Changes in patient activation following cardiac rehabilitation using the Active+me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation

Gabbi Frith, Kathryn Carver, Sarah Curry, Alan Darby, Anna Sydes, Stephen Symonds, Katrina Wilson, Gordon McGregor, Kevin Auton, Simon Nichols

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    Abstract

    Background: Restrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active +me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active +me. We also investigated changes in PAM among low, moderate, and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active +me. Methods: Patients received standard CR education and an exercise prescription. Active +me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active +me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active +me. Results: Forty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg .m 2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active +me was acceptable to patients and healthcare professionals. Conclusion: Participation in standard CR, with Active +me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active +me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face. Trial registration: As this was not a clinical trial, the study was not registered in a trial registry.

    Original languageEnglish
    Article number1363
    JournalBMC Health Services Research
    Volume21
    DOIs
    Publication statusPublished - 24 Dec 2021

    Bibliographical note

    This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

    Keywords

    • COVID-19
    • Cardiac rehabilitation
    • Patient activation
    • Self-efficacy
    • Tele-health

    ASJC Scopus subject areas

    • Health Policy

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