The use of virtual world-based cardiac rehabilitation to encourage healthy lifestyle choices among cardiac patients: intervention development and pilot study protocol.
The use of virtual world-based cardiac rehabilitation to encourage healthy lifestyle choices among cardiac patients: intervention development and pilot study protocol.
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DOI：
10.2196/resprot.4285
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发表时间：
2015-04-08
影响因子：
1.7
通讯作者：
Kopecky S
中科院分区：
文献类型：
--
作者：
Brewer LC;Kaihoi B;Zarling KK;Squires RW;Thomas R;Kopecky S
尽管通过心血管疾病（CVD）的二级预防和降低死亡率证明了益处，但心脏康复（CR）在心脏病患者中仍未得到充分利用。受心血管疾病影响最严重的服务不足人群，包括农村居民，低社会经济地位患者和种族/少数民族，由于获得障碍，参与率最低。基于互联网和移动的生活方式干预已成为补充和增加CR可及性的潜在模式。使用虚拟世界技术的门诊CR计划可以通过克服患者访问限制（例如地理位置、工作时间表限制和交通）来提供传统CR的有效替代方案。本文的目的是描述一项两阶段试点研究的研究方案，该研究将评估基于虚拟世界（第二人生）CR计划的可行性（第一阶段）和相对有效性（第二阶段）作为传统CR计划的扩展，以实现急性冠状动脉综合征（ACS）后和经皮冠状动脉介入治疗（PCI）后患者的健康行为改变。我们假设，虚拟世界CR用户将改善行为（体力活动，饮食和吸烟）比传统的CR参与者在更大程度上。在第1阶段，我们将招募至少10名最近因ACS住院的门诊CR患者（不稳定型心绞痛、ST段抬高型心肌梗死、非ST段抬高型心肌梗死）或近期在明尼苏达州罗切斯特市罗切斯特校区马约诊所医院接受择期PCI且至少有一个可修改的生活方式风险因素目标的患者（久坐不动的生活方式，不健康的饮食和目前吸烟）。招募的患者将参加为期12周的虚拟世界健康教育计划，该计划将提供有关干预的可行性，可用性和设计的反馈。在II期，我们将进行一项2组、平行组、单中心、随机对照试验（RCT）。患者将以1：1的比例随机分配至辅助基于虚拟世界的CR+传统CR或仅传统CR。主要结果是包括以下至少一项的复合指标：（1）每周至少150分钟的体力活动，（2）每天摄入五种或五种以上的水果和蔬菜，（3）戒烟。将在3、6和12个月时对患者进行评估。I期可行性研究目前正在招募，随后将进行II期RCT。该研究的预计完成日期为2016年5月。虽然在健康计划中使用虚拟世界技术的研究还处于起步阶段，但它提供了比当前基于Web的健康干预措施（包括社交互动和主动学习）独特的优势。它还增加了对心血管疾病负担较高的弱势群体的可及性。这项研究将产生结果的有效性的虚拟世界为基础的CR程序作为一个创新的平台，影响健康的生活方式行为和自我效能。
Despite proven benefits through the secondary prevention of cardiovascular disease (CVD) and reduction of mortality, cardiac rehabilitation (CR) remains underutilized in cardiac patients. Underserved populations most affected by CVD including rural residents, low socioeconomic status patients, and racial/ethnic minorities have the lowest participation rates due to access barriers. Internet-and mobile-based lifestyle interventions have emerged as potential modalities to complement and increase accessibility to CR. An outpatient CR program using virtual world technology may provide an effective alternative to conventional CR by overcoming patient access limitations such as geographics, work schedule constraints, and transportation. The objective of this paper is to describe the research protocol of a two-phased, pilot study that will assess the feasibility (Phase 1) and comparative effectiveness (Phase 2) of a virtual world-based (Second Life) CR program as an extension of a conventional CR program in achieving healthy behavioral change among post-acute coronary syndrome (ACS) and post-percutaneous coronary intervention (PCI) patients. We hypothesize that virtual world CR users will improve behaviors (physical activity, diet, and smoking) to a greater degree than conventional CR participants. In Phase 1, we will recruit at least 10 patients enrolled in outpatient CR who were recently hospitalized for an ACS (unstable angina, ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction) or who recently underwent elective PCI at Mayo Clinic Hospital, Rochester Campus in Rochester, MN with at least one modifiable, lifestyle risk factor target (sedentary lifestyle, unhealthy diet, and current smoking). Recruited patients will participate in a 12-week, virtual world health education program which will provide feedback on the feasibility, usability, and design of the intervention. During Phase 2, we will conduct a 2-arm, parallel group, single-center, randomized controlled trial (RCT). Patients will be randomized at a 1:1 ratio to adjunct virtual world-based CR with conventional CR or conventional CR only. The primary outcome is a composite including at least one of the following (1) at least 150 minutes of physical activity per week, (2) daily consumption of five or more fruits and vegetables, and (3) smoking cessation. Patients will be assessed at 3, 6, and 12 months. The Phase 1 feasibility study is currently open for recruitment which will be followed by the Phase 2 RCT. The anticipated completion date for the study is May 2016. While research on the use of virtual world technology in health programs is in its infancy, it offers unique advantages over current Web-based health interventions including social interactivity and active learning. It also increases accessibility to vulnerable populations who have higher burdens of CVD. This study will yield results on the effectiveness of a virtual world-based CR program as an innovative platform to influence healthy lifestyle behavior and self-efficacy.