Telerehabilitation Approaches for People with Chronic Heart Failure: A Systematic Review and Meta-Analysis
Sara Isernia, Chiara Pagliari, Nuccia Morici, Anastasia Toccafondi, Paolo Banfi, Federica Rossetto, Francesca Borgnis, Monica Tavanelli, Lorenzo Brambilla, Francesca Baglio
Abstract
INTRODUCTION: Telerehabilitation (TR) for chronic heart failure (CHF) allows for overcoming distance barriers and reducing exacerbations. However, little is known about TR descriptors, components, and efficacy in CHF. METHODS: This work systematically reviewed the TR strategies of randomized controlled trials in people with CHF. A meta-analysis was run to test its effect on exercise capacity and quality of life compared to no rehabilitation (NI) and conventional intervention (CI). RESULTS: Out of 6168 studies, 11 were eligible for the systematic review, and 8 for the meta-analysis. TR intervention was individual and multidimensional, with a frequency varying from 2 to 5 times per 8-12 weeks. The TR components mainly included an asynchronous model, monitoring/assessment, decision, and offline feedback. A few studies provided a comprehensive technological kit. Minimal adverse events and high adherence were reported. A large effect of TR compared to NI and a non-inferiority effect compared to CI was registered on exercise capacity, but no effects of TR compared to NI and CI on quality of life were observed. CONCLUSIONS: TR for people with CHF adopted established effective strategies. Future interventions may identify the precise TR dose for CHF, technological requirements, and engagement components affecting the patient's quality of life.