Authors (including presenting author) :
Chiu SH1, Chan NY1, Raymond Fung1, Wu KY1, Kwok YC1, Snowball Ip1, Irene Wong1, John Chau1, Rebecca Law1, Anita Ngan1, Fanny Wong2, Joshua Leung2
Affiliation :
1) Cardiac Rehabilitation Team, Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China 2) Community Rehabilitation Network, the Hong Kong Society for Rehabilitation, Hong Kong SAR, China
Introduction :
Cardiac rehabilitation (CR) has been proven to maximize patient outcomes. Traditionally, CR programs are located in the hospital or community rehabilitation center setting. However, about 70% of patients refused to get to the rehabilitation centers due to various reasons. An alternative model: tele-cardiac rehabilitation has demonstrated safety and efficacy in several clinical studies. With the outbreak of COVID-19, the centered-based CR service was totally suspended. To facilitate patients to exercise at home while being monitored. A pilot home-based cardiac tele-rehabilitation program was developed with a structured protocol at Princess Margaret Hospital (PMH) and rolled out from October 2020.
Objectives :
1. To minimize the impact of suspension of in-hospital CR service due to outbreak of COVID-19. 2. To evaluate the effects and develop a home-based CR program for remote rehabilitation, based on advanced technological infrastructure and complementary clinical protocols.
Methodology :
Target patients: Low risk cardiac patients who fulfil the intake criteria, able and willing to use digital monitoring devices including blood pressure machine, smart watch and smart phone. Program design: The program will last for 12 weeks and consists of education, exercise training and relaxation training. Each consenting patient will be given a training kit containing a training log-book, informative educational leaflets and a set of QR codes to access our home-made education, exercise training & relaxation practice videos. Individual phone consultation by multidisciplinary will be scheduled once a week at the first five weeks. Patients can view the video at their own convenience, and then discuss or ask questions during phone follow-up. Individualized exercise consists of warm up and cool down, aerobic and resistive exercise will be prescribed according to patients’ age, mobility and cardio fitness level. Patients can follow the given video to do exercise at home. They will be instructed to measure and record their blood pressure, heart rate, and rate perceived exertion (RPE) before and after exercise. Physiotherapist will phone call patient at week 1, 2, 3, 4, 6 & 8 to monitor and coach patients according to their self-monitoring record. Implementation: All patients will undergo a detailed face-to-face assessment and evaluation by our rehabilitation team members at baseline and at 12-week. They are including 6-minute walk test, body mass index (BMI), waist circumference, blood test for lipid profile, etc. In addition, patients will also request to fill in a set of questionnaires to measure the physical activity level, functional performance and psychological fitness.
Result & Outcome :
Within 3 months, total 57 eligible patients were invited to join the program with 22(38.6%) patients enrolled successfully. The main reasons to exclude were due to lack of digital monitoring devices but not willing to buy by self or showed no interest in any format of rehabilitation training. It was encouraged that the uptake rate for home-based CR was better than the previous conventional centered-based CR. It is foreseeable that home-based CR will continue beyond COVID-19 to meet the special needs of patients. For the clinical beneficence, it should be further examined.
