title: Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial.
abstract: OBJECTIVE
  Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI). This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients.
  
  
  METHODS
  In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n=60; 55.7±10.4 years) and CAP-CR (n=60; 55.5±9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants' homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression.
  
  
  RESULTS
  CAP-CR had significantly higher uptake (80% vs 62%), adherence (94% vs 68%) and completion (80% vs 47%) rates than TCR (p<0.05). Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks (TCR: 537±86-584±99 m; CAP-CR: 510±77-570±80 m), which was maintained at 6 months. CAP-CR showed slight weight reduction (89±20-88±21 kg) and also demonstrated significant improvements in emotional state (K10: median (IQR) 14.6 (13.4-16.0) to 12.6 (11.5-13.8)), and quality of life (EQ5D-Index: median (IQR) 0.84 (0.8-0.9) to 0.92 (0.9-1.0)) at 6 weeks.
  
  
  CONCLUSIONS
  This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services.
  
  
  BACKGROUND
  ANZCTR12609000251224.
authors: Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors: Marlien
authors: M
authors: Varnfield
authors: Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors: Mohanraj
authors: M
authors: Karunanithi
authors: Complex Chronic Disease Team, North Lakes Health Precinct, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
authors: Chi-Keung
authors: CK
authors: Lee
authors: Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia.
authors: Enone
authors: E
authors: Honeyman
authors: Complex Chronic Disease Team, North Lakes Health Precinct, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
authors: Desre
authors: D
authors: Arnold
authors: Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia.
authors: Hang
authors: H
authors: Ding
authors: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors: Catherine
authors: C
authors: Smith
authors: School of Medicine, University of Queensland, Brisbane, Queensland, Australia Department of Cardiology, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
authors: Darren L
authors: DL
authors: Walters
mesh_terms: D040421:Cell Phone / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000534:rehabilitation* / Q000628:therapy; D010349:Patient Compliance / Q000706:statistics & numerical data; D015397:Program Evaluation; D011793:Queensland; D012047:Rehabilitation Centers / Q000458:organization & administration; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013685:Telecommunications / Q000295:instrumentation; D016896:Treatment Outcome
keywords: MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)