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Wasilewski M, Vijayakumar A, Szigeti Z, Sathakaran S, Wang KW, Saporta A, Hitzig SL. Barriers and Facilitators to Delivering Inpatient Cardiac Rehabilitation: A Scoping Review. J Multidiscip Healthc 2023; 16:2361-2376. [PMID: 37605772 PMCID: PMC10440091 DOI: 10.2147/jmdh.s418803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Objective The purpose of this scoping review was to summarize the literature on barriers and facilitators that influence the provision and uptake of inpatient cardiac rehabilitation (ICR). Methods A literature search was conducted using PsycINFO, MEDLINE, EMBASE, CINAHL and AgeLine. Studies were included if they were published in English after the year 2000 and focused on adults who were receiving some form of ICR (eg, exercise counselling and training, education for heart-healthy living). For studies meeting inclusion criteria, descriptive data on authors, year, study design, and intervention type were extracted. Results The literature search resulted in a total of 44,331 publications, of which 229 studies met inclusion criteria. ICR programs vary drastically and often focus on promoting physical exercises and patient education. Barriers and facilitators were categorized through patient, provider and system level factors. Individual characteristics and provider knowledge and efficacy were categorized as both barriers and facilitators to ICR delivery and uptake. Team functioning, lack of resources, program coordination, and inconsistencies in evaluation acted as key barriers to ICR delivery and uptake. Key facilitators that influence ICR implementation and engagement include accreditation and professional associations and patient and family-centred practices. Conclusion ICR programs can be highly effective at improving health outcomes for those living with CVDs. Our review identified several patient, provider, and system-level considerations that act as barriers and facilitators to ICR delivery and uptake. Future research should explore how to encourage health promotion knowledge amongst ICR staff and patients.
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Affiliation(s)
- Marina Wasilewski
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Abirami Vijayakumar
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Zara Szigeti
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sahana Sathakaran
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kuan-Wen Wang
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Adam Saporta
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
| | - Sander L Hitzig
- St. John’s Rehab, Sunnybrook Research Institute, North York, Ontario, Canada
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McDonall J, Heynsbergh N, Oxley S, Botti M, Hutchinson A. Opportunities for patients to engage in postoperative recovery following cardiac surgery: A systematic narrative review. PATIENT EDUCATION AND COUNSELING 2020; 103:2095-2106. [PMID: 32381287 DOI: 10.1016/j.pec.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare patient booklets with clinical guidelines and care pathways to assess: gaps in content and depth of information delivered, opportunities for patients participation and to review the trajectory of care to inform recovery. METHODS A systematic review of the grey literature was conducted using Google search engine and a variety of terms related to cardiac surgery, patient outcomes and recovery pathways. Patient books and care pathways were obtained from major hospitals in Melbourne. Resources were included if they were published between January 2013-August 2018 and written in English. RESULTS A total of 31 resources were included in the review, (n = 14 patient booklets, n = 17 clinician guides). Twenty-one topics of recovery were identified. Patient booklets provided information on more topics of recovery than clinician guides (50 % and 24 % respectively). Clinician guides provided more depth on information on topics of recovery than patient booklets (85 % and 73 % respectively). The majority of patient booklets outlined patient participation was in five topics of recovery. CONCLUSIONS Gaps in the type and depth of information exist between patient and clinician guidelines. Clearer guidelines on how patients can participate in care are needed. PRACTICE IMPLICATIONS Nurses are key drivers in facilitating patient participation in postoperative recovery.
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Affiliation(s)
- Jo McDonall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia
| | - Natalie Heynsbergh
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia.
| | | | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia; Epworth HealthCare, Bridge Road, Melbourne, 3121 Australia
| | - Anastasia Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia; Epworth HealthCare, Bridge Road, Melbourne, 3121 Australia
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Conboy L, Krol J, Tomas J, Yeh GY, Wayne P, Salmoirago-Blotcher E. Tai Chi for heart attack survivors: qualitative insights. BMJ Support Palliat Care 2019; 10:e44. [PMID: 30948446 DOI: 10.1136/bmjspcare-2018-001685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Cardiac rehabilitation (CR) programmes are standard of care for patients following a coronary event. While such exercise-based secondary prevention programme do offer benefits, they are used by less than 30% of eligible patients and attrition within these programmes is high. This project is a nested qualitative assessment of a pilot programme considering Tai Chi (TC) as an alternative to CR. We hypothesised that TC may overcome several key barriers to CR. METHODS A semistructured focus group agenda was used to assess three key domains of feasibility: (1) patients' experiences, (2) reasons/barriers for not having attended CR and (3) any improvements in physical activity and other secondary outcomes (quality of life, weight, sleep). A thematic analysis was used to better understand the key concepts. RESULTS This high-risk group of patients reported that they enjoyed TC exercise, and felt confident and safe doing it. TC practice was reported to support other types of physical activity allowing for a generalisation of positive effects. DISCUSSION This analysis is consistent with published reports of TC practice improving mood and psychological well-being. Qualitative methods allowed us to find emergent experiential reports of behaviour change factors found in established behaviour change theories.
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Affiliation(s)
- Lisa Conboy
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA .,New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts, USA
| | - Julie Krol
- Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jose Tomas
- Miriam Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Gloria Y Yeh
- Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Wayne
- Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Stuebe J, Rydingsward J, Lander H, Ng J, Xu X, Kaneko T, Shekar P, Muehlschlegel JD, Body SC. A Pragmatic Preoperative Prediction Score for Nonhome Discharge After Cardiac Operations. Ann Thorac Surg 2018; 105:1384-1391. [DOI: 10.1016/j.athoracsur.2017.11.060] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
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Caregiver status: a simple marker to identify cardiac surgery patients at risk for longer postoperative length of stay, rehospitalization, or death. J Cardiovasc Nurs 2014; 29:12-9. [PMID: 23321779 DOI: 10.1097/jcn.0b013e318274d19b] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients who have undergone cardiac surgery, especially those with greater comorbidities, may be cared for by family members or paid aides. OBJECTIVE The purpose of this study was to evaluate the association between having a caregiver among patients who underwent cardiac surgery and clinical outcomes at 1 year. We hypothesized that patients with a caregiver would have longer lengths of stay and higher rehospitalization or death rates 1 year after surgery. METHODS We studied 665 patients consecutively admitted for cardiac surgery as part of the Family Cardiac Caregiver Investigation To Evaluate Outcomes sponsored by the National Heart, Lung, and Blood Institute. The participants (mean age, 65 years; women, 35%; racial/ethnic minorities, 21%) completed an interviewer-assisted questionnaire to determine caregiver status. Outcomes were documented by a hospital-based information system; demographics/comorbidities, by electronic records. Associations between having a caregiver and outcomes were evaluated by logistic regression, adjusted for demographic and comorbid conditions. RESULTS At baseline, 28% of the patients (n = 183) had a caregiver (8%, paid; 20%, informal only). Having a caregiver was associated with longer (>7 days) postoperative length of stay in univariate analysis among the patients with paid (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.57-5.74) or informal (OR, 1.55; 95% CI, 1.04-2.31) caregivers versus none; the association remained significant for the patients with paid (OR, 2.13; 95% CI, 1.00-4.55) but not with informal (OR, 1.12; 95% CI, 0.70-1.80) caregivers after adjustment. Having a paid caregiver was significantly associated with rehospitalization/death at 1 year in univariate analysis (OR, 2.09; 95% CI, 1.18-3.69); having an informal caregiver was not (OR, 1.39; 95% CI, 0.94-2.06). Increased odds of rehospitalization/death associated with having a paid caregiver attenuated after adjustment (OR, 1.39; 95% CI, 0.74-2.62). CONCLUSIONS The patients who underwent cardiac surgery who had a paid caregiver had a significantly longer length of stay independent of comorbidity. The increased risk of rehospitalization/death associated with having a paid caregiver was explained by demographics and comorbidity. These data suggest that caregiver status assessment may be a simple method to identify cardiac surgery patients at increased risk for adverse clinical outcomes.
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Influence of Age on Rehabilitation Outcomes and Survival in Post-Acute Inpatient Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2011; 31:230-8. [DOI: 10.1097/hcr.0b013e318207d314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Barnason S, Zimmerman L, Nieveen J, Schulz P, Miller C, Hertzog M, Tu C. Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery. Heart Lung 2010; 38:364-76. [PMID: 19755186 DOI: 10.1016/j.hrtlng.2009.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 01/13/2009] [Accepted: 01/28/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group). METHODS A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS. RESULTS Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use. CONCLUSION Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, Lincoln, 68588-0220, USA
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Factors associated with long hospital length of stay in patients receiving warfarin after cardiac surgery. J Cardiovasc Nurs 2010; 24:465-74. [PMID: 19858955 DOI: 10.1097/jcn.0b013e3181b152d7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients receiving warfarin therapy after coronary artery bypass graft (CABG) or valve surgery have longer length of stay (LOS) than those not receiving warfarin therapy. Longer LOS increases patient costs, postdischarge recovery time, and rehabilitation. It is important to identify variables of longer postoperative LOS in this patient population so that the healthcare team can develop and facilitate interventions to minimize length of hospitalization. METHODS Using a hospital registry and medical record review of cases completed in 2004, data from cardiac surgery patients having CABG and/or valve procedures and given warfarin postoperatively were analyzed based on short (<7 days, CABG; 9 days, valve procedure) and long (> or =7 days, CABG; > or =9 days, valve procedure) postoperative LOS. By groups, significant associations were assessed using chi or Fisher exact test for categorical variables and Wilcoxon 2-sample test or Student t test for continuous variables. RESULTS In 82 patients (33 CABG and 49 valve +/- CABG) who were given warfarin, most demographic, medical history, postoperative complications, and use of cardiac drugs did not predict longer LOS. Longer postoperative LOS was associated with being older (mean age, 73.5 vs 68.5 years), being not married, having postoperative respiratory insufficiency, and receiving more red blood cell transfusions, all P < .05; and having more healthcare consultations, longer critical care stay, and longer time between surgery date and start of warfarin; all P < .001. CONCLUSIONS Variables associated with longer LOS were nonmodifiable by nursing services and were difficult to assess preoperatively. They primarily involved intraoperative or postoperative bleeding that led to red blood cell infusion and longer critical care stays that delayed warfarin initiation. However, older age and marital status are nursing targets because they may be associated with social isolation and other psychosocial issues. Transition of care programs can be developed to promote earlier discharge.
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Barnason S, Zimmerman L, Schulz P, Tu C. Influence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden. Heart Lung 2009; 38:459-68. [PMID: 19944870 DOI: 10.1016/j.hrtlng.2009.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 01/05/2009] [Accepted: 01/28/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden. METHODS A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years). RESULTS There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time. CONCLUSION The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, Nebraska, USA
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Exercise-based cardiac rehabilitation for very old patients (> or =75 years): focus on physical function. J Cardiopulm Rehabil Prev 2008; 28:163-73. [PMID: 18496314 DOI: 10.1097/01.hcr.0000320066.58599.e5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Older patients have high rates of physical function impairment and disability following a cardiac event. Exercise training has been shown to favorably affect such limitations, as well as cardiovascular risk factors, symptoms, and mortality post coronary event in middle-aged patients. Aerobic capacity, body strength, quality of life, and physical function are improved with exercise-based cardiac rehabilitation (CR) in patients older than 65 years. However, there have been relatively few studies of the effects of exercise-based CR on physical function recovery in the very old patients (> or =75 years), despite the continuous growth of this segment of the population. After hospitalization for a cardiac event, postacute inpatient CR serves as a bridge between acute care and independent home living for the most disabled older patients. It plays an important role in the physical recovery process, particularly after cardiac surgery. Exercise-based outpatient (phase II) CR, starting early after hospital discharge, is safe in very old patients and studies demonstrate that these patients derive similar benefits from CR, compared with younger patients, regarding physical function improvement. Older patients, however, are less likely than younger cardiac patients to participate in outpatient CR programs. There is a need to find protocols that could increase the referral and participation rates of the frailer and older cardiac patient to exercise-based CR.
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Cardiac rehabilitation after cardiac surgery: a valuable opportunity that should not be missed. ACTA ACUST UNITED AC 2008; 16:115-6. [DOI: 10.1097/hjr.0b013e3282f8adbf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parkosewich JA. Cardiac Rehabilitation Barriers and Opportunities Among Women With Cardiovascular Disease. Cardiol Rev 2008; 16:36-52. [DOI: 10.1097/crd.0b013e31815aff8b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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