From hospital to home: a comprehensive platform supporting cardiac rehabilitation post-revascularization.

Abstract

Background: Cardiac rehabilitation (CR) post-revascularization faces significant challenges due to accessibility, cost, and patient adherence issues, particularly in center-based settings. Addressing these challenges, the HomeTele-CR platform, encompassing a web portal and mHealth app, was developed to offer a comprehensive, home-based CR solution for patients unable to attend traditional programs.

Methods: This two-phase mixed-methods developmental study aimed to design, develop, and evaluate the HomeTele-CR platform, a home-based cardiac rehabilitation (CR) system for post-revascularization patients. Phase 1 involved a needs assessment through a Delphi panel with 13 multidisciplinary healthcare professionals (cardiologists, nutritionists, psychologists, physiotherapists, pharmacists, nurses, and sports medicine). Phase 2 utilized Xiaomi Band 2 sensors, Android Studio, and Node.js to develop a patient-facing app (Android) and clinician portal, integrating real-time monitoring, multimedia education (e.g., exercise animations, CPR tutorials), and secure data transmission. Then, in this phase, think-aloud protocols (n = 18 patients) and heuristic evaluation (n = 5 HCI experts) were employed for usability testing.

Results: The HomeTele-CR platform is designed to facilitate home-based CR through a three-component system: a health wristband for users, a smartphone app, and a remote monitoring and mentoring portal for healthcare providers. The Xiaomi band 2 wristband tracks heart rate and steps, connecting to smartphones for real-time data sharing. The app, developed for Android smartphones, supports patient supervision, exercise guidance, mood and relaxation support, symptom tracking, educational content on heart health and medications, and personalized feedback and monitoring. It features multimedia training materials, health measure tracking, and interactive tools for patient engagement and compliance. The web portal allows nurses to access patient data, provide individualized advice, and monitor patient progress through comprehensive dashboards, enhancing the CR process by integrating patient-reported outcomes and sensor data. Usability evaluations highlighted areas for improvement, guiding enhancements to optimize user experience. In an app usability test, 30 issues were identified, 73% related to layout problems, especially the line chart and swipe feature. For the web portal, the most common issues involved "Privacy," "Help and documentation," and error recovery.

Conclusions: The HomeTele-CR platform represents a significant advancement in providing accessible, efficient, and effective home-based cardiac rehabilitation. By leveraging technology to overcome traditional barriers to CR, the platform promises to improve patient engagement, adherence, and outcomes in post-revascularization care. Future work will focus on expanding the platform's capabilities and evaluating its impact on patient health outcomes.