Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial

Question: Is a 12-week, home-based telerehabilitation program conducted in small groups non-inferior to a traditional centre-based program in terms of the change in 6-minute walk distance? Is the telerehabilitation program also non-inferior to a centre-based program in terms of functional capacity, muscle strength, quality of life, urinary incontinence, patient satisfaction, attendance rates, and adverse events? Design: Randomised, parallel, non-inferiority trial with concealed allocation, intention-to-treat analysis and assessor blinding. Participants: Patients with stable chronic heart failure (including heart failure with reduced or preserved ejection fraction) were recruited from two tertiary hospitals in Brisbane, Australia. Intervention: The experimental group received a 12-week, real-time exercise and education intervention delivered into the participant's home twice weekly, using online videoconferencing software. The control group received a traditional hospital outpatient-based program of the same duration and frequency. Both groups received similar exercise prescription. Outcome measures: Participants were assessed by independent assessors at baseline (Week 0), at the end of the intervention (Week 12) and at follow-up (Week 24). The primary outcome was a between-group comparison of the change in 6-minute walk distance, with a non-inferiority margin of 28 m. Secondary outcomes included other functional measures, quality of life, patient satisfaction, program attendance rates and adverse events. Results: In 53 participants (mean age 67 years, 75% males), there were no significant between group differences on 6-minute walk distance gains, with a mean difference of 15 m (95% CI-28 to 59) at Week 12. The confidence intervals were within the predetermined non-inferiority range. The secondary outcomes indicated that the experimental intervention was at least as effective as traditional rehabilitation. Significantly higher attendance rates were observed in the telerehabilitation group. Conclusion: Telerehabilitation was not inferior to a hospital outpatient-based rehabilitation program in patients with chronic heart failure. Telerehabilitation appears to be an appropriate alternative because it promotes greater attendance at the rehabilitation sessions. Crown Copyright (C) 2017 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association.