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Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial [with consumer summary]
Maddison R, Rawstorn JC, Stewart RAH, Benatar J, Whittaker R, Rolleston A, Jiang Y, Gao L, Moodie M, Warren I, Meads A, Gant N
Heart 2019 Jan;105(2):122-129
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; 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: Compare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD). METHODS: Participants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (VO2max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in VO2max at 12 weeks (inferiority margin -1.25 mL/kg/min); inferiority margins were not set for secondary outcomes. RESULTS: 162 participants (mean 61+/-12.7 years, 86% men) were randomised. VO2max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD) 0.51 (95% CI -0.97 to 1.98) mL/kg/min, p = 0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD -61.5 (95% CI -117.8 to -5.3) min/day, p = 0.03), while CBexCR participants had smaller waist (AMD 1.71 (95% CI 0.09 to 3.34) cm, p = 0.04) and hip circumferences (AMD 1.16 (95% CI 0.06 to 2.27) cm, p = 0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1,130/GBP573 versus NZD3,466/GBP1,758) and medication costs (NZD331/GBP168 versus NZD605/GBP307, p = 0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3,459/GBP1,754 versus NZD5,464/GBP2,771, p = 0.20). CONCLUSION: REMOTE-CR is an effective, cost-efficient alternative delivery model that could-as a complement to existing services-improve overall utilisation rates by increasing reach and satisfying unique participant preferences.
Reproduced with permission from the BMJ Publishing Group.

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