Tele-rehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study

Abstract

Background: Cardiac tele-rehabilitation is defined as using information and communication technology to support rehabilitation services. However, it requires a high level of patient activation and health literacy; this has not yet been explored. Aims: The purpose of this study was to evaluate patient activation and health literacy in tele-rehabilitation compared to hospital-based cardiac rehabilitation. Methods: We conducted a pilot study in patients with ischaemic or heart valve disease. In a non-randomised design, 24 patients attended a 12-week tele-rehabilitation programme, and 53 matched controls a 12-week hospital-based cardiac rehabilitation programme. The primary outcome was patient activation, which was assessed using the Patient Activation Measure before the intervention, at the end of the intervention and at follow-up six months after the intervention. The secondary outcome was health literacy, assessed using three dimensions from the Health Literacy Questionnaire before rehabilitation and at six-month follow-up: actively manage my health (HLQ3), ability to engage with healthcare providers (HLQ6) and understanding health information (HLQ9). Results: Patient activation improved similarly in tele-rehabilitation and hospital-based cardiac rehabilitation at all time points. Six months after the intervention, patients in tele-rehabilitation significantly improved on the dimension HLQ6 compared to patients in hospital-based cardiac rehabilitation. No significant between-group differences were found in HLQ3 or HLQ9. Conclusion: Tele-rehabilitation and hospital-based cardiac rehabilitation seemed to be equally successful in improving patient activation and health literacy. Tele-rehabilitation should be further tested in a randomised controlled trial, with a focus on whether patient levels of education and self-management at the initiation of rehabilitation are decisive factors for tele-rehabilitation participation.

Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review

“…Eighteen studies were randomised and included 1 cross over design [50], 5 cluster randomised [39,41,44,47,51] and 12 individually randomised trials [30-32, 34, 36-38, 40, 43, 45, 49, 52]. The remaining four were quasi-experimental pre-post controlled trials [33,35,42,48]. Studies took place in nine countries -USA [30,31,37,39,40,42,43,45], Australia [35,51,52], Iran [32,34,47], China [41,44], Japan [36,49], Taiwan [48], Niger [38], Germany [50] and Demark [33].…”

“…Two studies focused on the domain of disease prevention (cancer screening [39] and malaria health literacy [38]), eight focused on healthcare (diabetes [30,37], gestational diabetes [32], breast cancer [36], cardiac conditions [33,34], one or more chronic conditions [35] and people taking two or more medications daily [31]). The remaining 12 studies focused on health promotion with eight focusing on general health promotion [41,42,44,45,48,[50][51][52], two focusing on nutrition [40,43], one on nutrition and physical activity [49] and one on smoking prevention [47].…”

“…There was considerable variation in how health literacy was defined and measured (see Table 2). Six studies [36,40,42,43,45,47] did not provide a definition, two [31,34] gave a definition but no clear reference to identify it, and the remaining 14 studies referenced 10 different definitions (three studies [30,35,48] gave multiple definitions) with Ratzan and Parker [54] used in five studies [30,35,37,39,51] and Sorensen [6] cited in four studies [33,[48][49][50].…”

“…Four studies used condition specific measures [30,[37][38][39], four used culture specific measures [32,44,47,50], and three created measures for use in the studies [30,41,48]. The rest used validated general instruments such as newest vital sign -NVS [37,40,43], test of functional health literacy in adults / short test of functional health literacy in adults -TOFHLA/STOFHLA [31,34,37,42,45], Health Literacy Questionnaire -HLQ [33,35,51,52], HLS-EU-Q16 [49], and HLS14 [49]. Two studies used multiple measures [37,49].…”

Health Literacy among People in Cardiac Rehabilitation: Associations with Participation and Health-Related Quality of Life in the Heart Skills Study in Denmark

“…Mattson et al found that health literacy was associated with increased knowledge gain from cardiac patient education during a rehabilitation program [23]. A few intervention studies have also successfully addressed health literacy in their intervention design or measured it as an outcome [24,25]. In all these studies, as in most studies on health literacy in people with cardiac conditions, individual health literacy was measured using a single value or category [26][27][28][29].…”