Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial

  • Helle Spindler Department of Psychology and Behavioral Sciences, Aarhus University, Denmark http://orcid.org/0000-0002-7098-5699
  • Malene Hollingdal Cardiology Ward, Regional Hospital Viborg, Viborg, Denmark
  • Jens Refsgaard Cardiology Ward, Regional Hospital Viborg, Viborg, Denmark
  • Birthe Dinesen Laboratory for Welfare Technology - Telehealth & Telerehabilitation, Sport Sciences -Performance and Technology, Department of Health Science and Technology, Aalborg University, Denmark
Keywords: Heart failure, Motivation, Psychological distress, Telerehabilitation

Abstract

Concerns have been raised about motivation and psychological distress when implementing telerehabilitation in patients with heart failure. The current study compared conventional and telerehabilitation in two groups (n=67; n=70) of patients with heart failure at 0, 6, and 12 months on measures of motivation (Self-Determination Theory measures) and psychological distress (Hospital Anxiety and Depression scale). We found no significant changes in motivation across groups, although our telerehabilitation group had a slightly lower level of controlled motivation and higher levels of relatedness. In addition, there were no differences between groups with regard to psychological distress. This study demonstrates that telerehabilitation motivates patients with heart failure to the same degree as conventional rehabilitation, and that telerehabilitation is not associated with increased psychological distress. As such, telerehabilitation offers an alternative to conventional rehabilitation and addresses some of the barriers for participating in rehabilitation identified in the literature.

  

Author Biography

Helle Spindler, Department of Psychology and Behavioral Sciences, Aarhus University, Denmark

Associate Professor, Department of Psychology and Behavioral Sciences

References

Anderson, L., Sharp, G. A., Norton, R. J., Dalal, H., Dean, S. G., Jolly, K., Cowie, A., Zawada, A., & Taylor, R. S. (2017). Home‐based versus centre‐based cardiac rehabilitation. Cochrane database of systematic reviews, (6). https://doi.org/10.1002/14651858.CD007130.pub4

Balady, G. J., Ades, P. A., Bittner, V. A., Franklin, B. A., Gordon, N. F., Thomas, R. J., Tomaselli, G.F., & Yancy, C. W. (2011). Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: A presidential advisory from the American Heart Association. Circulation, 124(25), 2951-2960. https://doi.org/10.1161/CIR.0b013e31823b21e2

Batten, S. (2011). Essentials of acceptance and commitment therapy. Sage Publications.

Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of psychosomatic research, 52(2), 69-77. https://doi.org/10.1016/s0022-3999(01)00296-3

Brennan, D., Tindall, L., Theodoros, D., Brown, J., Campbell, M., Christiana, D., Smith, D., Cason, J., & Lee, A. (2010). A blueprint for telerehabilitation guidelines. International Journal of Telerehabilitation, 2(2), 31. https://doi.org/10.5195/ijt.2010.6063

Brouwers, R. W. M., van Exel, H. J., van Hal, J. M. C., Jorstad, H. T., de Kluiver, E. P., Kraaijenhagen, R. A., Kuijpers, M.J.C., van der Linde, M.R., Spee, R.F., Sunamura, M., Uszko-Lencer, N.H.M., Vromen, T., Wittekoek, M. E., & Kemps, H.M..C., on behalf of the Committee for Cardiovascular Prevention and Cardiac Rehabilitation of the Netherlands Society of Cardiology. (2020). Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Netherlands Heart Journal, 28, 443-451. https://doi.org/10.1007/s12471-020-01432-y

Buck, H. G., Lee, C. S., Moser, D. K., Albert, N. M., Lennie, T., Bentley, B., Worrall-Carter, L., & Riegel, B. (2012). Relationship between self-care and health-related quality of life in older adults with moderate to advanced heart failure. Journal of Cardiovascular Nursing, 27(1), 8-15. https://doi.org/10.1097/jcn.0b013e3182106299

Burns, A., Höfer, S., Curry, P., Sexton, E., & Doyle, F. (2014). Revisiting the dimensionality of the Hospital Anxiety and Depression Scale in an international sample of patients with ischaemic heart disease. Journal of Psychosomatic Research, 77(2), 116-121. https://doi.org/10.1097/jcn.0b013e3182106299

Cho, Y. M., Lee, S., Islam, S. M. S., & Kim, S. Y. (2018). Theories applied to m-health interventions for behavior change in low-and middle-income countries: A systematic review. Telemedicine and e-Health, 24(10), 727-741. https://doi.org/10.1089/tmj.2017.0249

Clemensen, J., Rothmann, M. J., Smith, A. C., Caffery, L. J., & Danbjorg, D. B. (2017). Participatory design methods in telemedicine research. Journal of telemedicine and telecare, 23(9), 780-785. https://doi.org/10.1177/1357633x16686747

Cook, C., Cole, G., Asaria, P., Jabbour, R., & Francis, D. P. (2014). The annual global economic burden of heart failure. International Journal of Cardiology, 171(3), 368-376. https://doi.org/10.1016/j.ijcard.2013.12.028

Cranen, K., Drossaert, C. H., Brinkman, E. S., Braakman‐Jansen, A. L., IJzerman, M. J., & Vollenbroek‐Hutten, M. M. (2012). An exploration of chronic pain patients’ perceptions of home telerehabilitation services. Health Expectations, 15(4), 339-350. https://doi.org/10.1111/j.1369-7625.2011.00668.x

Dalleck, L. C., Schmidt, L. K., & Lueker, R. (2011). Cardiac rehabilitation outcomes in a conventional versus telemedicine-based programme. Journal of Telemedicine and Telecare, 17(5), 217-221. https://doi.org/10.1258/jtt.2010.100407

Dinesen, B., Dittmann, L., Gade, J. D., Jørgensen, C. K., Hollingdal, M., Leth, S., Melholt, C., Spindler, H., & Refsgaard, J. (2019). “Future patient” telerehabilitation for patients with heart failure: Protocol for a randomized controlled trial. JMIR Research Protocols, 8(9), e14517. https://doi.org/10.2196/14517

Dinesen, B., Nonnecke, B,; Lindeman, D., Toft, E., Kidholm, K., Jethwani, K., Young, H.M., Spindler, H., Oestergaard, C.U., Southard, J.A., Gutierrez, M., Anderson, N., Albert, N.M., Han, J.J., & Nesbitt, T. (2016) Personalized telehealth in the future: A global research agenda. Journal of Medical Internet Research. 18, e53. https://doi.org/10.2196/jmir.5257

Egede, L. E., & Osborn, C. Y. (2010). Role of motivation in the relationship between depression, self-care, and glycemic control in adults with type 2 diabetes. Diabetes Educator, 36(2), 276-283. https://doi.org/10.1177/0145721710361389

Emons, W. H., Sijtsma, K., & Pedersen, S. S. (2012). Dimensionality of the Hospital Anxiety and Depression Scale (HADS) in cardiac patients: Comparison of Mokken scale analysis and factor analysis. Assessment, 19(3), 337-353. https://doi.org/10.1177/1073191110384951

Frederix, I., Vanhees, L., Dendale, P., & Goetschalckx, K. (2015). A review of telerehabilitation for cardiac patients. Journal of Telemedicine and Telecare, 21(1), 45-53. https://doi.org/10.1177/1357633x14562732

Gillison, F. B., Rouse, P., Standage, M., Sebire, S. J., & Ryan, R. M. (2019). A meta-analysis of techniques to promote motivation for health behaviour change from a self-determination theory perspective. Health Psychology Review, 13(1), 110-130. https://doi.org/10.1080/17437199.2018.1534071

Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results. Journal of Psychosomatic Research, 42(1), 17-41. https://doi.org/10.1016/S0022-3999(96)00216-4

Jaarsma, T., Cameron, J., Riegel, B., & Stromberg, A. (2017). Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: A literature update. Current Heart Failure Reports, 14(2), 71-77. https://doi.org/10.1007/s11897-017-0324-1

Jaarsma, T., Strömberg, A., Mårtensson, J., & Dracup, K. (2003). Development and testing of the European heart failure self‐care behaviour scale. European Journal of Heart Failure, 5(3), 363-370. https://doi.org/10.1016/s1388-9842(02)00253-2

Joensson, K., Melholt, C., Hansen, J., Leth, S., Spindler, H., Olsen, M. V., & Dinesen, B. (2019). Listening to the patients: Using participatory design in the development of a cardiac telerehabilitation web portal. mHealth, 5, [33]. https://doi.org/10.21037/mhealth.2019.08.06

Kessing, D., Denollet, J., Widdershoven, J., & Kupper, N. (2016). Psychological determinants of heart failure self-care: Systematic review and meta-analysis. Psychosomatic Medicine, 78(4), 412-431. https://doi.org/10.1097/psy.0000000000000270

Knudsen, M. V., Laustsen, S., Petersen, A. K., Hjortdal, V. E., & Angel, S. (2019). Experience of cardiac tele-rehabilitation: Analysis of patient narratives. Disability and Rehabilitation, 1-8. https://doi.org/10.1080/09638288.2019.1625450

Lee, C. S., Moser, D. K., Lennie, T. A., & Riegel, B. (2011). Event-free survival in adults with heart failure who engage in self-care management. Heart & Lung, 40(1), 12-20. https://doi.org/10.1016/j.hrtlng.2009.12.003

Martin, C. R., Thompson, D. R., & Barth, J. (2008). Factor structure of the Hospital Anxiety and Depression Scale in coronary heart disease patients in three countries. Journal of Evaluation in Clinical Practice, 14(2), 281-287. https://doi.org/10.1111/j.1365-2753.2007.00850.x

McAlister, F. A., Stewart, S., Ferrua, S., & McMurray, J. J (2004). Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials. Journal of the American College of Cardiology, 44, 810–819. https://doi.org/10.1016/j. jacc.2004.05.055

McLean, S., Protti, D., & Sheikh, A. (2011). Telehealthcare for long term conditions. Bmj, 342. https://doi.org/10.1136/bmj.d120

Pâquet, M., Bolduc, N., Xhignesse, M., & Vanasse, A. (2005). Re‐engineering cardiac rehabilitation programmes: Considering the patient's point of view. Journal of Advanced Nursing, 51(6), 567-576. https://doi.org/10.1111/j.1365-2648.2005.03544.x

Piotrowicz, E. (2017). The management of patients with chronic heart failure: The growing role of e-Health. Expert Review of Medical Devices, 14(4), 271-277. https://doi.org/10.1080/17434440.2017.1314181

Piotrowicz, E., Baranowski, R., Bilinska, M., Stepnowska, M., Piotrowska, M., Wójcik, A., Korewicki, J., Chojnowska, L., Malek, L., Klopotowski, M., Piotrowski, W., & Piotrowicz, R. (2010). A new model of home‐based telemonitored cardiac rehabilitation in patients with heart failure: Effectiveness, quality of life, and adherence. European Journal of Heart Failure, 12(2), 164-171. https://doi.org/10.1093/eurjhf/hfp181

Piotrowicz, E., Piepoli, M. F., Jaarsma, T., Lambrinou, E., Coats, A. J., Schmid, J. P., Corrà, U., Agostoni, P., Dickstein, K., Seferović, P.M., Adamopoulos, S., & Ponikowski, P. P. (2016). Telerehabilitation in heart failure patients: The evidence and the pitfalls. International Journal of Cardiology, 220, 408-413. https://doi.org/10.1016/j.ijcard.2016.06.277

Rahman, R. J., Hudson, J., Thøgersen-Ntoumani, C., & Doust, J. H. (2015). Motivational processes and well-being in cardiac rehabilitation: A self-determination theory perspective. Psychology, Health & Medicine, 20(5), 518-529. https://doi.org/10.1080/13548506.2015.1017509

Ryan, R. M., Patrick, H., Deci, E. L., & Williams, G. C. (2008). Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. The European Health Psychologist, 10(1), 2-5. https://doi.org/10.1186/1479-5868-9-18

Savarese, G., & Lund, L. H. (2017). Global public health burden of heart failure. Cardiac Failure Review, 3(1), 7.

Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological methods, 7(2), 147.https://doi.org/10.15420/cfr.2016:25:2

Scherer, M., Himmel, W., Stanske, B., Scherer, F., Koschack, J., Kochen, M. M., & Herrmann-Lingen, C. (2007). Psychological distress in primary care patients with heart failure: A longitudinal study. British Journal of General Practice, 57(543), 801-807.

Schumi, J., & Wittes, J. T. (2011). Through the looking glass: Understanding non-inferiority. Trials, 12(1), 1-12.

Schweitzer, R. D., Head, K., & Dwyer, J. W. (2007). Psychological factors and treatment adherence behavior in patients with chronic heart failure. Journal of Cardiovascular Nursing, 22(1), 76-83. https://doi.org/10.1097/00005082-200701000-00012

Shen, B. J., & Maeda, U. (2018). Psychosocial predictors of self-reported medical adherence in patients with heart failure over 6 months: An examination of the influences of depression, self-efficacy, social support, and their changes. Annals of Behavioral Medicine, 52(7), 613-619. https://doi.org/10.1007/s12529-011-9215-0

Spindler, H., Leerskov, K., Joensson, K., Nielsen, G., Andreasen, J. J., & Dinesen, B. (2019). Conventional rehabilitation therapy versus telerehabilitation in cardiac patients: A comparison of motivation, psychological distress, and quality of life. International Journal of Environmental Research and Public Health, 16(3), 512. https://doi.org/10.3390/ijerph16030512

Sundhedsstyrelsen. (2015). National klinisk retningslinje for hjerterehabilitering. Sundhedsstyrelsen, 3-62. https://www.sst.dk/da/udgivelser/2015/~/media/401919781C684EE9AAE544EB5E76847B.ashx

Sweet, S. N., Tulloch, H., Fortier, M. S., Pipe, A. L., & Reid, R. D. (2011). Patterns of motivation and ongoing exercise activity in cardiac rehabilitation settings: A 24-month exploration from the TEACH Study. Annals of Behavioral Medicine, 42(1), 55-63. https://doi.org/10.1007/s12160-011-9264-2

Tang, H. Y., Sayers, S. L., Weissinger, G., & Riegel, B. (2014). The role of depression in medication adherence among heart failure patients. Clinical Nursing Research, 23(3), 231-244. https://doi.org/10.1177/1054773813481801

Toback, M., & Clark, N. (2017). Strategies to improve self-management in heart failure patients. Contemporary Nurse, 53(1), 105-120. https://doi.org/10.1080/10376178.2017.1290537

Williams, G. C., Ryan, R. M., & Deci, E.L. (2004). Health-care, self-determination theory packet. http://selfdeterminationtheory.org/health-care-self-determination-theory/

Yohannes, A. M., Doherty, P., Bundy, C., & Yalfani, A. (2010). The long‐term benefits of cardiac rehabilitation on depression, anxiety, physical activity and quality of life. Journal of Clinical Nursing, 19(19‐20), 2806-2813. https://doi.org/10.1111/j.1365-2702.2010.03313.x

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x

Published
2021-05-18
How to Cite
Spindler, H., Hollingdal, M., Refsgaard, J., & Dinesen, B. (2021). Motivating Patients in Cardiac Rehabilitation Programs: A Multicenter Randomized Controlled Trial . International Journal of Telerehabilitation, 13(1). https://doi.org/10.5195/ijt.2021.6365
Section
Research