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 and Gant, Nicholas 2018, Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial, Heart, doi: 10.1136/heartjnl-2018-313189.

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Title Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
Author(s) Maddison, RalphORCID iD for Maddison, Ralph orcid.org/0000-0001-8564-5518
Rawstorn, Jonathan CharlesORCID iD for Rawstorn, Jonathan Charles orcid.org/0000-0002-9755-7993
Stewart, Ralph A. H.
Benatar, Jocelyne
Whittaker, Robyn
Rolleston, Anna
Jiang, Yannan
Gao, Lan
Moodie, MarjORCID iD for Moodie, Marj orcid.org/0000-0001-6890-5250
Warren, Ian
Meads, Andrew
Gant, Nicholas
Journal name Heart
Total pages 8
Publisher BMJ Publishing Group
Place of publication London, Eng.
Publication date 2018-08-27
ISSN 1468-201X
Keyword(s) cardiac rehabilitation
coronary artery disease
ehealth/telemedicine/mobile health
Summary 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 (V̇O2max, 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 V̇O2max 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. V̇O2 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.
Notes In Press
Language eng
DOI 10.1136/heartjnl-2018-313189
Field of Research 1102 Cardiovascular Medicine And Haematology
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2018, The Authors
Persistent URL http://hdl.handle.net/10536/DRO/DU:30113327

Document type: Journal Article
Collection: School of Exercise and Nutrition Sciences
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