New East-Westfalian Postoperative Therapy Concept: a telemedicine guide for the study of ambulatory rehabilitation of patients after cardiac surgery.
01 Aug 2006-Telemedicine Journal and E-health (Mary Ann Liebert, Inc. 2 Madison Avenue Larchmont, NY 10538 USA)-Vol. 12, Iss: 4, pp 475-483
TL;DR: It is indicated that home-based rehabilitation is more effective than in-hospital rehabilitation for patients after cardiac surgery and the total cost of rehabilitation was 58% lower in group 2 compared to group 1.
Abstract: In-hospital rehabilitation can improve recovery of patients after surgery, but also contributes to the high costs of the German health system. A telemedicine-based rehabilitation used in the home as an alternative to in-hospital rehabilitation was evaluated in a pilot study. In an open trial, 170 patients performed a 3-month ambulatory rehabilitation after cardiac surgery. There were two groups (group 1 [n = 70] and group 2 [n = 100]). Group 1 participated in conventional in-hospital rehabilitation. Group 2 received ambulant rehabilitation using telemedicine. Physical performance, quality of life, (measured with a questionnaire), complications and costs were assessed and compared between the two groups. Maximal physical performance (MPP) was assessed at 6 and at 12 months after cardiac surgery. It was significantly increased by 46–54 watts in both study groups compared to their baseline value. Moreover, physical and psychological quality of life had increased in both study groups compared to baseline valu...
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TL;DR: While evidence is mounting concerning the efficacy and effectiveness of telerehabilitation, high-quality evidence regarding impact on resource allocation and costs is still needed to support clinical and policy decision-making.
Abstract: Purpose. To identify clinical outcomes, clinical process, healthcare utilization and costs associated with telerehabilitation for individuals with physical disabilities.Method. Relevant databases were searched for articles on telerehabilitation published until February 2007. Reference lists were examined and key journals were hand searched. Studies that included telerehabilitation for individuals with physical impairments and used experimental or observational study designs were included in the analysis, regardless of the specific clientele or location of services. Data was extracted using a form to record methodological aspects and results relating to clinical, process, healthcare utilization and cost outcomes. Study quality of randomized clinical trials was assessed using the PEDro rating scale.Results. Some 28 articles were analysed. These dealt with rehabilitation of individuals in the community, neurological rehabilitation, cardiac rehabilitation, follow-up of individuals with spinal cord injuries, r...
451 citations
Cites background from "New East-Westfalian Postoperative T..."
...CO: Exercise capacity (workload, maximal oxygen consumption, pressure rate product), return to work PO: Compliance HCU: New arrhythmias Kortke et al. (2006) [30] Quasi-experimental pre-post intervention study with control group (control n¼ 70; intervention n¼ 100) N/A Patients who just underwent…...
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TL;DR: In this article, the authors identify and critique evidence for the effectiveness of alternative models of cardiac rehabilitation, such as multifactorial individualized telehealth and community- or home-based cardiac rehabilitation.
Abstract: The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.
201 citations
TL;DR: Telerehabilitation appears to be a feasible and effective additional and/or alternative form of rehabilitation, compared to conventional in-hospital CR, when taking into account patient safety and health economics.
Abstract: We conducted a literature review of telerehabilitation interventions on cardiac patients. We searched for studies evaluating some form of telerehabilitation in cardiac patients. A total of 116 publications were screened initially, of which 37 publications were eligible for further review. We assessed study strength, based on the level of evidence and the quality of the intervention. The majority of the articles (70%) represented the highest level of evidence. Most interventions were of good (46%) or fair (51%) quality. Most studies evaluated the efficacy of the telerehabilitation interventions (84%), while 38% reported on feasibility and acceptance. Most studies did not include safety and/or cost-benefit analyses. Most telerehabilitation interventions (90%) employed only one or two core components of cardiac rehabilitation (CR). Of the CR core components, physical activity was most frequently evaluated. Telerehabilitation appears to be a feasible and effective additional and/or alternative form of rehabilitation, compared to conventional in-hospital CR. Evaluations of telerehabilitation programmes taking into account patient safety and health economics are now required.
152 citations
TL;DR: This is the first study of the actual costs of in-home telere rehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient’s home.
Abstract: Background: Rehabilitation provided through home visits is part of the continuum of care after discharge from hospital following total knee arthroplasty (TKA). As demands for rehabilitation at home are growing and becoming more difficult to meet, in-home telerehabilitation has been proposed as an alternate service delivery method. However, there is a need for robust data concerning both the effectiveness and the cost of dispensing in-home telerehabilitation. Objective: The objective of this study was to document, analyze, and compare real costs of two service delivery methods: in-home telerehabilitation and conventional home visits. Methods: The economic analysis was conducted as part of a multicenter randomized controlled trial (RCT) on telerehabilitation for TKA, and involved data from 197 patients, post-TKA. Twice a week for 8 weeks, participants received supervised physiotherapy via two delivery methods, depending on their study group allocation: in-home telerehabilitation (TELE) and home-visit rehabilitation (VISIT). Patients were recruited from eight hospitals in the province of Quebec, Canada. The TELE group intervention was delivered by videoconferencing over high-speed Internet. The VISIT group received the same intervention at home. Costs related to the delivery of the two services (TELE and VISIT) were calculated. Student’s t tests were used to compare costs per treatment between the two groups. To take distance into account, the two treatment groups were compared within distance strata using two-way analyses of variance (ANOVAs). Results: The mean cost of a single session was Can $93.08 for the VISIT group (SD $35.70) and $80.99 for the TELE group (SD $26.60). When comparing both groups, real total cost analysis showed a cost differential in favor of the TELE group (TELE minus VISIT: -$263, 95% CI -$382 to -$143). However, when the patient’s home was located less than 30 km round-trip from the health care center, the difference in costs between TELE and VISIT treatments was not significant ( P =.25, .26, and .11 for the <10, 10-19, and 20-29 km strata, respectively). The cost of TELE treatments was lower than VISIT treatments when the distance was 30 km or more (30-49 km: $81<$103, P =.002; ≥50 km: $90<$152, P <.001). Conclusions: To our knowledge, this is the first study of the actual costs of in-home telerehabilitation covering all subcosts of telerehabilitation and distance between the health care center and the patient’s home. The cost for a single session of in-home telerehabilitation compared to conventional home-visit rehabilitation was lower or about the same, depending on the distance between the patient’s home and health care center. Under the controlled conditions of an RCT, a favorable cost differential was observed when the patient was more than 30 km from the provider. Stakeholders and program planners can use these data to guide decisions regarding introducing telerehabilitation as a new service in their clinic. Trial Registration: International Standard Registered Clinical Study Number (ISRCTN): 66285945; http://www.isrctn.com/ISRCTN66285945 (Archived by WebCite at http://www.webcitation.org/6WlT2nuX4). [J Med Internet Res 2015;17(3):e83]
122 citations
TL;DR: TR shows promise in many fields, but compelling evidence of benefit and of impact on routine rehabilitation programmes is still limited and there is a need for more detailed, better-quality studies and for studies on the use of TR in routine care.
Abstract: We systematically reviewed the evidence on the effectiveness of telerehabilitation (TR) applications. The review included reports on rehabilitation for any disability, other than mental health conditions, and drug or alcohol addiction. All forms of telecommunications technology for TR and all types of study design were considered. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each TR application had been successful, whether reported outcomes were clinically significant, and whether further data were needed to establish the application as suitable for routine use. Sixty-one scientifically credible studies that reported patient outcomes or administrative changes were identified through computerized literature searches on five databases. Twelve clinical categories were covered by the studies. Those dealing with cardiac or neurological rehabilitation were the most numerous. Thirty-one of the studies (51%) were of high or good quality. Study results showed that 71% of the TR applications were successful, 18% were unsuccessful and for 11% the status was unclear. The reported outcomes for 51% of the applications appeared to be clinically significant. Poorer-quality studies tended to have worse outcomes than those from high- or good-quality studies. We judged that further study was required for 62% of the TR applications and desirable for 23%. TR shows promise in many fields, but compelling evidence of benefit and of impact on routine rehabilitation programmes is still limited. There is a need for more detailed, better-quality studies and for studies on the use of TR in routine care.
119 citations
References
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TL;DR: Information is presented about the development and evaluation of the SF-36 Health Survey, a 36-item generic measure of health status, that summarizes studies of reliability and validity and provides administrative and interpretation guidelines for theSF-36.
2,338 citations
TL;DR: Methods and results of the German translation and psychometric testing of the SF-36 with six samples of over 1500 healthy and ill persons show that the use of the IQOLA study protocol led to a satisfactory German version of theSF-36 Health Survey and that psychometricTesting yielded good to excellent results as concerns scale structure and reliability.
Abstract: Der Short-Form-36 Health Survey (dh die Kurzform SF-36) ist ein aus der Medical Outcome Study entwickeltes Standardinstrument zur krankheitsubergreifenden Erfassung der gesundheitsbezogenen Lebensqualitat, dessen Internationale Verfugbarkeit zunehmend nachgefragt wird Im International Quality of Life Assessment Project (IQOLA), einer Arbeitsgruppe, zusammengesetzt aus Forschern verschiedener Lander, wird derzeit die Ubersetzung, psychometrische Testung und Normierung der SF-36 in 13 Landern, einschlieβlich Deutschland, durchgefuhrt Der Beitrag berichtetuber Methodik und Ergebnisse der deutschen Ubersetzung und psychometrischen Prufung des SF-36 an sechs Gruppen von uber 1500 gesunden und erkrankten Personen Die Ergebnisse zeigen, daβ mit Hilfe des IQOLA-Studienprotokolls fur die Ubersetzung eine befriedigende deutsche Form des SF-36 erstellt wurde und daβ die psychometrischen Testergebnisse uber alle Gruppen hinweg gute bis hervorragende Ergebnisse hinsichtlich Skalenstruktur und Reliabilitat erbringen Damit erscheint die SF-36, deren Normierung fur 1995 geplant ist, als ein im deutschen Sprachraum einsetzbares Instrument zur Erfassung der gesundheitsbezogenen Lebensqualitat
352 citations
TL;DR: Cloacal swabs from wild synanthropic and exoanthropic birds of 57 species in the Czech Republic yielded 32 strains of Salmonella typhimurium, most of which were derived from black-headed gulls, which might play a role in the dispersal of pathogenic salmonellae.
Abstract: Cloacal swabs, collected from 756 wild synanthropic and exoanthropic birds of 57 species in the Czech Republic, yielded 32 strains of Salmonella typhimurium [phage types (PT) 141, 104 and 41], six isolates of S. enteritidis (PT 8, 4 and 6e), and one each of S. panama and S. anatum. Except for one S. enteritidis isolate from a grey-lag goose (Anser anser) and one S. typhimurium isolate from a coot (Fulica atra), all of the other strains were derived from black-headed gulls (Larus ridibundus), of which 24.7% were found to be infected. The black-headed gull might play a role in the dispersal of pathogenic salmonellae.
227 citations
TL;DR: Home and group training are equally effective in increasing functional capacity of low-risk patients after myocardial infarction.
Abstract: To evaluate the efficacy of exercise training for increasing functional capacity in the 6 months after clinically uncomplicated myocardial infarction, 198 men 52 +/- 9 years of age participated in a training study. They were randomly assigned to one of four exercise protocols: 8 to 26 weeks of training at home (group 1, n = 66) or in a group program (group 2, n = 61) following treadmill testing performed 3 weeks after infarction, treadmill testing at 3 weeks without subsequent training (group 3, n = 34), and treadmill testing for the first time at 26 weeks (control, n = 37). At 26 weeks functional capacity was significantly higher in patients training at home or in a group program than that in patients without training or in control patients: 8.1 +/- 1.5, 8.5 +/- 1.3, 7.5 +/- 1.8, and 7.0 +/- 1.7 METs, respectively (p less than .05 and p less than .001). No significant differences in functional capacity were noted between patients training at home and those in a group program. No training-related complications occurred. Home and group training are equally effective in increasing functional capacity of low-risk patients after myocardial infarction.
158 citations
TL;DR: Patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs.
152 citations