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Ziel der Studie: Die langfristige Nutzung telemedizinischer Angebote hängt nicht nur von deren Wirksamkeit, sondern auch von der Akzeptanz und Zufriedenheit der Patienten ab. Für eine telemedizinische Bewegungstherapie für Patienten nach Implantation einer Knie- oder Hüft-Totalendoprothese und erfolgter Anschlussrehabilitation wurde die Wirksamkeit bereits in einer randomisiert kontrollierten Studie untersucht. Dieser Beitrag fokussiert die Akzeptanz und das Nutzungsverhalten der Patienten hinsichtlich des eingesetzten telerehabilitativen Systems.
Methodik: Zur Erfassung der Technikakzeptanz wurden 48 Patienten (53±7 Jahre; 26 Frauen; 35 Hüft-/13 Knie-TEP) im Anschluss an eine dreimonatige telemedizinische Bewegungstherapie mittels des Telehealth Usability Questionnaire befragt. Der Fragebogen besteht aus 21 Items (siebenstufige Likert-Skala) in sechs Skalen (z. B. Nützlichkeit, Qualität der Interaktionen, Verlässlichkeit). In einer zusätzlichen Skala wurden systemspezifische Fragen zusammengefasst. Die Ergebnisse wurden als Skalenprozent (100 ≙ vollkommene Zustimmung) dargestellt. Das Nutzungsverhalten wurde anhand systemgenerierter Prozessdaten zum Training sowie zu integrierten Sprach-/Textnachrichten untersucht.
Ergebnisse: Die TUQ-Skalen „Nützlichkeit“ (Mdn 95,2) sowie „Benutzerfreundlichkeit und Erlernbarkeit“ (Mdn 92,9) wurden am höchsten bewertet, während die „Verlässlichkeit“ (Mdn 57,1) und „Qualität der Interaktionen“ (Mdn 71,4) die geringsten Ausprägungen zeigten. Die systemspezifische Skala wurde im oberen Quartil eingeordnet (Mdn 85,7).
In der ersten Woche führten 39 Patienten (81%), in der zweiten 45 Patienten (94%) mindestens eine Trainingsübung mit dem System durch. Der Anteil aktiver Patienten (≥1 Übung/Woche) reduzierte sich im weiteren Verlauf auf 75% (n=36) in der 7. Woche und 48% (n=23) in der 12. Woche. Die systemeigenen Kommunikationsmöglichkeiten wurden nach Therapiestart zunächst häufig genutzt: in der ersten Woche sendeten 42 Patienten (88%) Nachrichten, 47 Patienten (98%) erhielten Nachrichten von ihrem Therapeuten. In der 7. Woche sendeten/erhielten 9 (19%) bzw. 13 (27%) Patienten Nachrichten über das System.
Schlussfolgerung: Die Patienten nahmen die telemedizinische Bewegungstherapie überwiegend als nützlich und benutzerfreundlich wahr und schienen im Wesentlichen mit dem System zufrieden, das sich damit für den kurzfristigen Einsatz von 6 bis 8 Wochen im Anschluss an eine Anschlussrehabilitation als gut geeignet zeigte.
Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR. We analyzed data from a registry of 489 working-age patients (51.5 +/- A 6.9 years, 87.9 % men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass graft (CABG 17.2 %), or heart valve replacement (9.0 %). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability. During a mean follow-up of 26.5 +/- A 11.9 months, 373 (76.3 %) patients returned to work, 116 (23.7 %) did not, and 60 (12.3 %) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 % CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 % CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 % CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 % CI 0.30-0.82; p = 0.006).
Background
Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain.
Methods/design
This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints.
Discussion
We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.
Background: Total hip or knee replacement is one of the most frequently performed surgical procedures. Physical rehabilitation following total hip or knee replacement is an essential part of the therapy to improve functional outcomes and quality of life. After discharge from inpatient rehabilitation, a subsequent postoperative exercise therapy is needed to maintain functional mobility. Telerehabilitation may be a potential innovative treatment approach. We aim to investigate the superiority of an interactive telerehabilitation intervention for patients after total hip or knee replacement, in comparison to usual care, regarding physical performance, functional mobility, quality of life and pain. Methods/design: This is an open, randomized controlled, multicenter superiority study with two prospective arms. One hundred and ten eligible and consenting participants with total knee or hip replacement will be recruited at admission to subsequent inpatient rehabilitation. After comprehensive, 3-week, inpatient rehabilitation, the intervention group performs a 3-month, interactive, home-based exercise training with a telerehabilitation system. For this purpose, the physiotherapist creates an individual training plan out of 38 different strength and balance exercises which were implemented in the system. Data about the quality and frequency of training are transmitted to the physiotherapist for further adjustment. Communication between patient and physiotherapist is possible with the system. The control group receives voluntary, usual aftercare programs. Baseline assessments are investigated after discharge from rehabilitation; final assessments 3 months later. The primary outcome is the difference in improvement between intervention and control group in 6-minute walk distance after 3 months. Secondary outcomes include differences in the Timed Up and Go Test, the Five-Times-Sit-to-Stand Test, the Stair Ascend Test, the Short-Form 36, the Western Ontario and McMaster Universities Osteoarthritis Index, the International Physical Activity Questionnaire, and postural control as well as gait and kinematic parameters of the lower limbs. Baseline-adjusted analysis of covariance models will be used to test for group differences in the primary and secondary endpoints. Discussion: We expect the intervention group to benefit from the interactive, home-based exercise training in many respects represented by the study endpoints. If successful, this approach could be used to enhance the access to aftercare programs, especially in structurally weak areas.
Background
Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization.
Methods
From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model.
Results
After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p < 0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive.
Conclusion
Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings.
Aim We aimed to identify patient characteristics and comorbidities that correlate with the initial exercise capacity of cardiac rehabilitation (CR) patients and to study the significance of patient characteristics, comorbidities and training methods for training achievements and final fitness of CR patients. Methods We studied 557 consecutive patients (51.76.9 years; 87.9% men) admitted to a three-week in-patient CR. Cardiopulmonary exercise testing (CPX) was performed at discharge. Exercise capacity (watts) at entry, gain in training volume and final physical fitness (assessed by peak O-2 utilization (VO2peak) were analysed using analysis of covariance (ANCOVA) models. Results Mean training intensity was 90.7 +/- 9.7% of maximum heart rate (81% continuous/19% interval training, 64% additional strength training). A total of 12.2 +/- 2.6 bicycle exercise training sessions were performed. Increase of training volume by an average of more than 100% was achieved (difference end/beginning of CR: 784 +/- 623 wattsxmin). In the multivariate model the gain in training volume was significantly associated with smoking, age and exercise capacity at entry of CR. The physical fitness level achieved at discharge from CR as assessed by VO2peak was mainly dependent on age, but also on various factors related to training, namely exercise capacity at entry, increase of training volume and training method. Conclusion CR patients were trained in line with current guidelines with moderate-to-high intensity and reached a considerable increase of their training volume. The physical fitness level achieved at discharge from CR depended on various factors associated with training, which supports the recommendation that CR should be offered to all cardiac patients.
Multicomponent cardiac rehabilitation in patients after transcatheter aortic valve implantation
(2017)
Background: In the last decade, transcatheter aortic valve implantation has become a promising treatment modality for patients with aortic stenosis and a high surgical risk. Little is known about influencing factors of function and quality of life during multicomponent cardiac rehabilitation. Methods: From October 2013 to July 2015, patients with elective transcatheter aortic valve implantation and a subsequent inpatient cardiac rehabilitation were enrolled in the prospective cohort multicentre study. Frailty-Index (including cognition, nutrition, autonomy and mobility), Short Form-12 (SF-12), six-minute walk distance (6MWD) and maximum work load in bicycle ergometry were performed at admission and discharge of cardiac rehabilitation. The relation between patient characteristics and improvements in 6MWD, maximum work load or SF-12 scales were studied univariately and multivariately using regression models. Results: One hundred and thirty-six patients (80.6 +/- 5.0 years, 47.8% male) were enrolled. 6MWD and maximum work load increased by 56.3 +/- 65.3 m (p < 0.001) and 8.0 +/- 14.9 watts (p < 0.001), respectively. An improvement in SF-12 (physical 2.5 +/- 8.7, p = 0.001, mental 3.4 +/- 10.2, p = 0.003) could be observed. In multivariate analysis, age and higher education were significantly associated with a reduced 6MWD, whereas cognition and obesity showed a positive predictive value. Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. Additionally, the baseline values of SF-12 had an inverse impact on the change during cardiac rehabilitation. Conclusions: Cardiac rehabilitation can improve functional capacity as well as quality of life and reduce frailty in patients after transcatheter aortic valve implantation. An individually tailored therapy with special consideration of cognition and nutrition is needed to maintain autonomy and empower octogenarians in coping with challenges of everyday life.