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A novel model of home-based, patient-tailored and mobile application-guided cardiac telerehabilitation in patients with atrial fibrillation: a randomised controlled trial [with consumer summary]
Cai C, Bao Z, Wu N, Wu F, Sun G, Yang G, Chen M
Clinical Rehabilitation 2022 Jan;36(1):40-50
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; 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: To assess the effectiveness of tele-monitored cardiac rehabilitation in patients who have undergone ablation for atrial fibrillation. DESIGN: Single-centre, prospective, assessment-blinded, randomised controlled trial. SETTING: Domiciliary rehabilitation with support from a tertiary care hospital. SUBJECTS: One hundred patients who underwent ablation for atrial fibrillation were recruited. INTERVENTIONS: Participants were randomly allocated to a 12-week standard rehabilitation treatment (control group) or a comprehensive, domiciliary, mobile application-guided and tele-monitored cardiac rehabilitation program (intervention group) in a 1:1 fashion. MAIN OUTCOME MEASURES: The primary endpoint was the improvement in VO2peak. The secondary outcomes included adherence, physical activity, beliefs related to cardiovascular disease and exercise self-efficacy. RESULTS: Ninety-seven patients completed follow-up. The mean VO2peak increased significantly in both the intervention group (n = 49) (baseline versus 12 weeks 19.1 +/- 4.7 versus 27.3 +/- 5.6 ml/min/kg, p < 0.01) and the control group (n = 48) (baseline versus 12 weeks 18.7 +/- 4.9 versus 22.9 +/- 6.3 ml/min/kg, p < 0.01). The results of the between-group analysis of aerobic capacity were significantly in favour of the intervention group. During the 12-week program, patients in the intervention group exhibited better adherence than those in the control group. Moreover, self-reported physical activity improved more in the intervention group than in the control group, as did the beliefs related to cardiovascular disease and exercise self-efficacy (all p < 0.01). CONCLUSIONS: Our domiciliary, mobile application-guided and tele-monitored cardiac rehabilitation program could lead to a more significant improvements in physical fitness, adherence and health beliefs than standard cardiac rehabilitation in patients who have undergone ablation for atrial fibrillation.

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