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Evaluation and development of a decision support system for patients after an open heart surgery : Early online cardiac telerehabilitation programme

Buursink, E.H. (2017) Evaluation and development of a decision support system for patients after an open heart surgery : Early online cardiac telerehabilitation programme.

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Abstract:A decision support system can contribute to the efficiency of eHealth in cardiac rehabilitation. This research uses the early online cardiac telerehabilitation program from the Medisch Spectrum Twente. Once every week, physiotherapists were asked to set up a training schedule for patients. The schedule was set up on the portal, supported by a fixed training schedule on paper. Besides that, the physiotherapists personalized the training schedule once every week with the use of a decision tree, e.g. to adjust the level of intensity for the exercises. A decision support system can automatically set up a training schedule for each patient. In addition, it can automatically adjust the exercises to personalize the exercises for a patient. The aim of this study was to; 1) validate the training schedule and the decision tree, and consequently, 2) to define requirements for the development of a decision support system which can automatically personalize the exercises within the training schedule per individual, as part of the early online cardiac telerehabilitation program of the Medisch Spectrum Twente. To validate the training schedule and the decision tree, we compared two situations, 1) The fixed training schedule and the decision tree with 2) how the physiotherapists set up the training schedule. Hereafter requirements were defined for a decision support system, with the use of interviews with physiotherapists and observations in daily practice by the researcher. The requirements were evaluated and a mock-up of a decision support system was made. It is stated that the training schedule and decision tree are valid if no unsafe exercises are prescribed and when the physiotherapists are satisfied with the training schedule or decision tree. 13 patients were included to validate the training schedule. To validate the decision tree 20 patients were included of which 16 patients were analyzed. The differences which were found between the 2 situations, were mainly caused by human errors, i.e. physiotherapists who were not focused when setting up the training schedule or adjusting the levels of intensity. Regarding the training schedule in 64% of the exercises a difference was found between the fixed training schedule and the outcome of the physiotherapist. Regarding the decision tree, in 11% of the total prescribed exercises a difference was observed between the decision tree and the outcome of the physiotherapist. The main reason for these differences were the same as the training schedule. Besides that, the physiotherapists did not believe the input of the patients on the portal. Overall, the physiotherapists were satisfied with the fixed training schedule and the decision tree. Therefore, it is assumed that the training schedule and the decision tree are valid. Moreover, the requirements had no feedback and no changes needed to be made. Furthermore, the decision support system is highly appreciated by the physiotherapists and would make their work more efficient and easier. Further work should focus on the experiences of patients with the program. With this information the programme can be further optimized to the needs of the patients. Besides that, the possibility to expand the programme with monitoring sensors could make the program more efficient and safe for the patient. In this way, vital functions such as heart rate and blood pressure can be monitored and warnings can be given to alert the patient.
Item Type:Essay (Master)
Clients:
Medisch Spectrum Twente, Enschede, Netherlands
Faculty:TNW: Science and Technology
Subject:02 science and culture in general, 44 medicine, 54 computer science
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/73733
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