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Redondo-Rodríguez C, Villafaina S, Ramos-Fuentes MI, Fuentes-García JP. The psychological well-being index and quality of life after a cardiac rehabilitation program based on aerobic training and psychosocial support. Physiol Behav 2024; 280:114560. [PMID: 38631544 DOI: 10.1016/j.physbeh.2024.114560] [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: 03/18/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND This study aimed to investigate the physical and psychological benefits of an alternative cardiac rehabilitation program based on therapeutic groups during physical exercise sessions and to compare the results with those of a conventional cardiac rehabilitation program. METHOD The sample included 112 patients from the cardiac rehabilitation unit of a medical center, 91.1 % of whom were male. The control group consisted of 47 subjects, with a mean age of 57.89 ± 12.30 and the experimental group consisted of 65 subjects, with a mean age of M = 58.38 ± 9.86. Quality of life, psychological well-being, health-related quality of life, body mass index, blood pressure, abdominal circumference and resting heart rate were measured before starting and at the end of the cardiac rehabilitation program. RESULTS The experimental group improved significantly more than the control group in body mass index, systolic and diastolic blood pressure, abdominal circumference, and resting heart rate (p value < 0.005). In addition, the experimental group had significantly greater improvements in quality of life, psychological well-being, and health-related quality of life than the control group (p-value < 0.001). CONCLUSIONS A cardiac rehabilitation program based on simultaneous aerobic training and psychosocial support improved the physical function, health-related quality of life and well-being.
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Affiliation(s)
| | - Santos Villafaina
- Faculty of Sport Science, University of Extremadura, Cáceres 10003, Spain
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Douma ER, Wirtz S, Fernandez MS, Schäfer H, Widdershoven JW, Habibović M, Gil CP, Bosch JA, Schmitz B, Kop WJ. Patient-reported preferences in eHealth-based cardiac rehabilitation: A qualitative investigation of behavior change techniques, barriers and facilitators. Internet Interv 2024; 35:100728. [PMID: 38405384 PMCID: PMC10883827 DOI: 10.1016/j.invent.2024.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cardiac rehabilitation (CR) reduces recurrent cardiac events and mortality in patients with cardiovascular diseases (CVD). Innovative eHealth methods can facilitate CR uptake and effectiveness by addressing barriers associated with clinic-based rehabilitation. Tailoring eHealth-based CR to patient preferences is needed to further enhance CR. Purpose To identify preferred behavior change techniques (BCTs) as well as barriers and facilitators for the different health behaviors targeted in eHealth-based CR among patients who have been referred to CR. Methods Thirty-nine patients were interviewed in nine focus groups in The Netherlands, Germany, and Spain. A thematic analysis, using a combined deductive and inductive approach to coding, was conducted to identify BCTs and barriers and facilitators to behavior change. Behaviors under investigation included physical activity, medication adherence, eating a cardiac healthy-diet, stress reduction and smoking cessation. Results The perceived helpfulness of BCTs depended on the specific behavior targeted. Common barriers were negative emotional state and physical limitations. A desire to feel physically or mentally well and having experienced a cardiac life event were the most common facilitators across health behaviors. Specific BCTs, barriers and facilitators were found for each of the health behavior. Conclusions Behavior change techniques that patients preferred for each health behavior targeted in eHealth-based CR were identified. A negative emotional state, experiencing a life event, and improving physical functioning are important barriers and facilitators in multiple behaviors targeted in eHealth-based CR programs. Additional tailoring of interventions to patient preferences for BCTs and patient-specific barriers and facilitators per health behavior could lead to further improvement of eHealth-based CR.
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Affiliation(s)
- Emma R. Douma
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Svenja Wirtz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Manuela Sestayo Fernandez
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Hendrik Schäfer
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Jos W.M.G. Widdershoven
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
- Elisabeth-TweeSteden Hospital, Department of Cardiology, Tilburg, the Netherlands
| | - Mirela Habibović
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
| | - Carlos Peña Gil
- Hospital Universitario de Santiago de Compostela, Servizo Galego De Saude, Santiago de Compostela, Spain
| | - Jos A. Bosch
- University of Amsterdam, Faculty of Social and Behavioral Sciences, Amsterdam, the Netherlands
| | - Boris Schmitz
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Willem J. Kop
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg, the Netherlands
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Vanzella LM, Cotie LM, Flores-Hukom M, Marzolini S, Konidis R, Ghisi GLDM. Patients' Perceptions of Hybrid and Virtual-Only Care Models During the Cardiac Rehabilitation Patient Journey: A Qualitative Study. J Cardiovasc Nurs 2024:i. [PMID: 38206327 DOI: 10.1097/jcn.0000000000001076] [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: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic initially led to discontinuation of the "traditional" center-based cardiac rehabilitation (CR) model. Virtual models emerged as an opportunity to deliver care, with many programs continuing to offer these models. OBJECTIVE The aim of this study was to explore patients' perceptions of virtual models of either hybrid (combining center-based and virtual) or virtual-only CR since the pandemic. METHODS Men and women who chose to participate in hybrid or virtual CR models between January 2022 and January 2023 were invited to attend 1 of 8 focus group sessions. Focus groups were conducted online until thematic saturation was reached. Transcripts were analyzed using thematic analysis. RESULTS Twenty-three patients (48% female; 83% attending hybrid CR) participated in the study. Analysis revealed 12 overarching themes associated with the CR patient journey: pre-CR, namely, (1) importance of endorsement from healthcare providers and (2) need for education/communication while waiting for program initiation; during CR, namely, (3) preference for class composition/structure, (4) need to enhance peer support in the virtual environment, (5) convenience and concerns with virtual sessions, (6) necessity of on-site sessions, (7) safety of the exercise prescription, (8) requirement/obligation for allied health offerings, (9) satisfaction with virtual education, and (10) use of technology to facilitate CR participation; and post-CR, namely, (11) acknowledgment of program completion and (12) need for support/education after program graduation. CONCLUSIONS Patients require ongoing support from time of referral to beyond CR program completion. Physical, psychosocial, nutritional, and educational supports are needed. Perceptions expressed by patients related to the program model are modifiable, and strategies to address these perceptions should be explored.
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Ghisi GLDM, Aultman C, Vanzella L, Konidis R, Sandison N, Oh P. Effectiveness of a virtual vs. in-person group-based education curriculum to increase disease-related knowledge and change health behaviour among cardiac rehabilitation participants. PATIENT EDUCATION AND COUNSELING 2024; 118:108021. [PMID: 37866071 DOI: 10.1016/j.pec.2023.108021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To investigate the effectiveness of a virtual 12-week group-based education curriculum and to compare results with a retrospective cohort that received the same education in-person for 24 weeks. METHODS Participants completed online surveys (pre- and post-intervention) assessing disease-related knowledge, adherence to the Mediterranean diet, exercise self-efficacy, and satisfaction. The number of steps taken per day was recorded using a wearable device. Paired t tests and repeated measures ANOVA were used. A Bonferroni correction was applied(p < 0.01). RESULTS 80 CR participants receiving virtual education completed both assessments. Following virtual education, participants significantly increased knowledge(p < 0.001), adherence to the Mediterranean diet(p < 0.001) and number of daily steps(p = 0.01). These results were similarly observed in the in-person education group(n = 80), with no significant differences between groups. Virtual education participants decreased their self-efficacy post-intervention(p < 0.001); in contrast, participants of the in-person education increased their exercise self-efficacy(p < 0.001). Overall,31% of virtual and 71% of in-person education participants reported being satisfied with the education delivery format. CONCLUSIONS A virtual group-based education curriculum was effective at improving knowledge and changing behaviour. Similar results were observed in those that received in-person education. Tailoring virtual education interventions to support exercise self-efficacy is warranted. PRACTICE IMPLICATION This study strengthens the evidence supporting virtual education in CR.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Lais Vanzella
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Renee Konidis
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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Fernández Coronado R, Olórtegui Yzu A. [Effectiveness of tertiary prevention on quality of life and control of risk factors in patients with ischemic coronary heart disease]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:88-95. [PMID: 38046229 PMCID: PMC10688413 DOI: 10.47487/apcyccv.v4i3.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/10/2023] [Indexed: 12/05/2023]
Abstract
Objective Determine the effectiveness of cardiac rehabilitation (CR) as a tertiary prevention strategy in the quality of life and control of risk factors of patients with ischemic coronary heart disease (ICC) of the National Cardiovascular Institute (INCOR) of EsSalud- Lima during the year 2018. Materials and methods A retrospective cohort of 280 patients with a diagnosis of CCI was studied who, after medical, interventional, or surgical treatment, were referred to the INCOR CR program for tertiary prevention (PT) in 2018. The program was developed according to the institutional guide for eight weeks with exercise sessions and educational, psychological, nutritional, and recreational workshops. At the beginning and at the end of this, the QLMI-2 quality of life test was applied, and anthropometric, laboratory, and risk factor control measurements were performed. Results Quality of life levels at the end of CR showed a statistically significant improvement in the emotional, social, physical, and global dimensions (p < 0.001). The same behavior was observed for the nutritional variables of weight, abdominal circumference, and BMI (p < 0.001). Physical capacity showed a statistically significant improvement in the aspects of muscle strength (12.2%), physical activity (38.0%), and functional capability (25.4%) (p < 0.001). The result was not homogeneous for the biochemical metabolic variables, where glycosylated hemoglobin, glycemia, and lipid profile did not show significant improvement, except for HDL, which raised its levels statistically significantly (p < 0.001). Conclusions CR is effective as a central strategy to perform tertiary prevention in patients with ICC since it notably improves quality of life and coronary risk factors.
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Affiliation(s)
| | - Adriel Olórtegui Yzu
- Instituto Nacional Cardiovascular INCOR, Lima, PerúInstituto Nacional Cardiovascular INCORLimaPerú
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Menezes HJ, D' Souza SRB, Padmakumar R, Babu AS, Rao RR, Kamath VG, Kamath A, Grace SL. Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle-income setting: A randomized controlled trial protocol. Res Nurs Health 2023; 46:13-25. [PMID: 36371623 DOI: 10.1002/nur.22276] [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: 06/16/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.
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Affiliation(s)
- Henita Joshna Menezes
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D' Souza
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Ramachandran Padmakumar
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Rohini R Rao
- Department of Computer Applications, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Veena G Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada.,KITE and Director Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Gabriela Lima de Melo G, Crystal A, Renee K, Nicole S, Paul O. Developing a group-based virtual education curriculum for cardiac rehabilitation and the associated toolkit to support implementation in Canada and across the globe. Heart Lung 2023; 57:80-94. [PMID: 36084400 DOI: 10.1016/j.hrtlng.2022.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND To overcome the many barriers faced by the long-lasting pandemic, the development of new ways to deliver cardiac rehabilitation (CR)'s components was needed. OBJECTIVE This mixed-methods study describes the process to create a virtual education curriculum and assess the level of user engagement and acceptability in CR participants. METHODS A 4-phase approach was used to develop the new virtual education curriculum for CR and collect feedback regarding patients' engagement with and acceptability of the curriculum in a convenience sample of 80 CR participants. Data were analyzed using a reflexive thematic analysis approach and mapped to the evidence-based implementation strategies, followed by stakeholder engagement. Considering all information gathered and applying best practices in patient education and curriculum development, a 16-week virtual education curriculum was established. RESULTS Five themes were identified on how the current education could be improved: focus on self-management, emphasize emotional wellbeing, improve facilitation, incorporate existing resources, and improve content flow. The recommendations associated with each theme informed the new curriculum and a tailored implementation plan to support the use of virtual education as part of routine care within the program. A toolkit that included a screening tool for comfort with/access to technology, patient-centered manuals with weekly learning plans, and a facilitator's manual was created. Overall, all recommended weekly education was completed by more than 70% of the participants, with greater acceptability. CONCLUSIONS The present study offers an example of a collaborative approach to tailoring strategies for the development of a new group-based virtual education model of CR.
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Affiliation(s)
- Ghisi Gabriela Lima de Melo
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada.
| | - Aultman Crystal
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada
| | - Konidis Renee
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada
| | - Sandison Nicole
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada
| | - Oh Paul
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 1R7, Canada
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Stark AL, Krayter S, Dockweiler C. Competencies required by patients and health professionals regarding telerehabilitation: A scoping review. Digit Health 2023; 9:20552076231218841. [PMID: 38107985 PMCID: PMC10722929 DOI: 10.1177/20552076231218841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background Telerehabilitation offers patients alternative access to therapy and has become more prominent during the COVID-19 pandemic. Despite the increasing attractiveness of such programs, there are research gaps regarding the required competencies in the demand-oriented technology use in rehabilitative care. Objective The study aims at collecting evidence on competencies required by patients and health professionals for using telerehabilitation. We analyse tasks and requirements associated with telerehabilitation and derive and systematise relevant competencies. Methods We conducted a scoping review and analysed MEDLINE, Psyndex, EMBASE, Cochrane Library, and Web of Science for empirical studies and grey literature from 2017 to May 2022. Articles had to be in English/German and refer to medical rehabilitation accompanied by health professionals taking place in the patient's home. Results One hundred ten articles were included, covering video conferencing systems, applications with video, audio, or visual therapy content, or wearables. Depending on the program, tasks before, during, and after therapy sessions differ, as do whether these are performed by health professionals, patients, or the technology. Users need digital, health-related, social, personal, and health professionals also professional competencies. This comprises telerehabilitation, technical, health-related, and clinical knowledge, a range of physical, cognitive, social-interactive, technical, and clinical skills, a positive attitude towards telerehabilitation and experience. Whether sociodemographic factors promote successful use is unclear. Conclusions Telerehabilitation requires a variety of different competencies from patients and health professionals - going beyond the sphere of technical skills. This highlights the need for an evaluation of existing programs for promoting competencies in the use of telerehabilitation and refinement of the programs in line with demands.
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Affiliation(s)
- Anna Lea Stark
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Stephan Krayter
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
| | - Christoph Dockweiler
- Department Digital Health Sciences and Biomedicine, School of Life Sciences, University of Siegen, Siegen, Germany
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Grace S, Sadeghi M, Turk-Adawi K, Supervia M, Fard M, Noohi F, Roohafza H, Sarrafzadegan N. Availability and nature of cardiac rehabilitation by province in Iran: A 2018 update of ICCPR's global audit. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023. [DOI: 10.4103/jrms.jrms_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Sadeghi M, Turk-Adawi K, Supervia M, Fard MR, Noohi F, Roohafza H, Sarrafzadegan N, Grace SL. Availability and nature of cardiac rehabilitation by province in Iran: A 2018 update of ICCPR's global audit. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:1. [PMID: 36974111 PMCID: PMC10039098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 03/29/2023]
Abstract
Background Cardiac rehabilitation (CR) is scantly available in Iran, although it is the cost-benefit strategy in cardiac patients, It has not been established how CR is delivered within Iran. This study aimed to determine: (a) availability, density and unmet need for CR, and (b) nature of CR services in Iran by province. Materials and Methods In this cross-sectional sub-study of the global CR audit, program availability was determined through cardiovascular networks. An online survey was then disseminated to these programs in June 2016-2017 which assessed capacity and characteristics; a paper-based survey was disseminated in 2018 to nonresponding and any new programs. CR density and need was computed based on annual incidence of acute myocardial infarction (AMI) in each province. Results Of the 31 provinces, 12 (38.7%) had CR services. There were 30 programs nationally, all in capital cities; of these, programs in 9 (75.0%) provinces, specifically 22 (73.3%) programs, participated. The national CR density is 1 spot per 7 incident AMI patients/year. Unmet need is greatest in Khuzestan, Tehran and west Azerbaijan, with 44,816 more spots needed/year. Most programs assessed cardiovascular risk factors, and offered comprehensive services, delivered by a multi-disciplinary team, comprised chiefly of nurses, dietitians and cardiologists. Median dose is 14 sessions/program in supervised programs. A third of programs offered home-based services. Conclusion Where programs do exist in IRAN, they are generally delivered in accordance with guidelines. Therefore, we must increase capacity in CR services in all provinces to improve secondary prevention services.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karam Turk-Adawi
- Department of Public Health, QU-Health, Qatar University, Doha, Qatar
| | - Marta Supervia
- Medicina Física y Rehabilitación, Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad Rafati Fard
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereydoun Noohi
- Rajaie Cardiovascular, Medical and Research Center, Iranian Network of Cardiovascular Research, Tehran, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
- Address for correspondence: Prof. Sherry L Grace, York University, 4700 Keele Street, Toronto, ON M3J1P3, Canada. E-mail:
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Wang J, Liu H, Chen C, Chang W, Ma Y, Zhao C, Smith SC, Han J, Yu M, Ma J, Qi J, Xing Y. Physical Activity and Factors Affecting Its Maintenance Among Patients With Coronary Heart Disease Not Undergoing Cardiac Rehabilitation in China. J Cardiovasc Nurs 2021; 35:558-567. [PMID: 32379163 PMCID: PMC7553193 DOI: 10.1097/jcn.0000000000000698] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The level of physical activity (PA) among patients with coronary heart disease (CHD) living in Chinese communities who do not participate in cardiac rehabilitation programs and the factors contributing to patient maintenance of PA are unclear. OBJECTIVE This cross-sectional study, guided by the Transtheoretical Model, evaluated (1) the maintenance of PA in Chinese patients with CHD 12 months after hospital discharge and (2) the demographic, clinical, and psychological characteristics associated with maintenance of PA. METHODS A total of 1162 patients completed 6 questionnaires at 12 months posthospitalization to assess their maintenance of PA, stage of change, symptoms of depression and anxiety, and health-related quality of life and sleep. RESULTS Only 40% of patients with CHD maintained regular PA 12 months after hospital discharge. Walking was their primary PA. Thirty-seven percent of patients reported no intention of having regular PA. Male sex (odds ratio [OR], 1.69), awareness of PA's cardiac benefit (OR, 4.12), a history of regular PA before the cardiac event (OR, 6.08), history of chronic disease (OR, 1.43), mild depressive symptoms (OR, 1.40), moderate and severe depressive symptoms (OR, 0.41), smoking (OR, 0.54), and years of CHD (OR, 0.96) were related to maintenance of regular PA. Patients with CHD who maintained regular PA had better quality of life and sleep (P < .001) and fewer unplanned clinic visits (P = .001) and cardiac cause readmissions (P = .012) and reported fewer declines in PA capacity (P < .001). CONCLUSIONS Walking is the most common form of PA 12 months posthospitalization among patients with CHD in China. Patient education and counseling about the cardiac benefits of PA, taking into account stage of change, are important considerations to improve maintenance of PA.
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Affiliation(s)
- Jianhui Wang
- Jianhui Wang, MSN PhD Candidate, School of Nursing Peking Union Medical College, Beijing, and Director, Nurse Administration Department, Tangshan Gongren Hospital, China. Huaping Liu, PhD, RN, FAAN President, School of Nursing, Peking Union Medical College, Beijing, China. Changxiang Chen, MSN, RN President, School of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, China. Wenhong Chang, BN, RN Manager, Cath Lab, Tangshan Gongren Hospital, China. Yi Ma, PhD, MD Director, Cardiovascular Department, Tangshan Gongren Hospital, China. Caijie Zhao, MSN, RN Secondary Prevention Research Assistant, Tangshan Gongren Hospital, China. Sidney C. Smith, Jr, MD Professor of Medicine/Cardiology, University of North Carolina, Chapel Hill. Jing Han, MSN, RN Manager, Cardiac Unit, Tangshan Gongren Hospital, China. Miao Yu, BN MSN Candidate, Nursing, Nursing and Rehabilitation College, North China University of Science and Technology, Tangshan, China. Jiahui Ma, BN MSN Candidate, Nursing, Tangshan Gongren Hospital, China. Jing Qi, BN, RN Director, Nurse Administration Department, Zhangjiakou First Hospital, China. Yan Xing, MSN, RN Manager of Cardiovascular Unit, Shijiazhuang First Hospital, China
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Mamataz T, Ghisi GLM, Pakosh M, Grace SL. Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review. BMC Cardiovasc Disord 2021; 21:459. [PMID: 34556036 PMCID: PMC8458788 DOI: 10.1186/s12872-021-02267-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Women do not participate in cardiac rehabilitation (CR) to the same degree as men; women-focused CR may address this. This systematic review investigated the: (1) nature, (2) availability, as well as (3a) utilization of, and (b) satisfaction with women-focused CR. Methods Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception to May 2020. Primary studies of any design were included. Adult females with any cardiac diseases, participating in women-focused CR (i.e., program or sessions included ≥ 50% females, or was 1-1 and tailored to women’s needs) were considered. Two authors rated citations for inclusion. One extracted data, including study quality rated as per the Mixed-Methods Assessment Tool (MMAT), which was checked independently by a second author. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results 3498 unique citations were identified, with 28 studies (53 papers) included (3697 women; ≥ 10 countries). Globally, women-focused CR is offered by 40.9% of countries that have CR, with 32.1% of programs in those countries offering it. Thirteen (46.4%) studies offered women-focused sessions (vs. full program), 17 (60.7%) were women-only, and 11 (39.3%) had gender-tailoring. Five (17.9%) programs offered alternate forms of exercise, and 17 (60.7%) focused on psychosocial aspects. With regard to utilization, women-focused CR cannot be offered as frequently, so could be less accessible. Adherence may be greater with gender-tailored CR, and completion effects are not known. Satisfaction was assessed in 1 trial, and results were equivocal. Conclusions Women-focused CR involves tailoring of content, mode and/or sex composition. Availability is limited. Effects on utilization require further study. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02267-0.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gabriela L M Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,Peter Munk Cardiac Centre, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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14
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Liu X, Ghisi GLM, Meng S, Grace SL, Shi W, Zhang L, Gallagher R, Oh P, Aultman C, Sandison N, Ding B, Zhang Y. Establishing a process to translate and adapt health education materials for natives and immigrants: The case of Mandarin adaptations of cardiac rehabilitation education. Heart Lung 2021; 50:794-817. [PMID: 34233218 DOI: 10.1016/j.hrtlng.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a proven model of secondary prevention in which patient education is a core component. OBJECTIVES to translate and culturally-adapt CR patient education for Mandarin-speaking patients living in China as well as immigrants, and offer recommendation for best practices in adaptation for both. METHODS these steps were undertaken in China and Canada: (1) preparation; (2) translation and adaptation; (3) review by healthcare providers based on PEMAT-P; (4) think-aloud review by patients; and (5) finalization. RESULTS Two independent Mandarin translations were undertaken using best practices: one domestic (China) and one international (immigrants). Input by 23 experts instigated revisions. Experts rated the language and content as culturally-appropriate, and perceived the materials would benefit their patients. A revised version was then administered to 36 patients, based on which a few edits were made to optimize understandability. CONCLUSIONS some important differences emerged between translations adapted for native versus immigrant settings.
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Affiliation(s)
- Xia Liu
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Gabriela L M Ghisi
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada.
| | - Shu Meng
- Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sherry L Grace
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada; Faculty of Health, York University, Toronto, Canada
| | - Wendan Shi
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ling Zhang
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Biao Ding
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Yaqing Zhang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
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Pakrad F, Ahmadi F, Grace SL, Oshvandi K, Kazemnejad A. Traditional versus extended hybrid cardiac rehabilitation based on the continuous care model for coronary artery bypass surgery patients in a middle-income country: A Randomized Clinical Trial. Arch Phys Med Rehabil 2021; 102:2091-2101.e3. [PMID: 34175270 DOI: 10.1016/j.apmr.2021.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare traditional (1-month supervised) versus hybrid cardiac rehabilitation (CR; usual care) with an additional 3 months offered remotely based on the continuous care model (CCM; intervention), in coronary artery bypass graft (CABG) patients. DESIGN randomized controlled trial, with blinded outcome assessment. SETTING A major heart center in a middle-income country. PARTICIPANTS Of 107 eligible patients that were referred to CR during the period of study, 88 (82.2%) were enrolled (target sample size). Participants were randomly assigned 1:1 (concealed; 44 per parallel arm). There was 92.0% retention. INTERVENTION After CR, participants were given an app and communicated biweekly with the nurse from months 1-4 to control risk factors. MAIN OUTCOME MEASURES Quality of life (QoL; SF-36; primary outcome), functional capacity (treadmill test), depression, anxiety and stress (DASS-21) were evaluated pre-CR, after one month, and three months after CR (end of intervention), as well as re-hospitalization. RESULTS The analysis of variance interaction effects for the physical and mental component summary scores of QoL were <.001, favoring intervention (per protocol); there were also significant increases from pre-CR to 1 month, and from 1 month to the final assessment in the intervention arm (p-values<.001), with change in the control arm only to 1 month. The effect sizes were 0.115 and 0.248, respectively. Similarly, the interaction effect for functional capacity was significant (p<.001), with a clinically-significant 1.5 MET increase in the intervention arm. There were trends for group effects for the psychosocial indicators, with paired t-tests revealing significant increases in each at both assessment points in the intervention arm. At 4 months, there were 4 (10.3%) re-hospitalizations in the control arm, and none in intervention (p=.049). Intended theoretical mechanisms were also impacted by the intervention. CONCLUSION Extending CR in this accessible manner, rendering it more comprehensive, was effective in improving outcomes.
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Affiliation(s)
- Fatemeh Pakrad
- PhD Candidate of Nursing, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Canada; KITE- Toronto Rehabilitation Institute, & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| | - Khodayar Oshvandi
- Department of Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Liu X, Fowokan A, Grace SL, Ding B, Meng S, Chen X, Xia Y, Zhang Y. Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Chinese/Mandarin Cardiac Rehabilitation Barriers Scale (CRBS-C/M). Rehabil Res Pract 2021; 2021:5511426. [PMID: 34239731 PMCID: PMC8233091 DOI: 10.1155/2021/5511426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Cardiovascular diseases are among the leading causes of morbidity in China and around the world. Cardiac rehabilitation (CR) effectively mitigates this burden; however, utilization is low. CR barriers in China have not been well characterized; this study sought to translate, cross-culturally adapt, and psychometrically validate the CR Barriers Scale in Chinese/Mandarin (CRBS-C/M). METHODS Independent translations of the 21-item CRBS were conducted by two bilingual health professionals, followed by back-translation. A Delphi process was undertaken with five experts to consider the semantics and cross-cultural relevance of the items. Following finalization, 380 cardiac patients from 11 hospitals in Shanghai were administered a validation survey including the translated CRBS. Following exploratory and confirmatory factor analysis, internal consistency was assessed. Validity was tested through assessing the association of the CRBS-C/M with the CR Information Awareness Questionnaire. RESULTS Items were refined and finalized. Factor analysis of CRBS-C/M (Kaiser Meyer Olkin = 0.867, Bartlett's test p < 0.001) revealed five factors: perceived CR need, external logistical factors, time conflicts, program and health system-level factors, and comorbidities/lack of vitality; Cronbach's alpha (α) of the subscales ranged from 0.67 to 0.82. The mean total CRBS score was significantly lower in patients who participated in CR compared with those who did not, demonstrating criterion validity (2.35 ± 0.71 vs. 3.08 ± 0.55; p < 0.001). Construct validity was supported by the significant associations between total CRBS scores and CR awareness, sex, living situation, city size, income, diagnosis/procedure, disease severity, and several risk factors (all p < 0.05). CONCLUSIONS CRBS-C/M is reliable and valid, so barriers can be identified and mitigated in Mandarin-speaking patients.
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Affiliation(s)
- Xia Liu
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Adeleke Fowokan
- KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sherry L. Grace
- KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Biao Ding
- Shanghai Sixth People's Hospital, Shanghai, China
| | - Shu Meng
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiu Chen
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yinghua Xia
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yaqing Zhang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
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17
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Abstract
Background We investigated impacts of COVID-19 on cardiac rehabilitation (CR) delivery around the globe, including virtual delivery, as well as effects on providers and patients. Methods In this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April to June 2020. The 50 members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and personal contacts facilitated program identification. Results Overall, 1062 (18.3% program response rate) responses were received from 70/111 (63.1% country response rate) countries in the world with existent CR programs. Of these, 367 (49.1%) programs reported they had stopped CR delivery, and 203 (27.1%) stopped temporarily (mean = 8.3 ± 2.8 weeks). Alternative models were delivered in 322 (39.7%) programs, primarily through low-tech modes (n = 226,19.3%). Furthermore, 353 (30.2%) respondents were re-deployed, and 276 (37.3%) felt the need to work due to fear of losing their job, despite the perceived risk of contracting COVID-19 (mean = 30.0% ± 27.4/100). Also, 266 (22.5%) reported anxiety, 241(20.4%) were concerned about exposing their family, 113 (9.7%) reported increased workload to transition to remote delivery, and 105 (9.0%) were juggling caregiving responsibilities during business hours. Patients were often contacting staff regarding grocery shopping for heart-healthy foods (n = 333, 28.4%), how to use technology to interact with the program (n = 329, 27.9%), having to stop their exercise because they have no place to exercise (n = 303, 25.7%), and their risk of death from COVID-19 due to pre-existing cardiovascular disease (n = 249, 21.2%). Respondents perceived staff (n = 488, 41.3%) and patient (n = 453, 38.6%) personal protective equipment, as well as COVID-19 screening (n = 414, 35.2%), and testing (n = 411, 35.0%) as paramount to in-person service resumption. Conclusion Given the estimated number of CR programs globally, these results suggest approximately 4400 CR programs globally have ceased or temporarily stopped service delivery. Those that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges. Highlights - COVID-19 has impacted cardiac rehabilitation (CR) delivery around the globe.- In this cross-sectional study, a survey was completed by 1062 (18.3%) CR programs from 70 (63.1%) countries.- The pandemic has resulted in at least temporary cessation of ~75% of CR programs, with others ceasing initiation of new patients, reducing components delivered, and/or changing of mode delivery with little opportunity for planning and training.- There is also significant psychosocial and economic impact on CR providers.- Alternative CR model (e.g., home-based, virtual) reimbursement advocacy is needed, to ensure safe, accessible secondary prevention delivery.
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Factibilidad y resultados de un programa de rehabilitación cardiaca intensiva. Perspectiva del estudio aleatorizado MxM (Más por Menos). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Buckley JP. The changing landscape of cardiac rehabilitation; from early mobilisation and reduced mortality to chronic multi-morbidity management. Disabil Rehabil 2021; 43:3515-3522. [PMID: 33989103 DOI: 10.1080/09638288.2021.1921062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM This paper aims to demonstrate how the rationale and delivery of cardiac rehabilitation (CR), in those countries with long term established standards of practice, has changed over the past eight decades. METHODS A narrative report based on the evolution of key published guidelines, systematic reviews and medical policies since the 1940s. RESULTS Case reports of the value of exercise in cardiac disease can be dated back to 1772. Formative groundwork for exercise-based CR was published between 1940 and 1970. However, it was not until the late 1980s that a large enough data set of controlled trials was available to show significant reductions in premature all-cause and cardiac mortality. Since the mid 1990s, cardiac mortality has been greatly reduced due to enhanced public health, emergency care and more sensitive diagnostic techniques and aggressive treatments. As a result, there appears to be an associated reduced potency of CR to affect mortality. New rationales for why, how and where CR is delivered have emerged including: adapting to a longer surviving ageing multi-morbid population, where healthcare cost savings and quality of life have become increasingly important. CONCLUSIONS In light of these results, an emerging focus for CR, and in some cases "pre-habilitation", is that of a chronic disability management programme increasingly delivered in community and home settings. Within this delivery model, the use of remote personalised technologies is now emerging, especially with new needs accelerated by the pandemic of COVID-19. IMPLICATIONS FOR REHABILITATIONWith continued advances in medical science and better long term survival, the nature of cardiac rehabilitation has evolved over the past eight decades. It was originally an exercise-focused intervention on short term recovery and reducing cardiac and all-cause mortality, to now being one part of a multi-factor lifestyle, behavioural, and medical chronic disease management programme.Throughout history, the important influence of psycho-social well-being and human behaviour has, however, always been of key importance to patients.The location of rehabilitation can now be suited to patient need, both medically and socially, where the same components can be delivered in either a traditional outpatient clinic, community settings, at home and more recently all of these being supported or augmented with the advent of mobile technology.
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Affiliation(s)
- John P Buckley
- Centre for Active Living, University Centre Shrewsbury/University of Chester, Chester, UK
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Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe. Arch Rehabil Res Clin Transl 2021; 2:100043. [PMID: 33543072 PMCID: PMC7853368 DOI: 10.1016/j.arrct.2020.100043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. Design Prospective observational multicenter register study in 12 rehabilitation centers throughout Germany. Setting Comprehensive 3-week CR. Participants Patients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). Interventions Not applicable. Main Outcome Measures Feasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). Results Based on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. Conclusions We provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.
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Key Words
- 6MWD, 6-minute walking distance
- 95% CI, 95% confidence interval
- ACS, acute coronary syndrome
- BMI, body mass index
- CR, cardiac rehabilitation
- Cardiac rehabilitation
- Cardiovascular diseases
- EDC, electronic data capture
- HAF-17, Herzangstfragebogen (German version of the Cardiac Anxiety Questionnaire)
- IRES-24, indicators of rehabilitation status-24
- KMO, Kaiser-Meyer-Olkin
- LDL, low-density lipoprotein
- OutCaRe, Outcome of Cardiac Rehabilitation
- Outcome measures
- PAD, peripheral artery disease
- PCS, physical component summary
- PHQ-9, Patient Health Questionnaire-9
- Quality indicators
- Rehabilitation
- Rehabilitation outcome
- SES, standardized effect size
- SF-12, Medical Outcomes Study 12-Item Short-Form Health Survey
- Secondary prevention
- WHO-5, 5-item World Health Organization Well-Being Index
- health care
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Young L, Zhang Q, Lian E, Roberts K, Weintraub N, Dong Y, Zhu H, Xu H, Schafer P, Dunlap S. Factors Predicting the Utilization of Center-Based Cardiac Rehabilitation Program. Geriatrics (Basel) 2020; 5:geriatrics5040066. [PMID: 32998237 PMCID: PMC7709641 DOI: 10.3390/geriatrics5040066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/16/2022] Open
Abstract
Although cardiac rehabilitation (CR) is clearly beneficial to improving patients’ physical functioning and reducing heart disease progression, significant proportions of patients do not complete CR programs. To evaluate the prevalence and predictors of completion of a center-based CR program in eligible cardiac patients, existing data collected from electronic medical records were used. To identify the predictors of CR completion, we used principal components analysis (PCA) and an artificial neural network (ANN) module. Among 685 patients, 61.4% (n = 421) completed the program, 31.7% (n = 217) dropped out, and 6.9% (n = 47) were referred but failed to initiate the program. PCA was conducted to consolidate baseline data into three factors—(1) psychosocial factors (depression, anxiety, and quality of life), (2) age, and (3) BMI, which explained 66.8% of the total variance. The ANN model produced similar results as the PCA. Patients who completed CR sessions had greater extremity strength and flexibility, longer six-minute walk distance, more CR knowledge, and a better quality of life. The present study demonstrated that patients who were older, obese, and who had depression, anxiety, or a low quality of life were less likely to complete the CR program.
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Affiliation(s)
- Lufei Young
- College of Nursing, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Qi Zhang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Eric Lian
- Departments of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (E.L.); (N.W.); (P.S.); (S.D.)
| | - Kimberly Roberts
- Department of Nursing, School of Health Sentences, Georgia Highlands College, Rome, GA 30161, USA;
| | - Neal Weintraub
- Departments of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (E.L.); (N.W.); (P.S.); (S.D.)
- Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Yanbin Dong
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (Y.D.); (H.Z.)
| | - Haidong Zhu
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (Y.D.); (H.Z.)
| | - Hongyan Xu
- Department of Biostats & Data, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Pascha Schafer
- Departments of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (E.L.); (N.W.); (P.S.); (S.D.)
| | - Stephanie Dunlap
- Departments of Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA; (E.L.); (N.W.); (P.S.); (S.D.)
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Feasibility and results of an intensive cardiac rehabilitation program. Insights from the MxM (Más por Menos) randomized trial. ACTA ACUST UNITED AC 2020; 74:518-525. [PMID: 32807709 DOI: 10.1016/j.rec.2020.03.029] [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: 12/26/2019] [Accepted: 03/20/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cardiac rehabilitation programs (CRP) are a set of interventions to improve the prognosis of cardiovascular disease by influencing patients' physical, mental, and social conditions. However, there are no studies evaluating the optimal duration of these programs. We aimed to compare the results of a standard vs a brief intensive CRP in patients after ST-segment elevation and non-ST-segment elevation acute coronary syndrome through the Más por Menos study (More Intensive Cardiac Rehabilitation Programs in Less Time). METHODS In this prospective, randomized, open, evaluator-blind for end-point, and multicenter trial (PROBE design), patients were randomly allocated to either standard 8-week CRP or intensive 2-week CRP with booster sessions. A final visit was performed 12 months later, after completion of the program. We assessed adherence to the Mediterranean diet, psychological status, smoking, drug therapy, functional capacity, quality of life, cardiometabolic and anthropometric parameters, cardiovascular events, and all-cause mortality during follow-up. RESULTS A total of 497 patients (mean age, 57.8±10.0 years; 87.3% men) were finally assessed (intensive: n=262; standard: n=235). Baseline characteristics were similar between the 2 groups. At 12 months, the results of treadmill ergometry improved by ≥ 1 MET in ≥ 93% of the patients. In addition, adherence to the Mediterranean diet and quality of life were significantly improved by CRP, with no significant differences between the groups. The occurrence of cardiovascular events was similar in the 2 groups. CONCLUSIONS Intensive CRP could be as effective as standard CRP in achieving adherence to recommended secondary prevention measures after acute coronary syndrome and could be an alternative for some patients and centers. Registered at ClinicalTrials.gov (Identifier: NCT02619422).
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Hwang CL, Elokda A, Ozemek C, Arena R, Phillips SA. More than a matter of the heart: the concept of intravascular multimorbidity in cardiac rehabilitation. Expert Rev Cardiovasc Ther 2020; 18:557-562. [PMID: 32700592 DOI: 10.1080/14779072.2020.1798761] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Coronary artery disease (CAD) is the major cause of death of cardiovascular disease. It is initiated by atherosclerosis, which narrows the coronary arteries and limits blood flow and oxygen to the heart. Multiple pathophysiological conditions within the arteries, such as arterial wall thickening, endothelial dysfunction, and arterial stiffening, are associated with the development of atherosclerosis. AREAS COVERED We introduce a new concept of 'intravascular multimorbidity,' the presence and integration of multiple pathophysiological conditions within the arteries. We also introduce some measurements of intravascular multimorbidity and discuss how these measurements can be utilized in cardiac rehabilitation (CR). EXPERT OPINION We propose that the measures of intravascular multimorbidity in different arteries may provide information on disease severity and serve as unique prognostic 'barometers' to disease progression in patients with CAD. By measuring the underlying disease mechanisms within the arteries and understanding individual variability of disease progression/regression, these measures may also provide a unique prognostic window in CR. The window into intravascular multimorbidity can help guide clinical strategies, for example, assessing progress and appropriate titration of exercise. Intravascular multimorbidity may represent an important opportunity for more researchers and clinical professions to evaluate patients in CR.
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Affiliation(s)
- Chueh-Lung Hwang
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Ahmed Elokda
- Department of Rehabilitation Sciences, Florida Golf Coast University , Fort Myers, FL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
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Babu AS, Arena R, Ozemek C, Lavie CJ. COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage. Can J Cardiol 2020; 36:792-794. [PMID: 32344000 PMCID: PMC7195273 DOI: 10.1016/j.cjca.2020.04.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Ross Arena
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA
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Cardiac Rehabilitation in India: Results from the International Council of Cardiovascular Prevention and Rehabilitation's Global Audit of Cardiac Rehabilitation. Glob Heart 2020; 15:28. [PMID: 32489801 PMCID: PMC7218762 DOI: 10.5334/gh.783] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is recommended in clinical practice guidelines for comprehensive secondary prevention. While India has a high burden of cardiovascular diseases (CVD), availability and nature of services delivered there is unknown. In this study, we undertook secondary analysis of the Indian data from the global CR audit and survey, conducted by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR). Methods In this cross-sectional study, an online survey was administered to CR programs, identified in India by CR champions and through snowball sampling. CR density was computed using Global Burden of Disease study ischemic heart disease (IHD) incidence estimates. Results Twenty-three centres were identified, of which 18 (78.3%) responded, from 3 southern states. There was only one spot for every 360 IHD patients/year, with 3,304,474 more CR spaces needed each year. Most programs accepted guideline-indicated patients, and most of these patients paid out-of-pocket for services. Programs were delivered by a multidisciplinary team, including physicians, physiotherapists, among others. Programs were very comprehensive. Apart from exercise training, which was offered across all centers, some centers also offered yoga therapy. Top barriers to delivery were lack of patient referral and financial resources. Conclusions Of all countries in ICCPR's global audit, the greatest need for CR exists in India, particularly in the North. Programs must be financially supported by government, and healthcare providers trained to deliver it to increase capacity. Where CR did exist, it was generally delivered in accordance with guideline recommendations. Tobacco cessation interventions should be universally offered.
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Buttery AK. Cardiac Rehabilitation for Frail Older People. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1216:131-147. [DOI: 10.1007/978-3-030-33330-0_13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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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Howarth M, Lister C. Social prescribing in cardiology: rediscovering the nature within us. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjca.2019.0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Personalised care is integral to the delivery of the NHS England Long Term Plan. Enabling choice and supporting patients to make decisions predicated on ‘what matters to them’, rather than ‘what is the matter with them’ is a fundamental part of the NHS vision. Social prescribing uses non-medical, asset-based, salutogenic approaches to promote this personalised paradigm, and places the patient central to decision making. This article discusses how personalised care can be used to help people with cardiovascular disease using socially prescribed ‘nature-based’ interventions to support the pre-habilitation and rehabilitation of patients with cardiovascular disease. The concept of personalised care outlined and the significance of salutogenic principles as a complementary approach to the pathogenic model is discussed. The authors argue that this seemingly novel approach to using nature-based interventions can help promote wellbeing for people with cardiovascular disease as part of the wider personalised agenda.
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Affiliation(s)
- Michelle Howarth
- Senior Lecturer in Nursing, School of Health and Society, University of Salford, Salford, UK
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Availability and delivery of cardiac rehabilitation in the Eastern Mediterranean Region: How does it compare globally? Int J Cardiol 2019; 285:147-153. [DOI: 10.1016/j.ijcard.2019.02.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/16/2019] [Accepted: 02/27/2019] [Indexed: 01/16/2023]
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Jesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060980. [PMID: 30893793 PMCID: PMC6466363 DOI: 10.3390/ijerph16060980] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/19/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
Abstract
Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions likely benefiting from physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts germane to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99% CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts likely benefiting from physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs likley benefiting from physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries did Age-standardized YLD Rates significantly decrease (p < 0.01; r2 = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs. This growth was found globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced, thereby highlighting important unmet needs.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
| | - Michel D Landry
- Physical Therapy Division, Department of Orthopeadic Surgery, School of Medicine, Duke University, Durham, NC 27705, USA.
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA.
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA.
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Zhao M, Graham I, Cooney MT, Grobbee DE, Vaartjes I, Klipstein-Grobusch K. Determinants of coronary artery disease risk factor management across three world regions. HEART ASIA 2019; 11:e011112. [PMID: 31031827 PMCID: PMC6454324 DOI: 10.1136/heartasia-2018-011112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
Abstract
Background The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD. Methods and results SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region. Conclusions Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
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Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marie Therese Cooney
- St Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Global Geo Health Data Center, Utrecht University, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Interventions to Promote Patient Utilization of Cardiac Rehabilitation: Cochrane Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8020189. [PMID: 30764517 PMCID: PMC6406265 DOI: 10.3390/jcm8020189] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023] Open
Abstract
Too few patients utilize cardiac rehabilitation (CR), despite its benefits. The Cochrane review assessing the effectiveness of interventions to increase CR utilization (enrolment, adherence, and completion) was updated. A search was performed through July 2018 of the Cochrane and MEDLINE (Medical Literature Analysis and Retrieval System Online) databases, among other sources. Randomized controlled trials in adults with myocardial infarction, angina, revascularization, or heart failure were included. Interventions had to aim to increase utilization of comprehensive phase II CR. Two authors independently performed all stages of citation processing. Following the random-effects meta-analysis, meta-regression was undertaken to explore the impact of pre-specified factors. Twenty-six trials with 5299 participants were included (35.8% women). Low-quality evidence showed an effect of interventions in increasing enrolment (risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.13⁻1.42). Meta-regression analyses suggested that the intervention deliverer (nurse or allied healthcare provider, p = 0.02) and delivery format (face-to-face, p = 0.01) were influential in increasing enrolment. There was low-quality evidence that interventions to increase adherence were effective (standardized mean difference (SMD) = 0.38, 95% CI = 0.20⁻0.55), particularly where remotely-offered (SMD = 0.56, 95% CI = 0.36⁻0.76). There was moderate-quality evidence that interventions to increase program completion were effective (RR = 1.13, 95% CI = 1.02⁻1.25). There are effective interventions to increase CR utilization, but more research is needed to establish specific, implementable materials and protocols, particularly for completion.
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Tran M, Pesah E, Turk-Adawi K, Supervia M, Lopez Jimenez F, Oh P, Baer C, Grace SL. Cardiac Rehabilitation Availability and Delivery in Canada: How Does It Compare With Other High-Income Countries? Can J Cardiol 2018; 34:S252-S262. [DOI: 10.1016/j.cjca.2018.07.413] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/22/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023] Open
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