PDF(Pubmed)
Abstract：
Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction and develop recommendations for future telehealth-delivered CR. The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE, and Cochrane Database) for randomized controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. We included 37 reports describing 26 randomized controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesized into four theories required to enhance participant outcomes and participation. These theories are as follows: (i) early and regular engagement; (ii) personalized interventions and shared goals; (iii) usable, accessible, and supported interventions; and (iv) exercise that is measured and monitored. Providing a personalized approach with frequent opportunities for bi-directional interaction was a critical feature for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.
摘要：
远程医疗提供的心脏康复（CR）计划可能会提高参与率，同时提供与基于设施的计划相同的结果。然而,这些降低心血管危险因素的干预措施的关键组成部分尚未区分.本研究旨在确定远程医疗提供的CR的特征，以改善二级预防结果，锻炼能力,参与,和参与者满意度，并为未来远程医疗提供的CR提出建议。我们的审查方案已在前瞻性系统审查登记册（＃CRD42021236471）中注册。我们系统地搜索了四个数据库(PubMed，Scopus,EMBASE,和Cochrane数据库），用于将远程医疗提供的CR计划与基于设施的干预措施或常规护理进行比较的随机对照试验。两名独立审稿人筛选了摘要，然后筛选了全文。使用定性审查方法(现实主义综合)，对纳入的文章进行评估，以确定影响心血管危险因素的环境因素和潜在机制，锻炼能力,参与干预，和增加满意度。我们纳入了37份报告，描述了2010年至2022年发表的26项随机对照试验。研究主要在欧洲和澳大利亚/亚洲进行。确定的环境因素和机制被综合为四个理论，以增强参与者的成果和参与。这些理论如下：（i）早期和定期参与；（ii）个性化干预和共同目标；（iii）可用，可访问,和支持的干预措施；和(iv)衡量和监测的锻炼。提供个性化的方法和频繁的双向互动机会是在远程医疗提供的CR试验中取得成功的关键特征。现在需要真实世界的有效性研究来补充我们的发现。
