Telehealth Home ExerciseDisease Management for Heart Failure: A Pilot Study

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Telehealth 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

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Acknowledgments

• This study funded in part by
• NIH NINR 5R03NR009223-02
• American Nurses Foundation Virginia Stone Grant

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Background 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

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• 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)

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Purpose

• Compare effects of a 12-week telehealth home
  exercise rehabilitation disease management
  program with usual treatment

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Design

• Prospective, 2 group, experimental design
• R Experimental O1 I O2
• R Attention/Control O1 A O2

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Conceptual 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
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Method

• 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

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Experimental 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

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Control Group

• Exercise prescription
• Called q2weeks to maintain involvement track
  utilization of healthcare services

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Hypothesis

• Experimental participants will have greater
  improvements in functional performance,
  psychological well-being, QOL than those in the
  control group

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Research 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?

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Results to Date
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Sample (n26 of 36)

• Typical Subject
• Male (69)
• 60 years of age (34-80)
• African American (58)
• Never exercise (44)

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Functional Performance

• Measured by 6-minute walk test
• t2.1, p.05

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Psychological 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

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Quality 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

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Cost 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

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• 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

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Participant Satisfaction

• 34-item Program Evaluation Form used
• Items scaled on 4-point Likert-type scale
• 1Strongly agree to 4Strongly disagree
• Mean score 1.47

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• 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)

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Implications

• 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

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Thank You
Questions?