DIFFERENTIATED HOME-BASED PHYSICAL THERAPY PROGRAMME AFTER MYOCARDIAL INFARCTION: MODELLING METHODOLOGY, STRATIFICATION CRITERIA AND IMPLEMENTATION ALGORITHM
DOI:
https://doi.org/10.67034/2786-8354.2026.20.2.10Keywords:
secondary prevention, telerehabilitation, self-management, kinesiophobia, digital literacy, exercise adherence, functional capacityAbstract
Introduction. To develop and provide a scientific rationale for a differentiated home-based physical therapy model following myocardial infarction, informed by international evidence, the Ukrainian regulatory and clinical context, and clinical, functional, psychological, digital, and social stratification criteria.
Materials and Methods. A conceptual analytical review was conducted with elements of regulatory analysis and author-driven modelling. Literature searches were performed in PubMed, the Cochrane Library, Scopus, Web of Science, PEDro, Google Scholar, and official Ukrainian regulatory databases. To enhance transparency, a PRISMA-style flow approach was applied. A total of 154 records were identified, of which 34 sources were included in the final synthesis. Model development included identification of evidence-based components of home-based cardiac rehabilitation, stratification domains, operational criteria for different levels of professional support, and an implementation algorithm.
Results. International evidence suggests that home-based cardiac rehabilitation may be an effective model of secondary prevention for clinically stable patients following myocardial infarction, with outcomes comparable to those of centre-based rehabilitation in terms of functional, behavioural, and selected clinical indicators.
Six stratification domains were identified: clinical risk, functional capacity, psychological profile, digital readiness, family support, and access to professional supervision. Based on these domains, a three-level support model was developed: minimal support for clinically stable low-risk patients, moderate support for patients with functional, behavioural, or digital barriers, and intensive support for patients with increased clinical, psychological, or social risk.
The implementation algorithm includes rehabilitation assessment, clinical risk stratification, psychological and behavioural screening, evaluation of digital readiness and the home environment, selection of the appropriate level of support, development of an individualised rehabilitation plan, patient and family education, programme delivery, safety monitoring, and periodic reassessment of outcomes.
Preliminary operational indicators include the Six-Minute Walk Test (6MWT), the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), measures of exercise self-efficacy, and assessment of digital literacy. The model incorporates digital literacy as an independent criterion for tailoring the intensity of rehabilitation support.
Conclusions. The proposed differentiated home-based physical therapy model following myocardial infarction provides a scientifically grounded framework for the development of a nationally adapted rehabilitation protocol, pilot implementation, and subsequent empirical evaluation. Future studies should assess its safety, functional effectiveness, adherence, psychological outcomes, and cost-effectiveness in clinical practice.
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