Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial.
Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial.
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DOI：
10.2196/jmir.4799
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发表时间：
2015-07-23
影响因子：
7.4
通讯作者：
Dendale P
中科院分区：
文献类型：
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作者：
Frederix I;Hansen D;Coninx K;Vandervoort P;Vandijck D;Hens N;Van Craenenbroeck E;Van Driessche N;Dendale P
心脏远程康复已被引入作为传统中心心脏康复的辅助或替代方案，以提高其长期疗效。然而，在现有卫生保健系统大规模实施和报销之前，需要对这一新的额外治疗战略的有效性进行精心设计的研究。这项试验的目的是评估一个基于互联网的、全面的、为患者量身定做的、具有短信服务(SMS)短信支持的心脏病患者远程康复计划的中期有效性。这项多中心随机对照试验包括140名心脏康复患者，随机(1：1)接受为期24周的远程康复计划，并结合常规心脏康复(干预组，n=70)或单纯常规心脏康复(对照组，n=70)。在门诊康复开始后6周开始的远程康复计划中，患者被刺激增加体力活动水平。根据注册的活动数据，他们通过电子邮件和短信接受半自动远程指导，鼓励他们逐步实现预定的运动训练目标。作为远程教学的一部分，还提供了针对患者的饮食和/或戒烟建议。主要终点是峰值有氧能力(VO2峰值)。次要终点包括加速计记录的每日步数，国际体力活动问卷(IPAQ)自我评估的体力活动，以及在基线和6周和24周时由HeartQol问卷评估的健康相关生活质量(HRQL)。干预组(n=69)平均VO2峰值从基线(平均22.46，SD 0.78 m L/min*kg)增加到24周(平均24.46，SD 1.00 m L/m in*kg，P<0.01)，而对照组(n=70)无明显变化(基线：平均22.72，SD 0.74 m L/m in*kg；24周：平均22.15，SD 0.77 m L/m in*kg，P=0.09)。组间有氧能力分析证实，干预组和对照组之间存在显著差异，干预组倾向于干预组(P<；.001)。在24周时，与对照组相比，干预组自我报告的体力活动改善更多(P=.01)，总体HRQL得分也是如此(P=.01)。这项研究表明，与仅以中心为基础的心脏康复相比，额外为期6个月的针对患者的全面远程康复计划可以在身体健康(VO2峰值)和相关的HRQL方面带来更大的改善。考虑到未来可能在标准心脏护理中实施，这些结果是支持的。
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. 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. 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. 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). 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.