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Annals of Physical and Rehabilitation Medicine

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Integrated Text Messaging (ITM) for people attending cardiac and pulmonary rehabilitation: A multicentre randomised controlled trial - 10/04/24

Doi : 10.1016/j.rehab.2023.101800 
Julie Redfern a, b, ⁎ , Anna C Singleton a, Rebecca Raeside c, Karla Santo d, e, Nashid Hafiz f, Lissa Spencer g, Regina WM Leung h, Mary Roberts i, j, Meredith King k, Jin-Gun Cho l, m, Bridie Carr n, Christine Jenkins o, Stephanie R Partridge a, p, Alison Hayes q, Clara K Chow r, Karice Hyun a, s
a Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia 
b Charles Perkins Centre, University of Sydney; The George Institute for Global Health, University of New South Wales, NSW, Australia 
c MPH, Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia 
d Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil 
e The George Institute for Global Health, University of New South Wales, NSW, Australia 
f MIPH, Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia 
g PhD, Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia 
h PhD, Department of Thoracic Medicine, Concord Repatriation General Hospital, Sydney Local Health District, NSW, Australia 
i MPal Care, Department of Respiratory and Sleep Medicine, Westmead Hospital, Western Sydney Local Health District, NSW, Australia 
j Faculty of Medicine and Health, The University of Sydney at Westmead Hospital, NSW, Australia 
k B Physiotherapy, Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, NSW, Australia 
l PhD, Department of Respiratory and Sleep Medicine, Westmead Hospital, NSW, Australia 
m Faculty of Medicine and Health, University of Sydney at Westmead Hospital, Australia 
n BA Comms, NSW Agency for Clinical Innovation, NSW, Australia 
o PhD, The George Institute for Global Health, Sydney and UNSW Faculty of Medicine and Health, NSW, Australia 
p Charles Perkins Centre, University of Sydney, Australia 
q PhD, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia 
r PhD, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney; Western Sydney Local Health District; The George Institute for Global Health, University of New South Wales, NSW, Australia 
s Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, NSW, Australia 

⁎Corresponding author at: University of Sydney at Westmead Hospital, Block K, Westmead Hospital, Hawkesbury Road, Westmead, NSW, Australia.University of Sydney at Westmead HospitalBlock K, Westmead Hospital, Hawkesbury RoadWestmeadNSWAustralia
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Highlights

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Randomised controlled trial of cardiac and pulmonary rehabilitation participants.
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Text messages supported behaviour changes and worked alongside rehabilitation.
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Intervention improved 6-minute walking distance, depression and anxiety scores at 6 months.
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Participants found the text message program easy to understand and useful.
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Texting is scalable and suitable for implementation within rehabilitation programs.

Il testo completo di questo articolo è disponibile in PDF.

Abstract

Background

People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient.

Objectives

To 1) test the effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes amongst people attending cardiac and pulmonary rehabilitation. Also, 2) to evaluate the program's acceptability and utility using patient-reported outcome and experience measures.

Methods

Multicentre randomised controlled trial (3:1, intervention:control) amongst cardiac and pulmonary rehabilitation attendees. Control received usual care (no message program). Intervention also received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, patient-reported outcome and experience measures, medication adherence and rehabilitation attendance.

Results

A total of 316 participants were recruited. They had a mean age of 66.7 (SD 10.1) years. Sixty percent were male (190/316) and 156 were cardiac rehabilitation participants. The cohort's mean baseline 6MWD was higher in the intervention than the control group. At 6 months, 6MWD improved in both groups; it was significantly greater amongst intervention than control participants (unadjusted mean difference of 43.4 m, 95 % CI 4.3 to 82.4; P = 0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2 m, -21.2 to 25.6; P = 0·85), medication adherence, or cardiovascular risk factors. At 6-month follow-up, intervention participants reported significantly lower depression scores (adjusted mean difference -1.3, 95 % CI -2.2 to -0.3; P = 0.0124) and CAT scores (adjusted mean difference -3.9, 95 % CI -6.6 to -1.3; P = 0.0038), and significantly lower anxiety (adjusted mean difference -1.1, 95 %CI -2.1 to 0; P = 0.0456). Most participants (86 %) read most of their messages and strongly/agreed that the intervention was easy to understand (99 %) and useful (86 %).

Conclusions

An educational and supportive text message program for cardiac and pulmonary rehabilitation attendees improved anxiety and depression plus program attendance. The program was acceptable to, and useful for, participants and would be suitable for implementation alongside rehabilitation programs.

Trial registration number

ACTRN12616001167459

Il testo completo di questo articolo è disponibile in PDF.

Key words : Text message, Cardiac rehabilitation, Pulmonary rehabilitation, Heart disease, Chronic obstructive pulmonary disease, Digital health

Abbreviations : 6MWD, ANCOVA, BMI, CAT, CHD, CI, COPD, CVD, HREC, ITM, METS, MRC, PREMs, PROMs, QOL, RCT, SD, SIM, TEXTME, WHO


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© 2023  The Authors. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 67 - N° 3

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