JUMPSTART: evaluation of an early mobilization program following transcatheter aortic valve replacement

Abstract

Abstract Background Patients with aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) are typically discharged from hospital the next day, leaving little time to support their mobilization needs. Therefore, to improve the early mobilization of post-TAVR patients, we investigated the adoption and acceptability of a self-directed, tailored and home-based exercise program (JUMPSTART), which consists of four exercise modules, available in virtual and paper formats. Methods This prospective, observational, non-randomized and comparative study was conducted at one regional cardiac centre in Ontario, Canada. The development of the JUMPSTART program was informed by the Knowledge-to-Action Cycle and the choice of study outcomes were guided by the RE-AIM Framework. Program adoption and acceptability were captured through two follow-up surveys, 14-days and three-months post-TAVR; survey questions were informed by the Consolidated Framework for Implementation Research. The target program adoption rate was 70% by three-months post-TAVR. Impact of program participation on quality-of-life scores, and study participants’ cardiac rehabilitation attendance, were also assessed. Results There were 144 study participants. Survey response rates were 86% at 14-days post-TAVR, and 78% at three-months post-TAVR. The program adoption rate was 75% while the cardiac rehabilitation attendance rate was 30%. Approximately 70% of participants preferred the paper-based program format. The technological requirement was the most common barrier to engaging with virtual formats. Most (70%) rated the exercises as being the right level of difficulty. There were no reports of major health or safety concerns while exercising. Quality-of-life scores significantly increased from baseline to three-months post-TAVR; however, this could not be attributed to frequency of program participation. Furthermore, 73% of program participants felt that their recovery was improved because of their participation in the program, and 96% reported that they would recommend it to others. The study team regularly reviewed preliminary findings and took action to improve the program and the implementation process. Conclusions Participants were satisfied with the JUMPSTART program, which will continue to be offered to post-TAVR patients. Despite the increasing use of virtual technologies, most of this patient population prefers paper-based resources. Future planning will involve developing additional modules and exploring ways to increase program adoption, as well as cardiac rehabilitation attendance. Clinical trial number Not applicable.

Keywords

• Aortic stenosis
• Aortic valve replacement
• TAVR
• TAVI
• Early mobilization
• Exercise program