Assessing Visual Feedback of HR Monitoring in Rehabilitation - Pilot

Shirley Ryan AbilityLab18 enrolled

Overview

Monitoring heart rate during exercise can provide feedback to the patient and provider that the patient is exercising in the appropriate, individualized and safe range for them. This is particularly important in a group setting when multiple individuals are supervised by one provider. This study is interested in assessing the difference in intensity of care delivered when visual feedback of heart rate is provided compared to no visual feedback of heart rate in rehabilitation. Visual feedback of heart rate will be provided through Heart Zones, a platform which synthesizes multiple signals from externally worn heart rate monitors. This study is interested in better understanding the acceptability, feasibility and appropriateness of this technology when used in rehabilitation.

OBJECTIVES: The purpose of this investigation is to determine if knowledge of heart rate (HR) and target HR zones (HRzone), with visual feedback vs no feedback of HR or HRzone improves patient exercise intensity during rehabilitation. The central hypothesis for this study is with visual feedback of HR and target HR zones with instruction about exercise intensity and targets will increase patient HR intensity during sessions within a safe range set by their medical team. For purposes of this study, patients will be monitored in inpatient sessions and is inclusive of all individuals with chronic health conditions. Physical activity and exercise guidelines recommend everyone, including those with chronic health conditions, strive for 150 minutes of moderate intensity aerobic exercise per week. This study will contribute to the knowledge of how patients achieve recommended individual HR and moderate-high intensity zones during exercise. Aim 1: Measure the extent to which monitoring and education regarding intensity is provided (1) when providers know HR monitoring is occurring but without visual feedback for the group, and (2) with visual feedback of HR monitoring in a group setting. The investigators hypothesize providers will modify their behavior in the number of times they ask about intensity, adjust session intensity or provide education regarding intensity when visual feedback is provided compared to no feedback. Aim 2: Determine the safety of using Heart Zones technology in rehabilitation settings for increasing participant exercise intensity. The investigators hypothesize the technology will be safe without an increase in number of adverse events throughout their rehabilitation stay. Aim 3: Assess patient acceptability, exercise self-efficacy and confidence following use of Heart Zones technology in group settings. The investigators hypothesize use of Heart Zones technology in rehabilitation with feedback will increase participant self-efficacy and confidence in reaching higher exercise intensities, and will be well accepted.

Interventions

Heart Rate Recording from Multiple Participants, No Visual FeedbackDEVICE

Heart rates are recorded from multiple participants during the group sessions. However during this intervention, it will not be cast to a TV for feedback to the participant or clinician.

Visual Feedback of Multiple Participant Heart RatesDEVICE

Visual feedback of HR is provided through a TV monitor. Multiple heart rates can be displayed and recorded simultaneously allowing for group encouragement, continuous monitoring and adjustment of all participants to ensure reaching appropriate target intensity.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 90 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Admitted to inpatient rehabilitation, day rehabilitation or participant in community fitness * Qualifies for group therapy based on diagnosis and insurance reimbursement * Physician clearance for participation Exclusion Criteria: * Unable to provide informed consent due to cognitive impairment * Inability to communicate with investigators * Sternal Precautions * Individuals with Left Ventricular assist devices * Pregnant women * Uncontrolled Hypertension * Serious and unstable cardiac arrhythmias * Loss of bilateral upper extremity sensation * At high risk for skin breakdown due to poor skin integrity (open wound, fragile skin, etc) * Previous participation in this study while in another level of care in the last 6 months

Outcomes

Primary Outcomes

Provider Behavior

Number of times heart rate (beats/minute), Rate of perceived exertion (6-20, higher = greater perceived exertion) or intensity (asked in session by HR/RPE) is monitored and/or modified based on feedback during rehabilitation sessions.

Time frame: Through study completion, an average of 3 months

Secondary Outcomes

Patient Participant Self-Efficacy and Confidence

Using a scale from 0-100% (higher is better), participant's rate their self-efficacy and confidence in their ability to achieve target exercise intensity and confidence in performing the activity without a heart rate monitor after each session. Data from each session are averaged to create a single value per participant.

Time frame: Assessed during therapy sessions (1-4 hrs/day, up to 5 days per week) through the duration of patient's rehabilitation stay (approximately 5-60 days).