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      Have You Met Your METs? – Enhancing Patient Motivation to Achieve Physical Activity Targets in Cardiac Tele-rehabilitation

      1 , 2 , 3 , 4 , 1

      Proceedings of the 32nd International BCS Human Computer Interaction Conference (HCI)

      Human Computer Interaction Conference

      4 - 6 July 2018

      Patient-centred computing, Self-management, Patient Motivation, Secondary Prevention, Tele-rehabilitation, Intelligibility, Self-awareness

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          Abstract

          Physical exercise is a primary component of cardiac rehabilitation. Interpreting exercise targets and being aware of the expected effort while rehabilitating independently at home is challenging for patients. Our work aims to assist cardiac patients in understanding their condition better and motivating them to achieve their exercise targets in a tele-rehabilitation setting. We introduce a patient-centric intelligible visualization approach to present prescribed rehabilitation targets to patients based on Metabolic Equivalent of Tasks (METs). We assessed efficacy of intelligible visualizations on patients’ comprehension in a lab study. We evaluated the impact on patient motivation and health outcomes in field studies. Patients were able to manage their prescribed activities, monitor their progress, and gained understanding on how their physical activities contribute to their rehabilitation targets. Patients confirmed that the intelligible visualizations motivated them to achieve their targets better. We observed an improvement in overall physical activity levels and health outcomes of patients.

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          Most cited references 15

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          Objective vs. Self-Reported Physical Activity and Sedentary Time: Effects of Measurement Method on Relationships with Risk Biomarkers

          Purpose Imprecise measurement of physical activity variables might attenuate estimates of the beneficial effects of activity on health-related outcomes. We aimed to compare the cardiometabolic risk factor dose-response relationships for physical activity and sedentary behaviour between accelerometer- and questionnaire-based activity measures. Methods Physical activity and sedentary behaviour were assessed in 317 adults by 7-day accelerometry and International Physical Activity Questionnaire (IPAQ). Fasting blood was taken to determine insulin, glucose, triglyceride and total, LDL and HDL cholesterol concentrations and homeostasis model-estimated insulin resistance (HOMAIR). Waist circumference, BMI, body fat percentage and blood pressure were also measured. Results For both accelerometer-derived sedentary time ( 50% lower for the IPAQ-reported compared to the accelerometer-derived measure (p<0.0001 for both interactions). The relationships for moderate-to-vigorous physical activity (MVPA) and risk factors were less strong than those observed for sedentary behaviours, but significant negative relationships were observed for both accelerometer and IPAQ MVPA measures with glucose, and insulin and HOMAIR values (all p<0.05). For accelerometer-derived MVPA only, additional negative relationships were seen with triglyceride, total cholesterol and LDL cholesterol concentrations, BMI, waist circumference and percentage body fat, and a positive relationship was evident with HDL cholesterol (p = 0.0002). Regression coefficients for HOMAIR, insulin and triglyceride were 43–50% lower for the IPAQ-reported compared to the accelerometer-derived MVPA measure (all p≤0.01). Conclusion Using the IPAQ to determine sitting time and MVPA reveals some, but not all, relationships between these activity measures and metabolic and vascular disease risk factors. Using this self-report method to quantify activity can therefore underestimate the strength of some relationships with risk factors.
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            Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee.

            To understand reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee. A qualitative study, nested within a randomised controlled trial, examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis. In the intervention arm, participants undertook a series of simple exercises and repositioning of the kneecap using tape. In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions, guided by a topic schedule, to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy. Interviews were audiotaped, fully transcribed and analysed thematically according to the method of constant comparison. A model explaining factors influencing compliance was developed. Patients were interviewed at home. The study was nested within a pragmatic randomised controlled trial. Twenty participants in the intervention arm of the randomised trial were interviewed three months after they had completed the physiotherapy programme. Eight were interviewed again one year later. Initial compliance was high because of loyalty to the physiotherapist. Reasoning underpinning continued compliance was more complex, involving willingness and ability to accommodate exercises within everyday life, the perceived severity of symptoms, attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis. A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms. Non-compliance with physiotherapy, as with drug therapies, is common. From the patient's perspective, decisions about whether or not to comply are rational but often cannot be predicted by therapists or researchers. Ultimately, this study suggests that health professionals need to understand reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention.
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              The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: A systematic review and meta-analysis of randomized and non-randomized studies – The Cardiac Rehabilitation Outcome Study (CROS)

              Background The prognostic effect of multi-component cardiac rehabilitation (CR) in the modern era of statins and acute revascularisation remains controversial. Focusing on actual clinical practice, the aim was to evaluate the effect of CR on total mortality and other clinical endpoints after an acute coronary event. Design Structured review and meta-analysis. Methods Randomised controlled trials (RCTs), retrospective controlled cohort studies (rCCSs) and prospective controlled cohort studies (pCCSs) evaluating patients after acute coronary syndrome (ACS), coronary artery bypass grafting (CABG) or mixed populations with coronary artery disease (CAD) were included, provided the index event was in 1995 or later. Results Out of n = 18,534 abstracts, 25 studies were identified for final evaluation (RCT: n = 1; pCCS: n = 7; rCCS: n = 17), including n = 219,702 patients (after ACS: n = 46,338; after CABG: n = 14,583; mixed populations: n = 158,781; mean follow-up: 40 months). Heterogeneity in design, biometrical assessment of results and potential confounders was evident. CCSs evaluating ACS patients showed a significantly reduced mortality for CR participants (pCCS: hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.20–0.69; rCCS: HR 0.64, 95% CI 0.49–0.84; odds ratio 0.20, 95% CI 0.08–0.48), but the single RCT fulfilling Cardiac Rehabilitation Outcome Study (CROS) inclusion criteria showed neutral results. CR participation was also associated with reduced mortality after CABG (rCCS: HR 0.62, 95% CI 0.54–0.70) and in mixed CAD populations. Conclusions CR participation after ACS and CABG is associated with reduced mortality even in the modern era of CAD treatment. However, the heterogeneity of study designs and CR programmes highlights the need for defining internationally accepted standards in CR delivery and scientific evaluation.
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                Author and article information

                Contributors
                Conference
                July 2018
                July 2018
                : 1-12
                Affiliations
                [1 ] Hasselt University-tUL-Expertise Center for Digital Media

                Diepenbeek, Belgium
                [2 ] Hasselt University-tUL- Flanders Make

                Expertise Center for Digital Media

                Diepenbeek, Belgium
                [3 ] Hasselt University- REVAL-BIOMED

                Heart Center, Hasselt, Belgium
                [4 ] Hasselt University- Faculty of Medicine and Life Sciences; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
                Article
                10.14236/ewic/HCI2018.48
                © Sankaran et al. Published by BCS Learning and Development Ltd. Proceedings of British HCI 2018. Belfast, UK.

                This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                Proceedings of the 32nd International BCS Human Computer Interaction Conference
                HCI
                32
                Belfast, UK
                4 - 6 July 2018
                Electronic Workshops in Computing (eWiC)
                Human Computer Interaction Conference
                Product
                Product Information: 1477-9358BCS Learning & Development
                Self URI (journal page): https://ewic.bcs.org/
                Categories
                Electronic Workshops in Computing

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