Improving cardiac rehabilitation outcomes using data from daily life: A novel, multi-method ambulatory assessment approach

利用日常生活数据改善心脏康复结果：一种新颖的多方法动态评估方法

• 批准号: 10399972
• 负责人: Deanna Kaplan
• 金额: $ 2.73万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-21 至 2022-03-04
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10399972
• 关键词: Accelerometer; Activities of Daily Living; Address; Adherence; Affect; Behavior; Behavioral Medicine; Biological; Biological Markers; Cardiac rehabilitation; Cardiology; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cognitive; Collection; Data; Distress; Dropout; Ecological momentary assessment; Emotions; Enrollment; Environment; Epidemiology; Event; Exercise Tolerance; Foundations; Gender; Goals; Home; Intervention; Investigation; Life; Medical; Mentors; Methodology; Methods; Modeling; Moods; Movement; Outcome; Participant; Patient Self-Report; Patient-Focused Outcomes; Patients; Pattern; Periodicity; Procedures; Process; Psychosocial Factor; Recommendation; Rehabilitation Outcome; Research; Research Methodology; Research Personnel; Resolution; Rest; Social Interaction; Social support; Symptoms; Technology; Testing; Time; Training; Translating; Traumatic injury; Treatment outcome; United States; Withdrawal; Woman; adaptive intervention; behavior measurement; behavior observation; cognitive reappraisal; compliance behavior; distraction; emotion regulation; experience; health related quality of life; heart rate monitor; improved; innovation; men; novel; patient response; person centered; precision medicine; predictive marker; prevent; programs; psychologic; psychological distress; psychosocial; responders and non-responders; response; treatment adherence; treatment response

PROJECT SUMMARY / ABSTRACT Cardiac rehabilitation (CR) is widely recognized as an effective and life-prolonging treatment for cardiovascular disease (CVD), yet many patients do not benefit from treatment. More than half of patients who begin, ultimately dropout. Even among treatment adherent patients, one third are “non-responders”, and past investigations into the demographic and biological profiles of responders and non-responders have been unable to identify reliable differences that can explain why. Prior research on treatment adherence and responsiveness in CR has been limited by reliance on methodological approaches that only allow for a small number of assessments taken in medical environments that have limited generalizability to actual experiences during normal daily life. Building on the large body of research indicating that cardiovascular events and psychosocial distress share a common epidemiology, and by emerging evidence that transdiagnostic psychosocial processes (e.g., emotion regulation, daily behaviors and social interactions) are predictive of key cardiovascular outcomes, the present study employs a novel assessment approach to collect data from patients enrolled in CR as they go about their normal daily lives. N = 50 patients who are enrolling in a typical 12-week cardiac rehabilitation program will undergo two weeks of daily life assessments (the first during week 1 and the second during week 12 of the program). Assessments will include: 1) Ecological Momentary Assessment (EMA) for the collection of subjective data about patients’ cognitive and emotion regulation strategies in daily life, 2) behavioral observation using the Electronically Activated Recorder (EAR) for passive assessment of patients’ daily behaviors and social interactions, and 3) an Actiwatch, for passive assessment of accelerometry, heartrate and heartrate variability during daily life. Participant burden is minimal due to the use of passive assessment approaches. We will use advanced longitudinal, person-centered modeling approaches to identify specific, treatment-modifiable factors that affect treatment adherence and response to CR. We hypothesize that cognitive and emotion regulation strategies (Aim 1), daily activity pacing and social interactions (Aim 2), and patterns in continuously assessed cardiovascular biomarkers (Aim 3, Exploratory) will each predict treatment adherence and responsiveness outcomes. The study is innovative in that it is the first study to integrate these three cutting-edge methods, and is among the very first to apply “high resolution” daily life research approaches to improving treatment outcomes for patients with CVD. Results will be used as pilot data to inform a K or R application focused on developing and testing a precision-medicine informed intervention that further leverages ambulatory technologies such as mobile adaptive interventions to increase patient responsiveness to CR through daily life treatment targets identified through the present study.

项目概要/摘要 心脏康复（CR）被广泛认为是心血管疾病的有效且延长生命的治疗方法 疾病（CVD），但许多患者并未从治疗中受益。超过一半的患者开始时， 最终辍学。即使在坚持治疗的患者中，也有三分之一是“无反应者”，而过去 对应答者和非应答者的人口和生物特征进行了调查 无法识别可以解释原因的可靠差异。先前关于治疗依从性和治疗依从性的研究 CR 的响应能力因依赖方法论方法而受到限制，这些方法学方法只允许少量的 在医疗环境中进行的评估数量对实际经验的普遍性有限 在正常的日常生活中。大量研究表明心血管事件和 社会心理困扰具有共同的流行病学特征，并且新出现的证据表明跨诊断 心理社会过程（例如情绪调节、日常行为和社交互动）可预测关键 心血管结果，本研究采用了一种新颖的评估方法来收集数据 患者在正常日常生活时参加 CR。 N = 50 名参加典型研究的患者 为期 12 周的心脏康复计划将进行两周的日常生活评估（第一次在一周内进行） 第 1 次和第 12 周期间的第二次）。评估将包括： 1) 生态瞬时 收集有关患者认知和情绪调节的主观数据的评估（EMA） 日常生活中的策略，2）使用电子激活记录器（EAR）进行被动行为观察 评估患者的日常行为和社交互动，以及 3) Actiwatch，用于被动评估 日常生活中的加速度测量、心率和心率变异性。由于使用，参与者的负担最小 被动评估方法。我们将使用先进的纵向、以人为中心的建模方法 确定影响治疗依从性和 CR 反应的特定的、可改变治疗的因素。我们 假设认知和情绪调节策略（目标 1）、日常活动节奏和社交 相互作用（目标 2）和持续评估的心血管生物标志物的模式（目标 3，探索性）将 每个都预测治疗依从性和反应性结果。该研究的创新之处在于它是第一个 研究整合这三种前沿方法，并是最早应用“高分辨率”日常的人之一 改善 CVD 患者治疗结果的生活研究方法。结果将用作试点 为专注于开发和测试精准医疗的 K 或 R 应用提供信息的数据 进一步利用流动技术（例如移动自适应干预措施）的干预措施，以增加 通过本研究确定的日常生活治疗目标，患者对 CR 的反应。

项目成果

Biological and psychological predictors of heart rate patterns during physical activity.

身体活动期间心率模式的生物和心理预测因素。

• DOI: 10.1016/j.psychsport.2022.102346
• 发表时间: 2023
• 期刊: Psychology of sport and exercise
• 影响因子: 3.4
• 作者: Kaplan,DeannaM;Palitsky,Roman;Dunsiger,ShiraI;Wu,Wen-Chih;Parker,AmiraG;Troubh,JessicaK;Whitworth,JamesW;Bock,BethC
• 通讯作者: Bock,BethC