title: Home-based versus in-hospital cardiac rehabilitation after cardiac surgery: a nonrandomized controlled study.
abstract: BACKGROUND
  Exercise rehabilitation after cardiac surgery has beneficial effects, especially on a long-term basis. Rehabilitative programs with telemedicine plus appropriate technology might satisfy the needs of performing rehabilitation at home.
  
  
  OBJECTIVE
  The purpose of this study was to compare exercise capacity after home-based cardiac rehabilitation (HBCR) or in-hospital rehabilitation in patients at low to medium risk for early mortality (EuroSCORE 0-5) following cardiac surgery.
  
  
  METHODS
  A quasi-experimental study was conducted.
  
  
  METHODS
  At hospital discharge, patients were given the option to decide whether to enroll in the HBCR program. Clinical examinations (electrocardiography, cardiac echo color Doppler, chest radiography, blood samples) of patients in the HBCR group were collected during 4 weeks of rehabilitation, and exercise capacity (assessed using the Six-Minute Walk Test [6MWT]) was assessed before and after rehabilitation. A group of patients admitted to the in-hospital rehabilitation program was used as a comparison group. Patients in the HBCR group were supervised at home by a medical doctor and telemonitored daily by a nurse and physical therapist by video conference. Periodic home visits by health staff also were performed.
  
  
  RESULTS
  One hundred patients were recruited into the HBCR group. An equal number of patients was selected for the comparison group. At the end of the 4-week study, the 2 groups showed improvement from their respective baseline values only in the 6MWT. No difference was found in time × group interaction.
  
  
  CONCLUSIONS
  Because patients self-selected to enroll in the HBCR program and because they were enrolled from a single clinical center, the results of the study cannot be generalized.
  
  
  CONCLUSIONS
  In patients who self-selected HBCR, the program was found to be effective and comparable to the standard in-hospital rehabilitative approach, indicating that rehabilitation following cardiac surgery can be implemented effectively at home when coadministered with an integrated telemedicine service.
authors.affiliation: Telemedicine Service, Fondazione Salvatore Maugeri, Institute for Care and Scientific Research (IRCCS), Via Giuseppe Mazzini, 129-25065 Lumezzane, Brescia, Italy. simonetta.scalvini@fsm.it
authors.forename: Simonetta
authors.initials: S
authors.lastname: Scalvini
authors.forename: Emanuela
authors.initials: E
authors.lastname: Zanelli
authors.forename: Laura
authors.initials: L
authors.lastname: Comini
authors.forename: Margherita
authors.initials: M
authors.lastname: Dalla Tomba
authors.forename: Giovanni
authors.initials: G
authors.lastname: Troise
authors.forename: Oreste
authors.initials: O
authors.lastname: Febo
authors.forename: Amerigo
authors.initials: A
authors.lastname: Giordano
mesh_terms: D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017216:Telemedicine; D016896:Treatment Outcome