The feasibility and effects of smartphone-based application on cardiac rehabilitation for percutaneous coronary intervention patients in Macau

D.Nurs.Background: Cardiac rehabilitation (CR) referral and participation are generally found to be underutilized worldwide. To improve cardiovascular (CV) risk factors modification and effects of CR, electronic applications (eHealth and mHealth) on CR are suggested in literature. An integrative literature review of eHealth and mHealth application on CR for patients with CHD was conducted. This review indicated the most effective program design, essential care components, core features of technology application on CR, and outcome measures. In order to promote the continuity and effects of CR in Macau, a phase I study (an exploratory CR survey) was conducted as to inform the phase II study (a mixed methods mCR study).Methods (phase II study): A mixed methods experimental mCR study, combining with two strands: the primary strand- a quantitative experimental randomizedcontrolled trial (RCT) and the secondary strand- embedded with a sequential qualitative study for program evaluation, was conducted. It was to assess the feasibility and effects of the mCR by comparing with usual CR care among post-PCI patients. In which 70 out of 90 recruited CR participants were eligible for RTC random assignment to either experimental group (EG), the mCR group, or control group (CG), the CR booklet group. The EG with the use of mCR app was grounded by Social Cognitive Theory (SCT). Three sets of data were collected at: before group assignment (T0), 6th weeks (T1) and the 12th weeks (T2) after hospital discharge. Measurements on nine aspects included anxiety and depression level, medication adherence, exercise capacity, physical activity level, CV risk factors modification, self-efficacy in performing cardiac exercise and diet, health-related quality of life (HRQL), cardiac-related rehospitalization, acute and emergency department visit, mCR app utility and satisfaction. For qualitative evaluation, a descriptive qualitative approach was undertaken to collect in-depth information regarding to the usability and satisfaction of mCR app. Ten mCR app users from EG by purposive sampling were recruited after program completion.Results: The mixed method results indicated that the effectiveness of mCR study on some major outcomes in physical, self-efficacy and HRQL were found to be well consistent from quantitative results and qualitative findings. Similar data analysis revealed that total cholesterol (ß = -0.864; p = 0.002), low-density lipoprotein (ß = - 0.816; p = 0.001), and sitting time reduction (ß = -0.245; p = 0.020), as well as improvements in regular exercise (OR = 14.902; p = 0.001), self-efficacy in performing cardiac exercise (ß = 13.228; p = 0.000) and diet (ß = 7.487; p = 0.015), and HRQL (ß = -8.986; p = 0.004) across three time points of measurements, were coherent by participants’ descriptions in benefits from mCR on well-being. Quantitative results and qualitative findings were found to be different in some outcomes of psychological and part of behavioral aspects in medication and self-care compliance.Conclusions: The feasibility and effectiveness of this theoretically-grounded mCR study were evaluated and tested by a mixed methods experimental study. The results of mCR study were encouraging and helped post-PCI patients adhere to their CR recommendations.背景：文獻顯示全球心臟復康轉介及參與皆利用不足。為改善心血管危險因子修正及心臟復康效果，文獻建議應用電子健康（eHealth和mHealth）。針對電子健康應用在冠心病病人的心臟復康，進行了一項綜合性文獻回顧。文獻回顧總結有效的計劃設計、必要照護組成部份、電子健康技術應用在心臟復康的重點特性，及效果評價。為促進心臟復康的延續性及效果， I期研究（探索性心臟復康調查）已進行，以指導II期研究（混合性mCR研究）的開展。方法（II期研究）：以混合性實驗性研究結合兩種方法：主研究為一個量性實驗性隨機對照試驗，副以一個相繼的質性研究作項目評價。90位心臟復康的病人中，有70位納入研究，並隨機分組至實驗組（智能電話心臟復康組）或對照組（小冊子心臟復康組）。實驗組使用的心臟復康智能應用程式建基於社會認知理論。三次資料收集為：分組前 (T0)，出院後第6周 (T1) 及第12周 (T2) 收集。九項成效包括：焦慮及抑鬱水平、服藥依從性、運動能力、身體活動水平、心血管危險因子修正、遵從心臟運動及飲食自我效能、健康相關生活質量、心臟相關住院及急症室使用、心臟復康電話應用程式使用及滿意度。質性評價則進行描述性質性研究來收集資料，評價智能電話心臟復康應用程式的使用，以目標取樣法集得十位實驗組參加者。結果：混合性結果顯示智能電話應用程式心臟復康研究結果，在身體、自我效能和健康相關生活質量中，發現量性結果與質性結果一致。資料分析顯示總膽固醇 (ß = -0.864; p = 0.002)、低密度脂蛋白 (ß = -0.816; p = 0.001) 和靜坐時間 (ß = -0.245; p = 0.020) 減少，及規律運動 (OR = 14.902; p = 0.001)、心臟運動自我效能 (ß = 13.228; p = 0.000)、心臟飲食自我效能 (ß = 7.487; p = 0.015) 及健康相關生活質量改善 (ß = -8.986; p = 0.004)，能被質性描述中的主題「從電話心臟復康程式中的得益」肯定。量性及質性結果在心理及部份行為效果中，發現結果不一致。總結：通過一項混合性研究，驗證此項以理論為本mCR計劃的可行性及有效性。此研究結果有鼓勵性，推動及幫助經被冠狀動脈入術後病人依從心臟復康建議。Lao, Sio Wa.Thesis D.Nurs. Chinese University of Hong Kong 2019.Includes bibliographical references (leaves 136-152).Abstracts also in Chinese; some appendixes in Chinese.Title from PDF title page (viewed on 27, January, 2021)