Discussion
atrial fibrillation, weight gain, Disability, CVD
INFECTIOUS DISEASES, HAND INFECTION, CVD, ATRIAL FIBRILLATION, DISEASE, ADVERSE EVENTS, EMERGENCY, CORONAVIRUS, SEVERE ACUTE RESPIRATORY SYNDROME
In this study, we compared the effectiveness of real-time remote CR with that of hospital-based CR for improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). The physical functioning of the remote CR group markedly improved compared with that of the hospital-based CR group.Data obtained from several studies on home-based CR suggest that it yields results comparable to those of hospital-based programmes [COVID-19 risk, close contact, and infection anxiety were associated with the use of public transportation in a previous study [COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2, which is easily transmitted through the eyes, tongue, and nasal passages [Patients with CVD are at risk of severe disease if they contract COVID-19 [Two participants in the remote CR group were excluded as one of them required treatment for atrial fibrillation and another patient developed a digestive system disease. Therefore, remote CR can eliminate the concerns regarding infectious diseases. No adverse events were observed during the study. In remote CR, real-time management of ECGs and blood pressure measurements during exercises are pertinent challenges [Many studies have been conducted to evaluate the improvements in physical function due to CR. Restrictions on outings due to the COVID-19 pandemic in Japan have increased the risk of frailty and resulted in weight gain in patients undergoing convalescent CR [CR requires comprehensive interventions such as counselling, exercise, and education [Educational guidance in this study included not only dietary guidance but also exercise guidance in the home environment. We believe that these exercises can be performed similar to remote CR, which would result in more marked improvements in outcomes. Improving quality of life is an important goal of CR, and during the COVID-19 pandemic, health literacy and health-related quality of life have declined [The WHODAS2.0-J is currently the only measure based on the International Classification of Functioning, Disability and Health biopsychosocial model [Therefore, we used the WHOQOL-BREF and WHODAS2.0-J for a comprehensive assessment of quality of life. The ΔWHOQOL-BREF scores did not differ between the remote and hospital-based CR groups. Moreover, the ΔWHODAS2.0-J scores did not significantly differ between the groups.Real-time remote CR revealed extensively improved participation based on the WHODAS2.0-J scores. The patients were asked how their situations and the people around them made it difficult for them to participate in social activities; it also included questions about the impact of health conditions on quality of life.With regard to participation, remote CR was more effective than hospital-based CR. Further, we can conclude that remote CR is equivalent to hospital-based CR in terms of performance in the other domains, including cognition, mobility, self-care, social interaction, and life activities.In addition, objective performance was markedly improved with remote CR. We examined patients in terms of cognition and social interaction levels using the WHODAS2.0-J and found that the results contributed extensively to Δpeak VOFinally, four issues were identified regarding the feasibility of remote CR: (1) response to equipment failure, (2) cost of medical equipment, (3) transition period from hospital-based CR to remote CR, and (4) emergency response. These are discussed in detail below.Response to equipment failureIt was established beforehand in this investigation that the means of communication were stable. However, if the communication means were not adequate or feasible, it would have been difficult to complete the study. This can be affected by social infrastructure facilities and is highly likely to vary between nations; this is an issue to be addressed in the future.Cost of medical equipmentIn this study, medical equipment was provided to each patient and was used for 3 months. The cost of the equipment per patient was higher than that for the hospital CR as equipment was provided to each patient in the hospital. The challenge remains as to how to reduce the cost of medical devices while increasing convenience for patients.The transition from hospital-based CR to remote CRIn this study, the patients underwent hospital-based CR sessions in the first 4 weeks to confirm that there were no adverse events. However, there are many instances in which a 4-week hospital-based CR is also difficult. Therefore, the decision regarding the timing of the transition to remote CR is a major issue for future implementation.Emergency responseECG monitoring can be used to quickly confirm changes, which is a major point in this study. If a patient meets the criteria for discontinuation, the treatment should be terminated immediately, and family support should be sought. We factored this in and accordingly prepared an emergency response manual in advance. We believe that each medical institution should prepare an adequate emergency response manual and discuss it with patients and family members prior to implementation.