Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care.Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty.Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up & Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d.Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales "function in sport and recreational activities" and "hip-related quality of life" of HOOS, and on the subscale "physical role limitations" of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2), endorsed by effect sizes on the self-reported outcomes.Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care.Keywords: home-based rehabilitation program; internet; osteoarthritis; physiotherapy; rehabilitation; remote coaching; tablet app; total hip arthroplasty; total hip replacement; usual care.
Referral to home-based cardiac rehabilitation (HBCR) is low among older and frailer patients due to low expectations regarding adherence by healthcare professionals. The aim of this study was to determine adherence to HBCR when old and frail patients are referred, and to explore any differences in baseline characteristics between adherent and nonadherent patients. Data of the Cardiac Care Bridge were used (Dutch trial register NTR6316). The study included hospitalized cardiac patients ≥ 70 years old and at high risk of functional loss. Adherence to HBCR was confirmed when two-thirds of the intended nine sessions were followed. Of the 153 patients included (age: 82 ± 6 years, 54% female), 29% could not be referred due to death before referral, not returning home, or practical problems. Of the 109 patients who were referred, 67% adhered. Characteristics associated with non-adherence were older age (84 ± 6 vs. 82 ± 6, p = 0.05) and higher handgrip strength in men (33 ± 8 vs. 25 ± 11, p = 0.01). There was no difference in comorbidity, symptoms, or physical capacity. Based on these observations, most older cardiac patients who return home after hospital admission appear to adhere to HBCR after referral, suggesting that most older cardiac patients are motivated and capable of receiving HBCR.
BackgroundCardiac rehabilitation (CR) can reduce mortality and improve physical functioning in older patients, but current programs do not support the needs of older patients with comorbidities or frailty, for example due to transport problems and physical limitations. Home-exercise-based cardiac rehabilitation (HEBCR) programs may better meet these needs, but physiotherapy guidelines for personalising HEBCR for older, frail patients with cardiovascular disease are lacking.PurposeTo provide expert recommendations for physiotherapists on how to administer HEBCR to older adults with comorbidities or frailty.MethodsThis Delphi study involved a panel of Dutch experts in physiotherapy, exercise physiology, and cardiology. Three Delphi rounds were conducted between December 2020 and February 2022. In the first round panellists provided expertise on applicability and adaptability of existing CR-guidelines. In the second round panellists ranked the importance of statements about HEBCR for older adults. In the third round panellists re-ranked statements when individual scores were outside the semi-interquartile range. Consensus was defined as a semi-interquartile range of ≤ 1.0.ResultsOf 20 invited panellists, 11 (55%) participated. Panellists were clinical experts with a median (interquartile range) work experience of 20 (10.5) years. The panel reached a consensus on 89% of statements, identifying key topics such as implementing the patient perspective, assessing comorbidity and frailty barriers to exercise, and focusing on personal goals and preferences.ConclusionThis Delphi study provides recommendations for personalised HEBCR for older, frail patients with cardiovascular disease, which can improve the effectiveness of CR-programs and address the needs of this patient population. Prioritising interventions aimed at enhancing balance, lower extremity strength, and daily activities over interventions targeting exercise capacity may contribute to a more holistic and effective approach, particularly for older adults.
