Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation: An extended feasibility study

Barbara Cristina Brocki; Jan Jesper Andreasen; Jens Aarøe; Jane Andreasen; Charlotte B Thorup

doi:10.26599/1671-5411.2023.11.003

Exercise-based real-time telerehabilitation for older patients recently discharged after transcatheter aortic valve implantation: An extended feasibility study

J Geriatr Cardiol. 2023 Nov 28;20(11):767-778. doi: 10.26599/1671-5411.2023.11.003.

Authors

Barbara Cristina Brocki¹, Jan Jesper Andreasen², Jens Aarøe³, Jane Andreasen^{1

4}, Charlotte B Thorup⁵

Affiliations

¹ Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Denmark.
² Department of Cardiothoracic Surgery, Aalborg University Hospital and Clinical Institute, Aalborg University, Denmark.
³ Department of Cardiology, Aalborg University Hospital, Denmark.
⁴ Public Health and Epidemiology Group, Health, Science and Technology, Aalborg University, Denmark.
⁵ Research Center of Health and Applied Technology, University College Northern Denmark, Denmark.

Abstract

Objectives: To assess the extended feasibility of a telerehabilitation program and its effects on physical performance in older adults who have recently undergone transcatheter aortic valve implantation (TAVI).

Methods: In this single-center feasibility study, patients underwent an eight-week telerehabilitation program, involving web-based home exercise training twice weekly, an activity tracker, access to an informative website, and one online session with a nurse, starting one-week postoperative. Data collection was performed before surgery and three months postoperative. The feasibility of the intervention was based on recruitment and adherence to the program. As a secondary outcome, we evaluated the change in six-minute walk distance from before surgery to three months postoperative.

Results: Forty-one patients scheduled for TAVI were assessed for eligibility; 15 patients (37%) were enrolled. Of these, eight were excluded after surgery due to tiredness (n = 2), non-cardiac related hospital readmission (n = 2), fluctuating health (n = 1), death during hospital stay (n = 1), and reduced cognition (n = 2). Seven patients completed the eight-week web-based intervention and were evaluated three months postoperative. Their median (IQR) age was 83 [81, 87] years, and the sample comprised three men and four women. Their walked distance improved from median (IQR) 262 [199, 463] before surgery, to 381 [267, 521] meters three months postoperative. No adverse events were reported.

Conclusion: Web-based telerehabilitation, including supervised exercise training, in older adults who have recently undergone TAVI was feasible for a small number of patients who completed the eight-week intervention. This was reflected in an improvement in their walked distance three months after the surgery. However, the low recruitment and retention rates do question the overall feasibility of this intervention in a frail, older population of post-TAVI patients.