Open Access
Open access
Journal of Medical Internet Research, volume 21, issue 4, pages e13281

Integration of Rehabilitation Activities Into Everyday Life Through Telerehabilitation: Qualitative Study of Cardiac Patients and Their Partners

Publication type: Journal Article
Publication date: 2019-03-24
scimago Q1
SJR: 2.020
CiteScore: 14.4
Impact factor: 5.8
ISSN: 14394456, 14388871
Health Informatics
Abstract
Implementation of cardiac rehabilitation has not been optimal, with patient participation rates below 50%. Factors that contribute to cardiac patients' lack of participation in rehabilitation programs are patient motivation, logistical difficulties in getting to the rehabilitation facilities, lack of psychosocial elements, and individualization of activities in the rehabilitation programs. Telerehabilitation has been proposed as a new way to address the challenge of engaging and motivating cardiac patients and their partners to participate in rehabilitation.The aim of this study was to explore the experiences of cardiac patients and their partners of participating in the Teledialog Telerehabilitation Program (TTP). The Teledialog program consisted of a digital rehabilitation plan, transmission of health data from patient's home to hospital and health care center, and an interactive Web portal with information and training videos.This case study used a theoretical approach combining the "community of practice" approach and self-determination theory. A triangulation of data collection techniques was used, including documents, participant observation (72 hours), and qualitative interviews with cardiac patients and their partners enrolled in the telerehabilitation group. A total of 14 cardiac patients, 12 patient spouses/partners, and 1 son participated in the study. The participants were interviewed at enrollment in the telerehabilitation program and after 12 weeks of participation in the program. Interview data were analyzed using NVivo 11.0.Patients and their partners found the Web portal ActiveHeart.dk and the electronic rehabilitation (e-rehabilitation) plan to be helpful tools for health education, coordinating rehabilitation goals, creating an overview of the data, and ensuring continuity in the rehabilitation process. The patients felt that the TTP treated them as individuals, gave them a sense of autonomy, and provided enhanced relatedness to health care professionals and partners and a sense of competence as active participants in their own rehabilitation process. Some patients missed being part of a community of practice with other cardiac patients and did not use the Web forum. Patients' partners found that the telerehabilitation program gave them a sense of security and helped them balance their involvement as a partner to the patient and not push the patient too hard.Cardiac patients and their partners found telerehabilitation technologies a useful digital toolbox in the rehabilitation process. Telerehabilitation motivated the patients to integrate rehabilitation activities into their work schedule and everyday life and made them feel like unique individuals. Participating in the Teledialog Telerehabilitation Program might not be a suitable strategy for all cardiac patients. Being a patient's partner in the telerehabilitation program was associated with a heightened sense of security, navigation between active involvement in the rehabilitation process, being an equal partner, and not pushing the patient too hard.
Found 27
By date By citations
MDPI
Conventional Rehabilitation Therapy Versus Telerehabilitation in Cardiac Patients: A Comparison of Motivation, Psychological Distress, and Quality of Life
Spindler H., Leerskov K., Joensson K., Nielsen G., Andreasen J., Dinesen B.
International Journal of Environmental Research and Public Health scimago Q2 Open Access , 
2019-02-12,  citations by CoLab: 48 ,  PDF,  Abstract  
Telerehabilitation (TR) has gained attention as a promising rehabilitation format. Our study examined how patients responded to TR and whether it provided adequate support for their lifestyle changes and self-care efforts when compared to conventional rehabilitation (CR). Cardiac patients (n = 136) were randomly assigned to a TR or CR group. The TR group was provided with relevant health care technology for a period of three months, and both groups filled in questionnaires on their motivation for lifestyle changes and self-care psychological distress, and quality of life at 0, 3, 6, and 12 months. Patients in both groups were found to be equally motivated for lifestyle changes and self-care (p < 0.05) and they experienced similar levels of psychological distress and quality of life. TR is comparable to conventional rehabilitation in motivating patients, preventing psychological distress and improving quality of life. Although we observed an initial increase in autonomous motivation in the telerehabilitation group, this positive difference in motivation does not last over time. As such, neither rehabilitation format seems able to ensure long-term motivation. Therefore, TR may serve as a viable replacement for conventional rehabilitation when considered relevant. Further research is needed to enhance long-term motivation, and maybe telerehabilitation can help to achieve this.
JMIR Publications
Cardiac Rehabilitees’ Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach
Anttila M., Kivistö H., Piirainen A., Kokko K., Malinen A., Pekkonen M., Sjögren T.
Journal of Medical Internet Research scimago Q1 wos Q1 Open Access , 
2018-10-26,  citations by CoLab: 22 ,  Abstract  
Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees' perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation.This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees' experiences and attitudes toward technology before 12 months of remote rehabilitation.Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser's mode of the grounded theory approach.The result of the study was an "identifying e-usage" experience category, which refers to the rehabilitees' notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees' technology experience. These subcategories are "feeling outsider," "being uninterested," "reflecting benefit," and "enthusiastic using." All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation.The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education.ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD).
JMIR Publications
The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study
Dinesen B., Spindler H.
JMIR Rehabilitation and Assistive Technologies scimago Q1 Open Access , 
2018-10-18,  citations by CoLab: 8 ,  Abstract  
Background: Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. Objective: This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. Methods: Theories of networks between organizations, the sociology of professions, and the “community of practice” approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. Results: The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. Conclusions: The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. Trial Registration: ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb)
Telerehabilitation for Cardiac Patients: Systematic Review
Cristo D.D., Nascimento N.P., Dias A.S., Sachetti A.
International Journal of Cardiovascular Sciences scimago Q4 Open Access , 
2018-05-24,  citations by CoLab: 9 , 
Elsevier
Cardiac patients’ experiences with a telerehabilitation web portal: Implications for eHealth literacy
Melholt C., Joensson K., Spindler H., Hansen J., Andreasen J.J., Nielsen G., Noergaard A., Tracey A., Thorup C., Kringelholt R., Dinesen B.I.
Patient Education and Counseling scimago Q1 wos Q1 , 
2018-05-01,  citations by CoLab: 48 ,  Abstract  
The aims of this study are two-fold: 1) To explore how cardiac patients experience their use of a telerehabilitation tool for recuperation from surgery, and 2) To study how the patients' use of the interactive 'Active Heart' web portal affected their eHealth literacy skills.The 'Active Heart' telerehabilitation web portal offers patients and their relatives information and exercises for recovery from cardiac surgery. 109 cardiac patients were using the Active Heart web portal for a duration of three months.49 patients completed questionnaires that were administered both before and after their use of the portal, resulting in a 45% response rate. Respondents had a mean age of 60.64 ± 10.75 years, and 82% of the respondents were males. The respondents had a positive impression of Active Heart, reporting that it was easy to access, user-friendly, and written in an understandable language. The patients' eHealth literacy skills increased during the trial period.Use of a cardiac telerehabilitation web portal can be beneficial for patient education and can increase cardiac patients' eHealth literacy skills.Online telerehabilitation portals may be used as a tool in patient education and cardiac rehabilitation.
SAGE
Resistance to change: Role of relationship and communal coping for coronary heart disease patients and their partners in making lifestyle changes
Nissen N.K., Jónsdóttir M., Spindler H., Zwisler A.O.
Scandinavian Journal of Public Health scimago Q1 wos Q2 , 
2018-02-05,  citations by CoLab: 20 ,  Abstract  
Background: Lifestyle behaviours are important risk factors for coronary heart disease (CHD) and, hence, motivation for lifestyle changes is suggested to be a key factor in the success of cardiac rehabilitation and secondary prevention programmes. The motivation for changing lifestyle among people with CHD may be influenced by those with whom they have long-term, intimate relationships. Aims: This study explores the role of the relationship between people with CHD and those closest to them in making lifestyle changes. This includes investigating if patients and partners experience autonomy, competence, and relatedness, and what role communal, i.e. relationship-centred coping serves in relation to patients’ health behaviour. Methods: The study is based on semi-structured, in-depth interviews with 10 couples; people who have experienced acute coronary syndrome, and their partners. Participants had diverse histories of disease and social backgrounds. A three-stage interview process was undertaken including focus group interviews, couple interviews and individual interviews. A thematic analysis, inspired by the self-determination theory and the interdependence theory, was conducted. Results: Communal coping is evident in various forms, and at different levels, among people with CHD and their partners. Satisfaction with new lifestyle, ownership of change, confidence in ability to change, and emotional distress are all factors that affect how couples deal with lifestyle changes in the aftermath of CHD. Conclusions: Rehabilitation efforts, aimed at lifestyle changes, need to address each individual, as well as the dyadic interaction within couples. Incorporating a dyadic perspective in the rehabilitation process may lead to a reduction in motivational barriers to lifestyle changes.
SAGE
Documentation of person-centred health plans for patients with acute coronary syndrome
Jansson I., Fors A., Ekman I., Ulin K.
European Journal of Cardiovascular Nursing scimago Q1 wos Q1 , 
2017-06-28,  citations by CoLab: 18 ,  PDF,  Abstract  
Background: Personalised care planning is argued for but there is a need to know more about what the plans actually contain. Aim: To describe the content of person-centred health, plans documented at three healthcare levels for patients with acute coronary syndrome. Design: Patients with acute coronary syndrome aged under 75 years and admitted to two coronary care units at a university hospital were enrolled in the study. This retrospective descriptive study documented 89 person-centred health plans at three healthcare levels: hospital, outpatient and primary care. In total, 267 health plans were reviewed and a quantitative content analysis conducted. The health plans included commonly formulated goals, patients’ own resources and support needed. Results: The health plan goals were divided into three categories: lifestyle changes, illness management and relational activities. The most frequently reported goal for better health was increased physical activity, followed by social life/leisure activities and return to paid professional work. In order to reach the goals, patients identified three ways: own resources, family and social support and healthcare system, in total three categories. The most frequently reported own capability was self-motivation. Spouses and children were important sources of family and social support. The most frequently reported healthcare support was cardiac rehabilitation. Conclusion: In traditional care and treatment plans devised by health professionals, patient goals often comprise behavioural changes. When patients identify their own goals and resources with the help of professionals, they include maintaining social relations and being able to return to important activities such as work.
Springer Nature
Effects of cardiac telerehabilitation in patients with coronary artery disease using a personalised patient-centred web application: protocol for the SmartCare-CAD randomised controlled trial
Brouwers R.W., Kraal J.J., Traa S.C., Spee R.F., Oostveen L.M., Kemps H.M.
BMC Cardiovascular Disorders scimago Q2 wos Q3 Open Access , 
2017-01-31,  citations by CoLab: 50 ,  PDF,  Abstract  
Cardiac rehabilitation has beneficial effects on morbidity and mortality in patients with coronary artery disease, but is vastly underutilised and short-term improvements are often not sustained. Telerehabilitation has the potential to overcome these barriers, but its superiority has not been convincingly demonstrated yet. This may be due to insufficient focus on behavioural change and development of patients’ self-management skills. Moreover, potentially beneficial communication methods, such as internet and video consultation, are rarely used. We hypothesise that, when compared to centre-based cardiac rehabilitation, cardiac telerehabilitation using evidence-based behavioural change strategies, modern communication methods and on-demand coaching will result in improved self-management skills and sustainable behavioural change, which translates to higher physical activity levels in a cost-effective way. This randomised controlled trial compares cardiac telerehabilitation with centre-based cardiac rehabilitation in patients with coronary artery disease. We randomise 300 patients entering cardiac rehabilitation to centre-based cardiac rehabilitation (control group) or cardiac telerehabilitation (intervention group). The core component of the intervention is a patient-centred web application, which enables patients to adjust rehabilitation goals, inspect training and physical activity data, share data with other caregivers and to use video consultation. After six supervised training sessions, the intervention group continues exercise training at home, wearing an accelerometer and heart rate monitor. In addition, physical activity levels are assessed by the accelerometer for four days per week. Patients upload training and physical activity data weekly and receive feedback through video consultation once a week. After completion of the rehabilitation programme, on-demand coaching is performed when training adherence or physical activity levels decline with 50% or more. The primary outcome measure is physical activity level, assessed at baseline, three months and twelve months, and is calculated from accelerometer and heart rate data. Secondary outcome measures include physical fitness, quality of life, anxiety and depression, patient empowerment, patient satisfaction and cost-effectiveness. This study is one of the first studies evaluating effects and costs of a cardiac telerehabilitation intervention comprising a combination of modern technology and evidence-based behavioural change strategies including relapse prevention. We hypothesise that this intervention has superior effects on exercise behaviour without exceeding the costs of a traditional centre-based intervention. Netherlands Trial Register NTR5156 . Registered 22 April 2015.
Springer Nature
Pedometer use and self-determined motivation for walking in a cardiac telerehabilitation program: a qualitative study
Thorup C.B., Grønkjær M., Spindler H., Andreasen J.J., Hansen J., Dinesen B.I., Nielsen G., Sørensen E.E.
BMC Sports Science, Medicine and Rehabilitation scimago Q2 wos Q2 Open Access , 
2016-08-18,  citations by CoLab: 45 ,  Abstract  
Exercise-based cardiac rehabilitation reduces morbidity and mortality. Walking is a convenient activity suitable for people with cardiac disease. Pedometers count steps, measure walking activity and motivate people to increase physical activity. In this study, patients participating in cardiac telerehabilitation were provided with a pedometer to support motivation for physical activity with the purpose of exploring pedometer use and self-determined motivation for walking experienced by patients and health professionals during a cardiac telerehabilitation program. A qualitative research design consisting of observations, individual interviews and patient documents made the basis for a content analysis. Data was analysed deductively using Self Determination Theory as a frame for analysis and discussion, focusing on the psychological needs of autonomy, competence and relatedness. Twelve cardiac patients, 11 health professionals, 6 physiotherapists and 5 registered nurses were included. The pedometer offered independence from standardised rehabilitation since the pedometer supported tailoring, individualised walking activity based on the patient’s choice. This led to an increased autonomy. The patients felt consciously aware of health benefits of walking, and the pedometer provided feedback on walking activity leading to an increased competence to achieve goals for steps. Finally, the pedometer supported relatedness with others. The health professionals’ surveillance of patients’ steps, made the patients feel observed, yet supported, furthermore, their next of kin appeared to be supportive as walking partners. Cardiac patients’ motivation for walking was evident due to pedometer use. Even though not all aspects of motivation were autonomous and self determined, the patients felt motivated for walking. The visible steps and continuous monitoring of own walking activity made it possible for each individual patient to choose their desired kind of activity and perform ongoing adjustments of walking activity. The immediate feedback on step activity and the expectations of health benefits resulted in motivation for walking. Finally, pedometer supported walking made surveillance possible, giving the patients a feeling of being looked after and supported. Current study is a part of The Teledi@log project.
SAGE
Factors associated with telemonitoring use among patients with chronic heart failure
Albert N.M., Dinesen B., Spindler H., Southard J., Bena J.F., Catz S., Kim T.Y., Nielsen G., Tong K., Nesbitt T.S.
Journal of Telemedicine and Telecare scimago Q1 wos Q1 , 
2016-07-08,  citations by CoLab: 25 ,  Abstract  
Background In adults with chronic heart failure (HF; defined as people with previously diagnosed left ventricular dysfunction) telemonitoring randomized controlled trials (RCTs) failed to consistently demonstrate improved clinical outcomes. We aimed to examine if patient and HF characteristics are associated with device preferences and use. Methods Using a cross-sectional, multicenter, international design, ambulatory and hospitalized adults with HF in Ohio, California, and Denmark viewed a six-minute video of telemonitoring configurations (tablet, smart phone, and key fob) and completed questionnaires. Comparative analyses were performed and when significant, pairwise comparisons were performed using Bonferroni-adjusted significance levels. Results Of 206 participants, 48.2% preferred smart phones for telemonitoring, especially when traveling (54.8%), with new/worsening symptoms (50%), for everyday use (50%), and connecting with doctors (48.5%). Participants preferred two-way communication and a screen with words over voice or number pads. Of device purposes, allowing for nurse communication ranked highest, followed by maintaining overall health. Very few patient and HF factors were associated with device preferences. Patients with higher health literacy ( p = 0.007), previous/current device use history ( p = 0.008), higher education level ( p = 0.035), and married/cohabitating status ( p = 0.023) had higher perceptions of ease of using devices. Those who were asymptomatic or had mild HF had higher self-confidence for health devices ( p = 0.024) and non-white patients perceived devices as more useful ( p = 0.033). Conclusion Telemonitoring use may be enhanced by simple plug-and-play type devices, two-way communication, and features that meet patients’ personal learning and use needs.
University of Toronto Press Inc. (UTPress)
Exercise Telemonitoring and Telerehabilitation Compared with Traditional Cardiac and Pulmonary Rehabilitation: A Systematic Review and Meta-Analysis
Chan C., Yamabayashi C., Syed N., Kirkham A., Camp P.G.
Physiotherapy Canada. Physiotherapie Canada scimago Q3 wos Q4 , 
2016-06-16,  citations by CoLab: 76 ,  Abstract  
Background: Despite exercise capacity and quality-of-life benefits, pulmonary rehabilitation (PR) and cardiac rehabilitation (CR) programmes are not easily accessed because of several barriers. A solution may be telerehabilitation (TR), in which patients exercise in their communities while they are monitored via teletechnology. However, the benefits of TR for the purposes of PR and CR have not been systematically reviewed. Objective: To determine whether the benefits of the exercise component of PR and CR using TR are comparable to usual-care (UC) programmes. Methods: A comprehensive literature search was performed of the Medline, Embase, and CINAHL databases up to July 13, 2015. Meta-analyses were performed for peak oxygen consumption, peak workload, exercise test duration, and 6-minute walk test (6MWT) distance using the I2 statistic and forest plots displaying standardized mean difference (SMD). Results: Of 1,431 citations found, 8 CR studies met the inclusion criteria. No differences were found in exercise outcomes between UC and TR groups for CR studies, except in exercise test duration, which slightly favoured UC (SMD 0.268, 95% CI: 0.002, 0.534, p<0.05). Only 1 PR study was included, and it showed similar improvements on the 6MWT between the UC and TR groups. Conclusion: TR for patients with cardiac conditions provided benefits similar to UC with no adverse effects reported. Similar studies of TR for patients with pulmonary conditions need to be conducted.
JMIR Publications
Personalized Telehealth in the Future: A Global Research Agenda
Dinesen B., Nonnecke B., Lindeman D., Toft E., Kidholm K., Jethwani K., Young H.M., Spindler H., Oestergaard C.U., Southard J.A., Gutierrez M., Anderson N., Albert N.M., Han J.J., Nesbitt T.
Journal of Medical Internet Research scimago Q1 wos Q1 Open Access , 
2016-03-01,  citations by CoLab: 204 ,  Abstract  
As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.
BMJ
Cardiac rehabilitation
Dalal H.M., Doherty P., Taylor R.S.
BMJ scimago Q1 wos Q1 , 
2015-09-29,  citations by CoLab: 308 ,  Abstract  
#### The bottom line Cardiac rehabilitation is a complex intervention offered to patients diagnosed with heart disease, which includes components of health education, advice on cardiovascular risk reduction, physical activity and stress management. Evidence that cardiac rehabilitation reduces mortality, morbidity, unplanned hospital admissions in addition to improvements in exercise capacity, quality of life and psychological well-being is increasing, and it is now recommended in international guidelines.1 2 3 4 5 6 This review focuses on what cardiac rehabilitation is and the evidence of its benefit and effects on cardiovascular mortality, morbidity and quality of life. #### Sources and selection criteria RST is a member of the Cochrane Heart Group and has led and conducted several systematic reviews of cardiac rehabilitation. We searched the Cochrane database (www.cochrane.org) for cardiac rehabilitation and equivalent terms. We identified current national and international clinical guidelines based on systematic reviews and meta-analyses. We referred to the National Audit of Cardiac Rehabilitation annual report, which was led by PD, and the British Heart Foundation’s website for statistics on coronary heart disease in the UK. We also consulted recent review articles from the UK, US, Canada, and Australia. We have included topics that would be of interest to hospital doctors and …
SAGE
A review of telerehabilitation for cardiac patients
Frederix I., Vanhees L., Dendale P., Goetschalckx K.
Journal of Telemedicine and Telecare scimago Q1 wos Q1 , 
2014-12-04,  citations by CoLab: 150 ,  Abstract  
We conducted a literature review of telerehabilitation interventions on cardiac patients. We searched for studies evaluating some form of telerehabilitation in cardiac patients. A total of 116 publications were screened initially, of which 37 publications were eligible for further review. We assessed study strength, based on the level of evidence and the quality of the intervention. The majority of the articles (70%) represented the highest level of evidence. Most interventions were of good (46%) or fair (51%) quality. Most studies evaluated the efficacy of the telerehabilitation interventions (84%), while 38% reported on feasibility and acceptance. Most studies did not include safety and/or cost-benefit analyses. Most telerehabilitation interventions (90%) employed only one or two core components of cardiac rehabilitation (CR). Of the CR core components, physical activity was most frequently evaluated. Telerehabilitation appears to be a feasible and effective additional and/or alternative form of rehabilitation, compared to conventional in-hospital CR. Evaluations of telerehabilitation programmes taking into account patient safety and health economics are now required.
MDPI
Attitudes of COPD Patients towards Tele-Rehabilitation: A Cross-Sector Case Study
Dinesen B., Huniche L., Toft E.
International Journal of Environmental Research and Public Health scimago Q2 Open Access , 
2013-11-15,  citations by CoLab: 35 ,  PDF, 
Found 32
By date By citations
Institute of Electrical and Electronics Engineers (IEEE)
Adapting the Education System to Support Remote Monitoring and Elderly Care Needs
Abidin N.A., Aminuddin R., Buja A.G.
2024-11-19,  citations by CoLab: 0 , 
Heart failure patients' experiences of telerehabilitation
Devlin J., Reid B.
British Journal of Nursing scimago Q3 , 
2024-06-20,  citations by CoLab: 0 ,  Abstract  
In the UK, almost 1 million people are living with heart failure, with heart and circulatory diseases accounting for 27% of all deaths, according to the British Heart Foundation. Current heart failure guidelines support cardiac rehabilitation as an intervention to reduce cardiovascular events, increase exercise tolerance and enhance patients' quality of life. Research indicates that telerehabilitation is an effective component of heart failure management, which helps overcome perceived barriers to cardiac rehabilitation including travel to appointments, long waiting times and accessibility. Understanding patient experiences and increasing telerehabilitation among heart failure patients is pertinent to implementing person-centred care, reducing risk and optimising quality of life.
MDPI
Experience of Older Patients with COPD Using Disease Management Apps: A Qualitative Study
Zou X., Sun P., Chen M., Nan J., Gao J., Huang X., Hou Y., Jiang Y.
Healthcare scimago Q2 wos Q3 Open Access , 
2024-04-07,  citations by CoLab: 1 ,  PDF,  Abstract  
(1) Background: Digital medicine is developing in the management of chronic diseases in older people, but there is still a lack of information on the use of disease management apps in older patients with COPD. This study aims to explore the views and experience of older patients with COPD on disease management apps to provide a basis for the development and promotion of apps for geriatric diseases. (2) Methods: A descriptive qualitative research method was used. Older patients with COPD (N = 32) with experience using disease management apps participated in semi-structured interviews. Thematic analysis was used to analyze the data. (3) Results: Seven themes were defined: (a) feeling curious and worried when facing disease management apps for the first time; (b) actively overcoming barriers to use; (c) gradually becoming independent by continuous online learning; (d) feeling safe in the virtual environment; (e) gradually feeling new value in online interactions; (f) relying on disease management apps under long-term use; (g) expecting disease management apps to meet personalized needs. (4) Conclusions: The adoption and use of disease management apps by older people is a gradual process of acceptance, and they can obtain a wide range of benefits in health and life.
Frontiers Media S.A.
Patients' experiences and perspectives regarding the use of digital technology to support exercise-based cardiac rehabilitation: a qualitative interview study
Zeller A., Gutenberg J., Niebauer J., Crutzen R., Kulnik S.T.
Frontiers in Sports and Active Living scimago Q1 wos Q2 Open Access , 
2024-03-18,  citations by CoLab: 1 ,  PDF,  Abstract  
IntroductionDespite the well-known benefits of exercise-based cardiac rehabilitation for the secondary prevention of cardiovascular disease, participation in cardiac rehabilitation programmes and adherence to secondary prevention recommendations remain limited. Digital technologies have the potential to address low participation and adherence but attempts at implementing digital health interventions in real-life clinical practice frequently encounter various barriers. Studies about patients' experiences and perspectives regarding the use of digital technology can assist developers, researchers and clinicians in addressing or pre-empting patient-related barriers. This study was therefore conducted to investigate the experiences and perspectives of cardiac rehabilitation patients in Austria with regard to using digital technology for physical activity and exercise.MethodsTwenty-five current and former cardiac rehabilitation patients (18 men and 7 women, age range 39 to 83) with various cardiac conditions were recruited from a clinical site in Salzburg, Austria. Semi-structured qualitative interviews were audio-recorded and transcribed verbatim. The analysis followed a descriptive phenomenological approach, applying the framework analysis method.ResultsThe sample was diverse, including interviewees who readily used digital devices to support their physical activity, exercise and health monitoring, and interviewees who did not. Simplicity, convenience and accessibility were highlighted as important facilitators for the use of digital technology, while annoyance with digital devices, concerns about becoming dependent on them, or simply a preference to not use digital technology were commonly stated reasons for non-use. Interviewees' views on data protection, data sharing and artificial intelligence revealed wide variations in individuals' prior knowledge and experience about these topics, and a need for greater accessibility and transparency of data protection regulation and data sharing arrangements.DiscussionThese findings support the importance that is attributed to user-centred design methodologies in the conceptualisation and design of digital health interventions, and the imperative to develop solutions that are simple, accessible and that can be personalised according to the preferences and capabilities of the individual patient. Regarding data protection, data sharing and artificial intelligence, the findings indicate opportunity for information and education, as well as the need to offer patients transparency and accountability in order to build trust in digital technology and digital health interventions.
Public Library of Science (PLoS)
Identifying central elements of the therapeutic alliance in the setting of telerehabilitation: A qualitative study
Seebacher B., Geimer C., Neu J., Schwarz M., Diermayr G.
PLoS ONE scimago Q1 wos Q1 Open Access , 
2024-03-08,  citations by CoLab: 2 ,  PDF,  Abstract  
Introduction Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. Purpose To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. Methods In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. Results The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. Conclusions In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies.
Elsevier
A web-based intervention for patients with an implantable cardioverter defibrillator – A qualitative study of nurses’ experiences (Data from the ACQUIRE-ICD study)
Helmark C., Egholm C.L., Rottmann N., Skovbakke S.J., Andersen C.M., Johansen J.B., Nielsen J.C., Larroudé C.E., Riahi S., Brandt C.J., Pedersen S.S.
PEC Innovation scimago Q3 Open Access , 
2023-12-01,  citations by CoLab: 3 ,  Abstract  
The aim of this study was to explore cardiac nurses’ experiences with a comprehensive web-based intervention for patients with an implantable cardioverter defibrillator. We conducted an explorative qualitative study based on individual semi-structured interviews with 9 cardiac nurses from 5 Danish university hospitals. We found one overall theme: “Between traditional nursing and modern eHealth”. This theme was derived from the following six categories: (1) comprehensive content in the intervention, (2) patient-related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were positive towards the web-based intervention and believe it holds a large potential. However, they felt challenged by not having in-person and face-to-face contact with patients, which they found valuable for assessing patients’ wellbeing and psychological distress. Specific training in eHealth communication seems necessary as web-based care entails a shift in the nursing role and requires a different way of communication. Innovation Focusing on the user experience in web-based care from the perspective of cardiac nurses is innovative, and by applying implementation science this leads to new knowledge to consider when developing and implementing web-based care.
Ovid Technologies (Wolters Kluwer Health)
Main Mechanisms of Remote Monitoring Programs for Cardiac Rehabilitation and Secondary Prevention
Clark A.M., Sousa B.J., Ski C.F., Redfern J., Neubeck L., Allana S., Peart A., MacDougall D., Thompson D.R.
Journal of Cardiopulmonary Rehabilitation and Prevention scimago Q1 wos Q2 Open Access , 
2023-11-01,  citations by CoLab: 1 ,  Abstract  
Purpose: The objective of this report was to identify the main mechanisms of home-based remote monitoring programs for cardiac rehabilitation (RM CR) and examine how these mechanisms vary by context. Methods: This was a systematic review using realist synthesis. To be included, articles had to be published in English between 2010 and November 2020 and contain specific data related to mechanisms of effect of programs. MEDLINE All (1946-) via Ovid, Embase (1974-) via Ovid, APA PsycINFO (1806-), CINAHL via EBSCO, Scopus databases, and gray literature were searched. Results: From 13 747 citations, 91 focused on cardiac conditions, with 23 reports including patients in CR. Effective RM CR programs more successfully adapted to different patient home settings and broader lives, incorporated individualized patient health data, and had content designed specifically for patients in cardiac rehabilitation. Relatively minor but common technical issues could significantly reduce perceived benefits. Patients and families were highly receptive to the programs and viewed themselves as fortunate to receive such services. The RM CR programs could be improved via incorporating more connectivity to other patients. No clear negative effects on perceived utility or outcomes occurred by patient age, ethnicity, or sex. Overall, the programs were seen to best suit highly motivated patients and consolidated rather than harmed existing relationships with health care professionals and teams. Conclusions: Remote monitoring CR programs are perceived by patients to be beneficial and attractive. Future RM CR programs should consider adaptability to different home settings, incorporate individualized health data, and contain content specific to patient needs.
Frontiers Media S.A.
Psychological couple-oriented interventions for patients with heart disease and their partners: a scoping review and guidelines for future interventions
Rapelli G., Giusti E.M., Tarquinio C., Varallo G., Franceschini C., Musetti A., Gorini A., Castelnuovo G., Pietrabissa G.
Frontiers in Psychology scimago Q2 wos Q2 Open Access , 
2023-09-29,  citations by CoLab: 1 ,  PDF,  Abstract  
ObjectiveThis scoping review aims to provide an accessible summary of available evidence on the efficacy of psychological couple-based interventions among patients with heart disease and their partners focusing on specific aspects and strategies by assessing different emotional and physical cardiac-related outcome measures.MethodsA literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the keywords “heart diseases” and “couple-based intervention.” A literature search using systematic methods was applied. Data were extracted to address the review aims and were presented as a narrative synthesis.ResultsThe database search produced 11 studies. Psychological couple-based interventions varied in terms of the type of intervention, personnel, format (group or individual, phone or in person), number of sessions, and duration. Most of the contributions also lacked adequate details on the training of professionals, the contents of the interventions, and the theoretical models on which they were based. Finally, although partners were involved in all the treatment, in most studies, the psychological strategies and outcomes were focused on the patient.ConclusionThe variability of the psychological couple-based interventions of included studies represents a challenge in summarizing the existing literature. Regarding their impact, psychological interventions for patients with cardiovascular disease and their partners were found to moderately improve patients’ and partners’ outcomes.
SAGE
Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review
Jacobsson R.J., Oikarinen A., Krogell J., Kankkunen P.
Clinical Rehabilitation scimago Q1 wos Q1 , 
2023-09-21,  citations by CoLab: 2 ,  Abstract  
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.
Wiley
Exploring patient experiences of participating in digital cardiac rehabilitation: A qualitative study
Kenny E., Byrne M., McEvoy J.W., Connolly S., McSharry J.
British Journal of Health Psychology scimago Q1 wos Q1 , 
2023-09-18,  citations by CoLab: 7 ,  Abstract  
AbstractObjectiveDigital cardiac rehabilitation (CR) has emerged as a promising alternative to in‐person CR. Understanding patients' experiences and perceptions can provide valuable insights into what makes these programmes successful and identify opportunities for improvement. This study aimed to explore patients' experiences of digital CR and to understand the factors that make these programmes successful.DesignA qualitative approach was taken.MethodsFrom March to August 2022, we conducted semi‐structured interviews with patients who were referred to one of two digital CR programmes offered on the island of Ireland. Interviews were audio‐recorded, transcribed verbatim and analysed using reflexive thematic analysis. A public and patient involvement panel guided the recruitment strategy and assisted with data analysis.ResultsEleven patients, predominantly male (82%) and with a mean age of 64 (range 50–75), participated in the study. Five themes were developed: (1) Empowered patients; (2) Controlling the recovery; (3) At home but not alone; (4) The world at your (digital) doorstep and; (5) Challenges of interacting online. Participants reported that digital CR equipped them with the necessary tools and support to modify their lifestyle and effectively manage their recovery. However, the opportunities for social interaction were limited and communicating online was not always straightforward.ConclusionsParticipants reported that digital CR guided them towards recovery and improved their sense of empowerment and control. However, the limited opportunities for social interaction may represent a challenge for patients seeking social support.
MDPI
Telerehabilitation in the Finnish Outpatient Rehabilitation Setting from the Perspective of the Socio-Technical Systems Theory
Partanen T., Seppänen-Järvelä R., Hiekkala S., Lindh J.
International Journal of Environmental Research and Public Health scimago Q2 Open Access , 
2023-08-03,  citations by CoLab: 1 ,  PDF,  Abstract  
Background: In the development of effective telerehabilitation (TR) interventions, understanding the various characteristics affecting its practice is essential. Remote connection creates a new technically shaped environment for therapy and, therefore, previous therapy methods do not work the same way as before. Objective: The objective of this survey was to describe the practice of TR through the socio-technical theory approach. Methods: The 629 respondents to the online questionnaire included music therapists, occupational therapists, speech and language therapists, physiotherapists, and neuropsychologists. The materials consisted of five open-ended questions. The analysis combined data-based and theory-based analysis. Results: In the data-based content analysis, we identified three main categories and eight generic categories, whereas in the theory-based, we categorised the main results according to the Fit Between Individuals, Tasks, Technology, and Environment (FITTE) framework dimensions. TR is everyday-life based, it requires shared participation, and the approach has to include coaching and collaboration with the client and their close associates. The everyday-life environment is one of the main dimensions that affect all the other dimensions. Conclusions: TR can be seen as technology-mediated home-based rehabilitation, as it can integrate rehabilitation into the client’s everyday life. In TR, therapy becomes multilateral and it creates a new kind of shared partnership into outpatient therapy.
Taylor & Francis
It is like someone holding your hand when you need it – lived experiences of patients with cardiovascular disease participating in a digital health intervention focusing on the maintenance of physical activity after cardiac rehabilitation
Hamborg T.G., Tang L.H., Andersen R.M., Skou S.T., Simonÿ C.
Disability and Rehabilitation: Assistive Technology scimago Q1 wos Q2 , 
2023-07-22,  citations by CoLab: 3 , 
MDPI
Upper-Limb Robotic Exoskeleton for Early Cardiac Rehabilitation Following an Open-Heart Surgery—Mathematical Modelling and Empirical Validation
Mocan B., Schonstein C., Murar M., Neamtu C., Fulea M., Mocan M., Dragan S., Feier H.
Mathematics scimago Q2 wos Q1 Open Access , 
2023-03-25,  citations by CoLab: 0 ,  PDF,  Abstract  
Robotic exoskeletons have the potential to enhance the quality of life of patients undergoing cardiac rehabilitation. Recent studies found that the use of such devices was associated with significant improvements in physical function, mobility, and overall well-being for individuals recovering from a cardiac event. These improvements were seen across a range of measures, including cardiovascular fitness, muscle strength, and joint range of motion. In addition, the use of robotic exoskeletons may help to accelerate the rehabilitation process, allowing patients to make faster progress towards their goals. This article proposes a new robotic exoskeleton structure with 12 DOFs (6 DOFs on each arm) in a symmetrical construction for upper limbs intended to be used in the early rehabilitation of cardiac patients following open-heart surgery or a major cardiac event. The mathematical modelling and empirical validation of the robotic exoskeleton prototype are described. The matrix exponential algorithm, kinetic energy, and generalized forces were employed to overcome the problem of high complexity regarding the kinematic and dynamic model of the robotic exoskeleton. The robotic exoskeleton prototype was empirically validated by assessing its functionalities in a lab and medical environment.
Wiley
Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis
Velez M., Lugo-Agudelo L.H., Patiño Lugo D.F., Glenton C., Posada A.M., Mesa Franco L.F., Negrini S., Kiekens C., Spir Brunal M.A., Roberg A.B., Cruz Sarmiento K.M.
Cochrane Database of Systematic Reviews scimago Q1 wos Q1 , 
2023-02-10,  citations by CoLab: 20 , 
Ovid Technologies (Wolters Kluwer Health)
Benefits, Facilitators, and Barriers of Alternative Models of Cardiac Rehabilitation
Platz K., Kools S., Howie-Esquivel J.
Journal of Cardiopulmonary Rehabilitation and Prevention scimago Q1 wos Q2 Open Access , 
2022-10-10,  citations by CoLab: 15 ,  Abstract  
Cardiac rehabilitation (CR) improves health outcomes and quality of life for patients with cardiovascular disease, yet only a quarter of eligible patients enroll. A myriad of CR models that use either an alternative location (ie, home-based) and/or an alternative exercise have been developed to overcome known attendance and physical limitation barriers; however, patient experiences with these models have not been systematically reviewed. Our aim is to review patient experiences with these models of CR.We conducted a systematic review and thematic analysis of qualitative studies published between 2009 and January of 2022 from CINAHL, PubMed, Web of Science, and PsycINFO.Twenty-five studies were included, representing the perspectives of 487 individuals who participated in an alternative model of CR. Exercises included walking, tai chi, yoga, aquatic exercise, exergaming, chair-based exercises, aerobics, physical activity trackers, and individualized exercise plans. Nineteen of 25 studies used home-based models and two used live video. Twelve studies included patients with heart failure. Patient perspectives comprised three central themes: exercise benefits, exercise facilitators, and participation barriers. Some thematic categories were reported variably by particular model/study design (eg, home-based) than by others. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise. These patient insights are critical for innovative delivery of CR that is appealing, accommodates physical limitations, and broadens access to improve health equity.

Top-30

Journals

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Journal of Cardiopulmonary Rehabilitation and Prevention
Journal of Cardiopulmonary Rehabilitation and Prevention, 3, 9.68%
JMIR Cardio
JMIR Cardio, 2, 6.45%
International Journal of Environmental Research and Public Health
International Journal of Environmental Research and Public Health, 2, 6.45%
Journal of Medical Internet Research
Journal of Medical Internet Research, 1, 3.23%
JMIR mHealth and uHealth
JMIR mHealth and uHealth, 1, 3.23%
JMIR Rehabilitation and Assistive Technologies
JMIR Rehabilitation and Assistive Technologies, 1, 3.23%
Cochrane Database of Systematic Reviews
Cochrane Database of Systematic Reviews, 1, 3.23%
Medicine (United States)
Medicine (United States), 1, 3.23%
PEC Innovation
PEC Innovation, 1, 3.23%
Archives of Physical Medicine and Rehabilitation
Archives of Physical Medicine and Rehabilitation, 1, 3.23%
Mathematics
Mathematics, 1, 3.23%
Physical and Occupational Therapy in Geriatrics
Physical and Occupational Therapy in Geriatrics, 1, 3.23%
European Journal of Cardiovascular Nursing
European Journal of Cardiovascular Nursing, 1, 3.23%
Clinical Medicine (Russian Journal), 1, 3.23%
Disability and Rehabilitation: Assistive Technology
Disability and Rehabilitation: Assistive Technology, 1, 3.23%
British Journal of Cardiac Nursing, 1, 3.23%
British Journal of Health Psychology
British Journal of Health Psychology, 1, 3.23%
Clinical Rehabilitation
Clinical Rehabilitation, 1, 3.23%
Frontiers in Psychology
Frontiers in Psychology, 1, 3.23%
PLoS ONE
PLoS ONE, 1, 3.23%
Frontiers in Sports and Active Living
Frontiers in Sports and Active Living, 1, 3.23%
Healthcare
Healthcare, 1, 3.23%
British Journal of Nursing, 1, 3.23%
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Publishers

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JMIR Publications
JMIR Publications, 5, 16.13%
Ovid Technologies (Wolters Kluwer Health)
Ovid Technologies (Wolters Kluwer Health), 4, 12.9%
MDPI
MDPI, 4, 12.9%
Wiley
Wiley, 2, 6.45%
Elsevier
Elsevier, 2, 6.45%
Taylor & Francis
Taylor & Francis, 2, 6.45%
SAGE
SAGE, 2, 6.45%
Mark Allen Group, 2, 6.45%
Frontiers Media S.A.
Frontiers Media S.A., 2, 6.45%
Medical Informational Agency Publishers, 1, 3.23%
Public Library of Science (PLoS)
Public Library of Science (PLoS), 1, 3.23%
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  • We do not take into account publications without a DOI.
  • Statistics recalculated only for publications connected to researchers, organizations and labs registered on the platform.
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