Therapeutic components of digital counseling for chronic heart failure

Abstract

BackgroundTask force statements support the use of cognitive behavioral therapy (CBT) and motivational interviewing (MI) to promote self-care in chronic heart failure (CHF) patients. Digital counseling interventions have the potential to complement conventional programs. However, therapeutic components of digital programs associated with improved outcomes are not clearly established.ObjectiveIdentify therapeutic components of the Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) protocol that were associated with improved health-related quality of life (HRQL).Materials and methodsOrdinal logistic regression was used to identify therapeutic components of the CHF-CePPORT protocol. The primary outcome was the 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) tertile. Logistic regressions determined the association between 12-month KCCQ-OS tertile, using logon hours for key segments of the protocol, modality of content delivery, and clinical themes.ResultsA total of 117 patients were enrolled in the e-Counseling arm of the CHF-CePPORT trial. Median age was 60 years (IQR 52–69). Total logon hours in the initial 4-month segment of CHF-CePPORT (Sessions 1–16) was associated with increased 12-month KCCQ-OS tertile (Odds Ratio, OR = 1.31, 95% CI, 1.1–1.5, P = 0.001). Within sessions 1–16, improved KCCQ-OS was associated with logon hours for self-assessment tools/trackers (OR = 1.49, 95% CI, 1.1–2.0, P = 0.007), and videos (OR = 1.57, 95% CI, 1.03–2.4, P = 0.04), but not for CHF information pages.ConclusionThis study highlights the importance of using evidence-based guidelines from CBT and MI as core components of digital counseling, delivered through videos and interactive tools/trackers, to improve HRQL with CHF.

Content Validity and Cognitive Testing in the Development of a Motivational Interviewing Self-Assessment Questionnaire

“…Various tools addressed the use of different elements of MI. Almost all of them encompassed selected aspects of the spirit of MI, with many focusing on skills ( 21 – 24 , 27 , 29 ) and emphasizing strategies for assessing readiness for change ( 18 , 21 , 26 , 29 , 32 ). The range of relevant items in these tools varied from one ( 19 ) to 20 ( 23 ).…”

“…The scales measured frequency ( 18 ), agreement ( 23 ), the extent of behaviour ( 19 – 21 , 31 ), or the number of occurrences of behaviour ( 20 , 31 ), expertise ( 24 , 25 ), optimality ( 27 ), or capability ( 29 ). In three cases, the possible response scales were not described ( 28 , 30 , 32 ).…”

“…Analysis of the remaining articles revealed the following: All of the current self-assessment tools were developed or published after 2003 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), with almost half from 2020 onwards (10,(27)(28)(29)(30)(31)(32).…”

Digital therapeutics in the clinic

“…DTx have shown promise in various disease areas including psychiatric, [36][37][38] cardiovascular, 29,39 metabolism, 40 gastrointestinal, 41 neurodevelopmental, 33,42 and neurological diseases, 43,44 among others. With such a broad application, DTx hold great potential in translatability and treatment across different disease areas among the general population.…”

“… 27 , 28 The software can be further divided into subtypes such as mobile applications, 29 web applications, 30 , 31 virtual reality (VR), 32 AI, 33 , 34 video games, 35 and approved devices, among others. DTx have shown promise in various disease areas including psychiatric, 36 , 37 , 38 cardiovascular, 29 , 39 metabolism, 40 gastrointestinal, 41 neurodevelopmental, 33 , 42 and neurological diseases, 43 , 44 among others. With such a broad application, DTx hold great potential in translatability and treatment across different disease areas among the general population.…”