Project Objective
At the national and state level, health care strategies are being focused on implementing care models to prevent and manage chronic diseases at home environment and avoid hospitalisation.
The CAP2 project is developing a novel solution for outpatient cardiac rehabilitation (CR) programs that offer effective means to prevent the recurrence of cardiac events. The main problem facing the current centre- based CR programs is the lower level of patient participation (14-43% after myocardial infarction) being reported consistently both in Australia and globally. Home-based models are considered as an alternative to avoid various barriers related to standard centre-based CR programs and also as a means to increase the uptake by patients.
The expected outcome of the CAP2 project is to establish and evaluate a sustainable home-based care model for outpatient cardiac rehabilitation by using mobile phones, web-services and other information and communication technology (ICT) tools.
Fig. 1 - The graph on the phone shows the number of daily steps. Photo by: David McCleneghan, CSIRO.
The CAP team's focus is to develop clinical solutions for managing and preventing chronic diseases to reduce burden on health care systems and improve the quality of service. This will be achieved by integrating R&D in clinical aspects of chronic diseases, human factors, health behaviours, information systems, and monitoring technology.
Care Model for Home- Based Cardiac Rehabilitation
The project has integrated mobile phones and web services into a comprehensive home-based care model for outpatient CR (Fig. 2). The patients are using smart mobile phones with a built-in accelerometer to measure their physical exercise at home. A WellnessDiary software (by Nokia Research) on the mobile phone is used to collect physiological data and self observations such as exercise, weight, blood pressure, stress, sleep quality, tobacco and alcohol use. Mobile phones are also used for video- and teleconferencing during weekly coaching sessions with a personal Mentor aiming at behavioural modifications through goal setting. Additionally, we are developing mobile phone software tools to capture and analyse Heart Rate and movement activity from wearable sensors. The data on the phones is synchronised daily to a web-portal that the Mentors use to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content and relaxation audio files (by Multi-ed Medical) are stored on the patients phone to be viewed on demand. The patients receive also daily motivational SMS messages which support the education and goal setting.
Fig. 2 - CAP system setup.
The project is currently conducting a randomized controlled clinical trial (RCT) within the Primary and Community Health Services of Metro North Health Service District of Queensland Health. The trial will provide evidence on the clinical and economic outcomes associated with the developed care model and technologies. In addition to innovations in process development and technologies, the trial is expected to create new clinical knowledge on physiological signal patterns, exercise, diet, lifestyle, and behaviour of cardiovascular patients in home care setting.
Demonstrated Experience
The Australian e-Health Research Centre has expertise on liaising with clinicians and running clinical trials involving ambulatory monitoring and other advanced ICT tools. The CAP team has finalised several clinical trials and projects in conjunction with Queensland Health across various healthcare settings.
The objective of the CAP Phase 1 completed in 2008 was to find useful measures which can be derived from ambulatory monitoring devices measuring movement activity and heart rate. The measures should help in assessing the patients' functional capacity attending a CR program. A clinical trial was carried out for this purpose on patients (N=17) undergoing stage 2 of CR program in Redcliffe and Caboolture hospitals. The main findings were that the changes observed in 6 Minute Walk Test (6MWT) distances correlate directly with the changes and absolute levels of the measured non-rehab day Energy Expenditure levels expressed in Metabolic Equivalent (MET). The results indicate that the ambulatory measures of MET levels in free living environment can be surrogate measures of 6MWT measurements performed in clinical settings.
We also developed a set of measures derived from accelerometer signals and ECG in ambulatory setting providing continuous measure of functional capacity. These measures include discrimination of walking from other high intensity activities, calculation of walking speed to determine index of functional capacity, energy expenditure, and the amount and duration of walking events that can be used to design personalized interventions. Other developed measures that indicate patient's functional capacity include fractal dimension to quantify gait patterns, detection and measurement of sit-to-stand transition duration, and various measures of heart rate variability (HRV). All these measures indicate different aspects of patient's physiological status during their rehabilitation and can be used to support the team of care professionals and patients for self management.
