Title: Telehealth Home ExerciseDisease Management for Heart Failure: A Pilot Study
1Telehealth Home Exercise/Disease Management for
Heart Failure A Pilot Study
- Jill M. Winters, PhD, RN,
- Mary Ann Papp, DO, FACC,
- Susan Cashin, PhD,
- Heather Seubert, BSN, RN
2Acknowledgments
- This study funded in part by
- NIH NINR 5R03NR009223-02
- American Nurses Foundation Virginia Stone Grant
3Background Significance
- Affects approximately 5 million Americans
- Heart failure (HF) is the leading cause of death
in this country - Single most costly health care problem in US
4- Exercise is a key factor for managing HF
- Low levels of exercise are associated with HF
- A user-centered telehealth-supported home-based
exercise program may enhance functional
performance, psychological well-being,
health-related quality of life (QOL)
5Purpose
- Compare effects of a 12-week telehealth home
exercise rehabilitation disease management
program with usual treatment
6Design
- Prospective, 2 group, experimental design
- R Experimental O1 I O2
-
- R Attention/Control O1 A O2
7Conceptual Framework
Science of Optimizing Rehab Intervention
Strategies (e.g., timing, frequency, intensity,
duration) Plan for Assessment (e.g., what,
when, where, why)
Consumer/ Client
Heart Failure
? Outcomes
Science of Optimizing Human-Technology User
Interfaces (e.g., convenience, usability,
effectiveness, reliability, accessibility)
Science of Behavioral Lifestyle
Modification (e.g., communication, motivation,
support, feedback)
Healthcare Provider
Winters Winters, 2004
Science of Optimizing Rehab Intervention
Strategies (e.g., timing, frequency, intensity,
duration) Plan for Assessment (e.g., what,
when, where, why)
Science of Optimizing Rehab Intervention
Strategies (e.g., timing, frequency, intensity,
duration) Plan for Assessment (e.g., what,
when, where, why)
Science of Optimizing Rehab Intervention
Strategies (e.g., timing, frequency, intensity,
duration) Plan for Assessment (e.g., what,
when, where, why)
Heart Failure
Heart Failure
Heart Failure
Science of Optimizing Human-Technology User
Interfaces (e.g., convenience, usability,
effectiveness, reliability, accessibility)
Science of Behavioral Lifestyle
Modification (e.g., communication, motivation,
support, feedback)
Healthcare Provider
Science of Optimizing Human-Technology User
Interfaces (e.g., convenience, usability,
effectiveness, reliability, accessibility)
Science of Behavioral Lifestyle
Modification (e.g., communication, motivation,
support, feedback)
Healthcare Provider
Science of Optimizing Human-Technology User
Interfaces (e.g., convenience, usability,
effectiveness, reliability, accessibility)
Science of Behavioral Lifestyle
Modification (e.g., communication, motivation,
support, feedback)
Healthcare Provider
8Method
- Baseline measures
- Submaximal 15 watt constant exercise test
- 6-minute walk test
- Minnesota Living with Heart Failure (QOL)
- Profile of Mood States (psychological well-being)
- All measures repeated after 12-weeks
9Experimental Group
- Exercise prescription
- Semi-recumbent stationary bike
- Telemonitoring equipment
- Polar monitor
- Exercise log
- Videoconferencing
- 3x/week first month
- 2x/month second month
- 1x/month third month
- prn
10Control Group
- Exercise prescription
- Called q2weeks to maintain involvement track
utilization of healthcare services
11Hypothesis
- Experimental participants will have greater
improvements in functional performance,
psychological well-being, QOL than those in the
control group
12Research Questions
- What is the cost associated with implementing a
home-based disease management/exercise program
for persons with moderate heart failure? - What is the level of satisfaction participants
will have with a home-based disease
management/home exercise program?
13Results to Date
14Sample (n26 of 36)
- Typical Subject
- Male (69)
- 60 years of age (34-80)
- African American (58)
- Never exercise (44)
15Functional Performance
- Measured by 6-minute walk test
- t2.1, p.05
16Psychological Well-Being
- Measured by the Profile of Mood Scales
- Total t2.97, p.009
- Tension t2.08, p.05
- Depression t2.93, p.01
- Fatigue t2.22, p.04
17Quality of Life
- Measured by Minnesota Living with Heart Failure
Instrument - Total t-1.6, p.12
- Physical t-2.2, p.04
- Emotional t.09, p.93
18Cost of Implementing Program
- Items included in analysis
- Nursing time
- Equipment
- Equipment set-up, delivery, pick-up
- Home visits
- Unscheduled clinic, emergency room, or hospital
admissions and/or visits related to HF
19- Experimental subjects 850/subject (mean)
- Control subjects 15/subject (mean)
- No subjects in either group had any unscheduled
clinic, emergency room, or hospital admissions
/or visits related to HF
20Participant Satisfaction
- 34-item Program Evaluation Form used
- Items scaled on 4-point Likert-type scale
- 1Strongly agree to 4Strongly disagree
- Mean score 1.47
21- Items with highest level of satisfaction
- Comfort with equipment (1.13)
- Family member comfortable with equipment (1.20)
- Items with lowest level of satisfaction
- Equipment worked like it was supposed to (2.14)
- Use of teleconferencing was helpful (2.20)
22Implications
- A user-centered telehealth home exercise/disease
management program may be a viable option for
improving functional performance, psychological
well-being, QOL in persons with moderate heart
failure - Small sample size limits generalizability
- Questions still remain as to necessary levels of
contact technology to achieve positive outcomes
23Thank You
Questions?