Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation.

INTRODUCTION: Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. METHODS AND ANALYSIS: The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.

Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study.

BACKGROUND: There has been an incremental increase in the use of technology in health care delivery. Feasibility, acceptability, and efficacy of interventions based on internet technologies are supported by a growing body of evidence. OBJECTIVE: The aim of this study was to investigate use and preferences in the general adult population in Germany for remote, internet-based interaction (eg, email, videoconferencing, electronic medical records, apps). METHODS: A nationwide cross-sectional questionnaire survey in adults that was representative in terms of age, sex and educational level was carried out. RESULTS: A total of 22.16% (538/2428) of survey participants reported not using the internet for work or private use. The nonuser phenotype can be described as being older, having lower educational and income status, and living in less populated areas. The majority of participants within the cohort of internet users reported that they would not consider using electronic medical records (973/1849, 52.62%), apps (988/1854, 53.29%), or emails to report symptoms (1040/1838, 56.58%); teleconference with one (1185/1852, 63.98%) or more experts (1239/1853, 66.86%); or participate in video psychotherapy (1476/1853, 79.65%) for the purpose of medical consultation or treatment. Older age and lower educational level were the most robust predictors of assumed future denial of use. CONCLUSIONS: Our results point toward low use and preference rates among the general population for the use of telemedicine. It also seems that those who might benefit from telemedical interventions the most, are, in fact, those who are most hesitating. These low use and preference rates of eHealth should be considered prior to designing and providing future telemedical care, supporting the need for easy-to-use, data secure solutions.

Exercise capacity and quality of life in patients with schizophrenia.

The aim of this study was to resolve the relationship between physical capacity (PC) and quality of life (Qol) in schizophrenic patients and healthy controls. 31 patients (PG: 18 male, 13 female) and a control group (CG) of 50 healthy subjects (15 male, 35 female) were involved. PC was assessed as peak oxygen uptake [VO2peak, (ml (min kgKG)(-1))] and power output expressed as watts per kilogram (W kg(-1)). Qol was assessed using the SF-36 questionnaire. Patients with schizophrenia showed reduced VO2peak (male: PG 29 ± 5 vs. CG 44 ± 10; female: PG 21 ± 4 vs. CG 30 ± 8) and power output (male: PG 2.04 ± 0.47 vs. CG 3.43 ± 0.70; female PG 1.40 ± 0.28 vs. CG 2.43 ± 0.52). Scales of the SF-36 questionnaire were lower in the PG. While in the CG correlations were found between PC and several subscales of Qol, this was not the case in the PG. The restricted PC seen in the PG showed no relation to their subjectively assessed worsened Qol, which would indicate that schizophrenic patients evaluate limitations arising from this differently than healthy control subjects.