IJCS | Volume 31, Nº4, July / August 2018

444 Cristo et al. Telerehabilitation for cardiac patients Int J Cardiovasc Sci. 2018;31(4)443-450 Review Article financial problems, those being the major hindrances to participation in CVR programs. Some authors have reported that only 27% of the patients adhere to CVR. 7 Therefore, different strategies to encourage physical exercise and changes inbehavior and lifestyle are necessary and should be implemented to modify the patients’ risk factors, preventingnewcardiovascular events andenabling the patients’ return to their usual daily activities. 7 Considering all that and the recent technological advance, an alternative to conventional CVR has been the use of the technology of telemedicine, 8 which proposes the delivery of healthcare services by use of information and communication technologies in situations where a health professional and a patient (or two health professionals), each in a different place, can communicate in real time, or even enables data storage for further analysis, consultation and opinion. In addition, it provides the safe transmission of medical data via texts, sounds and images required for prevention, diagnosis, treatment and patients’ follow-up. 9 Rehabilitation using telemedicine resources is known as telerehabilitation and has gained importance. Several ongoing studies are assessing its efficacy, but they are heterogeneous and use different tools to conduct telerehabilitation. Thus, this study was aimed at reviewing the literature and assessing the efficacy of telerehabilitation for cardiac patients. Methodology Study design and search strategy This is a systematic review of the literature, which does not require Ethics Committee in Research approval, but is being analyzed by the International Prospec t i ve Reg i s t e r o f Sys t ema t i c Rev i ews (PROSPERO). In addition, this systematic review has met the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted in the electronic databases MEDLINE/PubMed (Medical Literature Analysis and Retrieval System Online), PubMed Central ® (PMC), Cochrane Library, and Physiotherapy Evidence Database (PEDro), using the combination of descriptors, including terms of the Medical Subject Headings (MeSH) and its entry terms. The MeSH terms used in combination were: “telerehabilitation” AND “cardiac rehabilitation” (Table 1). Then, a manual search by use of the articles selected, as well as a search in the gray literature, was conducted. Inclusion and exclusion criteria This study included all randomized or nonrandomized clinical trials found in the databases, published in Portuguese, English or Spanish, with the full text available and no date restriction, conducted in human beings aged at least 18 years, in which patients with CVD participated in CVR programs, using telerehabilitation or telemedicine resources. Studies with the following characteristics were excluded: duplicate studies; not performed in human beings; not published in full text; whose population had been studied in more than one study and whose outcomes were similar, situations inwhich the first study was considered for inclusion in this review. Two reviewers evaluated independently the abstracts. The studies selected had their full text assessed for inclusion according to the criteria established. Identification and selection of studies Two reviewers independently read the titles and abstracts of each pre-selected study, identifying Table 1 - Search strategy used in PubMed #1 (“Telerehabilitation”[mesh] OR “Telerehabilitations” OR “Tele-rehabilitation” OR “Tele rehabilitation” OR “Tele-rehabilitations” OR “Remote Rehabilitation” OR “Rehabilitation, Remote” OR “Rehabilitations, Remote” OR “Remote Rehabilitations” OR “Virtual Rehabilitation” OR “Rehabilitation, Virtual” OR “Rehabilitations, Virtual” OR “Virtual Rehabilitations”) #2 (“Cardiac rehabilitation” [mesh] OR “Cardiac Rehabilitations” OR “Rehabilitation, Cardiac” OR “Rehabilitations, Cardiac” OR “Cardiovascular Rehabilitation” OR “Cardiovascular Rehabilitations” OR “Rehabilitation, Cardiovascular” OR “Rehabilitations, Cardiovascular”) #3 (randomized controlled trial[pt] OR controlled clinical trial[pt] OR randomized controlled trials[mh] OR random allocation[mh] OR double-blind method[mh] OR single- blind method[mh] OR clinical trial[pt] OR clinical trials[mh] OR (“clinical trial”[tw]) OR ((singl*[tw] OR doubl*[tw] OR trebl*[tw] OR tripl*[tw]) AND (mask*[tw] OR blind*[tw])) OR (“latin square”[tw]) OR placebos[mh] OR placebo*[tw] OR random*[tw] OR research design[mh:noexp] OR follow- up studies[mh] OR prospective studies[mh] OR cross- over studies[mh] OR control*[tw] OR prospectiv*[tw] OR volunteer*[tw]) NOT (animal[mh] NOT human[mh]) #4 (#1 AND #2 AND #3)