Nurse-led e-health rehab improves risk factors and HRQoL in CHD patients

A 12-week nurse-led e-health cardiac rehabilitation (NeCR) programme run on a website and a social media chat room effectively modifies behavioural risk factors and improves health-related quality of life (HRQoL) in Chinese patients hospitalized for coronary heart disease (CHD), researchers from the Hong Kong Polytechnic University and the University of Hong Kong have reported.

The programme began with a predischarge in-person assessment and counselling session with a nurse to identify individualized self-care needs, set goals, and develop an action plan to modify behavioural risk factors and orient the patient towards the use of the e-platform for cardiac rehabilitation. After discharge from hospital, patients utilized the programme’s website to learn about CHD management, obtain action advice about cardiac rehabilitation, and monitor goal attainment for health behavioural changes. A nurse provided feedback on patients’ goal attainment and lifestyle modifications on a weekly basis in a small chat group on WeChat. [Int J Nurs Stud 2021;122:104040]

Among 146 patients hospitalized for CHD (mean age, 55.78 years; male, 83.6 percent) in Tongji Hospital, Wuhan, China, those randomized to receive the 12-week comprehensive empowerment-based NeCR programme in addition to usual care (n=73) showed significant improvements in the number of daily steps (β=2628.48; p=0.022), weekly sitting minutes (β=-640.30; p=0.006), and health-promoting lifestyle profile (β=25.17; p<0.001) at 6 weeks after intervention compared with the control group (n=73) who received usual care alone.

At 12 weeks after intervention, participants in the NeCR group had significant improvements in number of daily steps (β=2520.00; p=0.006), weekly sitting minutes (β=-719.73; p=0.004), total (vigorous, moderate, and walking) exercise (β=1.36; p=0.015), health-promoting lifestyle profile (β=16.09; p<0.001), smoking cessation (p=0.04), and cardiac self-efficacy (β=0.61; p=0.005) compared with the control group. Significant improvements in the physical (β=0.45; p=0.049) and social (β=0.54; p=0.025) domains of HRQoL were also seen with NeCR vs control at 12-week follow-up.

In terms of specific health-promoting lifestyle behaviours, significant improvements were seen with NeCR vs control at 6 weeks and 12 weeks after intervention for physical activity (p<0.001 at both time points), health responsibility (p<0.001 at both time points), stress management (p<0.001 at both time points), and self-actualization (p<0.001 at 6 weeks; p=0.025 at 12 weeks).

However, no significant differences were found in changes in blood pressure, body mass index, body weight, and waist circumference between the NeCR and control groups.

“In our single-blind, randomized controlled trial, greater patient engagement was observed on the social media platform than on the website,” the researchers reported.

In the NeCR group, 56 participants (76.7 percent) visited the website, with an average number of 8.65 visits during the 12-week intervention period. Fifty-two participants (71.2 percent) had active interaction on WeChat, with an average of 6.12 discussions (messages on the same topic were counted as one discussion) over 12 weeks. Only 31 participants (42.5 percent) uploaded data on behavioural goal attainment, all of which indicated achievement of predetermined behavioural change goals, except two patients (2.7 percent) who reported moderate stress levels.

“It is worthwhile to explore the possibility of integrating all NeCR functions, including goal setting and health education, on the social media platform,” the researchers suggested.

“This study showed positive effects of a 12-week empowerment-based NeCR programme in improving physical activity level, healthy lifestyle, self-efficacy and HRQoL of patients with CHD following a cardiac event. Long-term follow-up is needed to further determine whether the behavioural changes can be translated to improved physiological risk parameters and psychological well-being,” they concluded.