The COVID-19 pandemic has forced many center-based cardiac rehabilitation (CBCR) programs to close or limit their usual offerings. In order for patients to continue to benefit from CR, programs need to rapidly adapt to the current environment. This review highlights ways CR has evolved, and reviews the history of CR and recent advancements in telemedicine including remote patient monitoring, and mobile health that can be applied to CR. Despite that initial studies indicate that home-based CR (HBCR) is safe and effective, HBCR has faced several challenges that have prevented it from becoming more widely implemented. Many previous concerns can now be addressed through the use of new innovations in home-based healthcare delivery. Since its inception, CR has become increasingly recognized as an important tool to improve patient mortality and quality of life in a broad range of cardiac diseases. While there has been little need to modify the delivery of CR since the 1950s, COVID-19 now serves as the necessary impetus to make HBCR an equal alternative to CBCR.

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Cardiac Rehab in the COVID Era and Beyond: mHealth and Other Novel Opportunities.

Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.

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Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives

Purpose of review To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. Recent findings Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. Summary Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.

Cardiac rehabilitation for coronary artery disease: latest updates.

Background Digital interventions are interventions supported by digital tools or technologies, such as mobile apps, wearables, or web-based software. Digital interventions in the context of public health are specifically designed to promote and improve health. Recent reviews have shown that many digital interventions target physical activity promotion; however, it is unclear how such digital interventions are evaluated. Objective We aimed to investigate evaluation strategies in the context of digital interventions for physical activity promotion using a scoping review of published reviews. We focused on the target (ie, user outcomes or tool performance), methods (ie, tool data or self-reported data), and theoretical frameworks of the evaluation strategies. Methods A protocol for this study was preregistered and published. From among 300 reviews published up to March 19, 2021 in Medline, PsycINFO, and CINAHL databases, 40 reviews (1 rapid, 9 scoping, and 30 systematic) were included in this scoping review. Two authors independently performed study selection and data coding. Consensus was reached by discussion. If applicable, data were coded quantitatively into predefined categories or qualitatively using definitions or author statements from the included reviews. Data were analyzed using either descriptive statistics, for quantitative data (relative frequencies out of all studies), or narrative synthesis focusing on common themes, for qualitative data. Results Most reviews that were included in our scoping review were published in the period from 2019 to 2021 and originated from Europe or Australia. Most primary studies cited in the reviews included adult populations in clinical or nonclinical settings, and focused on mobile apps or wearables for physical activity promotion. The evaluation target was a user outcome (efficacy, acceptability, usability, feasibility, or engagement) in 38 of the 40 reviews or tool performance in 24 of the 40 reviews. Evaluation methods relied upon objective tool data (in 35/40 reviews) or other data from self-reports or assessments (in 28/40 reviews). Evaluation frameworks based on behavior change theory, including goal setting, self-monitoring, feedback on behavior, and educational or motivational content, were mentioned in 22 out of 40 reviews. Behavior change theory was included in the development phases of digital interventions according to the findings of 20 out of 22 reviews. Conclusions The evaluation of digital interventions is a high priority according to the reviews included in this scoping review. Evaluations of digital interventions, including mobile apps or wearables for physical activity promotion, typically target user outcomes and rely upon objective tool data. Behavior change theory may provide useful guidance not only for development of digital interventions but also for the evaluation of user outcomes in the context of physical activity promotion. Future research should investigate factors that could improve the efficacy of digital interventions and the standardization of terminology and reporting in this field. International Registered Report Identifier (IRRID) RR2-10.2196/35332

https://jmir.org/api/download?alt_name=publichealth_v8i5e37820_app1.pdf&filename=3ef93146f4102b6ada510531a60b7264.pdf

Evaluation of Digital Interventions for Physical Activity Promotion: Scoping Review

OBJECTIVE Telerehabilitation is an option that should be adapted as soon as possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta-meta-analysis (MMA) of the available scientific evidence was performed to determine whether telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. METHODS A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta-meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews, MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. RESULTS Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference = 0.18; 95% CI = 0.03-0.34). CONCLUSION The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. IMPACT The advantages of lower cost and less interference by the rehabilitation processes in patients' daily life could justify implementing telerehabilitation in clinical settings in the coronavirus disease 2019 era.

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Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review with Meta-Meta-Analysis.

Background: The common drawbacks of standard cardiac rehabilitation (CR) models include low participation rate, high cost, and dependence on on-site exercise sessions. Therefore, hybrid CR protocols have been developed. Aim: We aimed to test whether hybrid CR models are superior or equivalent to the traditional CR models in patients after myocardial infarction, heart failure, and cardiac surgery, using a meta-analysis framework. Methods: Data from relevant original studies indexed in the Medline, Scopus, Cochrane Central, and Web of Science data­bases were extracted and analysed. The standardised mean difference (SMD) was used as a summary effect estimate, along with 95% confidence interval (CI). Results: Based on data from 1195 patients, the summary effect size showed similar improvement in functional capacity in hybrid and standard CR programmes (SMD = –0.04, 95% CI –0.18 to 0.09, p = 0.51). No significant difference was detected between the two models in terms of changes in exercise duration (SMD = –0.14, 95% CI –0.51 to 0.24, p = 0.47), systolic (SMD = –0.01, 95% CI –0.14 to 0.12, p = 0.91), and diastolic (SMD = –0.03, 95% CI –0.16 to 0.11, p = 0.7) blood pres­sure, or health-related quality of life (SMD = –0.08, 95% CI –0.23 to 0.07, p = 0.27). In terms of blood lipids, no significant difference was noted between hybrid and traditional CR models in all assessed lipid profile parameters, except for triglycerides (favouring the traditional CR model). Conclusions: Hybrid CR protocols showed comparable efficacy to the traditional model. Further well-designed studies are required to validate these findings, especially regarding the long-term outcomes.

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Congyin Wu

Papers

Hybrid versus traditional cardiac rehabilitation models: a systematic review and meta-analysis