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Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial

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 reha...

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Autores principales: Maddison, Ralph, Rawstorn, Jonathan Charles, Stewart, Ralph A H, Benatar, Jocelyne, Whittaker, Robyn, Rolleston, Anna, Jiang, Yannan, Gao, Lan, Moodie, Marj, Warren, Ian, Meads, Andrew, Gant, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352408/
https://www.ncbi.nlm.nih.gov/pubmed/30150328
http://dx.doi.org/10.1136/heartjnl-2018-313189
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author Maddison, Ralph
Rawstorn, Jonathan Charles
Stewart, Ralph A H
Benatar, Jocelyne
Whittaker, Robyn
Rolleston, Anna
Jiang, Yannan
Gao, Lan
Moodie, Marj
Warren, Ian
Meads, Andrew
Gant, Nicholas
author_facet Maddison, Ralph
Rawstorn, Jonathan Charles
Stewart, Ralph A H
Benatar, Jocelyne
Whittaker, Robyn
Rolleston, Anna
Jiang, Yannan
Gao, Lan
Moodie, Marj
Warren, Ian
Meads, Andrew
Gant, Nicholas
author_sort Maddison, Ralph
collection PubMed
description 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 (V̇O(2)max, 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 V̇O(2)max 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. V̇O(2) max 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 (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, 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.
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spelling pubmed-63524082019-02-21 Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial Maddison, Ralph Rawstorn, Jonathan Charles Stewart, Ralph A H Benatar, Jocelyne Whittaker, Robyn Rolleston, Anna Jiang, Yannan Gao, Lan Moodie, Marj Warren, Ian Meads, Andrew Gant, Nicholas Heart Cardiac Risk Factors and Prevention 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 (V̇O(2)max, 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 V̇O(2)max 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. V̇O(2) max 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 (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, 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. BMJ Publishing Group 2019-01 2018-08-27 /pmc/articles/PMC6352408/ /pubmed/30150328 http://dx.doi.org/10.1136/heartjnl-2018-313189 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Cardiac Risk Factors and Prevention
Maddison, Ralph
Rawstorn, Jonathan Charles
Stewart, Ralph A H
Benatar, Jocelyne
Whittaker, Robyn
Rolleston, Anna
Jiang, Yannan
Gao, Lan
Moodie, Marj
Warren, Ian
Meads, Andrew
Gant, Nicholas
Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
title Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
title_full Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
title_fullStr Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
title_full_unstemmed Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
title_short Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
title_sort effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
topic Cardiac Risk Factors and Prevention
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352408/
https://www.ncbi.nlm.nih.gov/pubmed/30150328
http://dx.doi.org/10.1136/heartjnl-2018-313189
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