Table 3.
Outcome studies.
| Study | Outcome | Intervention | Results | ||
|---|---|---|---|---|---|
| Feasibility | Efficacy | Safety | |||
| Główczyńska et al. (2021) [25] | Cardiopulmonary exercise capacity (using CPET) | Hybrid cardiac telerehabilitation | N/I | Patients in HCTR group were associated with longer exercise time. The differences in exercise time between HCTR and UC were 12.0 s (95% CI: 15.1–39.1; p = 0.666) in DM and 43.1 s (95% CI: 24.0–63.0 s; p < 0.001) in non-DM. HCTR group was also associated with lower ventilation at rest compared to UC. The differences were −0.34 L/min (95% CI: 1.60,−0.91 L/min; p = 0.892) in DM and 0.83 L/min (95% CI 0.06, 1.73 L/min; p = 0.082) in non-DM. In VE/VCO2 slope, a non-significant difference was found: 1.52 (95% CI; 1.55–4.59; p = 0.579) for DM vs. − 1.44 (95% CI −3.64–0.77; p = 0.336) for non-DM. | Both HCTR and UC are safe in DM and non-DM patients, as evidenced by lack of significant adverse effects experienced by patients. |
| Piotrowicz et al. (2020) [24] | QoL (SF-36) | Hybrid cardiac telerehabilitation | No patients were exluded or lost to follow-up during 9-week study period. | HCTR significantly improved overall QoL (p = 0.009). Greater improvement was observed in HCTR compared to UC group. QoL domain improvement in HCTR group: QoL—physical domain (p = 0.0003); QoL—physical functioning (p = 0.001); QoL—role functioning related to physical state (p = 0.003); QoL—bodily pain (p = 0.015). |
N/I |
| Orzechowski et al. (2021) [28] | Safety measured by frequency of cardiac arrhythmias | Hybrid cardiac telerehabilitation | 12/425 patients were discontinued for non-medical reasons. | N/I | No patients experienced symptomatic arrhythmia requiring the discontinuation of telerehabilitation. Sinus rhythm was detected in 320 (83%), while persistent atrial fibrillation (AF) was present in 66 (17%) patients. Ventricular and atrial premature beats were the most frequently seen arrhythmias, occurring in 76.4% and 27.7% of patients, respectively. Non-sustained ventricular tachycardia (21 occurrences in 8 patients) and paroxysmal atrial fibrillation (6 episodes in 4 patients) were considered uncommon. |
| Piotrowicz et al. (2020) [26] | Quality of life (SF-36) and clinical outcome | Hybrid cardiac telerehabilitation | No patients were exluded or lost to follow-up during 9-week study period. | HCTR significantly improved patients’ quality of life (1.58 (95% CI, 0.74–2.42) vs. 0.00 (95% CI, 0.84 −0.84); p = 0.008) and peak oxygen consumption (0.95 vs. 0.00 mL/kg/min; p = 0.001). | The intervention group did not show improved survival rates (91.9 vs. 92.8 days, with a likelihood of 0.49 (95% CI, 0.46–0.53; p = 0.74)), mortality rates (12.5%, vs. 12.4% (HR 1.03 [95% CI, 0.70–1.51])), or hospitalization rates (HR 0.94 (95 percent CI, 0.79–1.13)). |
| Piotrowicz et al. (2019) [29] | Model (see Table 2) | Hybrid cardiac telerehabilitation | Not applicable | Not applicable | Not applicable |
| Bernocchi et al. (2018) [22] | Primary: Feasibility and efficacy (6MWD) Secondary: Dyspnea; physical activity; disability; QoL (MRC; PASE: Barthel; MLHFQ) |
Home-based telerehabilitation | 93% participants performed designed activity at home. Patients’ satisfaction with the program was reportedly very high, with overall mean score 22.3/25. | After 4 months, patients in IG were able to walk further than they did at the beginning: the improvement in 6MWD in IG was 60 (22.2,97.8) m; meanwhile, CG showed no significant improvement (−15 (40.3,9.8)) m. The difference between two groups was significant. IG was associated with significant improvement in the PASE score (p = 0.0175), Barthel (p = 0.01), and MLHFQ score (p = 0.0175) compared to CG at 4 months. |
No major side effects were recorded. The IG group was better than CG. Required 113.4 days for the media in IG to reach a hospital or die, compared to 104.7 in the CG (p = 0.048, log-rank test). Cumulative hospitalizations happened in 21 patients (IG) and 37 patients (CG). |
| Peng et al. (2018) [23] | QoL (MLHFQ); 6MWD; resting HR; HADS; LVEF; the NYHA classification | Home-based telehealth exercise training progam | 4 patients were lost to follow-up and 3 were omitted from the intervention. | Patients receiving home-based telehealth were associated with significant improvements in QoL, 6MWD, and resting HR. No significant improvements were observed regarding NYHA classification, LVEF, anxiety, and depression at follow-up. | No significant complications or adverse outcomes reported during the program. |
| Hwang et al. (2017)-a [30] | Primary: 6MWD Secondary: QoL (MLHFQ); patients’ statisfication; attendance rates; adverse events |
Home-based telerehabilitation | IG had significantly higher attendance rates than CG, with a mean difference of 6 (95% CI: 2 to 9) sessions. | At Week 12, the IG had a 15 m (95% CI −28 to 59) advantage in the 6MWD (F(1,6) = 1.39; p = 0.24). At week 24, IG had a non-significant 2 m (95% CI −36 to 41) advantage compared to CG. Mean within-group QoL difference was 11 (95% CI: −19 to −3). | The number of adverse events was similar between groups. No patients died, had a heart attack, syncope, or fell during the workout period. Both groups reported modest adverse effects, including angina, diaphoresis, and palpitations. |
| Hwang et al. (2017)-b [33] | Experience and perspective | Home-based telerehabilitation | Participants described telerehabilitation program as easily accessible, safe, and structured. | Participants called for better audio quality and connectivity, as well as computer instruction for individuals who were new to computers. Most participants preferred a combination of face-to-face and online delivery. | N/I |
| Piotrowicz et al. (2016) [31] | Depression (BDI with cut-off point 20); LF/HF; physical capacity improvement | Hybrid cardiac telerehabilitation with Nordic walking training | All patients in intervention group completed telerehabilitation program. | Depression: IG (8.76 ± 6.73 to 6.70 ± 5.53; p = 0.0006) CG (11.57 ± 8.18 9.09 ± 7.34; p = 0.0490). Depressive symptoms were substantially reduced in both groups (TG, p = 0.0006; CG, p = 0.0490). LF/HF: IG (2.06 ± 1.14 to 1.19 ± 0.80; p < 0.0001) CG (2.01 ± 1.35 to 2.42 ± 1.39; p > 0.05). Between-group differences were significant (p = 0.0001). Peak VO2: IG (16.83 ± 3.72 to 19.14 ± 4.20 mL/kg per minute; p < 0.0001). Favorable results in CG were not observed. The differences between groups were significant (p < 0.0001). |
N/I |
| Piotrowicz et al. (2015)-a [32] | Safety, efficacy, adherence, and acceptance Primary: VO2 peak Secondary: workload duration (t) in 6MWT; QoL (SF-36); safety; adherence and acceptance |
Home-based telemonitored Nordic walking in HF patients with CIEDs (i.e., cardiac resynchronization therapy, implantable cardioverter–defibrillator) | All patients completed the program. The adherence was very high: 94.7% patients were adherent, while others were partially adherent. Moreover, 99% participants in IG reported that the device was very easy or easy to use, and 90% had no problems coordinating the exercise. |
Nordic walking telerehabilitation training resulted in significant improvement in: VO2 peak (16.1 ± 4.0 vs. 18.4 ± 4.1 mL/kg/min), test duration (471 ± 141 vs. 577 ± 158 s), 6MWD (428 ± 93 vs. 480 ± 87 m), and QoL (79.0 ± 31.3 vs. 70.8 ± 30.3). The improvement differences between IG and CG were significant in ΔVO2 peak (Δ2.0 ± 2.4 vs. Δ−0.2 ± 2.1), Δtest duration (Δ108 ± 108 vs. Δ0.94 ± 109, and Δ6MWT (Δ53.8 ± 63.9 vs. Δ22.0 ± 68.7). |
Patients felt safer during telemonitored training than self-exercise without supervision. No deaths, hospitalization, or additional CIED interventions were reported. |
| Piotrowicz et al. (2015)-b [27] | QoL (SF-36) | Hybrid cardiac telerehabilitation | 59/75 patients completed the program. | IG provided similar improvement in overall QoL score to CG group. IG (79.3 ± 25.6 to 70.5 ± 25.4, p = 0.007) vs. CG (81.6 ± 27.3 to 69.2 ± 26.4, p = 0.004). Significant improvement in IG: physical function (23.2 ± 11.32 to 21.60 ± 9.65, p = 0.049) mental health (8.05 ± 3.81 to 7.15 ± 4.03, p = 0.012) vitality (8.44 ± 3.36 to 7.25 ± 3.78, p = 0.001) Significant improvement in CG: physical function (25.39 ± 10.89 to 23.20 ± 10.71, p = 0.044) role limitation caused by physical problems (13.80 ± 7.46 to 11.39 ± 8.43, p = 0.034) bodily pain (2.74 ± 2.54 to 2.00 ± 2.07, p = 0.011) social function (2.22 ± 1.98 to 1.63 ± 1.54, p = 0.005) mental health (7.52 ± 4.51 to 5.89 ± 3.58, p = 0.009) vitality (7.94 ± 4.17 to 6.76 ± 3.17, p = 0.0197) |
N/I |
CPET = cardiopulmonary exercise test; ECG = electrocardiography; CI = confidence interval; CIEDs = cardiovascular implantable electronic devices; CG = control group; IG = intervention group; HAD(S) = Hospital Anxiety and Depression Scale; LVEF = left ventricular ejection fraction; MRC = Medical Research Council; MLHFQ = Minnesota Living with Heart Failure Questionnaire; 6MWD = six-minute walking distance; N/I = no information; PASE = Physical Activity Scale for Elderly; LF/HF = low frequency/high frequency; QoL = quality of life.