Providing Heart Failure Rehabilitation in the Home via Telerehabilitation

Abstract

Exercise is effective for patients with chronic heart failure (CHF). Despite this, many patients are unable to access traditional exercise-based rehabilitation programs for various reasons, such as transport difficulties and program availability. Telerehabilitation, in which telecommunication technologies are used to provide rehabilitation at a distance, is an alternative approach which may overcome some of these barriers.The current literature suggests that telerehabilitation is effective in patients with cardiopulmonary diseases. However the majority of studies focus on phone-based interventions, so there is a need for more studies on the use of video-based telerehabilitation programs. Video-based telerehabilitation is a new approach which enables patients to exercise in the comfort of their homes, whilst maintaining synchronous audiovisual communication. This approach enables the clinician to watch patients performing the exercises and to provide real-time feedback and modification as required, as well as facilitate the development of rapport between the clinician and patients, and peer support amongst patients. Video-based telerehabilitation also presents a potential way to conduct remote assessment of functional exercise capacity.This thesis aimed to explore a new service delivery model for providing heart failure exercise-based rehabilitation programs. The thesis commences with a systematic review of telerehabilitation in patients with cardiopulmonary diseases (Study 1, Paper 1). The next study aimed to determine the suitability of the timed up and go test (TUGT) as an outcome measurement in heart failure rehabilitation programs (Study 2, Paper 2). In addition, the validity and reliability of telerehabilitation assessments of functional tests including the TUGT were examined in patients with CHF (Study 3, Paper 3). A randomised controlled trial determined the feasibility and effectiveness of a home-based heart failure telerehabilitation program compared with a traditional centre-based program (Study 4, Paper 4). A mixed methods study was also conducted to determine patient experiences and perspectives related to a heart failure telerehabilitation program (Study 5, Paper 5).Based on the systematic review of 11 studies, telerehabilitation appears to be a promising alternative to traditional centre-based programs in patients with cardiopulmonary diseases. In particular, telerehabilitation has been shown to improve exercise capacity and quality of life in these patient groups and has higher adherence rates compared with traditional centre-based programs.iii However, suitable outcome measures that can be administered via telerehabilitation are required. A possible outcome measure is the TUGT, which is a quick and easy-to-administer functional test.However prior to using the TUGT as an outcome measure in telerehabilitation studies, it was first important to validate its use in both face-to-face and telerehabilitation environments. The TUGT demonstrated excellent test-retest reliability in patients with C...