Journal Article

Feasibility, Acceptability, and Clinical Effectiveness of a Technology-Enabled Cardiac Rehabilitation Platform (Physical Activity Toward Health-I): Randomized Controlled Trial

McCormack, Ciara, Woods, Catherine, Cornelissen, Véronique, Pattyn, Nele, Newton, Helen, Gillain, Alexandra, Claes, Jomme, Goetschalckx, Kaatje, Buys, Roselien, Budts, Werner, Cornelis, Nils, McDermott, Clare, Moran, Kieran, Moyna, Niall, Gallagher, Anne

2020

Overview

Cardiac rehabilitation (CR) is highly effective as secondary prevention for cardiovascular diseases (CVDs). Uptake of CR remains suboptimal (30% of eligible patients), and long-term adherence to a physically active lifestyle is even lower. Innovative strategies are needed to counteract this phenomenon. The Physical Activity Toward Health (PATHway) system was developed to provide a comprehensive, remotely monitored, home-based CR program for CVD patients. The PATHway-I study aimed to investigate its feasibility and clinical efficacy during phase III CR. Participants were randomized on a 1:1 basis to the PATHway (PW) intervention group or usual care (UC) control group in a single-blind, multicenter, randomized controlled pilot trial. Outcomes were assessed at completion of phase II CR and 6-month follow-up. The primary outcome was physical activity (PA; Actigraph GT9X link). Secondary outcomes included measures of physical fitness, modifiable cardiovascular risk factors, endothelial function, intima-media thickness of the common carotid artery, and quality of life. System usability and patients' experiences were evaluated only in PW. A mixed-model analysis of variance with Bonferroni adjustment was used to analyze between-group effects over time. Missing values were handled by means of an intention-to-treat analysis. Statistical significance was set at a 2-sided alpha level of .05. Data are reported as mean (SD). A convenience sample of 120 CVD patients (mean 61.4 years, SD 13.5 years; 22 women) was included. The PATHway system was deployed in the homes of 60 participants. System use decreased over time and system usability was average with a score of 65.7 (SD 19.7; range 5-100). Moderate-to-vigorous intensity PA increased in PW (PW: 127 [SD 58] min to 141 [SD 69] min, UC: 146 [SD 66] min to 143 [SD 71] min; P =.04; effect size of 0.42), while diastolic blood pressure (PW: 79 [SD 11] mmHg to 79 [SD 10] mmHg, UC: 78 [SD 9] mmHg to 83 [SD 10] mmHg; P =.004; effect size of -0.49) and cardiovascular risk score (PW: 15.9% [SD 10.4%] to 15.5% [SD 10.5%], UC: 14.5 [SD 9.7%] to 15.7% [SD 10.9%]; P =.004; effect size of -0.36) remained constant, but deteriorated in UC. This pilot study demonstrated the feasibility and acceptability of a technology-enabled, remotely monitored, home-based CR program. Although clinical effectiveness was demonstrated, several challenges were identified that could influence the adoption of PATHway. ClinicalTrials.gov NCT02717806; https://clinicaltrials.gov/ct2/show/NCT02717806. RR2-10.1136/bmjopen-2017-016781.

• Publisher: Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Acceptability / Adoption of innovations / Averages / Blood pressure / Cardiac arrhythmia / Cardiovascular disease / Cardiovascular diseases / Clinical effectiveness / Clinical trials / Data collection / Disease / Disease prevention / Efficacy / Ethics / Exercise / Feasibility / Health status / Heart rate / Home based / Hospitals / Internet access / Intervention / Lifestyles / Original Paper / Patients / Physical activity / Physical fitness / Pilot projects / Quality of life / Registration / Rehabilitation / Risk factors / Secondary prevention / Social research / Statistical significance / Technology / Uptake / Variance analysis / Women