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Rasmussen B, Maribo T, Skovsby Toft B. The content and characteristics of face-to-face interventions to encourage patients' enrollment in cardiac rehabilitation; a scoping review. Disabil Rehabil 2024; 46:2734-2746. [PMID: 37480155 DOI: 10.1080/09638288.2023.2236014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To provide an overview of the content and characteristics of face-to-face interventions to encourage enrollment in exercise-based cardiac rehabilitation (CR). METHODS Following a published protocol describing the methods, six databases were searched. The search was limited to studies published from January 2000 to December 2021. Two reviewers independently performed study selection and data extraction. RESULTS 5583 studies were identified and 20 studies with a variety of study designs met the inclusion criteria. Eight studies specified important content in face-to-face interventions to be: Education, problem-solving, support of autonomy, exploring reasons for change, emotional and cognitive support while showing understanding. Studies targeting patients' experiences used motivational interviewing and addressed worries and anticipated difficulties. Intention to attend, CR barriers, practical barriers, exercise self-efficacy, and patients asking questions supported enrollment. Reassurance could lead to nonattendance if patients had a high degree of worry and distress. CONCLUSION Face-to-face interventions are important to support patients' enrollment in CR and should integrate a person-centered dialogue exploring reasons for change and providing support to overcome barriers. Focus on the patients' perspectives, the mechanisms of change, and the evaluation of the intervention to inform implementation should be further explored.Implications for RehabilitationIn-hospital face-to-face interventions support enrollment in cardiac rehabilitation (CR) in patients with ischemic heart disease.This study suggests that individual worries and barriers toward CR should be jointly explored while considering patients' capacity for making choices as well as their vulnerability.Patients should be encouraged to ask questions.A too strong focus on reassurance and problem-solving can impede enrollment.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio- and Occupational Therapy, Horsens Regional Hospital, Horsens, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social & Health Services and Labour Market, Corporate Quality, Aarhus, Denmark
| | - Bente Skovsby Toft
- Research Centre for Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
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Höppchen I, Wurhofer D, Meschtscherjakov A, Smeddinck JD, Kulnik ST. Targeting behavioral factors with digital health and shared decision-making to promote cardiac rehabilitation-a narrative review. Front Digit Health 2024; 6:1324544. [PMID: 38463944 PMCID: PMC10920294 DOI: 10.3389/fdgth.2024.1324544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Cardiac rehabilitation (CR) represents an important steppingstone for many cardiac patients into a more heart-healthy lifestyle to prevent premature death and improve quality of life years. However, CR is underutilized worldwide. In order to support the development of targeted digital health interventions, this narrative review (I) provides understandings of factors influencing CR utilization from a behavioral perspective, (II) discusses the potential of digital health technologies (DHTs) to address barriers and reinforce facilitators to CR, and (III) outlines how DHTs could incorporate shared decision-making to support CR utilization. A narrative search of reviews in Web of Science and PubMed was conducted to summarize evidence on factors influencing CR utilization. The factors were grouped according to the Behaviour Change Wheel. Patients' Capability for participating in CR is influenced by their disease knowledge, awareness of the benefits of CR, information received, and interactions with healthcare professionals (HCP). The Opportunity to attend CR is impacted by healthcare system factors such as referral processes and HCPs' awareness, as well as personal resources including logistical challenges and comorbidities. Patients' Motivation to engage in CR is affected by emotions, factors such as gender, age, self-perception of fitness and control over the cardiac condition, as well as peer comparisons. Based on behavioral factors, this review identified intervention functions that could support an increase of CR uptake: Future DHTs aiming to support CR utilization may benefit from incorporating information for patients and HCP education, enabling disease management and collaboration along the patient pathway, and enhancing social support from relatives and peers. To conclude, considerations are made how future innovations could incorporate such functions.
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Affiliation(s)
- Isabel Höppchen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Department of Artificial Intelligence and Human Interfaces, Human Computer Interaction Division, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Daniela Wurhofer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Alexander Meschtscherjakov
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Department of Artificial Intelligence and Human Interfaces, Human Computer Interaction Division, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Jan David Smeddinck
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
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Santiago de Araújo Pio C, Gagliardi A, Suskin N, Ahmad F, Grace SL. Implementing recommendations for inpatient healthcare provider encouragement of cardiac rehabilitation participation: development and evaluation of an online course. BMC Health Serv Res 2020; 20:768. [PMID: 32819388 PMCID: PMC7439558 DOI: 10.1186/s12913-020-05619-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A policy statement recommending that healthcare providers (HCPs) encourage cardiac patients to enroll in cardiac rehabilitation (CR) was recently endorsed by 23 medical societies. This study describes the development and evaluation of a guideline implementation tool. METHODS A stepwise multiple-method study was conducted. Inpatient cardiac HCPs were recruited between September 2018-May 2019 from two academic hospitals in Toronto, Canada. First, HCPs were observed during discharge discussions with patients to determine needs. Results informed selection and development of the tool by the multidisciplinary planning committee, namely an online course. It was pilot-tested with target users through a think-aloud protocol with subsequent semi-structured interviews, until saturation was achieved. Results informed refinement before launching the course. Finally, to evaluate impact, HCPs were surveyed to test whether knowledge, attitudes, self-efficacy and practice changed from before watching the course, through to post-course and 1 month later. RESULTS Seven nurses (71.4% female) were observed. Five (62.5%) initiated dialogue about CR, which lasted on average 12 s. Patients asked questions, which HCPs could not answer. The planning committee decided to develop an online course to reach inpatient cardiac HCPs, to educate them on how to encourage patients to participate in CR at the bedside. The course was pilot-tested with 5 HCPs (60.0% nurse-practitioners). Revisions included providing evidence of CR benefits and clarification regarding pre-CR stress test screening. HCPs did not remember the key points to convey, so a downloadable handout was embedded for the point-of-care. The course was launched, with the surveys. Twenty-four HCPs (83.3% nurses) completed the pre-course survey, 21 (87.5%) post, and 9 (37.5%) 1 month later. CR knowledge increased from pre (mean = 2.71 ± 0.95/5) to post-course (mean = 4.10 ± 0.62; p ≤ .001), as did self-efficacy in answering patient CR questions (mean = 2.29 ± 0.95/5 pre and 3.67 ± 0.58 post; p ≤ 0.001). CR attitudes were significantly more positive post-course (mean = 4.13 ± 0.95/5 pre and 4.62 ± 0.59 post; p ≤ 0.05). With regard to practice, 8 (33.3%) HCPs reported providing patients CR handouts pre-course at least sometimes or more, and 6 (66.7%) 1 month later. CONCLUSIONS Preliminary results support broader dissemination, and hence a genericized version has been created ( http://learnonthego.ca/Courses/promoting_patient_participation_in_CR_2020/promoting_patient_participation_in_CR_2020EN/story_html5.html ). Continuing education credits have been secured.
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Affiliation(s)
| | - Anna Gagliardi
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neville Suskin
- Western University, London, ON, Canada
- St. Joseph's Health Care London, London, ON, Canada
| | | | - Sherry L Grace
- York University, Toronto, ON, Canada.
- University Health Network, University of Toronto, Toronto, ON, Canada.
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Elsakr C, Bulger DA, Roman S, Kirolos I, Khouzam RN. Barriers physicians face when referring patients to cardiac rehabilitation: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:414. [PMID: 31660313 DOI: 10.21037/atm.2019.07.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
While cardiac rehabilitation (CR) has been shown to be a beneficial form of secondary prevention for patients with cardiovascular disease, barriers of referral to CR still exist for patients. Barriers that specifically make it difficult for physicians to make the referral could be worthwhile to examine. This narrative review hypothesizes that increasing awareness and education on the various aspects of CR as well as simplifying the referral process could lead to increased referral rates as they target physician-related barriers. This narrative review seeks to further understand the physician-related barriers of low CR awareness and hindering referral processes. A search in Scopus was conducted with preference for articles examining CR referral strategies used by physicians; physicians' awareness of CR programs; physicians' perceptions, beliefs, or knowledge of the benefits of CR; or physicians' experience with or understanding of the selection process of CR programs, including indications for referral. Two systematic reviews and two observational studies were selected for discussion. Three of the selected studies had findings supporting the notion that increasing physicians' awareness of CR could impact referral rates. One of the studies evaluated the perceptions that physicians and CR programs had on various referral strategies. While more study is needed to assess the actual level of knowledge and awareness physicians have regarding CR, this review supports using educational interventions as well as targeting various aspects of the referral process for improving referral rates.
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Affiliation(s)
- Carol Elsakr
- Department of Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - David A Bulger
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sherif Roman
- Department of Medicine, Cairo University, Giza Governorate, Egypt
| | - Irene Kirolos
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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Rouleau CR, King-Shier KM, Tomfohr-Madsen LM, Aggarwal SG, Arena R, Campbell TS. A qualitative study exploring factors that influence enrollment in outpatient cardiac rehabilitation. Disabil Rehabil 2016; 40:469-478. [DOI: 10.1080/09638288.2016.1261417] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Codie R. Rouleau
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn M. King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Sandeep G. Aggarwal
- Total Cardiology Rehabilitation, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Alberta, Canada
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Pourhabib S, Kentner AC, Grace SL. The impact of patient-healthcare provider discussions on enrollment in cardiovascular rehabilitation. J Rehabil Med 2014; 46:924-31. [PMID: 25102939 PMCID: PMC4527842 DOI: 10.2340/16501977-1852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Secondary prevention programs such as cardiovascular rehabilitation significantly decrease the burden of cardiovascular disease, yet are under-used. The most successful strategy to promote cardiovascular rehabilitation utilization is systematic referral with a patient-provider discussion. This study investigated: (i) the elements of patient-provider discussions related to patient cardiovascular rehabilitation enrollment, and (ii) the frequency and correlates of these discussion elements. DESIGN/PARTICIPANTS This was a prospective study of cardiovascular patients and their healthcare providers. Discussions about "secondary prevention" were audio-recorded. Utterances were coded using the Roter Interaction Analysis System. Two months later, cardiovascular rehabilitation enrollment was ascertained. RESULTS Discussions between 26 healthcare providers and 50 patients were recorded, of whom 27 (54.0%) enrolled in cardiovascular rehabilitation. Participants were significantly more likely to enroll in cardiovascular rehabilitation when their healthcare providers offered less reassurance and optimism (odds ratio (OR) = 0.81), and when the patient asked more questions related to lifestyle (OR = 4.98). These were not common. CONCLUSION While caution is warranted due to the number of comparisons undertaken such that associations observed may be chance associations, these novel findings suggest that not overstating the beneficial effects of acute treatment, and allowing patients more time to ask questions about needed lifestyle changes should be investigated in future research.
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Affiliation(s)
| | | | - Sherry L. Grace
- York University, Toronto, Canada
- University Health Network, Toronto, Canada
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Pourhabib S, Chessex C, Murray J, Grace SL. Elements of patient-health-care provider communication related to cardiovascular rehabilitation referral. J Health Psychol 2014; 21:468-82. [PMID: 24740975 DOI: 10.1177/1359105314529319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular rehabilitation has been designed to decrease the burden of cardiovascular disease. This study described (1) patient-health-care provider interactions regarding cardiovascular rehabilitation and (2) which discussion elements were related to patient referral. This was a prospective study of cardiovascular patients and their health-care providers. Discussion utterances were coded using the Roter Interaction Analysis System. Discussion between 26 health-care providers and 50 patients were recorded. Cardiovascular rehabilitation referral was related to greater health-care provider interactivity (odds ratio = 2.82, 95% confidence interval = 1.01-7.86) and less patient concern and worry (odds ratio = 0.64, 95% confidence interval = 0.45-0.89). Taking time for reciprocal discussion and allaying patient anxiety may promote greater referral.
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Affiliation(s)
| | | | | | - Sherry L Grace
- York University, Canada University Health Network, Canada
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Neubeck L, Freedman SB, Clark AM, Briffa T, Bauman A, Redfern J. Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol 2012; 19:494-503. [PMID: 22779092 DOI: 10.1177/1741826711409326] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Participation in cardiac rehabilitation (CR) benefits patients with coronary heart disease (CHD), yet worldwide only some 15–30% of those eligible attend. To improve understanding of the reasons for poor participation we undertook a systematic review and meta-synthesis of the qualitative literature. METHODS Qualitative studies identifying patient barriers and enablers to attendance at CR were identified by searching multiple electronic databases, reference lists, relevant conference lists, grey literature, and keyword searching of the Internet (1990–2010). Studies were selected if they included patients with CHD and reviewed experience or understanding about CR. Meta-synthesis was used to review the papers and to synthesize the data. RESULTS From 1165 papers, 34 unique studies were included after screening. These included 1213 patients from eight countries. Study methodology included interviews (n = 25), focus groups (n = 5), and mixed-methods (n = 4). Key reasons for not attending CR were physical barriers, such as lack of transport, or financial cost, and personal barriers, such as embarrassment about participation, or misunderstanding the reasons for onset of CHD or the purpose of CR. CONCLUSIONS There is a vast amount of qualitative research which investigates patients’ reasons for non-attendance at CR. Key issues include system-level and patient-level barriers, which are potentially modifiable. Future research would best be directed at investigating strategies to overcome these barriers.
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Affiliation(s)
- Lis Neubeck
- Faculty of Medicine, University of Sydney, Sydney, Australia.
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Keib CN, Reynolds NR, Ahijevych KL. Poor use of cardiac rehabilitation among older adults: a self-regulatory model for tailored interventions. Heart Lung 2010; 39:504-11. [PMID: 20561883 PMCID: PMC2972354 DOI: 10.1016/j.hrtlng.2009.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 11/11/2009] [Accepted: 11/19/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND A greater number of older adults now live with coronary heart disease (CHD). This poses a significant public health problem, because older adults are at high risk for CHD-related mortality and morbidity. Overwhelming data support the benefits of cardiac rehabilitation for secondary prevention, yet only a small portion of eligible older adults receive it. METHODS AND RESULTS Whereas many studies examined factors that affect the use of cardiac rehabilitation among older adults, few interventions aimed to improve their cardiac rehabilitation participation rates. A substantial body of evidence indicates that an individual's illness perceptions play a pivotal role in health behavior, and may be a promising target for intervention. Drawing from the theoretic and empiric findings of others, a self-regulatory model is proposed that explicates how CHD perceptions of older adults may influence participation in cardiac rehabilitation. CONCLUSION The model may provide a useful guide for the development of effective interventions tailored to older adults.
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Affiliation(s)
- Carrie N Keib
- Department of Nursing, Cedarville University, Cedarville, Ohio 45314, USA.
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Hoover D, Domholdt E, Leland LG, Kluver J, Malloy A. Exploring aftercare programs following outpatient musculoskeletal physical therapy: A case series report. Physiother Theory Pract 2009; 25:99-128. [DOI: 10.1080/09593980802686888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fischer MJ, Scharloo M, Abbink JJ, van 't Hul AJ, van Ranst D, Rudolphus A, Weinman J, Rabe KF, Kaptein AA. Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respir Med 2009; 103:1564-71. [PMID: 19481919 DOI: 10.1016/j.rmed.2008.11.020] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 11/10/2008] [Accepted: 11/11/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND In spite of the well-demonstrated benefits for patients with COPD, pulmonary rehabilitation programmes show considerable drop-out and suboptimal attendance rates. The purpose of this prospective study is to examine causes for drop-out and non-attendance during a 12 week multidisciplinary pulmonary rehabilitation programme, and to investigate whether sociodemographic and medical factors as well as patients' perception of their illness are related to drop-out and non-attendance. METHODS Two hundred and seventeen patients with COPD who were referred to a rehabilitation centre participated in this multicentre study. Prior to treatment, patients received a questionnaire, which included the Illness Perception Questionnaire-Revised. Clinical data were drawn from medical records. Drop-out and attendance were recorded during the programme. RESULTS Fifty patients (23%) did not complete the rehabilitation course, of which half was due to medical reasons (e.g. exacerbations, hospitalisations). Non-completion could not be predicted by baseline sociodemographic, clinical or psychological variables. Patients who declined treatment did not differ from patients who dropped out due to medical reasons. On average, patients attended 92% of all scheduled appointments. Of all missed appointments, approximately 20% were accountable to factors beyond patients' control (e.g. absent therapists, hospitalisations). Smoking, living alone, a lower fat free mass and lower confidence in treatment increased the chance of patients not attending an appointment during rehabilitation. CONCLUSION In general, adherence in rehabilitation is high. However, paying attention to patients' nutritional status and creating a positive expectation of treatment during referral and intake appear to be important if one aims to optimise patients' attendance during rehabilitation.
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Affiliation(s)
- Maarten J Fischer
- Medical Psychology, Leiden University Medical Centre (LUMC), Wassenaarseweg 52, 2333 AK Leiden, The Netherlands.
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Fischer MJ, Scharloo M, Abbink JJ, Thijs-Van A, Rudolphus A, Snoei L, Weinman JA, Kaptein AA. Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective. Clin Rehabil 2007; 21:212-21. [PMID: 17329278 DOI: 10.1177/0269215506070783] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine patients' pretreatment beliefs and goals regarding pulmonary rehabilitation. DESIGN Qualitative study using semi-structured interviews. SETTING Interviews conducted at participants' homes. SUBJECTS Twelve patients with chronic obstructive pulmonary disease who had been referred to a rehabilitation clinic. MAIN MEASURES Patients' beliefs about pulmonary rehabilitation, self-set treatment goals and anticipated reasons for drop-out. RESULTS Patients' beliefs about pulmonary rehabilitation comprised positive aspects (participation as an opportunity for improvement, a safe and multidisciplinary setting, presence of motivating and supporting patients) and negative aspects of exercising in a rehabilitation centre (e.g. disruption of normal routine, being tired after training, transportation difficulties, limited privacy and confrontation with severely ill patients). Four types of treatment goals were formulated: increase in functional performance, weight regulation, reduction of dyspnoea, and improvement of psychosocial well being. Four clusters of anticipated reasons for drop-out were identified: the intensity of the programme, barriers to attending (e.g. transportation problems, sudden illness and other duties/responsibilities), lack of improvement and social factors. Four different attitudes towards pulmonary rehabilitation could be distinguished: optimistic, 'wait and see', sceptic and pessimistic. Follow-up data revealed that whereas a pessimistic attitude (high disability, low self-confidence, many concerns) was related to decline, the 'sceptic' patients had dropped out during the course. CONCLUSIONS Uptake and drop-out may be related to patients' perceived disabilities, expected benefits and concerns with regard to rehabilitation, practical barriers and confidence in their own capabilities.
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Affiliation(s)
- M J Fischer
- Medical Psychology, Leiden University Medical Centre, Leiden, The Netherlands.
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Grace SL, Scholey P, Suskin N, Arthur HM, Brooks D, Jaglal S, Abramson BL, Stewart DE. A prospective comparison of cardiac rehabilitation enrollment following automatic vs usual referral. J Rehabil Med 2007; 39:239-45. [PMID: 17468793 PMCID: PMC2935486 DOI: 10.2340/16501977-0046] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Cardiac rehabilitation remains grossly under-utilized despite its proven benefits. This study prospectively compared verified cardiac rehabilitation enrollment following automatic vs usual referral, postulating that automatic referral would result in significantly greater enrollment for cardiac rehabilitation. DESIGN Prospective controlled multi-center study. PATIENTS AND METHODS A consecutive sample of 661 patients with acute coronary syndrome treated at 2 acute care centers (75% response rate) were recruited, one site with automatic referral via a computerized prompt and the other with a usual referral strategy at the physician's discretion. Cardiac rehabilitation referral was discerned in a mailed survey 9 months later (n = 506; 84% retention), and verified with 24 cardiac rehabilitation sites to which participants were referred. RESULTS A total of 124 (52%) participants enrolled in cardiac rehabilitation following automatic referral, vs 84 (32%) following usual referral (p < 0.001). Automatically referred participants were more likely to be referred from an in- patient unit (p < 0.01), and to be referred in a shorter time period (p < 0.001). Logistic regression analyses revealed that, after controlling for sociodemographic characteristics and case-mix, automatically referred participants were significantly more likely to enroll in cardiac rehabilitation (odds ratio = 2.1; 95% confidence interval 1.4-3.3) than controls. CONCLUSION Automatic referral resulted in over 50% verified cardiac rehabilitation enrollment; 2 times more than usual referral. It also significantly reduced utilization delays to less than one month.
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