Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jan 23, 2020
Date Accepted: Jul 15, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Implementation of Telerehabilitation Interventions for the Self-management of Cardiovascular Disease: A Systematic Review
ABSTRACT
Background:
Cardiovascular diseases are the leading cause of disability and deaths worldwide, and secondary prevention is crucial to improve risk factors, reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional centre-based cardiac rehabilitation (CR) programs; therefore, alternative delivery models, including cardiac telerehabilitation, have been tested. Experimental studies have shown cardiac telerehabilitation can be effective and cost-effective; however, there is inadequate evidence about how to translate this research into routine clinical practice.
Objective:
This study aimed to synthesize research evaluating the effectiveness of the implementation of cardiac telerehabilitation interventions at scale in routine clinical practice—including factors underlying successful implementation processes—and experimental research evaluating implementation-related outcomes.
Methods:
Medline, Embase, PsycINFO and Global Health databases were searched from 1990 through 9 Nov 2018 for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists and relevant systematic reviews were also searched to identify additional eligible studies. Implementation outcomes included acceptability, appropriateness, adoption, feasibility, implementation cost, penetration and sustainability. A narrative synthesis of results was carried out. (PROSPERO registration number CRD42919124254).
Results:
We identified zero studies that evaluated the implementation of cardiac telerehabilitation in routine clinical practice. Eight studies evaluated aspects of implementation within experimental trials (n=1547). Acceptability (N=6), fidelity (N=5), appropriateness (N=4), implementation cost (N=3), and feasibility (N=1) were frequently evaluated from the participant perspective. Interventions delivering personalized text-messages were considered useful, safe and appropriate. However, smartphone- or web-based app interventions that provided more comprehensive services, including individualized real-time monitoring and coaching were preferred. Most studies showed high intervention fidelity and few studies signaled potential cost-effectiveness of cardiac telerehabilitation to improve service access. Key outcomes, including adoption, penetration and sustainability (all N=0), and perspectives of CR practitioners and healthcare organizations, have received little attention.
Conclusions:
Experimental trials suggest telehealth CR could be successfully implemented in clinical practice, but this must now be verified in pragmatic implementation studies. Addressing this gap is an urgent priority to realize the potential impact of cardiac telerehabilitation on accessibility and participation rates, as well as person-centered, health, and economic outcomes. Clinical Trial: PROSPERO CRD42919124254
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