Abstract:

Objective To construct a home cardiac rehabilitation program based on mobile healthcare for patients undergoing transcatheter aortic valve replacement（TAVR） and validate its application effectiveness. Methods Based on the best evidence summary，using the Behavior Change Wheel as a framework，15 experts from relevant fields were invited for the Delphi expert consultation to construct a home-based cardiac rehabilitation program and develop an intervention system. Using convenience sampling method，72 patients from a tertiary hospital in Zhejiang Province from January to March 2024 were selected as research subjects，and the intervention was implemented from June to August 2024. They were randomly divided into an experimental group and a control group using a random number table method，with 36 cases in each group. The experimental group received a home rehabilitation program based on mobile healthcare on the basis of routine care，while the control group received routine care. The differences in outcome indicators were compared between 2 groups of patients after 12 weeks of intervention. Results The expert authority coefficients for the 2 rounds of Delphi expert inquiry were 0.95，and Kendall’s W were 0.591 and 0.414，respectively（P<0.001）. The final draft of the intervention plan includes 6 primary indicators，14 secondary indicators，and 25 tertiary indicators. A total of 70 patients completed the intervention，with 35 in the experimental group and 35 in the control group. Before intervention，there was no statistically significant difference in home cardiac rehabilitation exercise compliance，frailty，and activities of daily living ability between the 2 groups（P>0.05）. After 12 weeks of intervention，the scores of the home-based cardiac rehabilitation exercise adherence scale in the experimental group improved compared to the control group（Z=-7.203，P<0.001）. Conclusion The home rehabilitation program for TAVR patients based on mobile healthcare is scientific and feasible，and can effectively improve patients’ exercise compliance with home cardiac rehabilitation. In the future，the rehabilitation program and the system can be continuously optimized in the clinical application to improve patient prognosis.

Key words: Transcatheter Aortic Valve Replacement, Cardiac Rehabilitation, Nursing Care, Home, Behavior Change Wheel

摘要：

目的 构建基于移动医疗的经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）患者居家心脏康复方案并验证其效果。方法 基于最佳证据总结，以行为改变轮为框架，邀请相关领域的15名专家开展德尔菲专家函询，构建居家心脏康复方案并开发干预系统。便利选取2024年1—3月浙江省某三级甲等综合医院的72例患者作为研究对象，于2024年6—8月实施干预。采用随机数字表法分为试验组和对照组，每组各36例。试验组在常规护理的基础上实施基于移动医疗的居家心脏康复方案，对照组接受常规护理。干预12周后比较两组结局指标的差异。结果 2轮德尔菲专家函询的专家权威系数均为0.95，肯德尔和谐系数分别为0.591、0.414（P<0.001）。方案终稿包含一级指标6个、二级指标14个、三级指标25个。共有70例患者完成干预，试验组和对照组各35例。干预前，两组居家心脏康复运动依从性、衰弱和日常生活活动能力比较，差异均无统计学意义（P>0.05）。干预12周后，试验组居家心脏康复运动依从性高于对照组（Z=-7.203，P<0.001）。结论 基于移动医疗的TAVR患者居家康复方案科学、可行，可有效改善TAVR患者的居家心脏康复运动依从性。未来，可在临床应用中不断优化康复方案的内容及干预系统，以改善患者预后。

关键词: 经导管主动脉瓣置换术, 心脏康复, 护理, 居家, 行为改变轮