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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    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
    Publication statusPublished - 24 Dec 2021

    Bibliographical note

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

    ASJC Scopus subject areas

    • Health Policy


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