Effectiveness of TechCR Among CHD Patients (TechCR)

Effectiveness of Technology-assisted Interventions in Hybrid Cardiac Rehabilitation (TechCR) Among Coronary Heart Disease Patients

During this ongoing pandemic, there is a crucial need for innovative approaches to deliver CR programmes other than frequent face-to-face sessions at the centre-based CR to reduce the number of times people come close in contact with others or gathering in large groups. This is a single setting, 2-arm parallel randomised clinical trial which aims to examine the effects of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR) among the coronary heart disease patients. Eligible participants will be randomly assigned into either intervention group (IG) or control group (CG) in 1:1 ratio using the computerised permuted blocks, alternating block sizes of 4 or 6. All participants will be followed up for three months and six months with data collection at baseline, (T0), three-month (T1) and six-month (T2) time points.

Study Overview

• Status: Completed
• Conditions: Coronary Heart Disease
• Intervention / Treatment: Behavioral: exercise training for TechCR; Behavioral: audio/video conference; Behavioral: educational video; Behavioral: Daily log; Behavioral: exercise training for centre-based

Detailed Description

In recent years, CR delivery platforms and approaches have been changing as technology has become an integral part of our daily lives. Some of the barriers to CR may be able to be tackled with the advancement of technology, as it provides an alternative to the traditional centre-based CR through virtual consultations and remote monitoring that may eliminate the hassle of face-to-face consultations, work and time conflicts. During this ongoing pandemic, there is a crucial need for innovative approaches to deliver CR programmes other than frequent face-to-face sessions at the centre-based CR to reduce the number of times people come close in contact with others or gathering in large groups.

The overall aim of this proposed study is to examine the effects of technology-assisted interventions in hybrid cardiac rehabilitation (TecHCR) among the coronary heart disease patients. The objectives are as followings:

1. to determine the effects of TecHCR on self-efficacy related to exercise;
2. to determine the effects of TecHCR on health promoting behaviours;
3. to determine the effects of TecHCR in adherence;
4. to determine the effects of TecHCR in exercise capacity;
5. to determine the effects of TecHCR on fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol, systolic blood pressure, diastolic blood pressure, body mass index and waist circumference;
6. to determine the effects of TecHCR anxiety and depression.

With the attrition rate of 20%, a total of 160 eligible participants with 80 per group will be recruited. The control group receives usual care including outpatient medical follow-up with the cardiologists and dietician counselling before hospital discharge. Then, the participants will have their first follow-up by the physicians in cardiac rehabilitation clinic and followed by monthly follow-up. Subsequently, they will have weekly, centre-based supervised exercise training by physiotherapist and follow-up with occupational therapist for 12 weeks. In addition of the usual care of outpatient medical follow-ups and dietary education, the intervention group will receive 3 times supervised exercise in the centre, weekly upload of CR education (audio-visual video) on WhatsApp for six weeks (Week 1 to Week 6). The prescribed exercise will then be continued at home with a pedometer as the "cue to action" to be worn by the participant; he or she will be required to upload the data daily to the web app on the smartphone. Participants will also receive a weekly audio/video-conferencing follow-up (Week 1 to Week 12). The outcome measures include Socio-demographic and Clinical Data, Bandura's exercise self efficacy scale (ESE), Health Promoting Lifestyle Profile II (HPLP II), adherence referring to the attendance to 12 weeks (supervised exercise training) for CG, and attendance (3 times supervised exercise training) and upload of exercise data (for 9 weeks) to web app for IG; and 12-week assessment for both groups, exercise capacity by Exercise Stress Test measuring the metabolic equivalents METs) and Hospital Anxiety and Depression Scale (HADS). The data entry and analysis will be performed using the IBM Social Package Statistical Software (SPSS) version 26.0 with a p value < 0.05 will be consider significant of the result.

• Study Type: Interventional
• Enrollment (Actual): 160
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Malaysia
  • Wilayah Persekutuan
    • Kuala Lumpur, Wilayah Persekutuan, Malaysia
      • University Malaya Medical Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. adults ≥ 18 years old;
2. patients with documented acute myocardial infarction, treated with thrombolysis, angioplasty or revascularisation surgery;
3. patients who own a mobile phone with internet access;
4. patients who have at least completion of primary school education;
5. understand English or Malay language;
6. patients who will return home for living after hospital discharge;
7. patients who are medically stable and referred to CR programme and able to give informed consent to participate in this study.

Exclusion Criteria:

1. patients who are participating in other studies;
2. patients who will undergo any repeat cardiac or other procedure in next 12 months;
3. patients with comorbidities such as dementia, impaired hearing or vision or psychiatric illness which may affect the ability to participate in the CR programme;
4. patients with pre-existing mobility problems which prevent them from exercising

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: TecHCR; 12 weeks Hybrid between supervised exercise training and video call sessions Educational videos Dietary and exercise log	Behavioral: exercise training for TechCR; 3 times of supervised exercise training at the centre-based, outpatient cardiac rehabilitation clinic; Behavioral: audio/video conference; weekly audio/video conference; Behavioral: educational video; weekly for 6 weeks, duration of video about 10-15 minutes; Behavioral: Daily log; daily dietary and exercise log
Other: Centre-based; 12 weeks usual care provided by the centre-based, outpatient cardiac rehabilitation clinic Dietary and exercise log	Behavioral: Daily log; daily dietary and exercise log; Behavioral: exercise training for centre-based; 6 times of supervised exercise training

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
self-efficacy related to exercise (Bandura's Exercise Self-efficacy)	Using Bandura's Exercise Self-efficacy to determine the effects of TecHCR on self-efficacy related to exercise before intervention (baseline)	Baseline (T0) - at 0 week, before initiation of interventions
self-efficacy related to exercise (Bandura's Exercise Self-efficacy)	Using Bandura's Exercise Self-efficacy to determine the effects of TecHCR on self-efficacy related to exercise post intervention (at 3-month)	post intervention (T1) - at 12 weeks after initiation of interventions
self-efficacy related to exercise (Bandura's Exercise Self-efficacy)	Using Bandura's Exercise Self-efficacy to determine the effects of TecHCR on self-efficacy related to exercise 3-month post intervention (T2) (at 6 month)	6-month post intervention (T2) - at 36 weeks after initiation of interventions

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
behavioural outcomes (Health-promoting Lifestyle Profile II)	Using Health-promoting lifestyle Profile II to determine the effects of TecHCR on health promoting behaviours	Baseline (T0) - at 0 week, before initiation of interventions
behavioural outcomes (Health-promoting Lifestyle Profile II)	Using Health-promoting lifestyle Profile II to determine the effects of TecHCR on health promoting behaviours	post intervention (T1) - at 12 weeks after initiation of interventions
behavioural outcomes (Health-promoting Lifestyle Profile II)	Using Health-promoting lifestyle Profile II to determine the effects of TecHCR on health promoting behaviours	6-month post intervention (T2) - at 36 weeks after initiation of interventions
psychological outcomes (Hospital Anxiety and Depression Scale)	Using Hospital Anxiety and Depression Scale to determine the effects of TecHCR on anxiety and depression	Baseline (T0) - at 0 week, before initiation of interventions
psychological outcomes (Hospital Anxiety and Depression Scale)	Using Hospital Anxiety and Depression Scale to determine the effects of TecHCR on anxiety and depression	post intervention (T1) - at 12 weeks after initiation of interventions
psychological outcomes (Hospital Anxiety and Depression Scale)	Using Hospital Anxiety and Depression Scale to determine the effects of TecHCR on anxiety and depression	6-month post intervention (T2) - at 36 weeks after initiation of interventions
fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (from laboratory blood test result)	to determine the effects of TecHCR on fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (mmol/L)	Baseline (T0) - at 0 week, before initiation of interventions
fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (from laboratory blood test result)	to determine the effects of TecHCR on fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (mmol/L)	post intervention (T1) - at 12 weeks after initiation of interventions
fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (from laboratory blood test result)	to determine the effects of TecHCR on fasting low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (mmol/L)	6-month post intervention (T2) - at 36 weeks after initiation of interventions
systolic and diastolic blood pressure (using blood pressure monitoring device)	to determine the effects of TecHCR on systolic and diastolic blood pressure	Baseline (T0) - at 0 week, before initiation of interventions
systolic and diastolic blood pressure (using blood pressure monitoring device)	to determine the effects of TecHCR on systolic and diastolic blood pressure	post intervention (T1) - at 12 weeks after initiation of interventions
systolic and diastolic blood pressure (using blood pressure monitoring device)	to determine the effects of TecHCR on systolic and diastolic blood pressure	6-month post intervention (T2) - at 36 weeks after initiation of interventions
Body Mass Index (BMI) (weight in kilogrammes*height in metres^2)	to determine the effects of TecHCR on BMI	Baseline (T0) - at 0 week, before initiation of interventions
Body Mass Index (BMI) (weight in kilogrammes*height in metres^2)	to determine the effects of TecHCR on BMI	post intervention (T1) - at 12 weeks after initiation of interventions
Body Mass Index (BMI) (weight in kilogrammes*height in metres^2)	to determine the effects of TecHCR on BMI	6-month post intervention (T2) - at 36 weeks after initiation of interventions
Waist circumference (measured by measuring tape in centimetres)	to determine the effects of TecHCR on waist circumference	Baseline (T0) - at 0 week, before initiation of interventions
Waist circumference (measured by measuring tape in centimetres)	to determine the effects of TecHCR on waist circumference	post intervention (T1) - at 12 weeks after initiation of interventions
Waist circumference (measured by measuring tape in centimetres)	to determine the effects of TecHCR on waist circumference	6-month post intervention (T2) - at 36 weeks after initiation of interventions

Collaborators and Investigators

• Sponsor: Chinese University of Hong Kong
• Investigators: Principal Investigator: Mei Sin Chong, Chinese University of Hong Kong

Study record dates

Study Major Dates

• Study Start (Actual): February 26, 2021
• Primary Completion (Actual): October 31, 2023
• Study Completion (Actual): October 31, 2023

Study Registration Dates

• First Submitted: April 7, 2021
• First Submitted That Met QC Criteria: April 24, 2021
• First Posted (Actual): April 28, 2021

Study Record Updates

• Last Update Posted (Actual): April 17, 2024
• Last Update Submitted That Met QC Criteria: April 16, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: coronary heart disease; technology-assisted interventions; hybrid cardiac rehabilitation
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Heart Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease
• Other Study ID Numbers: 2020.621

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No