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Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial [with consumer summary]
Varnfield M, Karunanithi M, Lee C-K, Honeyman E, Arnold D, Ding H, Smith C, Walters DL
Heart 2014 Nov 15;100(22):1770-1779
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI). This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients. METHODS: In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n = 60; 55.7 +/- 10.4 years) and CAP-CR (n = 60; 55.5 +/- 9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants' homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression. RESULTS: CAP-CR had significantly higher uptake (80% versus 62%), adherence (94% versus 68%) and completion (80% versus 47%) rates than TCR (p < 0.05). Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks (TCR 537 +/- 86 to 584 +/- 99 m; CAP-CR 510 +/- 77 to 570 +/- 80 m), which was maintained at 6 months. CAP-CR showed slight weight reduction (89 +/- 20 to 88 +/- 21 kg) and also demonstrated significant improvements in emotional state (K10 median (IQR) 14.6 (13.4 to 16.0) to 12.6 (11.5 to 13.8)), and quality of life (EQ5D-Index median (IQR) 0.84 (0.8 to 0.9) to 0.92 (0.9 to 1.0)) at 6 weeks. CONCLUSIONS: This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services. TRIAL REGISTRATION NUMBER: ANZCTR12609000251224.
Reproduced with permission from the BMJ Publishing Group.

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