E-coaching: New future for cardiac rehabilitation? A systematic review

Highlights

• E-coaching can be an effective tool to be used for cardiac rehabilitation.

• At follow-up, complex e-coaching seems to be more effective than usual care.

• However, it remains unclear which components of e-coaching are most effective.

• The content of e-coaching programs should be described more clearly and precisely.

Abstract

Objective

To provide an evidence-based overview of the effectiveness of e-coaching as a cardiac rehabilitation program (CRP).

Methods

Pubmed, Embase, PEDro and CINAHL were searched to identify relevant RCTs. The e-coaching programs were divided into basic or complex depending on their content. Two reviewers independently assessed the methodological quality and extracted the data. A best-evidence synthesis was used to summarize the results.

Results

19 RCTs were included. Detailed descriptions of the e-coaching programs were lacking. Complex e-coaching was more effective than usual-care for physical capacity (moderate evidence for short-, and mid-term; strong evidence for long-term), for clinical status (limited evidence for short- and mid-term; moderate evidence for the long-term), and for psychosocial health (moderate evidence for short-term; strong evidence for mid-, and long-term). For basic e-coaching only limited or no evidence for effectiveness was found.

Conclusion

Promising results were found for the effectiveness of complex e-coaching as a CRP to improve a patients’ physical capacity, clinical status and psychosocial health.

Practice implications

The content of the e-coaching programs were not clearly described. This makes it difficult to identify which components of e-coaching are most effective and should be further developed to deliver the most optimal care for cardiac rehabilitation patients.

Introduction

Cardiovascular disease (CVD) is the number one cause of death globally [1]. Cardiac rehabilitation (CR) is a medical supervised secondary prevention program that aims to improve the cardiovascular health of patients with a history of CVD [2]. CR mainly consists of supervised physiotherapy, as well as health education and psychosocial intervention conducted primarily in the hospital [2].

Currently, CR reduces hospitalization and improves health-related quality of life [3]. Also, CR patients are 32% less likely to die prematurely compared to non-CR participants [4]. Unfortunately, only 15–50% of patients maintain regular exercise 6 months after CR completion [5], [6], [7]. Moreover, only <50% of the eligible patient for CR actually participates in CR [2], [4], [8]. There are numerous reasons why a patient might be unable to attend CR sessions at the hospital, but a main limitation for CR uptake is the geographical barrier [9], for example patients may be unable to obtain transportation to the CR healthcare facilities.

Technology and internet have become an essential part of daily life and use of the internet to investigate medical information is expanding [10]. This applies particularly to use of online health-related social networks, which help patients feel connected to others in a similar situation [11]. The internet is used as a platform to provided many types of similar, but slightly different, medical services, including: e-coaching, e-health, telehealth, teleguidence, telemedicine, etc. Our review will focus on e-coaching. Unfortunately, a general consensus has not yet been reached on the definition of e-coaching. In this paper e-coaching is defined as an online communication system that provides medical assistance to a patient at home. This should not be confused with telemonitoring, where the patient’s vital signs are monitored at home [12].

E-coaching can provide online health-related networks, as well as providing accurate medical information. Therefore, e-coaching might play a positive role in solving the above-mentioned challenges for CR. E-coaching could help CR patients to achieve a more physical active lifestyle, which may improve recovery and reduce associated adverse effects. In addition, e-coaching can help to support patients’ adherence to lifestyle changes and self-care, even after the completion of CR. Furthermore, e-coaching is: i) primarily conducted at home, ii) convenient for the patient, iii) allows for anonymity and iv) can offer a variety of options compared to face-to-face interventions. Internet-based exercise interventions already showed to be successful in improving lifestyle changes in other populations, such as obesity [13], [14], [15]. In addition, home training is considered safe for heart failure patients [16].

Therefore, e-coaching may offer the possibility for more cardiac patients to participate in CR and provide them with long-term support. However, because there is a lack of clarity about the effectiveness of e-coaching in CR patients, this review investigates the effectiveness of e-coaching as a CR program in order to establish its clinical relevance.