Biopsychosocial Profiles of Patients With Cardiac Disease in Remote Rehabilitation Processes: Mixed Methods Grounded Theory Approach (Preprint)

Abstract

Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as a part of rehabilitation. This study was based on a previously published study that categorized 4 groups of patients with cardiac disease based on different experiences and attitudes toward technology (e-usage groups): <i>feeling outsider</i>, <i>being uninterested</i>, <i>reflecting benefit</i>, and <i>enthusiastic using.</i>

This study identifies differences in the biopsychosocial profiles of patients with cardiac disease in e-usage groups and deepen the understanding of these profiles in cardiac rehabilitation.

Focus group interviews and measurements were conducted with 39 patients with coronary heart disease, and the mean age was 54.8 (SD 9.4, range 34-77) years. Quantitative data were gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey honestly significant difference test, a <i>t</i> test, or nonparametric tests—Mann–Whitney and Kruskal–Wallis tests—to compare the 4 e-usage groups—<i>feeling outsider</i>, <i>being uninterested</i>, <i>reflecting benefit</i>, and <i>enthusiastic using</i>—in biopsychosocial variables. Second, we compared the results of the 4 e-groups in terms of recommended and reference values. This analysis contained 13 variables related to biomedical, psychological, and social functioning. Finally, we formed biopsychosocial profiles based on the integration of the findings by constant comparative analysis phases through classic grounded theory.

The biomedical variables were larger for waistline (mean difference [MD] 14.2; 95% CI 1.0-27.5; <i>P</i>=.03) and lower for physical fitness (MD −0.72; 95% CI −1.4 to −0.06; <i>P</i>=.03) in the <i>being uninterested</i> group than in the <i>enthusiastic using</i> group. The <i>feeling outsider</i> group had lower physical fitness (MD −55.8; 95% CI −110.7 to −0.92; <i>P</i>=.047) than the <i>enthusiastic using</i> group. For psychosocial variables, such as the degree of self-determination in exercise (MD −7.3; 95% CI −13.5 to −1.1; <i>P</i>=.02), the <i>being uninterested</i> group had lower values than the <i>enthusiastic using</i> group. Social variables such as performing guided tasks in the program (<i>P</i>=.03) and communicating via messages (<i>P</i>=.03) were lower in the <i>feeling outsider</i> group than in the <i>enthusiastic using</i> group. The <i>feeling outsider</i> and <i>being uninterested</i> groups had high-risk lifestyle behaviors, and adherence to the web-based program was low. In contrast, members of the <i>being uninterested</i> group were interested in tracking their physical activity. The <i>reflecting benefit</i> and <i>enthusiastic using</i> groups had low-risk lifestyle behavior and good adherence to web-based interventions; however, the <i>enthusiastic using</i> group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently. We renamed the 4 groups as <i>building self-awareness</i>, <i>increasing engagement</i>, <i>maintaining a healthy lifestyle balance,</i> and <i>strengthening self-confidence.</i>

The results facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation. Professionals can tailor individual web-based lifestyle risk interventions using these biopsychosocial profiles.