Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial

Ines Frederix, Dominique Hansen, Karin Coninx, Pieter Vandervoort, Dominique Vandijck, Niel Hens, Emeline Van Craenenbroeck, Niels Van Driessche, Paul Dendale, Ines Frederix, Dominique Hansen, Karin Coninx, Pieter Vandervoort, Dominique Vandijck, Niel Hens, Emeline Van Craenenbroeck, Niels Van Driessche, Paul Dendale

Abstract

Background: Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness. However, before large-scale implementation and reimbursement in current health care systems is possible, well-designed studies on the effectiveness of this new additional treatment strategy are needed.

Objective: The aim of this trial was to assess the medium-term effectiveness of an Internet-based, comprehensive, and patient-tailored telerehabilitation program with short message service (SMS) texting support for cardiac patients.

Methods: This multicenter randomized controlled trial consisted of 140 cardiac rehabilitation patients randomized (1:1) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation (intervention group; n=70) or to conventional cardiac rehabilitation alone (control group; n=70). In the telerehabilitation program, initiated 6 weeks after the start of ambulatory rehabilitation, patients were stimulated to increase physical activity levels. Based on registered activity data, they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals. Patient-specific dietary and/or smoking cessation advice was also provided as part of the telecoaching. The primary endpoint was peak aerobic capacity (VO2 peak). Secondary endpoints included accelerometer-recorded daily step counts, self-assessed physical activities by International Physical Activity Questionnaire (IPAQ), and health-related quality of life (HRQL) assessed by the HeartQol questionnaire at baseline and at 6 and 24 weeks.

Results: Mean VO2 peak increased significantly in intervention group patients (n=69) from baseline (mean 22.46, SD 0.78 mL/[min*kg]) to 24 weeks (mean 24.46, SD 1.00 mL/[min*kg], P<.01) versus control group patients (n=70), who did not change significantly (baseline: mean 22.72, SD 0.74 mL/[min*kg]; 24 weeks: mean 22.15, SD 0.77 mL/[min*kg], P=.09). Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group (P<.001). At 24 weeks, self-reported physical activity improved more in the intervention group compared to the control group (P=.01) as did the global HRQL score (P=.01).

Conclusions: This study showed that an additional 6-month patient-specific, comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness (VO2 peak) and associated HRQL compared to center-based cardiac rehabilitation alone. These results are supportive in view of possible future implementation in standard cardiac care.

Keywords: Internet; eHealth; effectiveness; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
CONSORT patient flow diagram. IPAQ: International Physical Activity Questionnaire.
Figure 2
Figure 2
Line charts depicting (A) mean VO2 peak (mL/[min*kg]), (B) mean Watt (% predicted), (C) median total daily steps, (D) median vigorous-moderate-walking (VMW) activity for all domains (MET-min/week), (E) median VMW activity for leisure time (MET-min/week), (F) median sitting time (min/week) for week 1, week 6, and week 24, respectively. Intervention group is represented by the heart icon; control group by the building icon. *P<.05 p>

References

    1. Scharf P. European Heart Network: Fighting Heart Disease and Stroke. 2015. [2015-05-31]. About us .
    1. Task FM, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di MC, Ferreira JR, Gersh BJ, Gitt AK, Hulot J, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall E, Vrints CJ, ESC Committee for Practice Guidelines. Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34(38):2949–3003. doi: 10.1093/eurheartj/eht296.
    1. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, ESC Committee for Practice Guidelines ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012 Jul;33(14):1787–847. doi: 10.1093/eurheartj/ehs104.
    1. Hansen Dominique, Dendale Paul, Raskin Anita, Schoonis Annick, Berger Jan, Vlassak Irmien, Meeusen Romain. Long-term effect of rehabilitation in coronary artery disease patients: randomized clinical trial of the impact of exercise volume. Clin Rehabil. 2010 Apr;24(4):319–27. doi: 10.1177/0269215509353262.
    1. Frederix Ines, Vanhees Luc, Dendale Paul, Goetschalckx Kaatje. A review of telerehabilitation for cardiac patients. J Telemed Telecare. 2015 Jan;21(1):45–53. doi: 10.1177/1357633X14562732.
    1. Huang Kaisen, Liu Wei, He Dingxiu, Huang Baotao, Xiao Dan, Peng Yong, He Yong, Hu Hongde, Chen Mao, Huang Dejia. Telehealth interventions versus center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. Eur J Prev Cardiol. 2015 Aug;22(8):959–71. doi: 10.1177/2047487314561168.
    1. Scharf P. European Heart Network: Fighting Heart Disease and Stroke. 2015. [2015-05-31]. EHN paper on eHealth .
    1. Frederix I, Hansen D, Coninx K, Vandervoort P, Van Craenenbroeck EM, Vrints C, Dendale P. Telerehab III: a multi-center randomized, controlled trial investigating the long-term effectiveness of a comprehensive cardiac telerehabilitation program - Rationale and study design. BMC Cardiovasc Disord. 2015;15(1):29. doi: 10.1186/s12872-015-0021-5.
    1. Van Vlaenderen I. Cardiale revalidatie: klinische doeltreffendheid en gebruik in België. Brussels: Federaal Kenniscentrum voor de Gezondheidszorg (KCE); 2010. [2015-05-31]. .
    1. Ross Robert M. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003 May 15;167(10):1451; author reply 1451. doi: 10.1164/ajrccm.167.10.950.
    1. Baba R, Nagashima M, Goto M, Nagano Y, Yokota M, Tauchi N, Nishibata K. Oxygen uptake efficiency slope: a new index of cardiorespiratory functional reserve derived from the relation between oxygen uptake and minute ventilation during incremental exercise. J Am Coll Cardiol. 1996 Nov 15;28(6):1567–72.
    1. Warren Janet M, Ekelund Ulf, Besson Herve, Mezzani Alessandro, Geladas Nickos, Vanhees Luc, Experts Panel. Assessment of physical activity - a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2010 Apr;17(2):127–39. doi: 10.1097/HJR.0b013e32832ed875.
    1. Oldridge Neil, Höfer Stefan, McGee Hannah, Conroy Ronan, Doyle Frank, Saner Hugo, (for the HeartQoL Project Investigators) The HeartQoL: part II. Validation of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014 Jan;21(1):98–106. doi: 10.1177/2047487312450545.
    1. Frederix I, Van Driessche N, Hansen D, Berger J, Bonne K, Alders T, Dendale P. Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients. Eur J Prev Cardiol. 2015 Feb;22(2):150–8. doi: 10.1177/2047487313514018.
    1. Agboola Stephen, Jethwani Kamal, Khateeb Kholoud, Moore Stephanie, Kvedar Joseph. Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program. J Med Internet Res. 2015;17(4):e101. doi: 10.2196/jmir.4417.
    1. Kitsiou Spyros, Paré Guy, Jaana Mirou. Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. J Med Internet Res. 2015;17(3):e63. doi: 10.2196/jmir.4174.
    1. Seto Emily, Leonard Kevin J, Cafazzo Joseph A, Barnsley Jan, Masino Caterina, Ross Heather J. Mobile phone-based telemonitoring for heart failure management: a randomized controlled trial. J Med Internet Res. 2012;14(1):e31. doi: 10.2196/jmir.1909.
    1. Zan Shiyi, Agboola Stephen, Moore Stephanie A, Parks Kimberly A, Kvedar Joseph C, Jethwani Kamal. Patient engagement with a mobile web-based telemonitoring system for heart failure self-management: a pilot study. JMIR Mhealth Uhealth. 2015;3(2):e33. doi: 10.2196/mhealth.3789.
    1. Barnason Susan, Zimmerman Lani, Nieveen Janet, Schulz Paula, Miller Connie, Hertzog Melody, Tu Chunhao. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Heart Lung. 2009;38(5):364–76. doi: 10.1016/j.hrtlng.2009.01.005.
    1. Hanssen Tove Aminda, Nordrehaug Jan Erik, Eide Geir Egil, Hanestad Berit Rokne. Does a telephone follow-up intervention for patients discharged with acute myocardial infarction have long-term effects on health-related quality of life? A randomised controlled trial. J Clin Nurs. 2009 May;18(9):1334–45. doi: 10.1111/j.1365-2702.2008.02654.x.
    1. Redfern J, Briffa T, Ellis E, Freedman S B. Choice of secondary prevention improves risk factors after acute coronary syndrome: 1-year follow-up of the CHOICE (Choice of Health Options In prevention of Cardiovascular Events) randomised controlled trial. Heart. 2009 Mar;95(6):468–75. doi: 10.1136/hrt.2008.150870.
    1. Jelinek Michael, Vale Margarite J, Liew Danny, Grigg Leeanne, Dart Anthony, Hare David L, Best James D. The COACH program produces sustained improvements in cardiovascular risk factors and adherence to recommended medications-two years follow-up. Heart Lung Circ. 2009 Dec;18(6):388–92. doi: 10.1016/j.hlc.2009.06.001.
    1. de Lusignan S, Wells S, Johnson P, Meredith K, Leatham E. Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure. Eur J Heart Fail. 2001 Dec;3(6):723–30.
    1. Clark RA, Tideman P, Tirimacco R, Wanguhu K, Poulsen V, Simpson P, Duncan MJ, Van Itallie A, Corry K, Vandelanotte C, Mummery WK. A pilot study of the feasibility of an Internet-based electronic Outpatient Cardiac Rehabilitation (eOCR) program in rural primary care. Heart Lung Circ. 2013 May;22(5):352–9. doi: 10.1016/j.hlc.2012.11.005.
    1. Piotrowicz Ewa, Baranowski Rafal, Bilinska Maria, Stepnowska Monika, Piotrowska Malgorzata, Wójcik Anna, Korewicki Jerzy, Chojnowska Lidia, Malek Lukasz A, Klopotowski Mariusz, Piotrowski Walerian, Piotrowicz Ryszard. A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence. Eur J Heart Fail. 2010 Feb;12(2):164–71. doi: 10.1093/eurjhf/hfp181.
    1. Koehler Friedrich, Winkler Sebastian, Schieber Michael, Sechtem Udo, Stangl Karl, Böhm Michael, Boll Herbert, Baumann Gert, Honold Marcus, Koehler Kerstin, Gelbrich Goetz, Kirwan Bridget-Anne, Anker Stefan D, Telemedical Interventional Monitoring in Heart Failure Investigators Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation. 2011 May 3;123(17):1873–80. doi: 10.1161/CIRCULATIONAHA.111.018473.
    1. Kraal JJ, Peek N, Van den Akker-Van Marle ME, Kemps HM. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home study. Eur J Prev Cardiol. 2014 Nov;21(2 Suppl):26–31. doi: 10.1177/2047487314552606.
    1. Widmer R Jay, Collins Nerissa M, Collins C Scott, West Colin P, Lerman Lilach O, Lerman Amir. Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Mayo Clin Proc. 2015 Apr;90(4):469–80. doi: 10.1016/j.mayocp.2014.12.026.
    1. Eysenbach Gunther, Consort- EHEALTHGroup. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.

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