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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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Sadeghi M, Askari A, Bostan F, Heidari A, Rafiee H, Alavi Tabatabaei G, Ghasemi G, Roohafza H. Impact of cardiac rehabilitation on erectile dysfunction in cardiovascular patients: a systematic review and meta-analysis. Sex Med 2024; 12:qfae043. [PMID: 38953013 PMCID: PMC11215551 DOI: 10.1093/sexmed/qfae043] [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: 04/08/2024] [Revised: 06/07/2024] [Accepted: 06/08/2024] [Indexed: 07/03/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals. Aim To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis. Methods This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis. Outcomes The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function. Results A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I 2 = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue. Clinical Translation CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group. Strengths and Limitations The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment. Conclusion The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625).
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Affiliation(s)
- Masoumeh Sadeghi
- Chamran Cardiovascular Research and Education Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Askari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Bostan
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Heidari
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Rafiee
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Golsa Ghasemi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Park C, Larsen B, Mogos M, Muchira J, Dietrich M, LaNoue M, Jean J, Norfleet J, Doyle A, Ahn S, Mulvaney S. A multiple technology-based and individually-tailored Sit Less program for people with cardiovascular disease: A randomized controlled trial study protocol. PLoS One 2024; 19:e0302582. [PMID: 38722831 PMCID: PMC11081313 DOI: 10.1371/journal.pone.0302582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024] Open
Abstract
Sedentary behavior, a key modifiable risk factor for cardiovascular disease, is prevalent among cardiovascular disease patients. However, few interventions target sedentary behavior in this group. This paper describes the protocol of a parallel two-group randomized controlled trial for a novel multi-technology sedentary behavior reduction intervention for cardiovascular disease patients (registered at Clinicaltrial.gov, NCT05534256). The pilot trial (n = 70) will test a 12-week "Sit Less" program, based on Habit Formation theory. The 35 participants in the intervention group will receive an instructional goal-setting session, a Fitbit for movement prompts, a smart water bottle (HidrateSpark) to promote hydration and encourage restroom breaks, and weekly personalized text messages. A control group of 35 will receive the American Heart Association's "Answers by Heart" fact sheets. This trial will assess the feasibility and acceptability of implementing the "Sit Less" program with cardiovascular disease patients and the program's primary efficacy in changing sedentary behavior, measured by the activPAL activity tracker. Secondary outcomes include physical activity levels, cardiometabolic biomarkers, and patient-centered outcomes (i.e. sedentary behavior self-efficacy, habit strength, and fear of movement). This study leverages commonly used mobile and wearable technologies to address sedentary behavior in cardiovascular disease patients, a high-risk group. Its findings on the feasibility, acceptability and primary efficacy of the intervention hold promise for broad dissemination.
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Affiliation(s)
- Chorong Park
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Britta Larsen
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, La Jolla, California, United States of America
| | - Mulubrhan Mogos
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - James Muchira
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mary Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Marianna LaNoue
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jason Jean
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - John Norfleet
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Abigail Doyle
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Soojung Ahn
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Shelagh Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
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Duszynski TJ, Fadel W, Dixon B, Yiannoutsos CT, Halverson P, Menachemi N. Characterizing participants who respond to text, email, phone calls, or postcards in a SARS-CoV-2 prevalence study. BMC Public Health 2024; 24:1113. [PMID: 38649843 PMCID: PMC11036578 DOI: 10.1186/s12889-024-18550-6] [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: 10/18/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Multiple modalities and frequencies of contact are needed to maximize recruitment in many public health surveys. The purpose of this analysis is to characterize respondents to a statewide SARS-CoV-2 testing study whose participation followed either postcard, phone outreach or electronic means of invitation. In addition, we examine how participant characteristics differ based upon the number of contacts needed to elicit participation. METHODS This is a cross-sectional analysis of survey data collected from participants who were randomly selected to represent Indiana residents and were invited to be tested for Covid-19 in April 2020. Participants received invitations via postcard, text/emails, and/or robocalls/texts based upon available contact information. The modality, and frequency of contacts, that prompted participation was determined by when the notification was sent and when the participant responded and subsequently registered to participate in the study. Chi square analyses were used to determine differences between groups and significant findings were analyzed using multinomial logistic regression. RESULTS Respondents included 3,658 individuals and were stratified by postcards (7.9%), text/emails (26.5%), and robocalls/text (65.7%) with 19.7% registering after 1 contact, 47.9% after 2 contacts, and 32.4% after 3 contacts encouraging participation. Females made up 54.6% of the sample and responded at a higher rate for postcards (8.2% vs. 7.5%) and text/emails (28.1 vs. 24.6%) as compared to males (χ2 = 7.43, p = 0.025). Compared to males, females responded at a higher percentage after 1 contact (21.4 vs. 17.9%, χ2 = 7.6, p = 0.023). Those over 60 years responded most often after 2 contacts (χ2 = 27.5, p < 0.001) when compared to others at younger age groups. In regression analysis, participant sex (p = 0.036) age (p = 0.005), educational attainment (p = < 0.0001), and being motivated by "free testing" (p = 0.036) were correlated with participation in the prevalence study. DISCUSSION Researchers should be aware that the modality of contact as well as the number of prompts used could influence differential participation in public health studies. Our findings can inform researchers developing studies that rely on selective participation by study subjects. We explore how to increase participation within targeted demographic groups using specific modalities and examining frequency of contact.
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Affiliation(s)
- Thomas J Duszynski
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - William Fadel
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Brian Dixon
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
| | | | - Paul Halverson
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Nir Menachemi
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
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Platz K, Metzger M, Cavanagh C, Park L, Howie-Esquivel J. Initiating and Continuing Long-Term Exercise in Heart Failure: A Qualitative Analysis From the GEtting iNTo Light Exercise-Heart Failure Study. J Cardiovasc Nurs 2024:00005082-990000000-00170. [PMID: 38411493 DOI: 10.1097/jcn.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Exercise is a class 1A recommendation to improve the lives of patients with heart failure, yet less than one-third adhere to physical activity guidelines, and less than 3% attend cardiac rehabilitation. OBJECTIVE The aim of this study was to determine the effect of gentle nonaerobic exercise on initial and long-term adherence in patients with heart failure. METHODS We used a qualitative descriptive approach with qualitative content analysis to analyze previously recorded interview data collected as part of the 6-month GEtting iNTo Light Exercise-Heart Failure study and looked for trends in responses among our sample. Thematic statements, representing salient aspects of the participants' experiences, were created and supported by illustrative excerpts from the data. RESULTS Twenty-two interviews were analyzed. Eight participants had ≥80% adherence, and the remaining 14 participants were super-adherers (>100% adherence). Super-adherers tended to be male and 65 years or older, and have no exercise for 3 months before the study, a body mass index ≥ 30, and poor to good Kansas City Cardiomyopathy Questionnaire scores. Participants initially enrolled because they saw the program as an opportunity to improve a health issue and to exercise. Long-term adherence was facilitated by convenience, individualization, experiencing psychological and physical improvements, and peer fellowship. CONCLUSIONS The GEtting iNTo Light Exercise-Heart Failure study that used home-based gentle nonaerobic exercise had 64% of participants come more than was asked. It is imperative that clinicians incorporate what participants with heart failure have directly stated is important for their initiation and long-term adherence to exercise so that we can work toward bridging sedentary patients to the full exercise guidelines to reduce morbidity and mortality.
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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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Blackwell J, Allen-Collinson J, Evans A, Henderson H. How Person-Centred Is Cardiac Rehabilitation in England? Using Bourdieu to Explore Socio-Cultural Influences and Personalisation. QUALITATIVE HEALTH RESEARCH 2024; 34:239-251. [PMID: 37933668 PMCID: PMC10768332 DOI: 10.1177/10497323231210260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
The National Health Service (NHS) cardiac rehabilitation patient care pathway has remained largely unchanged for many years despite, on average, half of all eligible patients declining to engage. To investigate reasons for non-engagement, we explored the experiences of ten cardiac patients who participated in cardiac rehabilitation, dropped out, or declined, as well as experiences of seven people deemed significant others by participants. Our ethnographic study involved participant observations, repeat in-depth semi-structured interviews, and reflexive journaling. Reflexive thematic analysis was conducted, focusing on participants' lived experiences. Utilising Bourdieusian concepts of habitus, capital, and field, this article highlights how personal biography, material conditions, and dispositional inclinations combine to make cardiac health care decision-making individual and complex. Despite this, health professionals were not always attuned to specific circumstances arising from differences in patients' experiences and lifeworlds. By considering service improvement recommendations that acknowledge socio-cultural influences, cardiac rehabilitation can work towards providing patients and their significant others with more appropriate, personalised, and person-centred support.
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Affiliation(s)
- Joanna Blackwell
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | | | - Adam Evans
- Department of Nutrition, Exercise, and Sport, University of Copenhagen, Copenhagen, Denmark
| | - Hannah Henderson
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
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Pelly ML, Fatehi F, Liew D, Verdejo-Garcia A. Digital Health Secondary Prevention Using Co-Design Procedures: Focus Group Study With Health Care Providers and Patients With Myocardial Infarction. JMIR Cardio 2023; 7:e49892. [PMID: 37902821 PMCID: PMC10644192 DOI: 10.2196/49892] [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: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) is a debilitating condition and a leading cause of morbidity and mortality worldwide. Digital health is a promising approach for delivering secondary prevention to support patients with a history of MI and for reducing risk factors that can lead to a future event. However, its potential can only be fulfilled when the technology meets the needs of the end users who will be interacting with this secondary prevention. OBJECTIVE We aimed to gauge the opinions of patients with a history of MI and health professionals concerning the functions, features, and characteristics of a digital health solution to support post-MI care. METHODS Our approach aligned with the gold standard participatory co-design procedures enabling progressive refinement of feedback via exploratory, confirmatory, and prototype-assisted feedback from participants. Patients with a history of MI and health professionals from Australia attended focus groups over a videoconference system. We engaged with 38 participants across 3 rounds of focus groups using an iterative co-design approach. Round 1 included 8 participants (4 patients and 4 health professionals), round 2 included 24 participants (11 patients and 13 health professionals), and round 3 included 22 participants (14 patients and 8 health professionals). RESULTS Participants highlighted the potential of digital health in addressing the unmet needs of post-MI care. Both patients with a history of MI and health professionals agreed that mental health is a key concern in post-MI care that requires further support. Participants agreed that family members can be used to support postdischarge care and require support from the health care team. Participants agreed that incorporating simple games with a points system can increase long-term engagement. However, patients with a history of MI emphasized a lack of support from their health care team, family, and community more strongly than health professionals. They also expressed some openness to using artificial intelligence, whereas health professionals expressed that users should not be aware of artificial intelligence use. CONCLUSIONS These results provide valuable insights into the development of digital health secondary preventions aimed at supporting patients with a history of MI. Future research can implement a pilot study in the population with MI to trial these recommendations in a real-world setting.
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Affiliation(s)
- Melissa Louise Pelly
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Farhad Fatehi
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Gao W, Li H, Chen Y, Zhang Y, Zhang M, Jin J. Effectiveness of a short-term multimodal prehabilitation program in adult patients awaiting selective cardiac surgery: study protocol for an open-label, pilot, randomized controlled trial. Front Cardiovasc Med 2023; 10:1201737. [PMID: 37456818 PMCID: PMC10347384 DOI: 10.3389/fcvm.2023.1201737] [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: 04/07/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
Background Prehabilitation has been demonstrated to positively impact postoperative recovery in patients undergoing selective cardiac surgery. However, the optimal modules included in prehabilitation programs are yet to be fully explored, as existing studies have primarily focused on exercise. This study will explore the effectiveness of a three-arm prehabilitation program among adult patients awaiting selective cardiac surgery. Methods and analysis A single-center, parallel-group randomized controlled trial will be conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU). A total of 152 adult patients scheduled for elective cardiac surgery (coronary artery bypass grafting or valvular surgery) will be recruited from a tertiary teaching hospital. The patients will be randomly assigned to either the control group or the prehabilitation group. Patients assigned to the control group will receive standard care, which includes patient education and counseling as well as personal guidance on exercise, breathing, and coughing. Patients in the intervention group will be provided a multimodal prehabilitation program, including nutrition guidance, a diet journal, mindfulness training, and exercise guidance. The interventions will begin with home-based training and continue after hospital admission and before surgery. The primary outcome will be the perioperative 6-minute walk distance (6 MWD). The secondary outcomes will include preoperative readiness, postoperative recovery, and patient experience with the program. Discussion The purpose of the study is to examine whether a short-term multimodal prehabilitation program will be associated with improved preoperative readiness and postoperative outcomes. The findings of this study will provide evidence to support the development of a perioperative program aimed at enhancing patient recovery. Clinical Trial Registration www.ClinicalTrials.gov; identifier: NCT05503004.
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Affiliation(s)
- Wen Gao
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Emergency Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyan Li
- Department of Rehabilitation, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yuaner Chen
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Zhang
- Emergency Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang University, Hangzhou, China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Zhejiang University, Hangzhou, China
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Tang LH, Doherty P, Skou ST, Harrison A. Optimal outcomes from cardiac rehabilitation are associated with longer-term follow-up and risk factor status at 12 months: An observational registry-based study. Int J Cardiol 2023:S0167-5273(23)00720-9. [PMID: 37201610 DOI: 10.1016/j.ijcard.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
AIM The purpose of Cardiac Rehabilitation (CR) is to promote and reduce risk factors in the short and long term, however, the latter has, to date, been poorly evaluated. We explored characteristics associated with provision and outcomes of a long-term assessment in CR. METHOD Data from the UK National Audit of CR between April 2015 and March 2020 was used. Programmes were selected if they had an established mechanism and routine methodology to collect the 12-month assessments. Risk factors pre and post phase II CR and at the 12-month assessment were explored; BMI ≤30, ≥150 min of physical activity per week, hospital anxiety and depression scale (HADS) scores <8. The data came from 32 programmes, 24,644 patients with coronary heart disease. Patients being in at least one optimal risk factor stage throughout phase II CR (OR = 1.43 95% CI 1.28 to 1.59) or successfully reaching an optimal stage during phase II CR (OR = 1.61 95% CI 1.44 to 1.80) had an increased likelihood of being assessed at 12 months compared to those who did not. Patients being in the optimal stage upon completion of phase II CR had an increased likelihood of still being in the optimal stage at 12 months. Most prominent was BMI; (OR = 14.6 (95% CI 11.1 to 19.2) for patients reaching an optimal stage throughout phase II CR. CONCLUSION Being in an optimal stage upon routine CR completion could be an overlooked predictor in the provision of a long-term CR service and prediction of longer-term risk factor status.
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Affiliation(s)
- Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark & Department of Health Sciences, University of York, England, United Kingdom.
| | - Patrick Doherty
- Department of Health Sciences, University of York, England, United Kingdom
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Alexander Harrison
- The Research Unit PROgrez, Department of Health Sciences, University of York, England, United Kingdom; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark; The Department of Regional Health Research, University of Southern Denmark, Department of Health Sciences, Denmark
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Borah N, Bhawalkar JS, Rathod H, Jadav V, Gangurde S, S J. Challenges to Cardiac Rehabilitation Post Coronary Artery Bypass Grafting: A Qualitative Study in Pune. Cureus 2023; 15:e35755. [PMID: 37033594 PMCID: PMC10075025 DOI: 10.7759/cureus.35755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Background Adherence to cardiac rehabilitation (CR) regimen is crucial in the post-coronary artery bypass grafting (CABG) period. Cardiac rehabilitation involves various lifestyle changes, including diet and exercise, regular follow-up in OPD, and implementing secondary prevention recommendations. This study aims to understand the challenges to CR post-CABG. Methodology Seven in-depth interviews using an interview guide were carried out in the outpatient section of the cardiothoracic vascular surgery (CTVS) department of a tertiary health care facility in Pune, India. A purposive sampling technique was followed. Results The qualitative study revealed that dietary restrictions were difficult to follow, that some patients could not quit smoking even after surgery, and that transportation costs were an issue regarding CR follow-up. The majority of the participants appreciated the importance of regular exercise in their post-surgery life. Conclusion Despite the hurdles, the majority of participants stated that the fact that CABG is a major treatment pushed them to attend routine CR follow-ups and adhere to the CR regimen. A solid CR team was one of the study's strengths, and the team established a routine of telephonic reminders for regular follow-up, which resulted in lower rates of loss to follow-up.
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Ghisi GLDM, Marzolini S, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Damlund ARS, Jørgensen LB, Blume B, Skou ST, Tang LH, Møller T. Reasons for dropout in the transition from hospital to municipality during exercise-based cardiac rehabilitation in a Danish cross-sectorial setting: a qualitative study. BMJ Open 2022; 12:e064660. [PMID: 36446448 PMCID: PMC9710337 DOI: 10.1136/bmjopen-2022-064660] [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: 12/02/2022] Open
Abstract
OBJECTIVES Despite documented benefits of cardiac rehabilitation (CR), attrition rates remain relatively high. Insights on patient perspectives concerning dropout during transition phases are deficient. This deeper understanding may help to inform on the perceived benefits and barriers in CR. This qualitative study explores the reasons why patients' dropout during the transition from a hospital-based CR programme to local healthcare facilities. SETTING A Danish hospital and seven local healthcare centres. PARTICIPANTS Twelve patients, who had dropped out of exercise-based cardiac rehabilitation (exCR) during the transition from hospital-based rehabilitation to local healthcare centres, were recruited to semistructured interviews based on a purposeful sampling. RESULTS Important patient needs during rehabilitation was the ability to identify and reflect oneself in a group of peers in a safe, specialised hospital-based environment. At the transition point, the meaningfulness of continuation of CR was revaluated. Findings showed that reasons for discontinuation varied within individuals. It encompassed on a balanced choice of reassessing benefits against competing agendas as work demands versus expectations of benefits in a changed exercise environment and own exercise capabilities. CONCLUSION The study indicated that patient needs as timely relevance, a specialised safe environment and peer support are significant for participation in exCR. These needs may change during the transition stage due to competing agendas as work obligations and assessment of own ability to take control themselves. Perceived meaningfulness may be a major motivational driver for both initiating and making a judiciously choice of leaving an exCR programme.
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Affiliation(s)
| | - Lars Bo Jørgensen
- Department of Occupational Therapy and Physiotherapy, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved, Slagelse, Ringsted Hospital, Slagelse Hospital, Slagelse, Sjaelland, Denmark
| | - Birgitte Blume
- Department of Occupational Therapy and Physiotherapy, Zealand University Hospital Roskilde, Roskilde, Sjaelland, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, Research Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Sjaelland, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Tom Møller
- The University Hospitals Centre for Health Research (UCSF), Department 9701, Copenhagen University Hospital, Copenhagen, Denmark
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Fadil Azim DH, Mohd Ghazi A, Ong SH, Abdul Majid HS, Morgan K, Hickey A. Improving physical and psychological outcomes of cardiac patients using the Naluri app: A study protocol for a randomized controlled trial. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13629.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Coronary artery disease (CAD) continues to be a significant burden to public health. Poor treatment and management can lead to more severe cardiac events that could result in death or disability. Early interventions like cardiac rehabilitation programs can provide patients the required knowledge, skills and support to recover from and prevent more cardiac events. Electronic health (eHealth) interventions have potential to complement hospital-based rehabilitation programs. This study aims to investigate the effectiveness of the Naluri app in improving health behaviours, clinical and psychological outcomes in a sample of cardiac patients in Malaysia. Methods: This study is a two-arm, parallel, superiority randomized control trial to be conducted at the Malaysian National Heart Institute. A total of 200 patients will be randomly assigned to either a 16-week theory-based Naluri app in addition to usual care (treatment) or to usual care only (control). Outcomes will be measured at baseline and at 16 weeks. Health behaviour outcomes include physical activity and diet. Clinical outcomes include BMI, hemoglobin A1c (HbA1c), and lipid levels. Psychological outcomes include anxiety, depression, and health related quality of life (HRQOL). The Naluri app theoretical framework is based on the Health Action Process Approach (HAPA) theory. Risk perception, self-efficacy, planning, intentions, outcome expectancies, illness perceptions and psychological outcomes will be measured using self-reported measures. Discussion: This trial will determine the effectiveness of the Naluri app intervention in improving various outcomes of cardiac patients after four months. It will provide data on the applicability of the HAPA theory in Mobile health (mHealth) intervention and the acceptance and efficacy of mHealth as a cardiac rehabilitation program for patients in Malaysia. The results may inform the potential implementation of the app for use with patients with other chronic illnesses like diabetes, stroke, and depression. Registration: Australia New Zealand Clinical Trials Registry (14/01/2019, ACTRN12619000104156).
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Tilgner N, Nehls D, Lichtmess C, Kober A, Küsel C, Radloff L, Gabrys L. Adherence to exercise and fitness following exercise-based outpatient cardiac rehabilitation: a cross-sectional survey for Germany. BMC Sports Sci Med Rehabil 2022; 14:191. [DOI: 10.1186/s13102-022-00585-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Exercise-based cardiac rehabilitation is safe and effective, evidence-based and implemented in national and international cardiac rehabilitation guidelines. Recent data show a decrease in cardiovascular mortality, reduced hospital admissions and an overall improvement in quality of life. To maintain positive effects and to prevent further cardiovascular events a major goal of cardiac rehabilitation is to induce a long-term health behaviour change and the integration of regular physical activity and exercise training in everyday life. The aim of this study is to evaluate the adherence of cardiac patients to exercise-based programs following rehabilitation phase III.
Methods
A nationwide online cross-sectional survey was conducted. All outpatient aftercare providers who offer sports rehabilitation programs (heart groups) for cardiac patients in Germany were contacted. The questionnaire comprised 15 questions in five subcategories (general information regarding the outpatient aftercare provider, structure of rehabilitation sport programs, membership structure, content of heart groups, adherence to exercise-based programs).
Results
560 of 2447 outpatient aftercare providers participated in the survey (response rate: 23%). On average, rehabilitation sport facilities hosted 2 (IQR 2) heart groups per week, and 23 patients (IQR 30) (61% males; 31% females) per facility completed rehabilitation sport prescription in 2018. Almost all providers offer follow-up programs on a self-payer basis after rehabilitation sport prescription ends. Adherence to follow-up programs was at 54% (IQR 65; 55% males and 50% females). With 60% (IQR 71), patients with a statutory health insurance (mainly pensioners) adhere slightly more often to a follow-up program compared to privately insured persons (mainly population with a high income or civil servants) with 50% and significantly more often compared to persons who were insured by the German pension fund (covering working population) with only 9% (IQR 89) adherence.
Conclusion
Almost all outpatient aftercare providers offer follow-up programs for cardiac rehabilitation patients but only half of them actually participate. Younger people (working population) do not adhere sufficiently to sport and exercise programs following rehabilitation phase III. This seems critical to address in terms of achieving long-term rehabilitation goals.
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Women's Health-Related Quality of Life Substantially Improves With Tailored Cardiac Rehabilitation: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2022; 42:217-226. [PMID: 35703271 DOI: 10.1097/hcr.0000000000000692] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Exercise-based cardiac rehabilitation (EBCR) offers an opportunity to improve women's otherwise poorer outcomes from coronary heart disease compared with men. However, synthesized evidence for the benefits of EBCR for health-related quality of life (HRQL) is lacking for women. The current study addresses this gap. METHODS Four electronic databases (PubMed, CINAHL, SCOPUS, and Cochrane) were searched for studies reporting HRQL using validated questionnaires in women attending EBCR. Two reviewers independently screened articles and extracted data. A random effects model was used for meta-analysis, where possible. RESULTS Eleven studies (1237 women) were included, with seven suitable for meta-analyses. Participation in EBCR improved multiple domains of HRQL, with greatest improvements in Role Physical (mean differences [MD] = 19.09: 95% CI, 2.37-35.81), Physical Functioning (MD = 10.43: 95% CI, 2.60-18.27), and Vitality (MD = 9.59: 95% CI, 0.31-18.86) domains of the 12-Item Short Form Health Survey and the 36-Item Short Form Health Survey. Adding psychosocial components tailored for women to traditional EBCR produced further gains in HRQL in Bodily Pain (MD = 9.82: 95% CI, 4.43-15.21), Role Physical (MD = 8.48: 95% CI, 1.31-9.97), Vitality (MD = 8.17: 95% CI, 3.79-12.55), General Health (MD = 5.64: 95% CI, 1.31-9.97), and Physical Functioning (MD = 5.61: 95% CI, 0.83-10.40) domains. CONCLUSIONS Women attending EBCR achieve clinically meaningful improvements in multiple areas of HRQL, with added benefits when strategies were tailored to their needs. These benefits should be highlighted to promote EBCR uptake in women.
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Borsoi L, Callea G, Tarricone R. How to Reduce Inequity of Access to Cardiac Rehabilitation After Surgical Aortic Valve Replacement. Recommendations for the Post–COVID-19 Era From a Real-World, Population-Based Study. Clin Ther 2022; 44:491-507. [DOI: 10.1016/j.clinthera.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 11/03/2022]
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Bohplian S, Bronas UG. Motivational Strategies and Concepts to Increase Participation and Adherence in Cardiac Rehabilitation: AN INTEGRATIVE REVIEW. J Cardiopulm Rehabil Prev 2022; 42:75-83. [PMID: 34753873 DOI: 10.1097/hcr.0000000000000639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low participation and adherence to cardiac rehabilitation (CR) leads to ineffective care and increased risk of cardiac complications. There is a need to identify effective motivational strategies and concepts to increase participation and adherence to CR. PURPOSE The aim of this review was to synthesize and integrate the current knowledge about motivational strategies and concepts to increase participation and adherence to CR. METHODS A literature search was performed using five electronic databases: CINAHL, Medline via PubMed, Scopus, Embase, and Rehabilitation & Sports Medicine Source. The search was limited to peer-reviewed studies, written in English, and publications from 2010 to 2019. A matrix and narrative synthesis were employed to organize and synthesize the findings, respectively. RESULTS Eight of 522 articles met the inclusion criteria. Four articles used motivational interviewing (MotI) and counseling strategy, three articles investigated the autonomy, competence, and relatedness of self-determination theory (SDT) concepts, and one article used a reinforced motivational strategy. Use of MotI led to improving the CR completion rate from 14% to 39%. The number of sessions attended/patient improved from 12 to 20 when the staff was provided attendance feedback and a reward. Autonomy, competence, and relatedness motivated patients to participate in and adhere to CR. CONCLUSIONS Motivational interviewing and counseling, motivational and reinforcement strategies, and the autonomy, competence, and relatedness of SDT concepts should be utilized to promote participation and motivation for CR. The effects of these techniques on long-term CR require further research, including combining the identified methods to investigate the efficacy of these techniques on CR adherence.
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Affiliation(s)
- Suweena Bohplian
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago
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Rangel-Cubillos DM, Vega-Silva AV, Corzo-Vargas YF, Molano-Tordecilla MC, Peñuela-Arévalo YP, Lagos-Peña KM, Jácome-Hortúa AM, Villamizar-Jaimes CJ, Grace SL, Dutra de Souza HC, Angarita-Fonseca A, Sánchez-Delgado JC. Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041911. [PMID: 35206100 PMCID: PMC8872241 DOI: 10.3390/ijerph19041911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 01/27/2023]
Abstract
Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.
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Affiliation(s)
- Diana Marcela Rangel-Cubillos
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Andrea Vanessa Vega-Silva
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Yully Fernanda Corzo-Vargas
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Maria Camila Molano-Tordecilla
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Yesica Paola Peñuela-Arévalo
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Karen Mayerly Lagos-Peña
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Adriana Marcela Jácome-Hortúa
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | | | - Sherry L. Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada;
- KITE-Toronto Rehab Institute, & Director of Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M4G 1R7, Canada
| | - Hugo Celso Dutra de Souza
- Laboratory of Physiology and Cardiovascular Physioterapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Correspondence: (H.C.D.d.S.); or (J.C.S.-D.)
| | - Adriana Angarita-Fonseca
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
- Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, QC J9X 5E4, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Juan Carlos Sánchez-Delgado
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
- Laboratory of Physiology and Cardiovascular Physioterapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Grupo de Investigación Ser Cultura y Movimiento, Universidad Santo Tomás-Bucaramanga, Santander 680001, Colombia
- Correspondence: (H.C.D.d.S.); or (J.C.S.-D.)
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Lee M, Wood T, Chan S, Marziali E, Tang T, Banner D, Lear SA. Cardiac rehabilitation program: An exploration of patient experiences and perspectives on program dropout. Worldviews Evid Based Nurs 2022; 19:56-63. [PMID: 35040245 PMCID: PMC9303891 DOI: 10.1111/wvn.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/23/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
Background Cardiac rehabilitation programs (CRP) are effective evidence‐based secondary prevention programs that reduce morbidity and mortality in patients with cardiovascular disease (CVD). However, participation remains suboptimal, resulting in under‐treatment and greater risk for recurrent cardiac events. Understanding the reasons behind CRP dropout is urgently needed to inform the development of programs that best meet patient needs and support sustained engagement. Aims The aim of this study was to identify and understand factors impacting CRP dropout from the patient perspective. Methods A qualitative study using semi‐structured interviews was undertaken to examine the experience of 23 patients who dropped out of a CRP within a large urban hospital in British Columbia, Canada. Data were coded, analyzed using the constant comparison technique, and organized thematically. Results Participants described multiple challenges when attempting to complete CRP. Analysis of the data led to the identification of three main categories: (1) challenges living with CVD, (2) perceived advantages and disadvantages of CRP, and (3) unmet needs during CRP. Linking evidence to action In the practice setting, assessment of readiness to engage in CRP, alongside patient preferences and engagement needs, should be undertaken for maximum CRP uptake and completion. Providing diverse modes of CRP delivery, along with exploring the impact of virtual options as compared to traditional in‐person programs, will further advance the CRP evidence and may help address pervasive access barriers.
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Affiliation(s)
- Monica Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Timothy Wood
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Sammy Chan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elsa Marziali
- Rotman Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Tricia Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Rivers JT, Smith C, Smith I, Cameron J. The Impact of a Mobile App on Participation in Cardiac Rehabilitation and Understanding Barriers to Success: Comparative Cohort Study. JMIR Cardio 2022; 6:e24174. [PMID: 35037891 PMCID: PMC8804955 DOI: 10.2196/24174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/23/2020] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost, and psychological constraints. Objective We evaluated the impact on CR participation rates associated with the addition of the option of mobile app–based CR (Cardihab) for patients declining conventional CR. Methods A total of 204 consecutive patients were offered CR following angioplasty; of these, 99 were in cohort 1 (offered conventional CR only) and 105 were in cohort 2 (app-based CR offered to those declining conventional CR). Patients in each cohort were followed throughout a 6-week CR program and participation rates were compared for both groups. Patients in cohort 2 declining both forms of CR were interviewed to assess reasons for nonparticipation. Results CR participation improved from 21% (95% CI 14%-30%) to 63% (95% CI 53%-71%) with the addition of the app (P<.001). Approximately 25% (9/39) of the group declining the app-based program identified technology issues as the reason for nonparticipation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. Conclusions Providing patients with the additional option of an app-based CR program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Further innovation in CR delivery systems is required to improve uptake.
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Affiliation(s)
- John T Rivers
- Queensland Cardiovascular Group, St Andrew's Specialist Centre, Brisbane, Australia.,St Andrew's War Memorial Hospital, Brisbane, Australia.,St Vincent's Private Hospital Northside, Brisbane, Australia
| | - Carla Smith
- Queensland Cardiovascular Group, St Andrew's Specialist Centre, Brisbane, Australia
| | - Ian Smith
- St Andrew's War Memorial Hospital, Brisbane, Australia
| | - James Cameron
- Queensland Cardiovascular Group, St Andrew's Specialist Centre, Brisbane, Australia.,St Andrew's War Memorial Hospital, Brisbane, Australia
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22
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Borges GLB, da Cruz MMA, Ricci-Vitor AL, da Silva PF, Grace SL, Vanderlei LCM. Publicly versus privately funded cardiac rehabilitation: access and adherence barriers. A cross-sectional study. SAO PAULO MED J 2022; 140:108-114. [PMID: 35043870 PMCID: PMC9623829 DOI: 10.1590/1516-3180.2020.0782.r1.31052021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. OBJECTIVE To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence. DESIGN AND SETTING Observational, cross-sectional study in public and private CR programs offered in Brazil. METHODS Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale. RESULTS From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012). CONCLUSION Publicly funded programs need to be tailored to meet their patients' requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.
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Affiliation(s)
- Giovanna Lombardi Bonini Borges
- PT. Physiotherapist, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Mayara Moura Alves da Cruz
- PT, MSc. Physiotherapist and Doctoral Student, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Ana Laura Ricci-Vitor
- PT, PhD. Professor, Escola Superior de Saúde Egas Moniz (ESSEM), Egas Moniz - Cooperativa de Ensino Superior (CRL), Almada, Setúbal, Portugal.
| | - Paula Fernanda da Silva
- PT. Physiotherapist and Master's Student, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Sherry Lynn Grace
- PhD, CRFC. Professor, Faculty of Health, York University, Toronto, Ontario, Canada; and Senior Scientist, KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Luiz Carlos Marques Vanderlei
- PhD. Professor, Department of Physiotherapy, School of Technology and Sciences, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
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Ballard LM, Jenkinson E, Byrne CD, Child JC, Inskip H, Lokulo-Sodipe O, Mackay DJG, Wakeling EL, Davies JH, Temple IK, Fenwick A. Experiences of adolescents living with Silver-Russell syndrome. Arch Dis Child 2021; 106:1195-1201. [PMID: 33741574 DOI: 10.1136/archdischild-2020-321376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The psychosocial impact of growing up with Silver-Russell syndrome (SRS), characterised by growth failure and short stature in adulthood, has been explored in adults; however, there are no accounts of contemporary lived experience in adolescents. Such data could inform current healthcare guidance and transition to adult services. We aimed to explore the lived experience of adolescents with SRS. DESIGN/SETTING/PATIENTS In-depth, semi-structured interviews were conducted between January 2015 and October 2016 with a sample of eight adolescents aged 13-18 (five girls) with genetically confirmed SRS from the UK. Qualitative interviews were transcribed and coded to identify similarities and differences using thematic analysis; codes were then grouped to form overarching themes. RESULTS We identified four themes from the interview data: (1) the psychosocial challenges of feeling and looking different; (2) pain, disability and fatigue; (3) anticipated stigma; and (4) building resilience and acceptance. Despite adolescents accepting SRS in their lives, they described ongoing psychosocial challenges and anticipated greater problems to come, such as stigma from prospective employers. CONCLUSIONS Adolescents with SRS may experience psychosocial difficulties from as young as 10 years old related to feeling and looking different; pain, disability and fatigue; anticipated stigma; and future challenges around employment. We discuss these findings in relation to recommendations for the care of adolescents with SRS to prepare them for adult life.
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Affiliation(s)
- Lisa Marie Ballard
- Clinical Ethics & Law, Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Jenkinson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Christopher D Byrne
- Nutrition and Metabolism Unit, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Oluwakemi Lokulo-Sodipe
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Emma L Wakeling
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Justin Huw Davies
- Department of Endocrinology, Southampton Children's Hospital, Southampton University Hospitals NHS Trust, Southampton, UK
| | - I Karen Temple
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics & Law, Faculty of Medicine, University of Southampton, Southampton, UK
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Rasmussen B, Håkonsen SJ, Toft B. Face-to-face interventions to encourage enrolment in cardiac rehabilitation: a scoping review protocol. BMJ Open 2021; 11:e050447. [PMID: 34845068 PMCID: PMC8634007 DOI: 10.1136/bmjopen-2021-050447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation has become an integral part of secondary treatment of cardiovascular heart disease. Despite evidence demonstrating that cardiac rehabilitation improves prognoses, reduces disease progression and helps patients to find a new foothold in life, many patients do not enrol. Face-to-face interventions can encourage patients to enrol; however, it is unclear which strategies have been developed, how they are structured in a hospital context and whether they target the life-world of the patients. The objective of this scoping review is to map and evaluate the nature and characteristics of studies that have reported on face-to-face interventions to encourage patients to enrol in cardiac rehabilitation. METHODS AND ANALYSIS This review will be guided by the Joanna Briggs Institute Methodology for Scoping Reviews. A search strategy developed in cooperation with a research secretary will be applied in six databases including studies published from 2000 in English, Danish, Norwegian, Swedish and German with no restriction on publication type or study design. Studies involving adult patients with ischaemic heart disease or heart failure will be included. Studies providing the intervention after enrolment in cardiac rehabilitation will be excluded. Study selection will be performed independently by two reviewers. Data will be extracted by two reviewers using predefined data charting forms. The presentation of data will be a narrative summary of the characteristics and key findings to facilitate the integration of diverse evidence, and as we deem appropriate will be supported by a diagrammatic or tabular presentation. ETHICS AND DISSEMINATION This scoping review will use data from existing publications and does not require ethical approval. Results will be reported through publication in a scientific journal and presented on relevant conferences and disseminated as part of future workshops with professionals involved in communication with patients about enrolment in cardiac rehabilitation.
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Affiliation(s)
- Birgit Rasmussen
- Department of Physio and Occupational Therapy, Regional Hospital Horsens, Horsens, Midtjylland, Denmark
| | - Sasja Jul Håkonsen
- The Danish Clinical Quality Program, National Clinical Registries, Innovation & Ressources, Aarhus, Midtjylland, Denmark
| | - Bente Toft
- Research Centre for Patient Involvement, Department of Public Health, Aarhus Universitet, Aarhus, Midtjylland, Denmark
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25
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Daw P, Withers TM, van Zanten JJCSV, Harrison A, Greaves CJ. A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure. BMC Health Serv Res 2021; 21:1267. [PMID: 34814927 PMCID: PMC8611948 DOI: 10.1186/s12913-021-07174-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. METHODS A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. RESULTS Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were 'the organisation of healthcare system', 'the organisation of cardiac rehabilitation programmes', 'healthcare professional' factors and 'guidelines'. The most frequent themes included 'lack of resources: time, staff, facilities and equipment' and 'professional's knowledge, awareness and attitude'. CONCLUSIONS Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research.
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Affiliation(s)
- Paulina Daw
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Thomas M. Withers
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | | | | | - Colin J. Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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26
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Rothe D, Schick-Makaroff K, Clark AM, Cox-Kennett N, O'Rourke T, Pituskin E. Benefits of Cardiac Rehabilitation for Patients With Lymphoma Undergoing Hematopoietic Stem Cell Transplantation. J Cardiopulm Rehabil Prev 2021; 41:357-358. [PMID: 34461623 DOI: 10.1097/hcr.0000000000000610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Derek Rothe
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Kara Schick-Makaroff
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander M Clark
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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Martynova V, Andreev D, Giverts I, Svet A, Syrkin A, Saner H. First experience with video-guided home-based exercise training for patients with stable coronary artery disease after elective percutaneous coronary interventions. Eur J Prev Cardiol 2021; 28:1145-1147. [PMID: 32689837 DOI: 10.1177/2047487320940106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Valentina Martynova
- Department of Cardiology, Functional and Ultrasound Diagnostics, First Moscow State Medical University named after I M Sechenov, Russia
| | - Denis Andreev
- Department of Cardiology, Functional and Ultrasound Diagnostics, First Moscow State Medical University named after I M Sechenov, Russia
| | - Ilya Giverts
- Department of Cardiology, Functional and Ultrasound Diagnostics, First Moscow State Medical University named after I M Sechenov, Russia
| | - Alexey Svet
- Department of Cardiology, Functional and Ultrasound Diagnostics, First Moscow State Medical University named after I M Sechenov, Russia
| | - Abram Syrkin
- Department of Cardiology, Functional and Ultrasound Diagnostics, First Moscow State Medical University named after I M Sechenov, Russia
| | - Hugo Saner
- Department of Cardiology, Functional and Ultrasound Diagnostics, First Moscow State Medical University named after I M Sechenov, Russia
- University Clinic for Cardiology, University Hospital Bern, Switzerland
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28
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Reliability of the Scale of Barriers for Cardiac Rehabilitation in the Colombian Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084351. [PMID: 33923963 PMCID: PMC8074057 DOI: 10.3390/ijerph18084351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
Cardiac rehabilitation is supported by the highest level of scientific evidence. However, less than 25% of those eligible to participate in a cardiac rehabilitation program initiate it; and of these, 50% drop out prematurely. A modified Spanish Cardiac Rehabilitation Barriers Scale (CRBS) has been translated, culturally adapted and validated in Colombia, however, the reliability remains to be evaluated. This study aimed to determine the internal consistency and test–retest reliability of the CRBS in a Colombian population. In total, 193 patients (67% men, average age = 65 ± 12 years) completed the scale twice, with an average of eight days between applications. Cronbach’s Alpha and intraclass correlation coefficients (ICC) were calculated. The internal consistency of the Colombian version of the CRBS was acceptable (Cronbach’s alpha = 0.84). The ICC of the CRBS was 0.69 (95% CI 0.61–0.76); 0.78 (95% CI 0.71–0.84) when the CRBS was completed by interview; and 0.47 (95% CI 0.21–0.67) when the CRBS was self-reported. The reliability of the interview version of the CRBS was substantial in the Colombian population; however, the reliability of the self-report version was lower. The use of this scale will allow developing strategies to increase participation and adherence to cardiac rehabilitation programs.
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Meng G, Qazi H, Chen H. Factors Associated With Non-enrollment of Center-Based Cardiovascular Rehabilitation Program Among Transient Ischemic Attack or Mild Stroke Patients: A MIXED-METHOD RETROSPECTIVE STUDY. J Cardiopulm Rehabil Prev 2021; 41:116-121. [PMID: 33186198 DOI: 10.1097/hcr.0000000000000558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cardiovascular rehabilitation programs (CRPs) are effective in secondary stroke prevention, yet the enrollment rate is suboptimal. This study aims to identify demographic and clinical factors and patient-reported reasons for non-enrollment in a center-based outpatient CRP among patients with transient ischemic attack (TIA) or mild stroke. METHODS This mixed-method retrospective chart review was conducted in an outpatient CRP affiliated with a tertiary care hospital in Canada from January 2009 to October 2017. A total of 621 patients with TIA or mild stroke were included. Multiple logistic regression was used to determine the relationship between demographic and clinical predictors with non-enrollment. A thematic analysis of multidisciplinary progress notes was done for the non-enrollment subgroup of patients to understand the patient-reported reasons. RESULTS The non-enrollment rate was 42%. Travel distance to CRP (OR = 1.024; 95% CI, 1.010-1.038), age (OR = 1.023; 95% CI, 1.004-1.042), and current smoking status (OR = 1.935; 95% CI, 1.230-3.042) were associated with non-enrollment. The patient-reported reasons for non-enrollment were occurrence of new medical events and comorbidities, their perceptions of health and CRP, transportation, work/time conflict, and distance. CONCLUSIONS This study found that patients with TIA or mild stroke who were older, lived farther from the CRP center, or were current smokers were less likely to enroll in a CRP. The present findings may help clinicians identify patients unlikely to enroll in a CRP and allow the implementation of interventions focused on health education and physical activity to improve enrollment. Future research should validate these factors in multiple settings using prospective mixed methods so that interventions can be developed to address non-enrollment in the CRP.
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Affiliation(s)
- Guangxia Meng
- Secondary Stroke Prevention Clinic, Chronic Disease Management, Southlake Regional Health Centre, University of Waterloo, Waterloo, Ontario, Canada (Ms Meng); and Applied Health Science, University of Waterloo, Waterloo, Ontario, Canada (Drs Qazi and Chen)
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30
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González-Salvado V, Peña-Gil C, Lado-Baleato Ó, Cadarso-Suárez C, Prada-Ramallal G, Prescott E, Wilhelm M, Eser P, Iliou MC, Zeymer U, Ardissino D, Bruins W, van der Velde AE, Van't Hof AWJ, de Kluiver EP, Kolkman EK, Prins L, González Juanatey JR. Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study. Eur J Prev Cardiol 2021; 28:558-568. [PMID: 33558875 DOI: 10.1093/eurjpc/zwaa104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. METHODS AND RESULTS The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes. CONCLUSION In this European cohort of elderly patients, older age and comorbidity tackled patients' referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients.
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Affiliation(s)
- Violeta González-Salvado
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Carlos Peña-Gil
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
| | - Óscar Lado-Baleato
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Cadarso-Suárez
- Department of Statistics, Mathematical Analysis and Optimization, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Prada-Ramallal
- Epidemiology, Statistics and Research Methodology Unit, Santiago de Compostela Institute for Research Foundation (FIDIS), Santiago de Compostela, Spain
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Diego Ardissino
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | | | - Astrid E van der Velde
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arnoud W J Van't Hof
- Isala Heart Centre, Zwolle, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | | | - José Ramón González Juanatey
- Department of Cardiology, University Hospital of Santiago de Compostela, SERGAS, IDIS (CIBER-CV), A Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
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Dunn SL, Robbins LB, Tintle NL, Collins EG, Bronas UG, Goodyke MP, Luong A, Gutierrez-Kapheim M, DeVon HA. Heart up! RCT protocol to increase physical activity in cardiac patients who report hopelessness: Amended for the COVID-19 pandemic. Res Nurs Health 2021; 44:279-294. [PMID: 33428224 PMCID: PMC7933089 DOI: 10.1002/nur.22106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 01/19/2023]
Abstract
Hopelessness is associated with decreased physical activity (PA) and increased adverse events and death in patients with ischemic heart disease (IHD). Rates of PA in patients with IHD continue to be low in both hospital-based cardiac rehabilitation and home settings. While researchers have investigated strategies to increase PA among patients with IHD, interventions to promote PA specifically in IHD patients who report hopelessness are lacking. We describe the protocol for a NIH-funded randomized controlled trial designed to establish the effectiveness of a 6-week intervention (Heart Up!) to promote increased PA in IHD patients who report hopelessness. Participants (n = 225) are randomized to one of three groups: (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse plus significant other support (SOS), or (3) attention control. Aims are to: (1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA; (2) determine the effects of change in moderate to vigorous PA on hopelessness; and (3) determine if perceived social support and motivation (exercise self-regulation) mediate the effects of the intervention on PA. A total of 69 participants have been enrolled to date. The protocol has been consistently and accurately used by research personnel. We address the protocol challenges presented by the COVID-19 pandemic and steps taken to maintain fidelity to the intervention. Findings from this study could transform care for IHD patients who report hopelessness by promoting self-management of important PA goals that can contribute to better health outcomes.
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Affiliation(s)
- Susan L Dunn
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lorraine B Robbins
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Nathan L Tintle
- Department of Statistics, Dordt University, Sioux Center, Iowa, USA
| | - Eileen G Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ulf G Bronas
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Madison P Goodyke
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anna Luong
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melissa Gutierrez-Kapheim
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
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Hawkes RE, Cameron E, Cotterill S, Bower P, French DP. The NHS Diabetes Prevention Programme: an observational study of service delivery and patient experience. BMC Health Serv Res 2020; 20:1098. [PMID: 33246460 PMCID: PMC7694420 DOI: 10.1186/s12913-020-05951-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The NHS Diabetes Prevention Programme (NHS-DPP) is a nine-month, group-based behavioural intervention for adults in England at risk of developing Type 2 diabetes. Four independent providers were commissioned to deliver versions of the NHS-DPP, in line with NHS England specifications. This observational study maps NHS-DPP delivery in routine practice against the NHS specification, and compares service delivery with observed patient experiences. METHODS Researchers observed service delivery across eight complete NHS-DPP courses (118 sessions, median 14 sessions per course), consenting 455 participants (36 staff, 398 patients, 21 accompanying persons). Key features of NHS-DPP delivery were described using the Template for Intervention Description and Replication (TIDieR) framework. Researchers wrote detailed field notes during each session, including observations of patient experience. Field notes were content analysed; instances of positive and negative experiences were labelled and grouped into categories. Researchers used a novel method of comparing observed patient experiences to variations in programme delivery. RESULTS Delivery broadly followed NHS England's specification and the plans set out by providers. Deviations included the scheduling and larger group sizes in some sessions. There was variation in the type and format of activities delivered by providers. Positive patient experiences included engagement, satisfaction with the programme, good within-group relationships and reported behavioural changes. Negative experiences included poor scheduling, large groups, and dissatisfaction with the venue. Where more interactive and visual activities were delivered in smaller groups of 10-15 people with good rapport, there were generally more instances of positive patient experiences, and where there were structural issues such as problems with the scheduling of sessions, poor venues and inadequate resources, there tended to be more negative patient experiences. CONCLUSIONS Addressing issues that we have identified as being linked to negative experiences with the NHS-DPP could increase uptake, reduce patient drop-out and increase the overall effectiveness of the programme. In particular, modifying structural aspects of the NHS-DPP (e.g. reliable session scheduling, reducing group sizes, enough session resources) and increasing interaction appear particularly promising for improving these outcomes.
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Affiliation(s)
- Rhiannon E Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Univeraity of Manchester, Manchester, UK.
| | - Elaine Cameron
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Univeraity of Manchester, Manchester, UK
- Division of Psychology, University of Stirling, Stirling, Scotland, UK
| | - Sarah Cotterill
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Univeraity of Manchester, Manchester, UK
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Depression Is Associated With Reduced Outpatient Cardiac Rehabilitation Completion Rates: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2020; 39:365-372. [PMID: 30913045 DOI: 10.1097/hcr.0000000000000419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Depression is associated with recurrent cardiac events and death in patients with coronary heart disease and congestive heart failure. Furthermore, depression may be associated with reduced completion of outpatient cardiac rehabilitation (CR), an empirically supported treatment for patients with coronary heart disease and congestive heart failure that reduces recurrent coronary events and cardiac mortality. The goal of the current systematic review and meta-analysis was to explore the association between depression and outpatient CR completion. METHOD A systematic literature review cross-referenced 3 electronic databases (PsycINFO, MEDLINE, and Dissertation Abstracts International) from inception through February 15, 2015. Studies quantifying an association between depression and outpatient CR completion were identified for review. A random-effects model was used to pool quantitative data, moderators were tested, and publication bias was analyzed. RESULTS Seventeen studies with 19 independent samples consisting of 30 586 cardiac patients were included in the meta-analysis. A moderate inverse relationship between depression and outpatient CR completion was observed (g = -0.44; 95% CI, -0.59 to -0.29), indicating that depressed CR patients were significantly less likely to complete their prescribed CR programs. No significant moderator variables were identified. A minor amount of publication bias was detected. CONCLUSION Depression is associated with reduced outpatient CR completion rates. Future research should focus on attendance interventions for depressed CR patients, as completion of outpatient CR reduces cardiac and all-cause mortality.
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Sex- and Gender-Related Factors Associated With Cardiac Rehabilitation Enrollment: A SECONDARY ANALYSIS AMONG SYSTEMATICALLY REFERRED PATIENTS. J Cardiopulm Rehabil Prev 2020; 39:259-265. [PMID: 30252783 DOI: 10.1097/hcr.0000000000000364] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To assess sex- and gender-related factors associated with cardiac rehabilitation (CR) enrollment following acute coronary syndrome among systematically referred patients. METHODS This secondary analysis of a randomized controlled trial used an exploratory approach to examine the TRANSITion process for patients between the coronary care unit and CR (TRANSIT-UC). The present analysis examined the relationship between sex- and gender-related factors and CR enrollment in systematically referred women (n = 35) and men (n = 207). We performed χ and logistic regression analyses to identify statistically significant results. Using the Bonferroni method, a P value of .002 or less was considered a significant statistical result. A raw difference of 15% or more between enrolled and nonenrolled participants was considered a difference worthy of further investigation. RESULTS Men who were regularly engaged in physical activity prior to their hospitalization and who lived near the CR center showed a statistically higher CR enrollment rate. In women and men, a radial entry site for percutaneous coronary intervention resulted in a clinically significant difference in favor of CR enrollment. In women, 3 sex-related and 9 gender-related variables were associated with a difference of 15% or more between enrolled and nonenrolled participants. CONCLUSION Factors related to CR enrollment in women and men are suggested. As women keep showing a lower rate of CR enrolment, the investigation of these factors in a larger sample of patients may hold valuable insights to improve CR enrolment.
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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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Abstract
PURPOSE Cardiac rehabilitation (CR) is effective at reducing further cardiac events. However, dropout rates are high, and maintenance of behavioral change post-CR is challenging. Health literacy (HL) may influence self-management of cardiac risk, yet few studies have explored this association. This study aimed to describe HL among CR attendees; first to describe the HL profiles of people commencing CR and second to examine HL changes between program entry and completion. METHODS CR attendees in Melbourne, Australia, completed the Health Literacy Questionnaire (HLQ) at program admission and completion. The HLQ measures HL across 9 scales. Cluster analysis grouped participants according to their HL profile. Effect sizes were used to determine changes in HLQ scores. Post-program interviews explored the role of HL in participant recovery. RESULTS Participants completed baseline (n = 60) and post-program (n = 38) data collection. Mean age was 60.3 ± 11.7 yr, and 38.3% had myocardial infarction and/or percutaneous coronary intervention. Approximately 18% of participants did not complete the program. Five HL clusters were revealed. The clusters most likely to drop out were confident users of the health system. The cluster least likely to drop out reported lower confidence in their ability to find health information and navigate services. Information-seeking ability improved over time, but no other HL improvements were seen. CONCLUSION There is a wide range of HL profiles in people attending CR. Findings suggest that CR programs should consider a variety of approaches to meet the diverse HL requirements of attendees.
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Brouwers RWM, van Exel HJ, van Hal JMC, Jorstad HT, de Kluiver EP, Kraaijenhagen RA, Kuijpers PMJC, van der Linde MR, Spee RF, Sunamura M, Uszko-Lencer NHMK, Vromen T, Wittekoek ME, Kemps HMC. Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Neth Heart J 2020; 28:443-451. [PMID: 32495296 PMCID: PMC7431507 DOI: 10.1007/s12471-020-01432-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Multidisciplinary cardiac rehabilitation (CR) reduces morbidity and mortality and increases quality of life in cardiac patients. However, CR utilisation rates are low, and targets for secondary prevention of cardiovascular disease are not met in the majority of patients, indicating that secondary prevention programmes such as CR leave room for improvement. Cardiac telerehabilitation (CTR) may resolve several barriers that impede CR utilisation and sustainability of its effects. In CTR, one or more modules of CR are delivered outside the environment of the hospital or CR centre, using monitoring devices and remote communication with patients. Multidisciplinary CTR is a safe and at least equally (cost-)effective alternative to centre-based CR, and is therefore recommended in a recent addendum to the Dutch multidisciplinary CR guidelines. In this article, we describe the background and core components of this addendum on CTR, and discuss its implications for clinical practice and future perspectives.
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Affiliation(s)
- R W M Brouwers
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.
| | | | - J M C van Hal
- Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R A Kraaijenhagen
- NDDO Institute for Prevention and E-health Development (NIPED), Amsterdam, The Netherlands
| | - P M J C Kuijpers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M R van der Linde
- Department of Cardiology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - R F Spee
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.,Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - N H M K Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands
| | - T Vromen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - H M C Kemps
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.,Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
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Kuriakose L, Kuczynska P, Timpel P, Yakub F, Bayley A, Papachristou Nadal I. Effectiveness of behaviour change techniques on lifestyle interventions of patients with a high risk of developing cardiovascular disease. Using a qualitative approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:998-1009. [PMID: 31965675 DOI: 10.1111/hsc.12933] [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: 04/17/2019] [Revised: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to identify key active ingredients on the maintenance of behaviour change for lifestyle interventions of patients with a high risk of developing cardiovascular disease (CVD) who participated in a MOtiVational intErviewing InTervention (MOVE IT) randomised control trial (RCT). A process evaluation was carried out using focus groups. Twenty-six participants of the MOVE IT RCT were purposively recruited and split into six focus groups. Four groups had attended six or more sessions of the intensive phase (completers) and two groups had withdrawn before the end of the intensive phase or had not attended any sessions (non-completers). Focus groups were audio recorded, transcribed verbatim and analysed inductively using thematic analysis. Three overall themes were generated from the six focus groups: (a) long-term benefits from diet and physical activity education, (b) group versus individual structure and adherence and (c) impact on health beliefs and risk of CVD. A fourth theme was generated from the two groups of non-completers only: (d) need for professional rapport building and feedback. We found that the key active ingredients for effective behavioural change in lifestyle interventions are having well-developed rapport between facilitators and patients; and providing alternative forms of feedback to encourage maintenance of behaviour change. Furthermore, such programmes also need to have established and strong relationships with associated health professionals (i.e. the General Practitioner) to increase participation and maintenance of engagement.
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Affiliation(s)
- Lisa Kuriakose
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paulina Kuczynska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Division of Health Services and Management, School of Health Sciences, University of London, London, UK
| | - Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Farah Yakub
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Iliatha Papachristou Nadal
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Lee LS, Banks L, Oh PI, Brooks D, Colella TJF. Capturing the perspectives of women with coronary artery disease regarding interval training or continuous exercise in cardiac rehabilitation. Disabil Rehabil 2020; 44:68-78. [PMID: 32343623 DOI: 10.1080/09638288.2020.1756469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Motivators and barriers to exercise participation in women with coronary artery disease remain poorly understood. With evidence suggesting that women with coronary artery disease are less likely to adhere to exercise during cardiac rehabilitation and are more likely to drop out, it is important to understand these factors in order to optimize cardiac rehabilitation programs for women.Methods: We contribute to the discussion by presenting findings from a qualitative study using two focus groups with nine women with coronary artery disease sharing their experiences with attending cardiac rehabilitation and exercising in this setting, in addition to their perceived motivators and barriers to performing aerobic interval training. Focus group transcripts were analysed using a deductive thematic approach with Bandura's Social Cognitive Theory as the guiding conceptual framework.Results: Four themes were identified regarding the attitudes and experiences of attending and exercising at cardiac rehabilitation, while five themes capturing the motivators and barriers for these women to perform aerobic interval training were identified for the first time. These novel themes encompassed the daunting nature of it, the physical discomfort associated with it, and conversely, the potential sense of enjoyment and accomplishment that it could bring.Conclusion: This study demonstrates the complexity of implementation of aerobic interval training into clinical practice, and suggests that further research is warranted to explore this domain.IMPLICATIONS FOR REHABILITATIONDespite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml·kg-1·min-1 in favour of aerobic interval training.The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs.Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient.
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Affiliation(s)
- Leanna S Lee
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Laura Banks
- Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Paul I Oh
- Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada
| | - Dina Brooks
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tracey J F Colella
- Cardiovascular Prevention and Rehabilitation Program, University Health Network/Toronto Rehabilitation Institute, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Forsyth F, Deaton C. Women and cardiac rehabilitation: Moving beyond barriers to solutions? Eur J Prev Cardiol 2020; 28:758-760. [PMID: 33611477 DOI: 10.1177/2047487320911843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Faye Forsyth
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK
| | - Christi Deaton
- University of Cambridge School of Clinical Medicine, Department of Public Health and Primary Care, UK.,Cambridge University Hospitals NHS Foundation Trust, UK
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An Exploration of the Impact of the "Open Gym" Scheduling Model of Cardiovascular Rehabilitation on Completion, Attendance, and Health Outcomes. J Cardiopulm Rehabil Prev 2020; 39:E1-E2. [PMID: 29757822 DOI: 10.1097/hcr.0000000000000312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the effects of implementation of the "Open Gym" (OG) scheduling model of cardiovascular rehabilitation administration on the rate of patient engagement and change in commonly measured clinical outcomes. Little data exist on the potential benefits of the OG model on patient completion, attendance, and clinical outcomes. METHODS A retrospective chart review was conducted that included the 1-y period both before and after OG model implementation. Bootstrapped regression and analysis of variance were utilized to determine (1) whether the scheduling model is associated with number of sessions attended and program completion, and (2) among those who meet their goals and thus complete the program, if the scheduling model predicts change in cardiovascular rehabilitation clinical outcomes (ie, percent weight change, 6-min walk distance, and peak metabolic equivalents during exercise) when controlling for baseline values. Follow-up analyses controlled for and explored interactions related to age, race, and sex. RESULTS In this racially diverse sample (34% nonwhite), patients under either the OG model (n = 125) or the Traditional model (n = 82) attended an equivalent number of sessions and were just as likely to complete their treatment. However, clinical outcomes favored the Traditional model, even as more patients participated in the OG model, especially racial minority patients. CONCLUSIONS Although the OG model is more consistent with patient-centered care, gains in functional capacity may be diminished. Furthermore, better controlled experiments are needed to examine the effects of implementing the OG model and should include measures of possible mechanisms influencing racial differences.
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McHale S, Astin F, Neubeck L, Dawkes S, Hanson CL. A systematic review and thematic synthesis exploring how a previous experience of physical activity influences engagement with cardiac rehabilitation. Eur J Cardiovasc Nurs 2019; 19:31-43. [PMID: 31612725 DOI: 10.1177/1474515119882549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation is recognised internationally as an effective therapy to improve quality of life and reduce the risk of hospital readmission for individuals diagnosed with acute coronary syndrome. Despite this, half of eligible individuals choose not to engage and the main reason is lack of interest. Furthermore, prior to attending, 40% of eligible individuals report meeting physical activity guidelines. It is unclear whether this influences decisions about engagement. AIMS The aim of this review is to examine systematically qualitative evidence describing patients' perceptions and experiences, and synthesise what is known about how a previous experience of physical activity in adults diagnosed with acute coronary syndrome influences engagement with physical activity during cardiac rehabilitation. METHODS A systematic review and thematic synthesis was conducted of primary qualitative studies to examine peer-reviewed literature published between1990 and 2017, accessed from database searches of MEDLINE, CINHAL, PsycINFO and Embase. RESULTS The initial search produced 486 studies, and of these 12 relevant studies were included in this review. Studies included 388 participants from six countries. For previously active individuals, communication factors, self-perceptions of an exercise identity and experience of cardiac rehabilitation influence engagement in physical activity during cardiac rehabilitation. CONCLUSION In adults diagnosed with acute coronary syndrome, communication post event and during cardiac rehabilitation is a source of self-appraisal and creates expectations of cardiac rehabilitation. In addition, perceptions of an exercise identity and experience of exercise-based cardiac rehabilitation influence decisions about engagement. To improve uptake and adherence, health professionals should consider previous physical activity levels and tailor information to optimise physical activity post event.
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Affiliation(s)
- Sheona McHale
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield, UK
| | - Lis Neubeck
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK.,Sydney Nursing School, University of Sydney, Australia
| | - Susan Dawkes
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK
| | - Coral L Hanson
- Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, UK
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Borg S, Öberg B, Leosdottir M, Lindolm D, Nilsson L, Bäck M. Factors associated with non-attendance at exercise-based cardiac rehabilitation. BMC Sports Sci Med Rehabil 2019; 11:13. [PMID: 31372231 PMCID: PMC6660668 DOI: 10.1186/s13102-019-0125-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/11/2019] [Indexed: 01/04/2023]
Abstract
Background Despite its well-established positive effects, exercise-based cardiac rehabilitation (exCR) is underused in patients following an acute myocardial infarction (AMI). The aim of the study was to identify factors associated with non-attendance at exCR in patients post-AMI in a large Swedish cohort. Methods A total of 31,297 patients who have suffered an AMI, mean age 62.4 ± 4 years, were included from the SWEDEHEART registry during the years 2010-2016. Comparisons between attenders and non-attenders at exCR were done at baseline for the following variables: age, sex, body mass index, occupational status, smoking, previous diseases, type of index cardiac event and intervention, and left ventricular function. Distance of residence from the hospital and type of hospital were added as structural variables in logistic regression analyses, with non-attendance at exCR at one-year follow-up as dependent, and with individual and structural variables as independent variables. Results In total, 16,214 (52%) of the patients did not attend exCR. The strongest predictor for non-attendance was distance to the exCR centre (OR 1.75 [95% CI: 1.64-1.86]). Other predictors for non-attendance included smoking, history of stroke, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), AMI or diabetes, male sex, being retired vs. being employed, and being followed-up at a county hospital. Patients with ST-elevation myocardial infarction (STEMI) and those intervened with PCI or CABG were more likely to attend exCR. Conclusions A distance greater than 16 km was associated with increased probability of non-attendance at exCR, as were smoking, a higher burden of comorbidities, and male sex. A better understanding of individual and structural factors can support the development of future rehabilitation services.
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Affiliation(s)
- Sabina Borg
- 1Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, SE-581 83 Linköping, Sweden.,2Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Birgitta Öberg
- 1Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, SE-581 83 Linköping, Sweden
| | - Margret Leosdottir
- 3Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Malmö, Sweden.,4Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Daniel Lindolm
- 5Department of Medical Sciences, Cardiology, Uppsala University; and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Lennart Nilsson
- 6Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Maria Bäck
- 1Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, SE-581 83 Linköping, Sweden.,7Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sutantri S, Cuthill F, Holloway A. ‘A bridge to normal’: a qualitative study of Indonesian women’s attendance in a phase two cardiac rehabilitation programme. Eur J Cardiovasc Nurs 2019; 18:744-752. [DOI: 10.1177/1474515119864208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: Cardiac rehabilitation is effective in reducing mortality and morbidity, in improving life expectancy and quality of life for people with cardiovascular disease. Despite these recognised benefits, women’s attendance rates in cardiac rehabilitation programmes remain suboptimal. Aims: This paper details the study that explored factors that influence women’s attendance of a phase two cardiac rehabilitation programme in Indonesia Methods: An exploratory qualitative research design was used in the study. Semi-structured interviews were used as the main method of data collection. Data were collected from June to September 2016. Twenty-three women aged between 30 and 66 years were interviewed. Transcribed interview data were analysed using a qualitative framework analysis. Results: Three major themes were inferred from the analysis: (a) a bridge to normal; (b) connecting with others; and (c) contextual factors. The first theme is illustrated by two subthemes: ‘making my heart work again’ and ‘performing social roles’. The second theme was illustrated by the following subthemes: ‘exchanging knowledge and experience’ and ‘developing a give-and-take relationship’. The third theme was illustrated by three subthemes: ‘recommendations from the staff’, ‘family support’ and ‘availability of health insurance’. Conclusion: Women’s attendance in cardiac rehabilitation in Indonesia is mainly influenced by their expectations and desire to be able to resume their previous social roles in the family and society. The findings of this study can assist healthcare professionals to understand better the needs of women and the fit between women’s needs and existing cardiac rehabilitation programmes. Such understanding could provide direction for more effective approaches to the cardiac rehabilitation programmes that are currently offered in Indonesia.
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Affiliation(s)
- Sutantri Sutantri
- Department of Nursing Studies, The University of Edinburgh, UK
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Indonesia
| | - Fiona Cuthill
- Department of Nursing Studies, The University of Edinburgh, UK
| | - Aisha Holloway
- Department of Nursing Studies, The University of Edinburgh, UK
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Santiago de Araújo Pio C, Beckie TM, Varnfield M, Sarrafzadegan N, Babu AS, Baidya S, Buckley J, Chen SY, Gagliardi A, Heine M, Khiong JS, Mola A, Radi B, Supervia M, Trani MR, Abreu A, Sawdon JA, Moffatt PD, Grace SL. Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement. Int J Cardiol 2019; 298:1-7. [PMID: 31405584 DOI: 10.1016/j.ijcard.2019.06.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its' benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. METHODS The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. RESULTS The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95 ± 0.69 (mean ± standard deviation), 5.33 ± 1.12 and 5.64 ± 1.08, respectively. CONCLUSIONS Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs.
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Affiliation(s)
| | | | - Marlien Varnfield
- Australian eHealth Research Centre, CSIRO, and Australian Cardiovascular Health and Rehabilitation Association (ACRA), Australia
| | - Nizal Sarrafzadegan
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, Canada; Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abraham S Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sumana Baidya
- Kathmandu University, Dhulikhel Hospital, Dhulikhel, Nepal
| | - John Buckley
- Centre for Active Living, University Centre Shrewsbury, Shrewsbury, UK
| | - Ssu-Yuan Chen
- Department of Physical Medicine & Rehabilitation, Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Anna Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Ana Mola
- Rehabilitation Medicine, New York University School of Medicine, New York City, NY, USA
| | - Basuni Radi
- National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Marta Supervia
- Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007 Madrid, Spain; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, MN, USA
| | - Maria R Trani
- Council of Cardiac Rehabilitation and Sports Cardiology, Philippine Heart Association, Pasig City, Philippines and Section of Cardiology, Chong Hua Hospital Heart Institute, Cebu City, Philippines
| | - Ana Abreu
- Cardiology Department, Hospital Santa Maria, CHLN, Lisbon, Portugal; Medical School of University of Lisbon, Lisbon, Portugal
| | - John A Sawdon
- Public Education and Special Projects, Cardiac Health Foundation of Canada, Toronto, Canada
| | - Paul D Moffatt
- Patient Partner Program, University Health Network, Toronto, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Canada; KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada.
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Mulligan H, Wilkinson A, Chen D, Nijhof C, Kwan N, Lindup A, Dalton S. Components of community rehabilitation programme for adults with chronic conditions: A systematic review. Int J Nurs Stud 2019; 97:114-129. [PMID: 31234105 DOI: 10.1016/j.ijnurstu.2019.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health services for individuals with chronic conditions often include a disease specific community rehabilitation programme to assist these individuals to maintain physical function and develop self-management skills. Nurses are often involved in the delivery of such programmes. Many individuals however live with more than one chronic condition and find it difficult to manage the rehabilitation demands for their different diagnoses. OBJECTIVE To identify core programme components and clinically meaningful measures for a generic rehabilitation programme. DATA SOURCES Full text English language journal articles identified from CINAHL, MEDLINE (Ovid), AMED and PubMed, plus reference lists of included articles. REVIEW METHOD A systematic search of databases using keywords and MeSH terms for randomised controlled trials detailing a group based community programme for adults with chronic conditions. Study quality was appraised using the Cochrane Collaboration Tool for assessing risk of bias for randomised controlled trials. Data summarising characteristics of the studies such as participant numbers, programme components and the questionnaires, scales and measures were extracted and tabulated. An additional search of wider literature was undertaken to identify the minimal clinically important difference for each questionnaire, scale or measure used within the included studies. RESULTS Fifteen good quality studies were identified. At baseline, there were 3856 participants (age range 42-84 years), with 642 participants lost to follow-up. Programmes were led by health professionals and/or lay leaders. Programme duration ranged from four to 12 weeks and included educational components targeting symptom management, and development of self-efficacy. Only three programmes included a supervised exercise component. Although many of the 64 outcomes measured across the programmes demonstrated statistically significant results, only three measures demonstrated clinically meaningful change for study participants and these measures were used in only two studies. CONCLUSIONS AND RECOMMENDATIONS The findings suggest community rehabilitation programmes for individuals with chronic conditions be a minimum of 4-6 weeks to cover necessary education for management of symptoms, be led by a health professional/s in combination with lay leaders, and include development of self-management skills. We recommend consideration be given to health literacy level of the programme, and that because of the known positive benefit of exercise on physical functioning, quality of life and in slowing progression of chronic conditions, an exercise time should be included. Lastly, we recommend that reporting and interpreting effect sizes of interventions within studies would facilitate more useful choice of outcome measures to be able to demonstrate clinically meaningful change.
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Affiliation(s)
- Hilda Mulligan
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Amanda Wilkinson
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Diana Chen
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Carlijn Nijhof
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Nicole Kwan
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Ash Lindup
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Sean Dalton
- School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand.
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Lawlor ER, Cupples ME, Donnelly M, Tully MA. Promoting physical activity among community groups of older women in socio-economically disadvantaged areas: randomised feasibility study. Trials 2019; 20:234. [PMID: 31023329 PMCID: PMC6482492 DOI: 10.1186/s13063-019-3312-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Insufficient physical activity (PA) is a major public health issue. Whilst PA is an important contributor to disease prevention, engagement in PA decreases with age, particularly among women in socio-economically disadvantaged areas. Research using existing support networks to engage 'hard to reach' populations in PA interventions is sparse. We developed and tested the feasibility of a PA-promoting intervention for older women within existing community groups in socio-economically disadvantaged areas. METHODS The Medical Research Council guidelines for complex interventions were used to guide the intervention's development. We recruited participants (n = 40) from older (aged ≥50 years) women's groups from four different community centres. A 12-week programme was delivered during existing sessions, informed by Social Practice Theory. The sessions provided education about PA, social support in the form of a PA 'buddy', group discussion and follow-up telephone calls, as well as printed information about local opportunities to participate in PA. The main uncertainties tested were rates of participant recruitment, retention, and completion of assessments of PA by accelerometry and of mental health using the Hospital Anxiety and Depression Scale (HADS). Intervention acceptability was assessed by questionnaire, and focus group interviews elicited participants' views about the intervention. Qualitative data were subjected to framework analysis. RESULTS The recruitment rate was high; 87% (n = 40/46) of women consented to participate, and 78% (n = 31) attended all education sessions. Uptake of follow-up telephone calls and PA 'buddies' was low. Few participants provided valid accelerometer data, but 63% (n=25) completed the HADS questionnaire at all time points. The printed materials and education sessions were viewed positively; telephone calls and 'buddy' support were not valued. Participants believed that organised group activities would lead to increased PA engagement, and whilst participants disliked wearing a waist accelerometer, they thought that regular PA feedback would facilitate necessary goal-setting. CONCLUSIONS High recruitment and retention rates suggest that use of existing social support groups is an acceptable and attractive method of delivering a PA intervention to this population. A randomised controlled trial of the intervention appears feasible, but its design requires refinement of the social support component, facilitation of goal-setting and reconsideration of the assessment of PA. TRIAL REGISTRATION ClinicalTrials.gov, NCT02880449 . Registered on 26 August 2016.
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Affiliation(s)
- Emma R Lawlor
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Margaret E Cupples
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.,Department of General Practice and Primary Care, Queen's University Belfast, 1 Dunluce Avenue, Belfast, BT9 7HR, Northern Ireland, UK
| | - Michael Donnelly
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK
| | - Mark A Tully
- UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland, UK.,School of Health Sciences, Institute of Mental Health Sciences, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland, UK
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49
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Jin K, Khonsari S, Gallagher R, Gallagher P, Clark AM, Freedman B, Briffa T, Bauman A, Redfern J, Neubeck L. Telehealth interventions for the secondary prevention of coronary heart disease: A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2019; 18:260-271. [PMID: 30667278 DOI: 10.1177/1474515119826510] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation, an evidence-based CHD secondary prevention programme, remains underutilized. Telehealth may offer an innovative solution to overcome barriers to cardiac rehabilitation attendance. We aimed to determine whether contemporary telehealth interventions can provide effective secondary prevention as an alternative or adjunct care compared with cardiac rehabilitation and/or usual care for patients with CHD. METHODS Relevant randomized controlled trials evaluating telehealth interventions in CHD patients with at least three months' follow-up compared with cardiac rehabilitation and/or usual care were identified by searching electronic databases. We checked reference lists, relevant conference lists, grey literature and keyword searching of the Internet. Main outcomes included all-cause mortality, rehospitalization/cardiac events and modifiable risk factors. (PROSPERO registration number 77507.). RESULTS In total, 32 papers reporting 30 unique trials were identified. Telehealth was not significant associated with a lower all-cause mortality than cardiac rehabilitation and/or usual care (risk ratio (RR)=0.60, 95% confidence interval (CI)=0.86 to 1.24, p=0.42). Telehealth was significantly associated with lower rehospitalization or cardiac events (RR=0.56, 95% CI=0.39 to 0.81, p<0.0001) compared with non-intervention groups. There was a significantly lower weighted mean difference (WMD) at medium to long-term follow-up than comparison groups for total cholesterol (WMD= -0.26 mmol/l, 95% CI= -0.4 to -0.11, p <0.001), low-density lipoprotein (WMD= -0.28, 95% CI = -0.50 to -0.05, p=0.02) and smoking status (RR=0.77, 95% CI =0.59 to 0.99, p=0.04]. CONCLUSIONS Telehealth interventions with a range of delivery modes could be offered to patients who cannot attend cardiac rehabilitation, or as an adjunct to cardiac rehabilitation for effective secondary prevention.
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Affiliation(s)
- Kai Jin
- 1 Charles Perkins Centre, Sydney Nursing School, University of Sydney, Australia
| | - Sahar Khonsari
- 2 School of Health and Social Care, Edinburgh Napier University, UK
| | - Robyn Gallagher
- 3 Charles Perkins Centre, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Australia
| | | | | | - Ben Freedman
- 1 Charles Perkins Centre, Sydney Nursing School, University of Sydney, Australia
| | - Tom Briffa
- 6 School of Public Health, University of Western Australia, Perth, Australia
| | - Adrian Bauman
- 7 Sydney School of Public Health, Charles Perkins Centre, Faculty of Medicine and Health and the Australian Prevention Partnership Centre, The University of Sydney, Australia
| | - Julie Redfern
- 8 Westmead Clinical School, Sydney Medical School, The University of Sydney, Australia
| | - Lis Neubeck
- 2 School of Health and Social Care, Edinburgh Napier University, UK
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50
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Doyle F, Freedland K, Carney R, de Jonge P, Dickens C, Pedersen S, Sorensen J, Dempster M. Network meta-analysis of randomised trials of pharmacological, psychotherapeutic, exercise and collaborative care interventions for depressive symptoms in patients with coronary artery disease: hybrid systematic review of systematic reviews protocol. Syst Rev 2019; 8:71. [PMID: 30878039 PMCID: PMC6420728 DOI: 10.1186/s13643-019-0985-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/11/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Depression is common in patients with coronary artery disease (CAD) and is associated with poorer outcomes and higher costs. Several randomised controlled trials (RCTs) targeting depression, of various modalities (including pharmacological, psychotherapeutic and other approaches), have been conducted and summarised in pairwise meta-analytic reviews. However, no study has considered the cumulative evidence within a network, which can provide valuable indirect comparisons and information about the relative efficacy of interventions. Therefore, we will adopt a review of review methodology to develop a network meta-analysis (NMA) of depression interventions for depression in CAD. METHODS We will search relevant databases from inception for systematic reviews of RCTs of depression treatments for people with CAD, supplementing this with comprehensive searches for recent or ongoing studies. We will extract data from and summarise characteristics of individual RCTs, including participants, study characteristics, outcome measures and adverse events. Cochrane risk of bias ratings will also be extracted or if not present will be conducted by the authors. RCTs that compare depression treatments (grouped as pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) to placebo, usual care, waitlist control or attention controls, or directly in head-to-head comparisons, will be included. Primary outcomes will be the change in depressive symptoms (summarised with a standardised mean difference) and treatment acceptability (treatment discontinuation: % of people who withdrew). Secondary outcomes will include change in 6-month depression outcomes, health-related quality of life (HRQoL), mortality, cardiovascular morbidity, health services use and adverse events. Secondary analyses will form further networks with individual anti-depressants and psychotherapies. We will use frequentist, random effects multivariate network meta-analysis to synthesise the evidence for depression intervention and to achieve a ranking of treatments, using Stata. Rankograms and surface under the cumulative ranking curves will be used for treatment ranking. Local and global methods will evaluate consistency. GRADE will be used to assess evidence quality for primary outcomes. DISCUSSION The present review will address uncertainties about the evidence in terms of depression management in CAD and may allow for a ranking of treatments, including providing important information for future research efforts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018108293.
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Affiliation(s)
- Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. .,School of Psychology, Queen's University Belfast, University Road, Belfast, BT71NN, Northern Ireland, UK.
| | | | - Robert Carney
- Washington University School of Medicine, St. Louis, USA
| | | | | | | | - Jan Sorensen
- Royal College of Surgeons in Ireland, Dublin, Ireland
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