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Cardiac risk factors and prevention
Original research article
Web-based cardiac REhabilitatioN alternative for those declining or dropping out of conventional rehabilitation: results of the WREN feasibility randomised controlled trial
  1. Linzy Houchen-Wolloff1,
  2. Nikki Gardiner1,
  3. Reena Devi2,
  4. Noelle Robertson3,
  5. Kate Jolly4,
  6. Tom Marshall4,
  7. Gill Furze5,
  8. Patrick Doherty6,
  9. Ala Szczepura7,
  10. John Powell8 and
  11. Sally Singh1,9
  1. 1 Centre for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Centre (BRC)- Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2 Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  3. 3 Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
  4. 4 Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  5. 5 Faculty of Health and Life Sciences, Coventry University, Coventry, UK
  6. 6 Health Sciences, University of York, York, UK
  7. 7 Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
  8. 8 Medical Sciences Division, University of Oxford, Oxford, UK
  9. 9 Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
  1. Correspondence to Dr Linzy Houchen-Wolloff; Linzy.Houchen{at}uhl-tr.nhs.uk

Abstract

Introduction Cardiac rehabilitation (CR) is typically delivered in hospital-based classes and is recommended to help people reduce their risk of further cardiac events. However, many eligible people are not completing the programme. This study aimed to assess the feasibility of delivering a web-based CR intervention for those who decline/drop out from usual CR.

Intervention A web-based CR programme for 6 months, facilitated with remote support.

Methods Two-centre, randomised controlled feasibility trial. Patients were randomly allocated to web-based CR/usual care for 6 months. Data were collected to inform the design of a larger study: recruitment rates, quality of life (MacNew), exercise capacity (incremental shuttle walk test) and mood (Hospital Anxiety and Depression Scale). Feasibility of health utility collection was also evaluated.

Results 60 patients were randomised (90% male, mean age 62±9 years, 26% of those eligible). 82% completed all three assessment visits. 78% of the web group completed the programme. Quality of life improved in the web group by a clinically meaningful amount (0.5±1.1 units vs 0.2±0.7 units: control). Exercise capacity improved in both groups but mood did not change in either group. It was feasible to collect health utility data.

Conclusions It was feasible to recruit and retention to the end of the study was good. The web group reported important improvements in quality of life. This intervention has the opportunity to increase access to CR for patients who would otherwise not attend. Promising outcomes and recruitment suggest feasibility for a full-scale trial.

Trial registration number 10726798.

  • cardiac rehabilitation
  • delivery of care
  • education

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by/4.0

https://doi.org/10.1136/openhrt-2018-000860

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    Footnotes

    • Contributors LHW conducted the work, analysed the data and reported the work described in the article. NG conducted the work, managed the web usage data and helped redraft the work described in the article. RD, KJ, TM, GF, PD and JP planned the work and helped redraft the work described in the article. NR planned the work, led the qualitative analysis and helped redraft the work described in the article. AS planned the work, led the health utility feasibility work and helped redraft the work described in the article. SS planned the work, helped redraft the work described in the article and is responsible for the overall content as guarantor.

    • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB-PG-1013-32059). The work was also supported by the NIHR Leicester Biomedical Research Centre-Respiratory. LHW and SS are supported by NIHR CLAHRC East Midlands. KJ and TM are funded by the NIHR CLAHRC West Midlands. JP is supported by NIHR CLAHRC Oxford at Oxford Health NHS Foundation Trust.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval NRES Committee East Midlands-Leicester (ref: 15/EM/0291).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Unpublished qualitative and health economic data are held by the authors—these will be published in subsequent manuscripts.