instructors, organizers and, if applicable, paramedics. Additionally, partially structured interviews with attending physicians are conducted according to an interview guide.
Study Overview
Status
Conditions
Detailed Description
Exercise groups are a form of rehabilitation sport that is offered to cardiac patients (e.g. after a heart attack) in long-term rehabilitation. In Germany it is paid for by the health insurance, when certain quality criteria are fulfilled. Among others, the constant presence of a physician is mandatory. In order to meet the increasing demand for heart groups, the National Paralympic Committee Germany (NPCG) received a special permit to try other forms of medical care during a pilot project. In this so-called "supervisor conception" the physician focuses on higher-level supervision for several exercise groups. Emergency care during the heart group sessions is ensured with three alternatives: by paramedics, by a physician-on-call or by specially trained instructors.
In the present study the investigators compare these alternatives (three experimental conditions) with the conventional way (control condition). Before the start of the research project, the different versions were defined and approved by the NPCG and other responsible actors in German rehabilitation sport. The project is implemented for 12 months.
The objectives of the evaluation are:
- Safety and acceptance of the participants, instructors and supervisors with regard to medical care, consultation and cooperation, feasibility and communication between the interfaces.
- Learning effects and implementation of the training measures for emergency management and health education measures
- Implementability of the supervisor conception in the clubs and regional associations of the three model regions and transferability on the clubs and state associations of the NPCG.
The methods used are questionnaires to the participants, instructors, organizers and, if applicable, paramedics, in which the assessment of the respondents is measured for perceived safety, acceptance and feasibility. The questionnaires to the participants and instructors are carried out during a session by employees of the participating sports clubs. The organizers fill out their questionnaires at a self-chosen time point. The questionnaires were developed by the university and were sent out after the client has given his/her informed consent.
Additionally, partially structured interviews with attending physicians are conducted according to an interview guide. The questions address the physicians' assessment of safety, acceptance and feasibility of the supervisor conception.The guidelines are developed by us and are used by us after approval by the client. We conduct the interviews ourselves by telephone and evaluate them.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Lower Saxony
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Hannover, Lower Saxony, Germany, 30169
- Behinderten-Sportverband Niedersachsen e.V.
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North-Rhine Westfalia
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Frechen, North-Rhine Westfalia, Germany, 50226
- National Paralympic Committee Germany (NPCG)
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Münster, North-Rhine Westfalia, Germany, 48149
- Instiute of Sport and Exercise Sciences
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Saxony
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Leipzig, Saxony, Germany, 04105
- Sächsischer Behinderten- und Rehabilitationssportverband e. V.
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- For participants: Participation in the heart sports group with the consent of the prescribing physician
Exclusion Criteria:
- None
Study Plan
How is the study designed?
Design Details
- Primary Purpose: HEALTH_SERVICES_RESEARCH
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Version 1: Paramedic
Physician is replaced by a paramedic, but the physician still acts as a supervisor.
|
Instead of a physician, who is constantly present, a paramedic is present next to the instructor during the sessions, who can give first aid in case of an emergency and bridge the time until the ambulance arrives on site.
The physician still acts as a supervisor visiting the group roughly every six weeks.
|
EXPERIMENTAL: Version 2: Physician-on-call
Physician is not present, but is on call.
|
This version implicates that a physician is not physically present but is on call during the sessions and must be constantly accessible by phone and able to arrive within three minutes in case of an emergency.
To ensure this, version two should be implemented in facilities, which are linked to cardiac or rehabilitation center.
|
EXPERIMENTAL: Version 3: Trained instructor
Physician acts as a supervisor, but is not constantly present.
The instructor received a special training preparing for emergency cases.
|
The sessions take place with the instructor only, who receives a comprehensive emergency training before and during the model phase and replaces the constantly present physician.
Just like in the previous versions the physician still acts as a supervisor visiting the group roughly every six weeks.
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NO_INTERVENTION: Control group
The sessions take place in the usual way, meaning that a physician is present in every session.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Trust at M3
Time Frame: Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
|
Trust of the participants, instructors, organizers and paramedics towards the three alternative versions in cardiac rehabilitation.
It is measured with one question offering a six-point Likert scale.
The feasibility criterion is met, if 50% or less of the respondents tick box 5 or 6 (strong rejection/ no trust).
|
Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
|
Trust at M10
Time Frame: Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
|
Trust of the participants, instructors, organizers and paramedics towards the three alternative versions in cardiac rehabilitation.
It is measured with one question offering a six-point Likert scale.
The feasibility criterion is met, if 50% or less of the respondents tick box 5 or 6 (strong rejection/ no trust).
|
Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
|
Willingness at M3
Time Frame: Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Willingness of the participants, instructors and organizers to implement the versions of the supervisor conception.
It is assessed with a "yes-no-question" in the questionnaire.
The feasibility criterion is met, if 50% or less of the respondents answer "no".
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Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Willingness at M10
Time Frame: Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Willingness of the participants, instructors and organizers to implement the versions of the supervisor conception.
It is assessed with a "yes-no-question" in the questionnaire.
The feasibility criterion is met, if 50% or less of the respondents answer "no".
|
Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Potential at M3
Time Frame: Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Assessment of the organizers, instructors and paramedics if the supervisor conception has the potential to be able to offer more cardiac rehabilitation groups.
It is measured with one question offering a six-point Likert scale.
The feasibility criterion is met, if 50% or less of the respondents tick box 5 or 6 (strong rejection/ no potential).
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Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Potential at M10
Time Frame: Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Assessment of the organizers, instructors and paramedics if the supervisor conception has the potential to be able to offer more cardiac rehabilitation groups.
It is measured with one question offering a six-point Likert scale.
The feasibility criterion is met, if 50% or less of the respondents tick box 5 or 6 (strong rejection/ no potential).
|
Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Costs at M3
Time Frame: Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Organizers are asked if the supervisor conception causes more, less or the same amount of costs compared to the conventional cardiac rehabilitation group.
It is measured with one question offering a seven-point Likert scale.
The feasibility criterion is met, if 50% or less of the respondents tick box 6 or 7 (more or much more costs).
|
Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Costs at M10
Time Frame: Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Organizers are asked if the supervisor conception causes more, less or the same amount of costs compared to the conventional cardiac rehabilitation group.
It is measured with one question offering a seven-point Likert scale.
The feasibility criterion is met, if 50% or less of the respondents tick box 6 or 7 (more or much more costs).
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Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Other questions on the implementation of the concept (M3)
Time Frame: Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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The questionnaire containing the 4 primary outcome questions includes also other questions on the implementation of the concept, e.g. the supervision, the communication between actors and the activity of the exercise instructor.
No score is calculated.
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Month 3 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
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Other questions on the implementation of the concept (M10)
Time Frame: Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
|
The questionnaire containing the 4 primary outcome questions includes also other questions on the implementation of the concept, e.g. the supervision, the communication between actors and the activity of the exercise instructor.
No score is calculated.
|
Month 10 of the intervention. The clubs received the questionnaires by mail and had one month to fill them out and send them back.
|
Collaborators and Investigators
Collaborators
Investigators
- Study Director: Benedikt Ewald, National Paralympic Committee Germany (NPCG)
- Principal Investigator: Michael Brach, Prof. Dr., University of Münster
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 2019-28-MB
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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