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. 2025 Jan 16;15(1):ibae068.
doi: 10.1093/tbm/ibae068.

Advancing translational research in digital cardiac rehabilitation: The preparation phase of the Multiphase Optimization Strategy

Eanna Kenny  1 , John W McEvoy  2   3 , Jenny McSharry  1 , Rod S Taylor  4 , Molly Byrne  1
Affiliations

Advancing translational research in digital cardiac rehabilitation: The preparation phase of the Multiphase Optimization Strategy

Eanna Kenny et al. Transl Behav Med. .

Abstract

While digital cardiac rehabilitation (CR) is an effective alternative to center-based CR, its components and mechanisms of change remain poorly understood. The Multiphase Optimization Strategy (MOST) provides a framework that allows the effects of individual components of complex interventions to be studied. There is limited guidance within MOST on how to develop a conceptual model. This article describes the development of a conceptual model of digital CR. The conceptual model was developed based on several strands of evidence: (i) a systematic review of 25 randomized controlled trials to identify the behavior change techniques in digital CR interventions, (ii) a qualitative study of patients' (n = 11) perceptions of the mechanisms of digital CR, and (iii) a review of international guidelines. Tools and frameworks from behavioral science, including the Behaviour Change Wheel, Capability, Opportunity, Motivation and Behavior model, and Theoretical Domains Framework were used to integrate the findings. An initial conceptual model of digital CR was developed and then refined through discussion. The conceptual model outlines the causal process through which digital CR can enhance outcomes for patients with cardiovascular disease. The model illustrates the key intervention components (e.g. goal setting and self-monitoring, education, exercise training), targeted outcomes (e.g. physical activity, healthy eating, medication adherence), and theorized mediating variables (e.g. knowledge, beliefs about capability). The article provides an example of how behavioral science frameworks and tools can inform the preparation phase of MOST. The developed conceptual model of digital CR will inform guide decision-making in a future optimization trial.

Keywords: Multiphase Optimization Strategy; behavior change; behavioral science; cardiac rehabilitation; cardiovascular disease; digital.

Plain language summary

Digitally delivered cardiac rehabilitation (CR) appears to be effective at improving outcomes for patients with cardiovascular disease. However, the specific elements that make these interventions effective are not clear. The Multiphase Optimization Strategy is an approach that can help identify these effective elements. In the preparation phase of this approach, a key aim is to develop a conceptual model that outlines how the intervention is expected to work. This article describes how we developed a conceptual model of digital CR by reviewing the evidence from randomized controlled trials, interviewing patients who attended a digital CR program, and reviewing international rehabilitation guidelines. We used tools and frameworks from behavioral science, such as the Behaviour Change Wheel, to pull together the findings from these three sources. This article provides researchers with an example of how the findings from different studies can be used to develop a conceptual model. The conceptual model that we developed will be used to guide decision-making in a future optimization trial of digital CR.

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Figures

Figure 1
Figure 1
COM-B factors, TDF domains, and explanatory themes identified during the qualitative analysis
Figure 2
Figure 2
Conceptual model of digital cardiac rehabilitation
See this image and copyright information in PMC

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