Devi Reena, Powell John, Singh Sally
Coventry University, Applied Research Centre in Health and Lifestyle Interventions, Coventry, United Kingdom.
J Med Internet Res. 2014 Sep 12;16(9):e186. doi: 10.2196/jmir.3340.
Angina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative.
Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina.
We conducted a randomized controlled trial, recruiting those diagnosed with angina from general practitioners (GPs) in primary care to an intervention or control group. Intervention group participants were offered a 6-week Web-based rehabilitation program ("ActivateYourHeart"). The program was introduced during a face-to-face appointment and then delivered via the Internet (no further face-to-face contact). The program contained information about the secondary prevention of coronary heart disease (CHD) and set each user goals around physical activity, diet, managing emotions, and smoking. Performance against goals was reviewed throughout the program and goals were then reset/modified. Participants completed an online exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room. Participants in the control group continued with GP treatment as usual, which consisted of being placed on a CHD register and attending an annual review. Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessments. The primary outcome measure was change in daily steps at 6 weeks, measured using an accelerometer. Secondary outcome measures were energy expenditure (EE), duration of sedentary activity (DSA), duration of moderate activity (DMA), weight, diastolic/systolic blood pressure, and body fat percentage. Self-assessed questionnaire outcomes included fat/fiber intake, anxiety/depression, self-efficacy, and quality of life (QOL).
A total of 94 participants were recruited and randomized to the intervention (n=48) or the usual care (n=46) group; 84 and 73 participants completed the 6-week and 6-month follow-ups, respectively. The mean number of log-ins to the program was 18.68 (SD 13.13, range 1-51), an average of 3 log-ins per week per participant. Change in daily steps walked at the 6-week follow-up was +497 (SD 2171) in the intervention group and -861 (SD 2534) in the control group (95% CI 263-2451, P=.02). Significant intervention effects were observed at the 6-week follow-up in EE (+43.94 kcal, 95% CI 43.93-309.98, P=.01), DSA (-7.79 minutes, 95% CI -55.01 to -7.01, P=.01), DMA (+6.31 minutes, 95% CI 6.01-51.20, P=.01), weight (-0.56 kg, 95% CI -1.78 to -0.15, P=.02), self-efficacy (95% CI 0.30-4.79, P=.03), emotional QOL score (95% CI 0.01-0.54, P=.04), and angina frequency (95% CI 8.57-35.05, P=.002). Significant benefits in angina frequency (95% CI 1.89-29.41, P=.02) and social QOL score (95% CI 0.05-0.54, P=.02) were also observed at the 6-month follow-up.
An Internet-based secondary prevention intervention could be offered to those with angina. A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness.
International Standard Randomized Controlled Trial Number (ISRCTN): 90110503; http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503 (Archived by WebCite at http://www.webcitation.org/6RYVOQFKM).
全球有超过5000万人患有心绞痛。诸如心脏康复等二级预防干预措施在这一人群中并未广泛普及。基于互联网的版本可能提供一种可行的替代方案。
我们的目的是检验基于网络的心脏康复项目对心绞痛患者的有效性。
我们进行了一项随机对照试验，从基层医疗的全科医生（GP）处招募被诊断为心绞痛的患者，分为干预组或对照组。干预组参与者接受为期6周的基于网络的康复项目（“激活你的心脏”）。该项目在面对面预约时介绍，然后通过互联网提供（不再有进一步的面对面接触）。该项目包含有关冠心病（CHD）二级预防的信息，并为每个用户设定围绕身体活动、饮食、情绪管理和吸烟的目标。在整个项目中会审查目标完成情况，然后重新设定/修改目标。参与者完成在线运动日记，并通过电子邮件链接/同步聊天室与康复专家交流。对照组参与者继续接受常规的全科医生治疗，包括被列入冠心病登记册并参加年度复查。在面对面评估时，在6周和6个月随访时测量结果。主要结局指标是6周时使用加速度计测量的每日步数变化。次要结局指标包括能量消耗（EE）、久坐活动时长（DSA）、中等强度活动时长（DMA）、体重、舒张压/收缩压和体脂百分比。自我评估问卷结果包括脂肪/纤维摄入量、焦虑/抑郁、自我效能感和生活质量（QOL）。
共招募了94名参与者并随机分为干预组（n = 48）或常规护理组（n = 46）；分别有84名和73名参与者完成了6周和6个月的随访。该项目的平均登录次数为18.68（标准差13.13，范围1 - 51），每位参与者平均每周登录3次。干预组在6周随访时每日步数变化为 +497（标准差2171），对照组为 -861（标准差2534）（95%可信区间263 - 2451，P = 0.02）。在6周随访时观察到干预在能量消耗（+43.94千卡，95%可信区间43.93 - 309.98，P = 0.01）、久坐活动时长（-7.79分钟，95%可信区间 -55.01至 -7.01，P = 0.01）、中等强度活动时长（+6.31分钟，95%可信区间6.01 - 51.20，P = 0.01）、体重（-0.56千克，95%可信区间 -1.78至 -0.15，P = 0.02）、自我效能感（95%可信区间0.30 - 4.79，P = 0.03）、情绪生活质量评分（95%可信区间0.01 - 0.54，P = 0.04）和心绞痛发作频率（95%可信区间8.57 - 35.05，P = 0.002）方面有显著效果。在6个月随访时，心绞痛发作频率（95%可信区间1.89 - 29.41，P = 0.02）和社会生活质量评分（95%可信区间0.05 - 0.54，P = 0.02）也有显著益处。
可以为心绞痛患者提供基于互联网的二级预防干预措施。需要进行更大规模的实用试验以提供有效性和成本效益的确切证据。
国际标准随机对照试验编号（ISRCTN）：90110503；http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503（由WebCite存档于http://www.webcitation.org/6RYVOQFKM）
