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Westerdahl E, Bergh C, Urell C. Patient-reported physical activity, pain, and fear of movement after cardiac surgery: a descriptive cross-sectional study. SCAND CARDIOVASC J 2024; 58:2393311. [PMID: 39158171 DOI: 10.1080/14017431.2024.2393311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/15/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES After cardiac surgery, there may be barriers to being physically active. Patients are encouraged to gradually increase physical activity, but limited knowledge exists regarding postoperative physical activity levels. This study aimed to assess patient-reported physical activity six months after cardiac surgery, determine adherence to WHO's physical activity recommendations, and explore potential relationships between pain, dyspnea, fear of movement, and activity levels. METHODS The study design was a cross-sectional study at Örebro University Hospital, Sweden. Preoperative and surgical data were retrieved from medical records and questionnaires concerning physical activity (Frändin-Grimby Activity Scale, the Physical activity Likert-scale Haskell, Patient-Specific Functional Scale, and Exercise Self-efficacy Scale) were completed six months after surgery. Data were collected on pain, dyspnea, general health status and kinesiophobia i.e. fear of movement, using the Tampa Scale of Kinesiophobia Heart. RESULTS In total, 71 patients (68 ± 11 years, males 82%) participated in this study. Most patients (76%) reported a light to moderate activity level (Frändin-Grimby levels 3-4) six months after cardiac surgery. In total, 42% of the patients adhered to the WHO's physical activity recommendations (150 min/week). Pain and dyspnea were low. Patients with lower activity levels exhibited significantly higher levels of fear of movement (p =.025). CONCLUSIONS The majority of patients reported engaging in light to moderate activity levels six months after cardiac surgery. Despite this, less than half of the patients met the WHO's physical activity recommendations. Potential barriers to physical activity such as pain, dyspnea and fear of movement were reported to be low.
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Affiliation(s)
- Elisabeth Westerdahl
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Cecilia Bergh
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Charlotte Urell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Maze Y, Tokui T, Narukawa T, Murakami M, Yamaguchi D, Inoue R, Hirano K, Takamura T, Nakamura K, Seko T, Kasai A. Impact of the Barthel Index Score and Prognosis on Patients Undergoing Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement. Circ J 2024; 88:483-491. [PMID: 37899252 DOI: 10.1253/circj.cj-23-0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Few studies have compared the Barthel Index (BI) score and postoperative outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We aimed to examine the relationship between the BI score and postoperative outcomes in patients who underwent TAVR and SAVR. METHODS AND RESULTS The study included patients who underwent SAVR between January 2014 and December 2022 (n=293) and patients who underwent TAVR between January 2016 and December 2022 (n=312). We examined the risk factors for long-term mortality in the 2 groups. The mean (±SD) preoperative BI score was 88.7±18.0 in the TAVR group and 95.8±12.3 in the SAVR group. The home discharge rate was significantly lower in the SAVR than TAVR group. The BI score at discharge was significantly higher in the SAVR than in TAVR group (86.2 vs. 80.2; P<0.001). Significant risk factors for long-term mortality in the TAVR group were sex (P<0.001) and preoperative hemoglobin level (P=0.008), whereas those in the SAVR group were preoperative albumin level (P=0.04) and postoperative BI score (P=0.02). The cut-off point of the postoperative BI score determined by receiver operating characteristic curve analysis was 60.0. CONCLUSIONS The BI score at discharge was a significant risk factor for long-term mortality in the SAVR group, with a cut-off value of 60.0.
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Affiliation(s)
- Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Takahiro Narukawa
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Masahiko Murakami
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Daisuke Yamaguchi
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | - Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital
| | | | | | - Tetsuya Seko
- Department of Cardiology, Ise Red Cross Hospital
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Matsuo T, Morisawa T, Yamamoto S, Nyuba K, Maehata M, Fujii D, Iwaki H, Ueno K, Iwata K, Saitoh M, Takahashi T. Effect of in-patient cardiac rehabilitation at rehabilitation hospital for cardiology patients: two-center trial. Heart Vessels 2024; 39:75-85. [PMID: 37702812 DOI: 10.1007/s00380-023-02310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
The effectiveness of cardiac rehabilitation (CR) in patients with cardiovascular disease requiring continuous CR from an acute care hospital to a convalescent rehabilitation hospital is unknown. Therefore, we compared the effect of CR in a rehabilitation hospital for patients with cardiovascular disease with that of those who underwent cardiovascular surgery. Sixty-nine consecutive patients were admitted to two rehabilitation hospitals for CR. Patients were classified by primary disease into two groups: patients with cardiovascular disease (cardiology group, 26 patients) and patients who underwent cardiovascular surgery (surgery group, 43 patients). Clinical information, physical function, cognitive function, activities of daily living (ADL), quality of life (QOL), amount of CR, and length of hospital stay were compared between the two groups. Compared with clinical features, age was significantly higher in the cardiology group (P < 0.001), and the preadmission Barthel index was significantly lower in the cardiology group (P = 0.025). Physical function at the time of transfer was significantly lower in the cardiology group than in the surgery group for the short physical performance battery (P < 0.001), gait speed (P = 0.005), and 6-min walking distance (P = 0.042). No significant difference was found in the amount of CR performed or the length of hospital stay, and no interaction effects were observed in improvements in physical function, exercise tolerance, or QOL. In conclusion, in rehabilitation hospitals, patients with cardiovascular disease were older, had lower preadmission ADL, and had lower a physical function at transfer than those who underwent cardiovascular surgery, but CR improved physical function and QOL to the same extent. The results suggest that the recovery of patients with cardiovascular disease may be similar to those who undergo cardiovascular surgery.
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Affiliation(s)
- Tomohiro Matsuo
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Satoshi Yamamoto
- Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, 3-11-1 Azukizawa, Itabashi-ku, Tokyo, 174-0051, Japan
| | - Kyohei Nyuba
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Miyuki Maehata
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Daisuke Fujii
- Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, 3-11-1 Azukizawa, Itabashi-ku, Tokyo, 174-0051, Japan
| | - Hirokazu Iwaki
- Department of Rehabilitation, IMS Itabashi Rehabilitation Hospital, 3-11-1 Azukizawa, Itabashi-ku, Tokyo, 174-0051, Japan
| | - Katsuhiro Ueno
- Department of Rehabilitation, Nishi Memorial Port-island Rehabilitation Hospital, 8-5-2, Minatojimanakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1-2 Minatojimaminami-Cho, Chuo-ku, Kobe-shi, 650-0047, Japan
| | - Masakazu Saitoh
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan
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Low ZK, Liew L, Chua V, Chew S, Ti LK. Predictors of unplanned hospital readmission after non-cardiac surgery in Singapore: a 2-year retrospective review. BMC Surg 2023; 23:202. [PMID: 37442969 DOI: 10.1186/s12893-023-02102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Unplanned hospital readmissions after surgery contribute significantly to healthcare costs and potential complications. Identifying predictors of readmission is inherently complex and involves an intricate interplay between medical factors, healthcare system factors and sociocultural factors. Therefore, the aim of this study was to elucidate the predictors of readmissions in an Asian surgical patient population. METHODS A two-year single-institution retrospective cohort study of 2744 patients was performed in a university-affiliated tertiary hospital in Singapore, including patients aged 45 and above undergoing intermediate or high-risk non-cardiac surgery. Unadjusted analysis was first performed, followed by multivariable logistic regression. RESULTS Two hundred forty-nine patients (9.1%) had unplanned 30-day readmissions. Significant predictors identified from multivariable analysis include: American Society of Anaesthesiologists (ASA) Classification grades 3 to 5 (adjusted OR 1.51, 95% CI 1.10-2.08, p = 0.01), obesity (adjusted OR 1.66, 95% CI 1.18-2.34, p = 0.04), asthma (OR 1.70, 95% CI 1.03-2.81, p = 0.04), renal disease (OR 2.03, 95% CI 1.41-2.92, p < 0.001), malignancy (OR 1.68, 95% CI 1.29-2.37, p < 0.001), chronic obstructive pulmonary disease (OR 2.46, 95% CI 1.19-5.11, p = 0.02), cerebrovascular disease (OR 1.73, 95% CI 1.17-2.58, p < 0.001) and anaemia (OR 1.45, 95% CI 1.07-1.96, p = 0.02). CONCLUSION Several significant predictors of unplanned readmissions identified in this Asian surgical population corroborate well with findings from Western studies. Further research will require future prospective studies and development of predictive risk modelling to further address and mitigate this phenomenon.
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Affiliation(s)
- Zhao Kai Low
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Lydia Liew
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Vanessa Chua
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sophia Chew
- Department of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, National University Hospital, Main Building, Level 3 (Near Lift Lobby 1), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Department of Anaesthesia, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Zhang QL, Ge M, Chen C, Fan FD, Jin Y, Zhang N, Wang L. Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery: A Randomized Controlled Trial. Chin J Integr Med 2023:10.1007/s11655-023-3637-9. [PMID: 37243804 DOI: 10.1007/s11655-023-3637-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the feasibility and safety of Liuzijue exercise (LE) for the clinical effect in patients after cardiac surgery. METHODS Totally 120 patients who underwent cardiac surgery and were admitted to the Cardiothoracic Intensive Care Unit of Nanjing Drum Tower Hospital between July and Oclober, 2022 were allocated to the LE group, the conventional respiratory training (CRT) group, and the control group by a random number table at a ratio of 1:1:1; 40 patients in each group. All patients received routine treatment and cardiac rehabilitation. LE group and CRT group respectively performed LE and CRT once a day for 30 min for 7 days. Control group did not receive specialized respiratory training. The forced vital capacity, forced expiratory volume in 1 s, peak inspiratory flow rate, peak expiratory flow rate, maximum inspiratory pressure, maximum expiratory pressure, modified Barthel index (MBI), and Hamilton Rating Scale for Anxiety (HAM-A) were evaluated before, after 3 and 7 days of intervention. In addition, the postoperative length of hospital stay (LOS) and the adverse events that occurred during the intervention period were compared. RESULTS A total of 107 patients completed the study, 120 patients were included in the analysis. After 3 days of intervention, the pulmonary function, respiratory muscle strength, MBI and HAM-A of all 3 groups improved compared with that before the intervention (P<0.05 or P<0.01). Compared with the control group, pulmonary function and respiratory muscle strength were significantly improved in the CRT and LE groups (P<0.05 or P<0.01). MBI and HAM-A were significantly improved in the LE group compared with the control and CRT groups (P<0.05 or P<0.01). On the 7th day after intervention, the difference was still statistically significant (P<0.01), and was significantly different from that on the 3rd day (P<0.05 or P<0.01). In addition, on the 7th day of intervention, the pulmonary function and respiratory muscle strength in the LE group were significantly improved compared with those in the CRT group (P<0.01). MBI and HAM-A were significantly improved in the CRT group compared with the control group (P<0.01). There were no significant differences in postoperative LOS among the 3 groups (P>0.05). No training-related adverse events occurred during the intervention period. CONCLUSIONS LE is safe and feasible for improving pulmonary function, respiratory muscle strength, the ability to complete activities of daily living and for relieving anxiety of patients after cardiac surgery (Registration No. ChiCTR2200062964).
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Affiliation(s)
- Qiao-Li Zhang
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Min Ge
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Cheng Chen
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Fu-Dong Fan
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yan Jin
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Ning Zhang
- Department of Ultrasound, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Lei Wang
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, 210008, China.
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
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Wright JR, Koch-Hanes T, Cortney C, Lutjens K, Raines K, Young D. Quantifying the Risk for Hospital Readmission When Physical Therapist Discharge Recommendations Are Not Followed. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2023. [DOI: 10.1097/jat.0000000000000212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Development and validation of early prediction models for new-onset functional impairment at hospital discharge of ICU admission. Intensive Care Med 2022; 48:679-689. [PMID: 35362765 DOI: 10.1007/s00134-022-06688-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/21/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE We aimed to develop and validate models for predicting new-onset functional impairment after intensive care unit (ICU) admission with predictors routinely collected within 2 days of admission. METHODS In this multi-center retrospective cohort study of acute care hospitals in Japan, we identified adult patients who were admitted to the ICU with independent activities of daily living before hospitalization and survived for at least 2 days from April 2014 to October 2020. The primary outcome was functional impairment defined as Barthel Index ≤ 60 at hospital discharge. In the internal validation dataset (April 2014 to March 2019), using routinely collected 94 candidate predictors within 2 days of ICU admission, we trained and tuned the six conventional and machine-learning models with repeated random sub-sampling cross-validation. We computed the variable importance of each predictor to the models. In the temporal validation dataset (April 2019 to October 2020), we measured the performance of these models. RESULTS We identified 19,846 eligible patients. Functional impairment at discharge was developed in 33% of patients (n = 6488/19,846). In the temporal validation dataset, all six models showed good discrimination ability with areas under the curve above 0.86, and the differences among the six models were negligible. Variable importance revealed newly detected early predictors, including worsened neurologic conditions and catabolism biomarkers such as decreased serum albumin and increased blood urea nitrogen. CONCLUSION We successfully developed early prediction models of new-onset functional impairment after ICU admission that achieved high performance using only data routinely collected within 2 days of ICU admission.
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