Patients receptive to home-based cardiac telerehabilitation programs

Patients seem to have positive opinions of home-based cardiac telerehabilitation programs, finding the usability, utility, and acceptability of such interventions to be good, according to a recent Singapore study. Nevertheless, these programs still have room for improvement, particularly as regards interactivity, peer interactions, and postintervention support.

“As the appeal for home-based cardiac telerehabilitation grows during the coronavirus disease 2019 (COVID-19) pandemic and beyond, findings from this review can be used to provide guidance for stakeholders and clinicians in developing and evaluating patient-centred home-based cardiac telerehabilitation programs,” the researchers said.

The current systematic review drew from the online databases of Scopus, PsycINFO, CINAHL, Embase, Pubmed, and Central. From an initial list of 1,798 studies, 18 were eventually deemed eligible for final inclusion, describing a total of 14 unique home-based telerehabilitation programs.

Content analysis showed that the home-based programs were delivered mainly through smartphone apps (n=11) and less frequently through websites (n=3). Supplementary modes of delivery included text messaging (n=6), telephone calls (n=5), and emails (n=2), among others. [J Med Internet Res 2022;24:e34657]

To aid the remote exercise training by the cardiac care team, these programs also used telemonitoring devices, such as heart rate monitors and pedometers.

Of note, programs featured core components as prescribed by the American Heart Association, including patient assessment (n=14), exercise training (n=13), dietary (n=10) and risk factor (n=11) management, medication adherence (n=10), and psychosocial support (n=6).

Seven of the 18 included studies assessed patient perspectives regarding program usability. Taking stock of easy of system use and navigation, ease of use and comfort of wearable devices, and ease of undertaking program tasks, these studies found overall high usability rating scores for home-based telerehabilitation.

Similarly, the programs were generally perceived to have high utility especially in terms of supporting behaviour change, managing psychological wellbeing, controlling symptoms, reducing visits, and tracking goals and progress.

As a result, home-based cardiac telerehabilitation programs earned high rates of acceptability, ranging from 81.3 percent to 88 percent.

The researchers also looked at potential points for improvement and found that study respondents desired more interactive components, such as chat platforms, noticeboards, and other opportunities to connect with peers. There was also a need for intra- and postprogram support.

Moreover, despite favourable feedback and high rates of acceptance, important barriers remain that hamper the use of these programs. These include connectivity issues, reliability of the technology (ie, battery life), lack of time or motivation, perceived self-efficacy in operating the telerehabilitation system, and safety and privacy concerns, among others.

“Our results demonstrated that, while patient perspectives on home-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high, a number of external variables influence technology acceptance of home-based cardiac telerehabilitation programs,” the researchers said. “Additionally, gaps in current home-based cardiac telerehabilitation evaluation timing and approaches were revealed.”