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      The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology

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          Abstract

          The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.

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          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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                Author and article information

                Contributors
                Journal
                Eur J Prev Cardiol
                Eur J Prev Cardiol
                eurjpc
                European Journal of Preventive Cardiology
                Oxford University Press
                2047-4873
                2047-4881
                03 July 2020
                : 2047487320939671
                Affiliations
                [ ]Faculty of Medicine and Life Sciences, UHasselt – Hasselt University , Belgium
                [ ]Department of Cardiology, Jessa Hospital , Belgium
                [ ]Department of Cardiology, University Hospital of Bern , Switzerland
                [ ]Faculty of Rehabilitation Sciences, UHasselt – Hasselt University , Belgium
                [ ] BIOMED/REVAL (Rehabilitation Research Centre) , Belgium
                [ ]Heart Centre Hasselt, Jessa Hospital , Belgium
                [ ]Department of Rehabilitation Medicine, University of Potsdam , Germany
                [ ]Rehabilitation Centre for Internal Medicine, Klinik am See, Germany
                [ ]Department of Rehabilitation Sciences, KU Leuven , Belgium
                [ ]Faculty of Medicine and Health Sciences, Antwerp University , Belgium
                [ ]Intenisve Care Unit, Antwerp University Hospital , Belgium
                [ ]Department of Cardiology, Máxima Medical Center , The Netherlands
                [ ]Department of Industrial Design, Technical University Eindhoven , The Netherlands
                Author notes
                [*]Paul Dendale, Jessa Ziekenhuis, Stadsomvaart 11, Hasselt, Belgium. Email: paul.dendale@ 123456jessazh.be
                Article
                10.1177_2047487320939671
                10.1177/2047487320939671
                7928994
                32615796
                260a579c-64cc-47a8-8654-018f4af68008
                © The European Society of Cardiology 2020

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                History
                : 27 April 2020
                : 15 June 2020
                Categories
                Review
                AcademicSubjects/MED00200
                Custom metadata
                PAP

                covid-19,cardiovascular disease,telerehabilitation,comprehensive cardiac rehabilitation

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