A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP)

Abstract

Background: Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT).

Methods/design: We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines.

Discussion: The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients.

Trial registration: The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) with number ACTRN12609000251224.

Figure 1

CAP System diagram. The mobile phone acts as the communication medium through which a) the Community Care Tam provides mentoring and goal setting, b) daily motivational messages, educational videos and relaxation audio are sent, and c) self observations and measurements are entered to the Wellness Diary application. All data is synchronised and stored on a daily basis to a Wellness Diary Connected portal on a remote server.

Figure 2

Wellness Diary Connected web-portal, Dashboard view. Arbitrarily chosen patient's data on the Wellness Diary Connected web-portal at the end of the 6 week rehabilitation program. The top of the screen shows the Goal Tracker bar graph used to set and follow personal goals for reducing smoking and increasing exercise duration. The Smoking chart shows the patients self-recorded daily amount of cigarettes (6-8/day). The Blood Pressure and Weight charts depict the measured values during the past 2 weeks. Exercise by Duration chart shows the total amount of exercise (average 120 min/day) and the Steps daily chart the patient's walking activity (2000-5000 steps/day) measured with the phone's inbuilt accelerometer. Sleeping chart shows the self-reported sleeping time (5-8 h/night).

Figure 3

RCT Design block diagram. The study is a prospective randomized comparison of a traditional cardiac rehabilitation program versus a mobile phone based cardiac rehabilitation program that utilises information and communication technology. The study includes patients with STEMI or NSTEMI referred for Phase 2 rehabilitation.