A digitally-supported shared decision making approach for patients during cardiac rehabilitation: a randomised controlled trial
Authors: Kizilkilic S E , Ramakers W , Falter M , Pieters Z , Vos M , De Pauw M , Coninx K , Dendale P 
Published: June 2024

Abstract

Background
Physical activity is a key component of cardiac rehabilitation. However, inclusion rates in cardiac rehabilitation programs remain low and patients currently have only limited input in their exercise prescription. SharedHeart is a digitally-supported shared decision making approach that assists patients with heart disease and their caregivers in collaboratively setting up exercise goals and creating an exercise plan for the patient.

Purpose
The aim of the study is to determine the clinical effectiveness of a digitally-supported shared decision making approach in cardiac rehabilitation. The study investigates the influence of such an approach on the patient’s quality of life, exercise capacity, and physical activity.

Methods
The study design was a prospective randomised controlled trial. Eligible 80 cardiac rehabilitation patients were 1:1 randomised into a 12-week center-based cardiac rehabilitation program (control group), and a 12-week center-based cardiac rehabilitation program combined with a shared decision making based telerehabilitation program (intervention group). The shared decision making based telerehabilitation consisted of using digital tools (smartphone application, web application, tablet application) and shared decision making encounters with caregivers. The primary outcome is patients’ quality of life, assessed with the HeartQoL questionnaire. Secondary outcomes are related to patients’ exercise capacity, and physical activity.

Results
A total of 66 patients finished the study. Results are depicted in table 1. There is a significant improvement (P &lt; 0,001) in quality of life in the intervention group from 29 (21,5-35) to 38,5 (34-41,25) and (P &lt; 0,001) in the control group from 31 (22-35) to 34 (29-39) with significant between-group differences after 12 weeks of intervention (P = 0,036). Exercise capacity expressed as peak oxygen uptake showed a significant improvement (P &lt; 0,001) in the intervention group from 18,95 (14,33-23,88) mL/kg/min to 22,50 (17,65-26,70) mL/kg/min and (P = 0,006) in the control group from 18,10 (15,60-22,20) mL/kg/min to 20,65 (17,50-24,08) mL/kg/min with significant between-group differences after 12 weeks of intervention (P = 0,029). Physical activity expressed as step count showed a significant improvement (P &lt; 0,001) in the intervention group from 8352 (4725-11920) step count per day to 9776 (7209-13586) step count per day and (P = 0,688) no significant improvement in the control group. At least, there is a significant between-group differences in step count per day after 12 weeks of intervention (P = 0,006).

Conclusion
This study shows that a combination of a digitally-supported shared decision making based telerehabilitation program with a center-based cardiac rehabilitation program is found to be more effective in increasing patients’ quality of life, exercise capacity and physical activity compared with a center-based cardiac rehabilitation. Table 1:results.