Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators.

Background: Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR. Purpose: To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR. Methods: Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation. Results: The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior. Conclusions: Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.

Living Lab Data of Patient Needs and Expectations for eHealth-Based Cardiac Rehabilitation in Germany and Spain From the TIMELY Study: Cross-Sectional Analysis.

BACKGROUND: The use of eHealth technology in cardiac rehabilitation (CR) is a promising approach to enhance patient outcomes since adherence to healthy lifestyles and risk factor management during phase III CR maintenance is often poorly supported. However, patients' needs and expectations have not been extensively analyzed to inform the design of such eHealth solutions. OBJECTIVE: The goal of this study was to provide a detailed patient perspective on the most important functionalities to include in an eHealth solution to assist them in phase III CR maintenance. METHODS: A guided survey as part of a Living Lab approach was conducted in Germany (n=49) and Spain (n=30) involving women (16/79, 20%) and men (63/79, 80%) with coronary artery disease (mean age 57 years, SD 9 years) participating in a structured center-based CR program. The survey covered patients' perceived importance of different CR components in general, current usage of technology/technical devices, and helpfulness of the potential features of eHealth in CR. Questionnaires were used to identify personality traits (psychological flexibility, optimism/pessimism, positive/negative affect), potentially predisposing patients to acceptance of an app/monitoring devices. RESULTS: All the patients in this study owned a smartphone, while 30%-40% used smartwatches and fitness trackers. Patients expressed the need for an eHealth platform that is user-friendly, personalized, and easily accessible, and 71% (56/79) of the patients believed that technology could help them to maintain health goals after CR. Among the offered components, support for regular physical exercise, including updated schedules and progress documentation, was rated the highest. In addition, patients rated the availability of information on diagnosis, current medication, test results, and risk scores as (very) useful. Of note, for each item, except smoking cessation, 35%-50% of the patients indicated a high need for support to achieve their long-term health goals, suggesting the need for individualized care. No major differences were detected between Spanish and German patients (all P>.05) and only younger age (P=.03) but not sex, education level, or personality traits (all P>.05) were associated with the acceptance of eHealth components. CONCLUSIONS: The patient perspectives collected in this study indicate high acceptance of personalized user-friendly eHealth platforms with remote monitoring to improve adherence to healthy lifestyles among patients with coronary artery disease during phase III CR maintenance. The identified patient needs comprise support in physical exercise, including regular updates on personalized training recommendations. Availability of diagnoses, laboratory results, and medications, as part of a mobile electronic health record were also rated as very useful. TRIAL REGISTRATION: ClinicalTrials.gov NCT05461729; https://clinicaltrials.gov/study/NCT05461729.

Concurrent Validity and Reliability of In-Field Vertical Jump Performance Measures on Sand Surfaces.

ABSTRACT: Wirtz, S, Julian, R, Schmale, R, and Eils, E. Concurrent validity and reliability of in-field vertical jump performance measures on sand surfaces. J Strength Cond Res 38(4): 687-693, 2024-Beach sports, such as handball, volleyball, and soccer, involve dynamic actions, primarily jumps. Nonetheless, there is a need for more established measurement devices that are both valid and feasible in accurately evaluating jumping performance on sand surfaces. This study aims to assess the reliability and concurrent validity of MyJump2 and an inertial measurement unit (VERT) for quantifying countermovement jump performance on the sand. Twenty-one subjects performed 5 countermovement jumps on the sand. Jumping height was measured simultaneously by a force plate, VERT, and MyJump2. The VERT and MyJump2 reliability measures were evaluated using the intraclass correlation coefficients (ICC) for both absolute agreement (ICC 2,1 ) and consistency (ICC 3.1 ). The day-to-day reliability of both devices and the interrater and intrarater reliability of the MyJump2 were assessed. The concurrent validity of the VERT and MyJump2 was assessed using ICCs 2.1, 3.1 and Bland-Altman plots. A near-perfect agreement was seen for intrarater (ICC = 0.98) and interrater (ICC = 0.98) reliability of the MyJump2. Moreover, a near-perfect agreement was also observed when comparing the MyJump2 with the force plate (ICC = 0.92), with a mean bias of -2.31 cm. The VERT device only demonstrated a moderate agreement (ICC = 0.55) with a mean bias of 6.31 cm compared with the force plate, despite showing good day-to-day reliability (ICC = 0.79). The study's results indicate that MyJump2 is valid and reliable for assessing jump heights on sand surfaces, whereas VERT cannot be recommended.