open access

Vol 76, No 12 (2018)
Original articles
Published online: 2018-08-09
Submitted: 2018-06-13
Accepted: 2018-08-07
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Hybrid versus traditional cardiac rehabilitation models: a systematic review and meta-analysis

Congyin Wu, Yan Li, Juan Chen
DOI: 10.5603/KP.a2018.0175
·
Pubmed: 30251248
·
Kardiol Pol 2018;76(12):1717-1724.

open access

Vol 76, No 12 (2018)
Original articles
Published online: 2018-08-09
Submitted: 2018-06-13
Accepted: 2018-08-07

Abstract

Background: The common drawbacks of standard cardiac rehabilitation (CR) models include low participation rate, high cost, and dependence on on-site exercise sessions. Therefore, hybrid CR protocols have been developed.

Aim: We aimed to test whether hybrid CR models are superior or equivalent to the traditional CR models in patients after myocardial infarction, heart failure, and cardiac surgery, using a meta-analysis framework.

Methods: Data from relevant original studies indexed in the Medline, Scopus, Cochrane Central, and Web of Science data­bases were extracted and analysed. The standardised mean difference (SMD) was used as a summary effect estimate, along with 95% confidence interval (CI).

Results: Based on data from 1195 patients, the summary effect size showed similar improvement in functional capacity in hybrid and standard CR programmes (SMD = –0.04, 95% CI –0.18 to 0.09, p = 0.51). No significant difference was detected between the two models in terms of changes in exercise duration (SMD = –0.14, 95% CI –0.51 to 0.24, p = 0.47), systolic (SMD = –0.01, 95% CI –0.14 to 0.12, p = 0.91), and diastolic (SMD = –0.03, 95% CI –0.16 to 0.11, p = 0.7) blood pres­sure, or health-related quality of life (SMD = –0.08, 95% CI –0.23 to 0.07, p = 0.27). In terms of blood lipids, no significant difference was noted between hybrid and traditional CR models in all assessed lipid profile parameters, except for triglycerides (favouring the traditional CR model).

Conclusions: Hybrid CR protocols showed comparable efficacy to the traditional model. Further well-designed studies are required to validate these findings, especially regarding the long-term outcomes.

Abstract

Background: The common drawbacks of standard cardiac rehabilitation (CR) models include low participation rate, high cost, and dependence on on-site exercise sessions. Therefore, hybrid CR protocols have been developed.

Aim: We aimed to test whether hybrid CR models are superior or equivalent to the traditional CR models in patients after myocardial infarction, heart failure, and cardiac surgery, using a meta-analysis framework.

Methods: Data from relevant original studies indexed in the Medline, Scopus, Cochrane Central, and Web of Science data­bases were extracted and analysed. The standardised mean difference (SMD) was used as a summary effect estimate, along with 95% confidence interval (CI).

Results: Based on data from 1195 patients, the summary effect size showed similar improvement in functional capacity in hybrid and standard CR programmes (SMD = –0.04, 95% CI –0.18 to 0.09, p = 0.51). No significant difference was detected between the two models in terms of changes in exercise duration (SMD = –0.14, 95% CI –0.51 to 0.24, p = 0.47), systolic (SMD = –0.01, 95% CI –0.14 to 0.12, p = 0.91), and diastolic (SMD = –0.03, 95% CI –0.16 to 0.11, p = 0.7) blood pres­sure, or health-related quality of life (SMD = –0.08, 95% CI –0.23 to 0.07, p = 0.27). In terms of blood lipids, no significant difference was noted between hybrid and traditional CR models in all assessed lipid profile parameters, except for triglycerides (favouring the traditional CR model).

Conclusions: Hybrid CR protocols showed comparable efficacy to the traditional model. Further well-designed studies are required to validate these findings, especially regarding the long-term outcomes.

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Keywords

cardiac rehabilitation, functional capacity, hybrid, meta-analysis

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About this article
Title

Hybrid versus traditional cardiac rehabilitation models: a systematic review and meta-analysis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 12 (2018)

Pages

1717-1724

Published online

2018-08-09

DOI

10.5603/KP.a2018.0175

Pubmed

30251248

Bibliographic record

Kardiol Pol 2018;76(12):1717-1724.

Keywords

cardiac rehabilitation
functional capacity
hybrid
meta-analysis

Authors

Congyin Wu
Yan Li
Juan Chen

References (33)
  1. World Health Organization. Cardiovascular diseases (CVDs). http://www who int/mediacentre/factsheets/fs317/en/index html (2009).
  2. Gabelhouse J, Eves N, Grace SL, et al. Traditional versus hybrid outpatient cardiac rehabilitation: a comparison of patient outcomes. J Cardiopulm Rehabil Prev. 2018; 38(4): 231–238.
  3. Janssen V, De Gucht V, van Exel H, et al. A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence. J Behav Med. 2014; 37(2): 308–321.
  4. Balady GJ, Ades PA, Bittner VA, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association. Circulation. 2011; 124(25): 2951–2960.
  5. Najafi F, Nalini M. Hospital-based versus hybrid cardiac rehabilitation program in coronary bypass surgery patients in western Iran: effects on exercise capacity, risk factors, psychological factors, and quality of life. J Cardiopulm Rehabil Prev. 2015; 35(1): 29–36.
  6. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011; 162(4): 571–584.e2.
  7. Clark AM, Hartling L, Vandermeer B, et al. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med. 2005; 143(9): 659–672.
  8. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116(10): 682–692.
  9. Frederix I, Hansen D, Coninx K, et al. Telerehab III: a multi-center randomized, controlled trial investigating the long-term effectiveness of a comprehensive cardiac telerehabilitation program--rationale and study design. BMC Cardiovasc Disord. 2015; 15: 29.
  10. Piepoli MF, Corrà U, Adamopoulos S, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol. 2014; 21(6): 664–681.
  11. Korzeniowska-Kubacka I, Dobraszkiewicz-Wasilewska B, Bilińska M, et al. Two models of early cardiac rehabilitation in male patients after myocardial infarction with preserved left ventricular function: comparison of standard out-patient versus hybrid training programmes. Kardiol Pol. 2011; 69(3): 220–226.
  12. Piotrowicz R, Wolszakiewicz J. Cardiac rehabilitation following myocardial infarction. Cardiol J. 2008; 15(5): 481–487.
  13. Beckie TM, Mendonca MA, Fletcher GF, et al. Examining the challenges of recruiting women into a cardiac rehabilitation clinical trial. J Cardiopulm Rehabil Prev. 2009; 29(1): 13–21; quiz 22.
  14. Moore SM, Dolansky MA, Ruland CM, et al. Predictors of women's exercise maintenance after cardiac rehabilitation. J Cardiopulm Rehabil. 2003; 23(1): 40–49.
  15. Hwang R, Bruning J, Morris NR, et al. Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. J Physiother. 2017; 63(2): 101–107.
  16. Franklin BA. An alternative approach to the delivery of cardiac rehabilitation services: a "hybrid'' model for patient care. J Cardiopulm Rehabil. 2004; 24(6): 383–386.
  17. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009; 3(3): e123–e130.
  18. Carlson JJ, Johnson JA, Franklin BA, et al. Program participation, exercise adherence, cardiovascular outcomes, and program cost of traditional versus modified cardiac rehabilitation. Am J Cardiol. 2000; 86(1): 17–23.
  19. Saeidi M, Soroush A, Komasi S, et al. A hybrid cardiac rehabilitation is as effective as a hospital-based program in reducing chest pain intensity and discomfort. Korean J Pain. 2017; 30(4): 265–271.
  20. Korzeniowska-Kubacka I, Bilińska M, Dobraszkiewicz-Wasilewska B, et al. Comparison between hybrid and standard centre-based cardiac rehabilitation in female patients after myocardial infarction: a pilot study. Kardiol Pol. 2014; 72(3): 269–274.
  21. Mendis S, Puska P, Norrving B, et al. Global atlas on cardiovascular disease prevention and control: Geneva: World Health Organization. 2011.
  22. Dafoe W, Arthur H, Stokes H, et al. Universal access: but when? Treating the right patient at the right time: access to cardiac rehabilitation. Can J Cardiol. 2006; 22(11): 905–911.
  23. Candido E, Richards JA, Oh P, et al. The relationship between need and capacity for multidisciplinary cardiovascular risk-reduction programs in Ontario. Can J Cardiol. 2011; 27(2): 200–207.
  24. Stone JA, Arthur HM. Canadian Association of Cardiac Rehabilitation Guidelines Writing Group. Canadian guidelines for cardiac rehabilitation and cardiovascular disease prevention, second edition, 2004: executive summary. Can J Cardiol. 2005; 21 (Suppl D): 3D–319D.
  25. Leung YW, Grewal K, Gravely-Witte S, et al. Quality of life following participation in cardiac rehabilitation programs of longer or shorter than 6 months: does duration matter? Popul Health Manag. 2011; 14(4): 181–188.
  26. Dalal HM, Zawada A, Jolly K, et al. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ. 2010; 340: b5631.
  27. Baratloo A, Rahimpour L, Abushouk AI, et al. Effects of telestroke on thrombolysis times and outcomes: a meta-analysis. Prehosp Emerg Care. 2018; 22(4): 472–484.
  28. Terkelsen CJ, Nørgaard BL, Lassen JF, et al. Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction. J Intern Med. 2002; 252(5): 412–420.
  29. Russell TG. Physical rehabilitation using telemedicine. J Telemed and Telecare. 2007; 13(5): 217–220.
  30. Jolly K, Taylor RS, Lip GYH, et al. Home-based cardiac rehabilitation compared with centre-based rehabilitation and usual care: a systematic review and meta-analysis. Int J Cardiol. 2006; 111(3): 343–351.
  31. Pomerleau J, Lock K, Knai C, et al. Interventions designed to increase adult fruit and vegetable intake can be effective: a systematic review of the literature. J Nutr. 2005; 135(10): 2486–2495.
  32. Giallauria F, De Lorenzo A, Pilerci F, et al. Long-term effects of cardiac rehabilitation on end-exercise heart rate recovery after myocardial infarction. Eur J Cardiovasc Prev Rehabil. 2006; 13(4): 544–550.
  33. Balsam P, Główczyńska R, Zaczek R, et al. The effect of cycle ergometer exercise training on improvement of exercise capacity in patients after myocardial infarction. Kardiol Pol. 2013; 71(10): 1059–1064.

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