Cardiac patients’ biopsychosocial profiles in remote rehabilitation process: Mixed-methods grounded theory approach (Preprint)

BACKGROUND Digital development has caused rehabilitation services and rehabilitees to become increasingly interested in using technology as part of rehabilitation. However, there is insufficient information available on the biopsychosocial differences between technology user groups. This study was based on previous published research article that categorized four cardiac patient groups based on different experiences and attitudes towards technology (e-usage groups): “feeling outsider”, “being uninterested”, “reflecting benefit”, and “enthusiastic using”. OBJECTIVE This study aimed to identify differences in cardiac patients’ biopsychosocial profiles in e-usage groups and to deepen the understanding of these profiles in cardiac rehabilitation. METHODS Focus group interviews and measurements were conducted with 39 coronary heart disease (CHD), mean age 54.8 years (SD 9.4, range 34 to 77 years). Quantitative data was gathered during a 12-month rehabilitation period. First, we used analysis of variance and Tukey’s HSD test, a t-test or non-parametric tests, i.e., Mann-Whitney and Kruskal-Wallis tests, to compare the four e-usage groups, “feeling outsider”, “being uninterested”, “reflecting benefit”, and “enthusiastic using”, in biopsychosocial variables. Second, we compared the four e-groups’ results in terms of recommended and reference values. This analysis contained thirteen pre- and post-intervention variables related to biomedical, psychological and social functioning. Finally, we formed biopsychosocial profiles based on integrated the findings by the constant comparative analysis phases through classic grounded theory. RESULTS The biomedical pre-intervention variables were larger for waistline (MD 14.2, 95% 1.0 to 27.5, p= .031) and lower for physical fitness (MD -0.72, 95% CI -1.4 to -0.06, p = .029) in the “being uninterested” group than in the “enthusiastic using” group. The “feeling outsider” group had lower physical fitness (MD - 55.8, 95% -110.7 to -0.92, p = .047) than the “enthusiastic using” group. For psychosocial post-intervention variables, such as the degree of self-determination in exercise (MD -7.3, 95% CI -13.5 to -1.1, p = .023), the “being uninterested” group had lower values than the “enthusiastic using” group. Social variables such as performing guided tasks in the program (p=.025) and communicating via messages (p=.034) were lower in the “feeling outsider” group than in the “enthusiastic using” group. The recommended and reference values were lower than the cut-off values for waistline and physical fitness for the “feeling outsider” and “being uninterested” groups than for the “reflecting benefit” and “enthusiastic using” groups. Exercise self-efficacy was lower in the “enthusiastic using” group than in the “feeling outsider” group. The most essential result of the study was the formation of the “personalized lifestyle changing as part of the rehabilitation process” core category associated with different biopsychosocial profiles in remote rehabilitation. The “feeling outsider” and “being uninterested” groups had high-risk lifestyle behavior, and adherence to the Web-based program was low. In contrast, members of the “being uninterested” group were interested in tracking their physical activity. The “reflecting benefit” and “enthusiastic using” groups had low-risk lifestyle behavior and good adherence to Web-based interventions, but the “enthusiastic using” group had low self-efficacy in exercise. These profiles showed how individuals reflected their lifestyle risk factors differently in the rehabilitation process. We re-named the four groups “building self-awareness”, “increasing engagement”, “maintaining a healthy lifestyle balance” and “strengthening self-confidence”. CONCLUSIONS The results can facilitate more effective and meaningful personalization guidance and inform the remote rehabilitation counseling process. Cardiac rehabilitation professionals can tailor individual Web-based lifestyle risk interventions by using these biopsychosocial profiles. Ac-cording to the classic grounded theory approach, the study results will be used to generate substantive theory. CLINICALTRIAL ISRCTN Registry: ISRCTN61225589