## 4 Discussion  
The key and innovative outcome of our prospective, non-randomized study is that the proposed model of home-based telerehabilitation, centered on walking training, is feasible and safe for stable HF patients with LVADs. We observed a significant improvement in both physical capacity and QoL after 12 weeks of HTR. Additionally, the program was highly accepted by participants, with strong adherence to the HTR regimen. Telerehabilitation with telecare is an emerging field that leverages technology to deliver rehabilitation services remotely. This approach can be particularly beneficial for patients with advanced HF who have undergone implantation of LVADs. Patients with LVADs require regular monitoring to assess their device function and overall health status. Telerehabilitation can utilize telehealth platforms to facilitate telemonitoring of vital signs, medication adherence, and any adverse symptoms [18]. This proactive approach can lead to timely interventions, improving patient outcomes. Exercise is a critical component of rehabilitation for LVAD patients, as it helps improve physical capacity, muscle strength, and overall mental status. Telerehabilitation enables healthcare providers to design personalized exercise regimens that can be adjusted remotely based on patient progress, making rehabilitation more tailored and effective. Education on device management, lifestyle modifications, and self-care practices is essential for LVAD patients [19; 20; 21]. Telerehabilitation can incorporate educational modules delivered through calls or online resources. Moreover, support groups can be organized virtually, fostering a sense of community among patients who share similar experiences [14; 17]. Living with an LVAD can lead to feelings of isolation and anxiety. Telerehabilitation can provide psychological support through counseling and peer interaction, addressing mental health challenges while promoting emotional well-being [16; 17]. In part of our study referring to patients' experience and perceived QoL, the study group reported enhanced functioning in most areas, including overall QoL and its major components. The changes the patients observed were linked to better physical capability and the level of vitality, as well as their everyday functioning, with fewer limitations perceived due to physical and mental health. It indicated that LVAD patients also noticed the enhancement observed in physical tests, influencing their subjective QoL. All this is seen despite no significant changes in the perception of overall health. The results of this study support other research showing that cardiac telerehabilitation contributes to both physical capacity improvement and a better QoL in HF, including an increase in mental, social, and sexual activities and a reduction in mortality and readmission rates [21; 22]. In the context of the current study, it is worth noticing that there is evidence suggesting that LVAD implantation itself initially improves health status, anxiety, and depression levels within the first few months post-implantation. However, these improvements are often not sustained long-term, and patients may continue to experience significant psychological distress, especially when adverse effects occur [11; 23; 24; 25]. Providing prolonged care focusedon everyday functioning and QoL, which is performed during HTR, can lower the risk of adjustment disorders in the long-term perspective. This improvement in QoL perception can be beneficial in sustaining the motivation for self-care and, as a result, may be crucial for long-term treatment results and patients' prognosis [26; 27]. Despite no significant changes in social functioning from patients' perspectives, LVAD recipients reported significant improvement in their everyday lives after the HTR, claiming to experience fewer role limitations related to their physical and emotional state post-implantation. This could be linked to the ability to return to their social roles after the LVAD implantation and HTR.