Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden

Abstract

Background Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes following CABS. Purpose To determine if a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms following CABS, was effective in improving outcomes (physical activity, physiological and psychological functioning) for older adults (> 65 years old) with higher disease burden. Design A descriptive, repeated measures experimental design was used. Follow-up data was collected at 3- and 6-weeks and 3-months after CABS. Sample Subjects were drawn from a larger randomized clinical trial (RCT). Parent study subjects who had high disease burden preoperatively [physical component score of <50 on the Medical Outcome Study Short Form 36 (MOS SF-36) and a RISKO score of > 6], were included (N=55); with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n=31). Subjects ranged from 65–85 years old (M=71.6 + 5.1). Findings There was a significant main effect by group [F(1,209)=4.66, p<.05), the intervention group had a least square means of 27.9 kcal/kg/day of energy expenditure compared to the usual care group of 26.6 kcal/kg/day per the RT3® accelerometer. Both groups had significantly improved physical [F(2,171)=3.26, p<.05] and role-physical [F(2,171)=6.64, p<.005] functioning over time. Conclusions The subgroup of CABS subjects with high disease burden was responsive to an early recovery telehealth intervention. Improving patients’ physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.

Measurement of physical activity in older adult interventions: a systematic review

“…Objective measures were used in 12 of the studies reviewed while self-report were used in 32 studies 28 31 32 34–38 40–48 50 51 53–55 57–61 63 64 66 69 70. Six studies used multiple measures29 33 39 47 52 62 and three studies used a combination of objective measures and self-report 29 33 39…”

“…There were 32 studies that measured PA via self-report 28 29 31–48 50 51 53–55 57–61 63 64 66 69 70. Among those using self-report, four studies used multiple measures,29 33 39 47 with three of them also using objective measures,29 33 39 and the remaining study utilising two different self-reports 47.…”

“…Among those using self-report, four studies used multiple measures,29 33 39 47 with three of them also using objective measures,29 33 39 and the remaining study utilising two different self-reports 47. Studies using self-report ranged in size from 16 to 1800 participants 28 29 31–48 50 51 53–55 57–61 63 64 66 69 70…”

The ADOPT Model: Accelerating Diffusion of Proven Technologies for Older Adults

“…The Center for Connected Health has indicated that the use of telehealth, remote patient monitoring, and disease management approaches can promote patient adherence, engagement, and improved clinical outcomes (Monegain 2009). Another study found that a telehealth intervention was able to increase older adults' physical functioning following coronary artery bypass surgery, an important aspect of preventing further mortality and morbidity (Barnason et al 2009). Researchers have also found success using online programs for older adults, such as a six-month Internet-based program for diabetic adults ages 60 and older that resulted in significant reductions in HbA1c, weight, and cholesterol levels and HDL improvement compared to a control group (Bond et al 2007).…”

Telerehabilitation and recovery of motor function: a systematic review and meta-analysis

“…Among these 64 papers were excluded for the following reasons: 35 because the ICTs used were not aimed to rehabilitation purposes ; eight papers were protocols of ongoing studies and results were not available [52][53][54][55][56][57][58][59] ; seven studies did not have a control group [60][61][62][63][64][65][66] ; five because the intervention setting was the same in the two groups 8,[67][68][69][70] ; five were pilot studies [71][72][73][74][75] ; two were secondary analysis of RCTs already included 76,77 ; two studies were excluded because the poor reporting precluded any possible assessment of its eligibility 78,79 . Finally, 12 RCTs for a total of 1047 participants were included in the review ( Figure 1).…”