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.
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.
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心脏远离治疗对冠状动脉疾病患者的影响，使用个性化患者以患者为中心的Web应用程序：SmartCare-CAD随机对照试验的方案。
DOI：
10.1186/s12872-017-0477-6
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发表时间：
2017-01-31
影响因子：
2.1
通讯作者：
Kemps HM
中科院分区：
文献类型：
--
作者：
Brouwers RW;Kraal JJ;Traa SC;Spee RF;Oostveen LM;Kemps HM
心脏康复对冠状动脉疾病患者的发病率和死亡率有有益的影响，但其利用不足，短期改善往往无法持续。远程康复有可能克服这些障碍，但它的优越性尚未得到令人信服的证明。这可能是由于对行为改变和患者自我管理技能的发展不够重视。此外，潜在的有益的沟通方式，如互联网和视频咨询，很少被使用。我们假设，与以中心为基础的心脏康复相比，使用循证行为改变策略、现代沟通方法和按需指导的心脏远程康复将提高自我管理技能和可持续的行为改变，从而以具有成本效益的方式转化为更高的身体活动水平。这项随机对照试验比较了冠心病患者的心脏远程康复与中心心脏康复。我们将300名进入心脏康复的患者随机分为以中心为基础的心脏康复组（对照组）和心脏远程康复组（干预组）。干预的核心组成部分是一个以患者为中心的网络应用程序，它使患者能够调整康复目标，检查训练和身体活动数据，与其他护理人员共享数据并使用视频咨询。经过六次有监督的训练后，干预组继续在家中进行运动训练，佩戴加速度计和心率监测器。此外，每周有四天通过加速度计评估身体活动水平。患者每周上传训练和身体活动数据，并通过每周一次的视频咨询获得反馈。在康复计划完成后，当训练依从性或身体活动水平下降50%或更多时，进行按需指导。主要结果衡量指标是身体活动水平，在基线、3个月和12个月时评估，并根据加速度计和心率数据计算。次要结局指标包括身体健康、生活质量、焦虑和抑郁、患者赋权、患者满意度和成本效益。本研究是首批评估心脏远程康复干预的效果和成本的研究之一，该干预包括现代技术和循证行为改变策略（包括复发预防）的结合。我们假设这种干预在不超过传统的以中心为基础的干预成本的情况下对运动行为有更好的影响。荷兰试验登记册编号NTR5156。注册于2015年4月22日。本文的在线版本（doi:10.1186/s12872-017-0477-6）包含补充材料，可供授权用户使用。
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. The online version of this article (doi:10.1186/s12872-017-0477-6) contains supplementary material, which is available to authorized users.