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Fucile I, Attanasio F, Conte M, Tesone M, Fiorillo F, Rozza F, Mancusi C, De Luca N. Nursing Counseling in Patients Recently Admitted in Cardiac Rehabilitation Unit: A Pilot Study-Brief Letter for Publication. High Blood Press Cardiovasc Prev 2024; 31:221-223. [PMID: 38557856 DOI: 10.1007/s40292-024-00637-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Ilaria Fucile
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Filomena Attanasio
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
| | - Maurizio Conte
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
| | - Maddalena Tesone
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Fulvio Fiorillo
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Rozza
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Costantino Mancusi
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy.
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Nicola De Luca
- Cardiac Rehabilitation Unit, University Hospital of Naples Federico II, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Zadro JR. Appraisal of Clinical Practice Guideline: Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how. A position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. J Physiother 2023; 69:128. [PMID: 36914525 DOI: 10.1016/j.jphys.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
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Mocan B, Mocan M, Fulea M, Murar M, Feier H. Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System. Int J Environ Res Public Health 2022; 19:11628. [PMID: 36141899 PMCID: PMC9517082 DOI: 10.3390/ijerph191811628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 06/01/2023]
Abstract
This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a robotic and Virtual Reality module for cardiac patients to be used in their rehabilitation program. In this study, a novel strategy was used to integrate existing equipment and applications with newly developed ones, with the aim of reducing the need for technical skills of patients using remote control. Patients with acute or chronic heart diseases require long-term, individualized rehabilitation in order to promote their motor recovery and maintain an active and independent lifestyle. This will be accomplished by creating a system for at-home cardiac telerehabilitation augmented by a VR and cobot systems, which can be used long-term at home by each individual patient. In the pre-feasibility study carried out on healthy volunteers familiar with software applications and robotic systems, we demonstrate that RoboTeleRehab could be technically feasible both hardware and software.
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Affiliation(s)
- Bogdan Mocan
- Department of Design Engineering and Robotics, Technical University of Cluj-Napoca, 400020 Cluj-Napoca, Romania
| | - Mihaela Mocan
- Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Mircea Fulea
- Department of Design Engineering and Robotics, Technical University of Cluj-Napoca, 400020 Cluj-Napoca, Romania
| | - Mircea Murar
- Department of Design Engineering and Robotics, Technical University of Cluj-Napoca, 400020 Cluj-Napoca, Romania
| | - Horea Feier
- Institute for Cardiovascular Diseases Timisoara, University of Medicine and Pharmacy Timisoara, Gheorghe Adam Nr. 13A, 300310 Timisoara, Romania
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Riley H, Stabile L, Wu WC. Transition to Home-Based Treatment Plans for Center-Based Cardiac, Pulmonary, and Vascular Rehabilitation during COVID-19. R I Med J (2013) 2020; 103:30-33. [PMID: 33126784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Traditional rehabilitation services, whether they are cardiac, pulmonary, or vascular, consist of 6-36 center-based, supervised sessions; however, due to COVID-19, in-person visits were suspended. This study sought to implement a transitional home-based treatment plan (HBTP) to patients. METHOD Patients enrolled in a rehabilitation service at the Miriam Hospital during the time of temporary closure were provided with a HBTP that was individualized to their needs and multi-disciplinary in nature. Patients were called weekly for continual guidance and support. RESULTS Of the 129 patients that received a HBTP, 115 (89%) participated in follow-up correspondence (63±12 years, 83% white, 66% male, 81% enrolled in cardiac rehab). Nearly 70% of patients continued to participate in regular exercise and upon re-opening, 69 (60%) of patients returned to center-based care. Psychosocial factors appeared to inhibit treatment adherence. CONCLUSIONS Patients are receptive to an HBTP and subsequent follow-up throughout temporary closure of rehabilitation services.
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Affiliation(s)
- Hayden Riley
- Center for Cardiac Fitness, The Miriam Hospital, Providence, RI
| | - Loren Stabile
- Center for Cardiac Fitness, The Miriam Hospital, Providence, RI
| | - Wen-Chih Wu
- Center for Cardiac Fitness, The Miriam Hospital, Providence, RI;Providence Veterans Affairs Medical Center, Providence, RI; Department of Medicine, Alpert Medical School of Brown University, Providence, RI
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Simonelli C, Vitacca M, Ambrosino N, Scalvini S, Rivadossi F, Saleri M, Fokom AG, Speltoni I, Ghirardi R, Paneroni M. Therapist Driven Rehabilitation Protocol for Patients with Chronic Heart and Lung Diseases: A Real-Life Study. Int J Environ Res Public Health 2020; 17:E1016. [PMID: 32033505 PMCID: PMC7037983 DOI: 10.3390/ijerph17031016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 01/01/2023]
Abstract
Therapist driven protocols may help to tailor rehabilitation programs to individual patients. We aimed to test the feasibility, safety, and clinical usefulness of a therapist driven protocol for rehabilitation including exercise training of patients with heart or lung diseases. An internal audit elaborated the Cardio-Respiratory Exercise Maugeri Algorithm (CREMA) based on: (a) standardized baseline assessments, (b) decision-making pathways, and (c) frequency/intensity/time/type (FITT) of prescription for each exercise. Outpatients (n = 620) with chronic heart disease (CHD), recent myocardial revascularization (REVASC), chronic airway (Obstructive), and restrictive lung (Restrictive) diseases underwent exercise training according to CREMA during 4 years. Peripheral muscle strengthening was the most prescribed exercise (83.6%), while arm endurance training was the least frequently (0.75%). Exercise prescription varied widely among the disease groups (interval training 19-47%, balance 35-49%, lower limb muscle training 6-15%). After training, REVASC patients were the best improvers in the 6 min walking distance (+48.7 (56.1) m), maximal inspiratory pressure (+9.6 (15.4) cmH2O), and daily steps (+1087.2 (3297.1) n/day). Quadriceps and biceps strength, maximal expiratory pressure, and balance improved in all groups, without significant differences. Minor side effects were observed in 11.2% of the patients. The CREMA therapist driven protocol was feasible, safe, and useful for prescribing tailored training programs. Exercise prescriptions and training response differed among diseases.
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Affiliation(s)
- Carla Simonelli
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (C.S.); (S.S.); (F.R.); (I.S.)
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (M.V.); (M.S.); (A.G.F.); (R.G.)
| | - Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, 27040 Montescano (PV), Italy;
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (C.S.); (S.S.); (F.R.); (I.S.)
| | - Francesca Rivadossi
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (C.S.); (S.S.); (F.R.); (I.S.)
| | - Manuela Saleri
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (M.V.); (M.S.); (A.G.F.); (R.G.)
| | - Aubin G Fokom
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (M.V.); (M.S.); (A.G.F.); (R.G.)
| | - Ilaria Speltoni
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (C.S.); (S.S.); (F.R.); (I.S.)
| | - Riccardo Ghirardi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (M.V.); (M.S.); (A.G.F.); (R.G.)
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, 25065 Lumezzane (BS), Italy; (M.V.); (M.S.); (A.G.F.); (R.G.)
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6
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Hu DY. [Never forget why you started, try the best to promote the healthy development of the prevention and rehabilitation for patients with cardiopulmonary diseases]. Zhonghua Xin Xue Guan Bing Za Zhi 2019; 47:680-682. [PMID: 31550833 DOI: 10.3760/cma.j.issn.0253-3758.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- D Y Hu
- Department of Cardiology, Peking University People's Hospital, Beijing 100044, China
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7
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Mendes A. Heart disease: from living to living well. Br J Nurs 2019; 28:946. [PMID: 31348712 DOI: 10.12968/bjon.2019.28.14.946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aysha Mendes, Editor, British Journal of Cardiac Nursing, aysha.freelance@gmail.com, discusses support for patients living with heart disease.
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Madueño Caro AJ, Mellado Fernández ML, Pardos Lafarga M, Muñoz Ayllón M, Martín-López C, Gómez-Salgado J. [Perceived self-efficacy in patients after a cardiac rehabilitation programme in primary care: A new model of attention.]. Rev Esp Salud Publica 2019; 93:e201907046. [PMID: 31313755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/12/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The literature points to the possibility of carrying out an intervention, from primary prevention to rehabilitation after a cardiac event, towards decreasing the incidence of such cardiac events and facilitating the return to daily life. The objective was to determine the effect of a cardiac rehabilitation intervention over perceived selfefficacy for patients who have suffered a cardiac event. METHODS A community clinical trial, open, controlled, and randomised, was designed, and performed in primary care. To determine the sample size, the research team used the General Self-Efficacy Scale by Baessler and Schwarzer. The mean difference between groups considered of clinical relevance was of at least 6 points in the aforementioned General Self-Efficacy Scale. A precision of 95% and a test power of 80% were accepted. The result proposed a sample of 44 subjects in each group. Over 12 months, all subjects of legal age (N = 104), both sexes, that had concluded phase II in the cardiac rehabilitation unit of the university Hospital Puerta del Mar (Cadiz) were offered to participate in the study. The patients were informed about the study development, asking for their participation and providing them with a written informed consent. The subjects were randomly assigned to the intervention or control group through blind allocation (in a sealed envelope to the researcher), on a pre-set 2:1 ratio (two patients assigned to the intervention group to one assigned to the control group). A non-response or rejection to participate in the study record was made for the non-response analysis. RESULTS A total of 89 subjects were included in the statistical analysis (response rate of 85.57%), with an average age of 63.01 years (SD: 8.75). The main dependent variable was the scores difference between groups, comparing means before and after the intervention, through the General Self-Efficacy Scale by Baessler & Schwarner. A mean difference of 6.0972 points was obtained between the intervention and the control groups (p<0.0053; 95% CI -4.1950 to -10.29), as a result of a 3.3750 mean points increase (standard deviation: 7.01) in the intervention group and a 3.3750 mean points decrease (standard deviation: 7.19) in the control group. In relation to the possible changes to be detected through the Hamilton anxiety scale and the Beck's depression inventory, after finishing the intervention, an estimate and contrast of population means was made between groups for the scores difference in the Hamilton scale, determined on the final visit, with no significant differences found (t-student 0.1211; p <0.9 43). Similarly, no significant differences were found between the groups for the means obtained in the variable "Beck's depression inventory scores difference" (t-student -0.1281; p<0.8987). CONCLUSIONS The inclusion in cardiac rehabilitation programmes carried out in primary care improves the general perceived self-efficacy of patients who have suffered cardiac events.
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Affiliation(s)
| | | | | | - Marta Muñoz Ayllón
- Centro de salud La Laguna. Distrito Sanitario Cádiz Bahía La Janda. Cádiz. España
| | | | - Juan Gómez-Salgado
- Departamento de Enfermería. Universidad de Huelva. Huelva. España
- Universidad Espíritu Santo. Guayaquil. Ecuador
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Duijndam S, Denollet J. Social inhibition in population-based and cardiac patient samples: Robustness of inhibition, sensitivity and withdrawal as distinct facets. Gen Hosp Psychiatry 2019; 58:13-23. [PMID: 30822657 DOI: 10.1016/j.genhosppsych.2019.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Behavioral inhibition plays a key role in animal stress research and developmental research in children. Therefore, we examined the robustness of our multifaceted model of adult social inhibition that comprises behavioral inhibition, interpersonal sensitivity, and social withdrawal components. METHOD A total of 899 adults completed the 15-item Social Inhibition Questionnaire (SIQ15) and measures of emotional distress. Confirmatory Factor Analysis (CFA), reliability estimates, and correlational and second-order factor analyses were used to examine the robustness of our model. RESULTS CFA (RMSEA = 0.052; NFI = 0.938; CFI = 0.957) and Cronbach's α estimates ≥0.87 confirmed the robustness of our multi-facet social inhibition model based on three correlated inhibition, sensitivity, and withdrawal factors in 560 adults from the general population and in 194 undergraduate students. Inhibition, sensitivity, and withdrawal were stable over time (3-month test-retest correlations ≥ 0.78), and were closely related to the Gest Behavioral Inhibition and PID-5 Withdrawal measures in a clinical sample of 145 cardiac patients. Of note, male cardiac patients reported more inhibition and withdrawal than female patients. Across samples, social inhibition was distinctly different from negative affectivity. CONCLUSIONS Our 3-facet model of inhibition, sensitivity and withdrawal was robust across samples, and may promote research on adult social inhibition in population-based and clinical studies.
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Affiliation(s)
- Stefanie Duijndam
- CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands.
| | - Johan Denollet
- CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, the Netherlands; Department of Cardiology, University Hospital of Antwerp, Antwerp, Belgium
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Kano N, Kato T, Tomohara T, Futamura Y, Yoshida S, Okumura T, Maeda K, Murohara T, Oda K. Gatekeeping in an inpatient rehabilitation facility to reduce morbidity and mortality due to cardiac disease: screening program using of BNP and ECG Auto-diagnosis. Nagoya J Med Sci 2019; 81:303-312. [PMID: 31239598 PMCID: PMC6556463 DOI: 10.18999/nagjms.81.2.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022]
Abstract
The Kaifukuki-Rehabilitation Ward (KRW) is a type of inpatient rehabilitation facility in Japan. In the KRW of our institute, mortality and frequency of emergency referrals in 2013 were rather high, 2.6% and 4.3%, respectively. We aimed to investigate the usefulness of an original gatekeeping system to reduce mortality and morbidity from cardiac complications, and to improve the quality of medical care in the KRW. A total of 370 consecutive patients admitted to the KRW of Kobayashi Memorial Hospital between 1 May 2015 and 31 March 2016 were enrolled in this prospective observational study. All patients underwent a screening evaluation in which we defined patients as being screen positive (SC-positive) if they had at least one of 20 diagnostic ECG codes and/or BNP level over 140 pg/dL at admission. A cardiologist provided weekly interventions to those among SC-positive patients who needed cardiac disease treatment during hospitalization. In all, 129 patients were classified as SC-positive (mean age 80 years, 124 [32%] male), and weekly intervention was needed in 28 patients, including start of cardiac medication in 17 cases. Mortality and frequency of emergency transfer due to cardiac disease during hospital stay were 0.3% and 0.3%, respectively. Our gatekeeping system involving a screening evaluation at admission and weekly intervention in selected patients by a cardiologist may be useful in reducing mortality and rate of transfer due to cardiac disease and may improve quality of medical care in KRWs.
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Affiliation(s)
- Naoaki Kano
- Kobayashi Memorial Hospital, Hekinan, Japan
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | | | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kengo Maeda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Oda
- Kobayashi Memorial Hospital, Hekinan, Japan
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Riley H, Headley S, Lindenauer PK, Goff S, Szalai H, Gaalema DE, Pack QR. Patient Perception of How Smoking Status Influences Cardiac Rehabilitation Attendance After an Acute Cardiac Hospitalization. J Cardiopulm Rehabil Prev 2019; 39:181-186. [PMID: 31022000 PMCID: PMC6492621 DOI: 10.1097/hcr.0000000000000366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Patients hospitalized with a cardiac condition are less likely to attend cardiac rehabilitation (CR) if they are smokers despite the benefits of doing so. The present study sought to investigate how, if at all, a patient's decision to attend CR was influenced by his or her tobacco use post-discharge. METHODS We surveyed smokers during their hospitalization for a cardiac condition. Four to 8 wk after discharge, a follow-up survey assessed self-reported CR attendance, smoking cessation (SC), and patient opinion of how their smoking status influenced CR attendance. RESULTS Of the 81 patients who completed the baseline survey (68% male, 57 ± 10 y), 62 (77%) completed the follow-up survey. Consistent with prior findings, there was a substantial correlation between SC and CR attendance (OR: 16.0, P < .001) with 36 (44%) patients attending CR overall and 38 (47%) abstaining from smoking. Patients reported a wide variety of reasons for not attending CR, but most patients (n = 39, 63%) reported that their smoking status did not influence their decision to attend CR. However, 5 patients (8%) reported attending CR because they successfully quit smoking, and 5 (8%) attended CR anticipating support with SC. CONCLUSION A strong relationship exists between SC and CR attendance following a cardiac hospitalization; however, most patients did not feel that their smoking status was a factor in their decision to attend CR. Regardless of the reason, it appears that success with one behavior may be related to the other and that both SC and CR attendance should be encouraged.
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Affiliation(s)
- Hayden Riley
- Division of Cardiovascular Medicine (Ms Riley and Dr Pack), Institute for Health Care Delivery and Population Science (Drs Lindenauer, Goff, and Pack), Department of Internal Medicine (Dr Lindenauer), and Division of Cardiology (Ms Szalai and Dr Pack), Baystate Medical Center, Springfield, Massachusetts; Department of Exercise Science and Sports Studies, Springfield College, Springfield, Massachusetts (Ms Riley and Dr Headley); Cardiac and Pulmonary Rehabilitation, The Miriam Hospital, Providence, Rhode Island (Ms Riley); University of Massachusetts Medical School at Baystate, Springfield (Drs Lindenauer and Goff); and Department of Psychiatry, The University of Vermont, Burlington (Dr Gaalema)
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12
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Millstein RA, Chung WJ, Hoeppner BB, Boehm JK, Legler SR, Mastromauro CA, Huffman JC. Development of the State Optimism Measure. Gen Hosp Psychiatry 2019; 58:83-93. [PMID: 31026732 PMCID: PMC6501845 DOI: 10.1016/j.genhosppsych.2019.04.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Optimism, or positive expectations about the future, is associated with better health. It is commonly assessed as a trait, but it may change over time and circumstance. Accordingly, we developed a measure of state optimism. METHODS An initial 29-item pool was generated based on literature reviews and expert consultations. It was administered to three samples: sample 1 was a general healthy population (n = 136), sample 2 was people with cardiac disease (n = 96), and sample 3 was persons recovering from problematic substance use (n = 265). Exploratory factor analysis and item-level descriptive statistics were used to select items to form a unidimensional State Optimism Measure (SOM). Confirmatory factor analysis (CFA) was performed to test fit. RESULTS The selected seven SOM items demonstrated acceptable to high factor loadings on a single dominant factor (loadings: 0.64-0.93). There was high internal reliability across samples (Cronbach's alphas: 0.92-0.96), and strong convergent validity correlations in hypothesized directions. The SOM's correlations with other optimism measures indicate preliminary construct validity. CFA statistics indicated acceptable fit of the SOM model. CONCLUSIONS We developed a psychometrically-sound measure of state optimism that can be used in various settings. Predictive and criterion validity will be tested in future studies.
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Affiliation(s)
- Rachel A Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Wei-Jean Chung
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Bettina B Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Sean R Legler
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Spindler H, Leerskov K, Joensson K, Nielsen G, Andreasen JJ, Dinesen B. Conventional Rehabilitation Therapy Versus Telerehabilitation in Cardiac Patients: A Comparison of Motivation, Psychological Distress, and Quality of Life. Int J Environ Res Public Health 2019; 16:ijerph16030512. [PMID: 30759761 PMCID: PMC6388222 DOI: 10.3390/ijerph16030512] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/03/2019] [Accepted: 02/09/2019] [Indexed: 12/16/2022]
Abstract
Telerehabilitation (TR) has gained attention as a promising rehabilitation format. Our study examined how patients responded to TR and whether it provided adequate support for their lifestyle changes and self-care efforts when compared to conventional rehabilitation (CR). Cardiac patients (n = 136) were randomly assigned to a TR or CR group. The TR group was provided with relevant health care technology for a period of three months, and both groups filled in questionnaires on their motivation for lifestyle changes and self-care psychological distress, and quality of life at 0, 3, 6, and 12 months. Patients in both groups were found to be equally motivated for lifestyle changes and self-care (p < 0.05) and they experienced similar levels of psychological distress and quality of life. TR is comparable to conventional rehabilitation in motivating patients, preventing psychological distress and improving quality of life. Although we observed an initial increase in autonomous motivation in the telerehabilitation group, this positive difference in motivation does not last over time. As such, neither rehabilitation format seems able to ensure long-term motivation. Therefore, TR may serve as a viable replacement for conventional rehabilitation when considered relevant. Further research is needed to enhance long-term motivation, and maybe telerehabilitation can help to achieve this.
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Affiliation(s)
- Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark.
| | - Kasper Leerskov
- SMI®, Department of Health Science and Technology, Aalborg University, 9200 Aalborg East, Denmark.
| | - Katrine Joensson
- Department of Micro- and Nanotechnology, The Technical University of Denmark, 2800 Kgs. Lyngby, Denmark.
| | - Gitte Nielsen
- Department of Cardiology, Vendsyssel Hospital, 9800 Hjoerring, Denmark.
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark.
| | - Birthe Dinesen
- Laboratory of Welfare Technologies - Telehealth and Telerehabilitation, Department of Health Science and Technology, Aalborg University, 9200 Aalborg East, Denmark.
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Glazachev OS, Dudnik EN, Zapara MA, Samarceva VG, Kofler WW. [Adaptation to dosed hypoxia-hyperoxia as a factor in improving the quality of life of elderly patients with cardiac pathology.]. Adv Gerontol 2019; 32:145-151. [PMID: 31228381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In order to substantiate new approaches to maintain the quality of life of elderly patients with cardiac pathology, the current study is made to evaluate the effectiveness and safety of technology, based on the principles of adaptive medicine, the method of interval hypoxic-hyperoxic training (IHHT). It was proved the use of IHHT technology in elderly people with HIBS in the prescribed regime leads to a substantial increase in the subjective perception of the quality of life, their psycho-emotional status, the number of attacks of angina pectoris, which was accompanied by an increase in the level of physical working capacity, exercise tolerance, normalization of lipid and carbohydrate metabolism. Treatments by interval hypoxic-hyperoxic training are well tolerated, do not cause side effects; when developing optimal individualized regimens' principles IHHT can be used in the complex rehabilitation of elderly patients with cardiac and co-morbid pathology.
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Affiliation(s)
- O S Glazachev
- I.M.Sechenov First Moscow State Medical University, 8 bld. 2 Trubetskaya str., Moscow 119991, Russian Federation; e-mail:
| | - E N Dudnik
- I.M.Sechenov First Moscow State Medical University, 8 bld. 2 Trubetskaya str., Moscow 119991, Russian Federation; e-mail:
| | - M A Zapara
- I.M.Sechenov First Moscow State Medical University, 8 bld. 2 Trubetskaya str., Moscow 119991, Russian Federation; e-mail:
| | - V G Samarceva
- I.M.Sechenov First Moscow State Medical University, 8 bld. 2 Trubetskaya str., Moscow 119991, Russian Federation; e-mail:
| | - W W Kofler
- I.M.Sechenov First Moscow State Medical University, 8 bld. 2 Trubetskaya str., Moscow 119991, Russian Federation; e-mail:
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Najem SA, Groll A, Schmermund A, Nowak B, Voigtländer T, Kaltenbach U, Dohmann P, Andresen D, Scharhag J. Walking activity during ambulant cardiac rehabilitation is related to maximum working capacity, age, and smoking behavior. Vasc Health Risk Manag 2018; 14:361-369. [PMID: 30519032 PMCID: PMC6235325 DOI: 10.2147/vhrm.s179798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A total of 6,500 to 8,000 steps per day are recommended for cardiovascular secondary prevention. The aim of this research was to examine how many steps per day patients achieve during ambulant cardiac rehabilitation (CR), and if there is a correlation between the number of steps and physical and cardiological parameters. METHODS In all, 192 stable CR patients were included and advised for sealed pedometry. The assessed parameters included maximum working capacity and heart rate, body mass index (BMI), New York Heart Association (NYHA) class, ejection fraction (EF), coronary artery disease status, beta-blocker medication, age, sex, smoking behavior, and laboratory parameters. A regularized regression approach called least absolute shrinkage and selection operator (LASSO) was used to detect a small set of explanatory variables associated with the response for steps per day. Based on these selected covariates, a sparse additive regression model was fitted. RESULTS The model noted that steps per day had a strong positive correlation with maximum working capacity (P=0.001), a significant negative correlation with higher age (P=0.01) and smoking (smoker: P<0.05; ex-smoker: P=0.01), a positive correlation with high-density lipoprotein (HDL), and a negative correlation with beta-blockers. Correlation between BMI and walking activity was nonlinear (BMI 18.5-24: 7,427±2,730 steps per day; BMI 25-29: 6,448±2,393 steps/day; BMI 30-34: 6,751±2,393 steps per day; BMI 35-39: 5,163±2,574; BMI >40: 6,077±1,567). CONCLUSION Walking activity during CR is reduced in patients who are unfit, older, smoke, or used to smoke. In addition to training recommendations, estimated steps per day during CR could be seen as a baseline orientation that helps patients to stay generally active or even to increase activity after CR.
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Affiliation(s)
- Sinann Al Najem
- German Heart Foundation, Frankfurt, Germany,
- Institute of Sports and Preventive Medicine, Saarbrücken, Germany,
| | - Andreas Groll
- Chair of Statistics, Georg August University, Göttingen, Germany
- Faculty of Statistics, Technical University Dortmund, Dortmund, Germany
| | - Axel Schmermund
- Cardioangiologisches Centrum Bethanien Herzwerk, Frankfurt, Germany
- Bethanien Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Bernd Nowak
- Cardioangiologisches Centrum Bethanien Herzwerk, Frankfurt, Germany
- Bethanien Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Thomas Voigtländer
- Cardioangiologisches Centrum Bethanien Herzwerk, Frankfurt, Germany
- Bethanien Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Peter Dohmann
- Cardioangiologisches Centrum Bethanien Herzwerk, Frankfurt, Germany
| | | | - Jürgen Scharhag
- Institute of Sports and Preventive Medicine, Saarbrücken, Germany,
- Outpatients' Clinic for Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Munich, Germany
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Wells A, McNicol K, Reeves D, Salmon P, Davies L, Heagerty A, Doherty P, McPhillips R, Anderson R, Faija C, Capobianco L, Morley H, Gaffney H, Heal C, Shields G, Fisher P. Metacognitive therapy home-based self-help for cardiac rehabilitation patients experiencing anxiety and depressive symptoms: study protocol for a feasibility randomised controlled trial (PATHWAY Home-MCT). Trials 2018; 19:444. [PMID: 30115112 PMCID: PMC6097432 DOI: 10.1186/s13063-018-2826-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/27/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety and depression are common among patients attending cardiac rehabilitation services. Currently available pharmacological and psychological interventions have limited effectiveness in this population. There are presently no psychological interventions for anxiety and depression integrated into cardiac rehabilitation services despite emphasis in key UK National Health Service policy. A new treatment, metacognitive therapy, is highly effective at reducing anxiety and depression in mental health settings. The principal aims of the current study are (1) to evaluate the acceptability of delivering metacognitive therapy in a home-based self-help format (Home-MCT) to cardiac rehabilitation patients experiencing anxiety and depressive symptoms and conduct a feasibility trial of Home-MCT plus usual cardiac rehabilitation compared to usual cardiac rehabilitation; and (2) to inform the design and sample size for a full-scale trial. METHODS The PATHWAY Home-MCT trial is a single-blind feasibility randomised controlled trial comparing usual cardiac rehabilitation (control) versus usual cardiac rehabilitation plus home-based self-help metacognitive therapy (intervention). Economic and qualitative evaluations will be embedded within the trial. Participants will be assessed at baseline and followed-up at 4 and 12 months. Patients who have been referred to cardiac rehabilitation programmes and have a score of ≥ 8 on the anxiety and/or depression subscales of the Hospital Anxiety and Depression Scale will be invited to take part in the study and written informed consent will be obtained. Participants will be recruited from the National Health Service in the UK. A minimum of 108 participants will be randomised to the intervention and control arms in a 1:1 ratio. DISCUSSION The Home-MCT feasibility randomised controlled trial will provide evidence on the acceptability of delivering metacognitive therapy in a home-based self-help format for cardiac rehabilitation patients experiencing symptoms of anxiety and/or depression and on the feasibility and design of a full-scale trial. In addition, it will provide provisional point estimates, with appropriately wide measures of uncertainty, relating to the effectiveness and cost-effectiveness of the intervention. TRIAL REGISTRATION ClinicalTrials.gov, NCT03129282 , Submitted to Registry: 11 April 2017.
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Affiliation(s)
- Adrian Wells
- The University of Manchester, School of Psychological Sciences, Faculty of Biology, Medicine and Health, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Kirsten McNicol
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - David Reeves
- The University of Manchester, NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Peter Salmon
- University of Liverpool, Institute of Psychology, Health and Society, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL UK
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Centre for Health Economics, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Anthony Heagerty
- The University of Manchester, School of Medical Sciences, Core Technology Facility, Grafton Street, Manchester, M13 9NT UK
- Central Manchester Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD UK
| | - Rebecca McPhillips
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Rebecca Anderson
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Cintia Faija
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Lora Capobianco
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Helen Morley
- Division of Neuroscience and Experimental Psychology, The University of Manchester, School of Biological Sciences, Oxford Road, Manchester, M13 9PL UK
| | - Hannah Gaffney
- Division of Psychology and Mental Health, The University of Manchester, School of Health Sciences, Oxford Road, Manchester, M13 9PL UK
| | - Calvin Heal
- The University of Manchester, Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Manchester, M13 9PL UK
| | - Gemma Shields
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Centre for Health Economics, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Peter Fisher
- University of Liverpool, Institute of Psychology, Health and Society, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL UK
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP UK
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17
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Soroush A, Heydarpour B, Komasi S, Saeidi M, Ezzati P. Barriers for the referral to outpatient cardiac rehabilitation: A predictive model including actual and perceived risk factors and perceived control. Ann Card Anaesth 2018; 21:249-254. [PMID: 30052210 PMCID: PMC6078027 DOI: 10.4103/aca.aca_87_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the roles of demographic factors, actual and perceived risk factors, and perceived control in the referral to cardiac rehabilitation (CR) after coronary artery bypass graft (CABG). METHODS In this cross-sectional study, data related to 312 CABG patients in a hospital of the Western part of Iran, gathered through demographics and actual risk factors' checklist, open single item of perceived heart risk factors, life stressful events scale, and perceived control questionnaire. Data analyzed by binary logistic regression. RESULTS The results showed that only 8.3% of CABG patients refer to CR. The facilitators of this referral included official employment (P < 0.05), coronary history (P = 0.016), and hyperlipidemia (P = 0.030) but more distance to the CR center (P = 0.042) and perceived physiological risk factor (P = 0.025) are concerned as the barriers for the referral to CR. CONCLUSION Providing appropriate awareness about the benefits of CR for patients with regard to their job status, coronary history, and perception about the illness risk factors can be effective in referral to CR. In addition, the presence of CR centers in towns and facilitated achievement to these centers can play a significant role in patients' participation.
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Affiliation(s)
- Ali Soroush
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Heydarpour
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeid Komasi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Saeidi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Ezzati
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Melholt C, Joensson K, Spindler H, Hansen J, Andreasen JJ, Nielsen G, Noergaard A, Tracey A, Thorup C, Kringelholt R, Dinesen BI. Cardiac patients' experiences with a telerehabilitation web portal: Implications for eHealth literacy. Patient Educ Couns 2018; 101:854-861. [PMID: 29305064 DOI: 10.1016/j.pec.2017.12.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 12/05/2017] [Accepted: 12/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aims of this study are two-fold: 1) To explore how cardiac patients experience their use of a telerehabilitation tool for recuperation from surgery, and 2) To study how the patients' use of the interactive 'Active Heart' web portal affected their eHealth literacy skills. METHODS The 'Active Heart' telerehabilitation web portal offers patients and their relatives information and exercises for recovery from cardiac surgery. 109 cardiac patients were using the Active Heart web portal for a duration of three months. RESULTS 49 patients completed questionnaires that were administered both before and after their use of the portal, resulting in a 45% response rate. Respondents had a mean age of 60.64 ± 10.75 years, and 82% of the respondents were males. The respondents had a positive impression of Active Heart, reporting that it was easy to access, user-friendly, and written in an understandable language. The patients' eHealth literacy skills increased during the trial period. CONCLUSION Use of a cardiac telerehabilitation web portal can be beneficial for patient education and can increase cardiac patients' eHealth literacy skills. PRACTICE IMPLICATIONS Online telerehabilitation portals may be used as a tool in patient education and cardiac rehabilitation.
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Affiliation(s)
- Camilla Melholt
- Laboratory of Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.
| | - Katrine Joensson
- Laboratory of Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus Graduate School of Business and Social Sciences, Aarhus University, Denmark
| | - John Hansen
- Laboratory of Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark; Laboratory for Cardio-Technology, Medical Informatics Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Gitte Nielsen
- Department of Cardiology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Astrid Noergaard
- Laboratory of Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Anita Tracey
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Thorup
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Rikke Kringelholt
- Department of Cardiology, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Birthe Irene Dinesen
- Laboratory of Welfare Technologies - Telehealth & Telerehabilitation, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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Hamilton S, Mills B, McRae S, Thompson S. Evidence to service gap: cardiac rehabilitation and secondary prevention in rural and remote Western Australia. BMC Health Serv Res 2018; 18:64. [PMID: 29382343 PMCID: PMC5791246 DOI: 10.1186/s12913-018-2873-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 01/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD), a leading cause of morbidity and mortality, has similar incidence in metropolitan and rural areas but poorer cardiovascular outcomes for residents living in rural and remote Australia. Cardiac Rehabilitation (CR) is an evidence-based intervention that helps reduce subsequent cardiovascular events and rehospitalisation. Unfortunately CR attendance rates are as low as 10-30% with rural/remote populations under-represented. This in-depth assessment investigated the provision of CR and secondary prevention services in Western Australia (WA) with a focus on rural and remote populations. METHODS CR and Aboriginal Community Controlled Health Services were identified through the Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Structured interviews with CR coordinators included questions specific to program delivery, content, referral and attendance. RESULTS Of the 38 CR services identified, 23 (61%) were located in rural (n = 11, 29%) and remote (n = 12, 32%) regions. Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) found 77% of rural/remote services were hospital-based, with no service providing a comprehensive home-based or alternative method of program delivery. The majority of rural (60%) and remote (80%) services provided CR through chronic condition exercise programs compared with 17% of metropolitan services; only 27% of rural/remote programs provided education classes. Rural/remote coordinators were overwhelmingly physiotherapists, and only 50% of rural and 33% of remote programs had face-to-face access to multidisciplinary support. Patient referral and attendance rates differed greatly across WA and referrals to rural/remote services generally numbered less than 5 per month. Program evaluation was reported by 33% of rural/remote coordinators. CONCLUSION Geography, population density and service availability limits patient access to CR services in rural/remote WA. Current inadequacies in delivering comprehensive centre-based CR in rural/remote settings impedes management of cardiovascular risk and opportunities for event reduction. Health pathways that ensure referral and continuity of care are needed, with emerging technology-based CR support to supplement centre-based CR services requiring assessment. Implementing systematic data collection across services to establish benchmarks and enable service monitoring and evaluation is needed.
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Affiliation(s)
- Sandra Hamilton
- Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
- Western Australian Centre for Rural Health, PO Box 109, Geraldton, WA 6531 Australia
| | - Belynda Mills
- Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Shelley McRae
- National Heart Foundation of Australia, 334 Rokeby Road, Subiaco, WA 6009 Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
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20
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Sumner J, Böhnke JR, Doherty P. Does service timing matter for psychological outcomes in cardiac rehabilitation? Insights from the National Audit of Cardiac Rehabilitation. Eur J Prev Cardiol 2018; 25:19-28. [PMID: 29120237 PMCID: PMC5757407 DOI: 10.1177/2047487317740951] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/16/2017] [Indexed: 01/13/2023]
Abstract
Background The presence of mental health conditions in cardiac rehabilitation (CR) patients such as anxiety and depression can lead to reduced programme adherence, increased mortality and increased re-occurrence of cardiovascular events undermining the aims and benefit of CR. Earlier research has identified a relationship between delayed commencement of CR and poorer physical activity outcomes. This study wished to explore whether a similar relationship between CR wait time and mental health outcomes can be found and to what degree participation in CR varies by mental health status. Methods Data from the UK National Audit of Cardiac Rehabilitation, a dataset that captures information on routine CR practice and patient outcomes, was extracted between 2012 and 2016. Logistic and multinomial regression models were used to explore the relationship between timing of CR and mental health outcomes measured on the hospital anxiety and depression scale. Results The results of this study showed participation in CR varied by mental health status, particularly in relation to completion of CR, with a higher proportion of non-completers with symptoms of anxiety (5% higher) and symptoms of depression (8% higher). Regression analyses also revealed that delays to CR commencement significantly impact mental health outcomes post-CR. Conclusion In these analyses CR wait time has been shown to predict the outcome of anxiety and depression status to the extent that delays in starting CR are detrimental. Programmes falling outside the 4-week window for commencement of CR following referral must strive to reduce wait times to avoid negative impacts to patient outcome.
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Affiliation(s)
- Jennifer Sumner
- Department of Health Sciences, University of York, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jan R Böhnke
- Department of Health Sciences, University of York, UK
- School of Nursing and Health Sciences (SNHS), University of Dundee, UK
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21
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Rossi VA, Schmied CM, Niederseer D. [Sports in Patients with Heart Disease: What Should Be Recommended?]. Praxis (Bern 1994) 2018; 107:585-591. [PMID: 29788848 DOI: 10.1024/1661-8157/a002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sports in Patients with Heart Disease: What Should Be Recommended? Abstract. Sports is recommended in the European guidelines for the prevention and initial treatment of many cardiovascular diseases as well as the metabolic syndrome. However, the individually recommended intensity and duration of physical activity that unfolds the maximal protective effects in terms of prevention, largely differs. Indeed, a J-curve relationship with regard to exercise training has been postulated, with the assumption that too much sports is equally harmful or potentially even more harmful than too little sports. In this review, we try to answer the question of how much and which sports is optimal for cardiac patients.
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Affiliation(s)
- Valentina Alice Rossi
- 1 Universitäres Herzzentrum Zürich, Klinik für Kardiologie, Universitätsspital Zürich
| | - Christian M Schmied
- 1 Universitäres Herzzentrum Zürich, Klinik für Kardiologie, Universitätsspital Zürich
| | - David Niederseer
- 1 Universitäres Herzzentrum Zürich, Klinik für Kardiologie, Universitätsspital Zürich
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Turner KM, Winder R, Campbell JL, Richards DA, Gandhi M, Dickens CM, Richards S. Patients' and nurses' views on providing psychological support within cardiac rehabilitation programmes: a qualitative study. BMJ Open 2017; 7:e017510. [PMID: 28864707 PMCID: PMC5589022 DOI: 10.1136/bmjopen-2017-017510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore patients' and nurses' views on the feasibility and acceptability of providing psychological care within cardiac rehabilitation services. DESIGN In-depth interviews analysed thematically. PARTICIPANTS 18 patients and 7 cardiac nurses taking part in a pilot trial (CADENCE) of an enhanced psychological care intervention delivered within cardiac rehabilitation programmes by nurses to patients with symptoms of depression. SETTING Cardiac services based in the South West of England and the East Midlands, UK. RESULTS Patients and nurses viewed psychological support as central to good cardiac rehabilitation. Patients' accounts highlighted the significant and immediate adverse effect a cardiac event can have on an individual's mental well-being. They also showed that patients valued nurses attending to both their mental and physical health, and felt this was essential to their overall recovery. Nurses were committed to providing psychological support, believed it benefited patients, and advocated for this support to be delivered within cardiac rehabilitation programmes rather than within a parallel healthcare service. However, nurses were time-constrained and found it challenging to provide psychological care within their existing workloads. CONCLUSIONS Both patients and nurses highly value psychological support being delivered within cardiac rehabilitation programmes but resource constraints raise barriers to implementation. Consideration, therefore, should be given to alternative forms of delivery which do not rely solely on nurses to enable patients to receive psychological support during cardiac rehabilitation. TRIAL REGISTRATION NUMBER ISCTRN34701576.
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Affiliation(s)
- Katrina M Turner
- Population Health Sciences, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), Bristol, UK
| | - Rachel Winder
- University of Exeter Medical School, Exeter, Devon, UK
| | | | | | - Manish Gandhi
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Suzanne Richards
- University of Exeter Medical School, Exeter, Devon, UK
- Leeds Institute of Health Research, Leeds, UK
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Lizamore CA, Hamlin MJ. The Use of Simulated Altitude Techniques for Beneficial Cardiovascular Health Outcomes in Nonathletic, Sedentary, and Clinical Populations: A Literature Review. High Alt Med Biol 2017; 18:305-321. [PMID: 28846046 DOI: 10.1089/ham.2017.0050] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lizamore, Catherine A., and Michael J. Hamlin. The use of simulated altitude techniques for beneficial cardiovascular health outcomes in nonathletic, sedentary, and clinical populations: A literature review. High Alt Med Biol 18:305-321, 2017. BACKGROUND The reportedly beneficial improvements in an athlete's physical performance following altitude training may have merit for individuals struggling to meet physical activity guidelines. AIM To review the effectiveness of simulated altitude training methodologies at improving cardiovascular health in sedentary and clinical cohorts. METHODS Articles were selected from Science Direct, PubMed, and Google Scholar databases using a combination of the following search terms anywhere in the article: "intermittent hypoxia," "intermittent hypoxic," "normobaric hypoxia," or "altitude," and a participant descriptor including the following: "sedentary," "untrained," or "inactive." RESULTS 1015 articles were returned, of which 26 studies were accepted (4 clinical cohorts, 22 studies used sedentary participants). Simulated altitude methodologies included prolonged hypoxic exposure (PHE: continuous hypoxic interval), intermittent hypoxic exposure (IHE: 5-10 minutes hypoxic:normoxic intervals), and intermittent hypoxic training (IHT: exercising in hypoxia). CONCLUSIONS In a clinical cohort, PHE for 3-4 hours at 2700-4200 m for 2-3 weeks may improve blood lipid profile, myocardial perfusion, and exercise capacity, while 3 weeks of IHE treatment may improve baroreflex sensitivity and heart rate variability. In the sedentary population, IHE was most likely to improve submaximal exercise tolerance, time to exhaustion, and heart rate variability. Hematological adaptations were unclear. Typically, a 4-week intervention of 1-hour-long PHE intervals 5 days a week, at a fraction of inspired oxygen (FIO2) of 0.15, was beneficial for pulmonary ventilation, submaximal exercise, and maximum oxygen consumption ([Formula: see text]O2max), but an FIO2 of 0.12 reduced hyperemic response and antioxidative capacity. While IHT may be beneficial for increased lipid metabolism in the short term, it is unlikely to confer any additional advantage over normoxic exercise over the long term. IHT may improve vascular health and autonomic balance.
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Affiliation(s)
- Catherine A Lizamore
- Department of Tourism, Sport and Society, Lincoln University , Lincoln, New Zealand
| | - Michael J Hamlin
- Department of Tourism, Sport and Society, Lincoln University , Lincoln, New Zealand
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Højskov IE, Moons P, Hansen NV, La Cour S, Olsen PS, Gluud C, Winkel P, Lindschou J, Thygesen LC, Egerod I, Berg SK. SheppHeartCABG trial-comprehensive early rehabilitation after coronary artery bypass grafting: a protocol for a randomised clinical trial. BMJ Open 2017; 7:e013038. [PMID: 28096255 PMCID: PMC5253598 DOI: 10.1136/bmjopen-2016-013038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patients undergoing coronary artery bypass graft surgery often experience a range of symptoms. Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation have a positive physiological and psychological effect in early outpatient rehabilitation. The SheppHeartCABG trial will investigate the effect of early comprehensive rehabilitation in early phase rehabilitation versus usual care. The aim of this paper is to present the protocol for the SheppHeartCABG trial. METHODS/ANALYSIS SheppHeartCABG is an investigator-initiated randomised clinical superiority trial with blinded outcome assessment, employing 1:1 central randomisation to rehabilitation plus usual care versus usual care alone. On the basis of a sample size calculation, 326 patients undergoing coronary artery bypass grafting will be included from two clinical sites. All patients receive usual care and patients allocated to the experimental intervention follow 4 weeks rehabilitation consisting of an exercise programme, psycho-educative consultations and a compact mindfulness programme. The primary outcome is physical function measured by the 6-min walk test. The secondary outcomes are mental health and physical activity measured by the Medical Outcome Study Short Form (SF-12), anxiety and depression measured by the Hospital Anxiety and Depression Scale questionnaire, physical, emotional and global scores by the HeartQoL questionnaire, sleep measured by the Pittsburgh Sleep Quality Index, pain measured by the Örebro Musculoskeletal Screening Questionnaire and muscle endurance measured by the sit-to-stand test. A number of explorative analyses will also be conducted. ETHICS AND DISSEMINATION SheppHeartCABG is approved by the regional ethics committee (no. H-4-2014-109) and the Danish Data Protection Agency (no. 30-1309) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form. Positive, neutral and negative results of the trial will be submitted to international peer-reviewed journals. Furthermore, results will be presented at national and international conferences relevant to the subject fields. TRIAL REGISTRATION NUMBER NCT02290262; pre-results.
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Affiliation(s)
- Ida Elisabeth Højskov
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Søren La Cour
- The Centre for Research in Existence and Society, University of Copenhagen, Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Martin OJ, Wu WC, Taveira TH, Eaton CB, Sharma SC. Multidisciplinary Group Behavioral and Pharmacologic Intervention for Cardiac Risk Reduction in Diabetes. Diabetes Educ 2017; 33:118-27. [PMID: 17272798 DOI: 10.1177/0145721706297456] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of a multidisciplinary team providing both education and medication management in a group setting for cardiac risk reduction in patients with diabetes mellitus. METHODS The electronic medical records of patients with diabetes who participated in group behavioral and pharmacologic interventions for cardiac risk reduction during May to October 2002 at the Providence VA Medical Center were reviewed. Forty-one veterans with diabetes mellitus attended the weekly sessions of a diabetes education and intervention program directed by pharmacists for 1 month. Two groups of 15 to 20 patients received four 1.5-hour diabetes self-management education classes provided by a multidisciplinary team consisting of a pharmacist (leader), nurse educator, dietician, physical therapist, and social worker and four 1-hour group medication adjustment sessions provided by the pharmacist. Pharmacists followed medication adjustment algorithms for blood pressure, diabetes, and cholesterol management previously developed in collaboration with physician specialists in the field. Baseline and 3-month after-intervention data were collected for glycosylated hemoglobin A1C (A1C), systolic and diastolic blood pressure (SBP and DBP, respectively), low-density lipoprotein cholesterol, and body mass index. RESULTS Thirty-six patients attended 4 sessions, and 5 patients attended 3 sessions. All parameters improved after the intervention, with significant reductions in A1C (-1.5% +/- 1.0%) and DBP (-5 mm Hg). Reductions were further accentuated when baseline values were abnormal, with significant improvement in A1C (-2.0% +/- 0.5%), SBP (-14 +/- 3 mm Hg), and DBP (-13 +/- 3 mm Hg). CONCLUSIONS Short-term multidisciplinary group behavioral and pharmacologic intervention programs may be effective in improving cardiac risk factors in patients with diabetes.
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Affiliation(s)
- Oanh J Martin
- Pharmacy Service, Veterans Affairs Medical Center, and the Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Providence VA Medical Center, Providence, Rhode Island (Dr Martin)
| | - Wen-Chih Wu
- Medical Service, Veterans Affairs Medical Center, Providence VA Medical Center, and Brown Medical School, Brown University, Providence, Rhode Island (Dr Wu, Dr Sharma)
| | - Tracey H Taveira
- Pharmacy Service, Veterans Affairs Medical Center, and the Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy (Dr Taveira)
| | - Charles B Eaton
- The Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island, and the Department of Family Medicine, Brown Medical School, Brown University, Providence, Rhode Island (Dr Eaton)
| | - Satish C Sharma
- Medical Service, Veterans Affairs Medical Center, Providence VA Medical Center, and Brown Medical School, Brown University, Providence, Rhode Island (Dr Wu, Dr Sharma)
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Dollard J, Smith J, R Thompson D, Stewart S. Broadening the Reach of Cardiac Rehabilitation to Rural and Remote Australia. Eur J Cardiovasc Nurs 2017; 3:27-42. [PMID: 15053886 DOI: 10.1016/j.ejcnurse.2003.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Accepted: 10/27/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) has an evidence base but traditional models may not readily apply to people living in rural and remote regions. AIM : To outline published comprehensive and non-hospital based CR models used for people discharged from hospital after a cardiac event that have potential relevance to those living in rural and remote areas in Australia. METHODS The PubMed database was searched using Medical subject headings (MeSH) terms and the key word 'cardiac rehabilitation' limited to clinical trials. Articles were retrieved if they included at least two components of CR and were not based in an outpatient setting. RESULTS No CR models specifically developed for rural and remote areas were identified. However, 14 studies were found that outlined 11 non-conventional comprehensive CR models. All provided CR in a home-based setting. Health professionals provided support via telephone contact or home visits, and via resources such as the Heart Manual. Reported outcomes from these CR programs varied: ranging from an increase in knowledge of risk factors, to improvements in physical activity, decreased risk factor profile, improved psychological and social functioning and reductions in health service costs and mortality. CONCLUSION Home-based, CR models have the most substantive evidence base and, therefore the greatest potential to be developed and made accessible to eligible people living in rural and remote areas.
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Affiliation(s)
- Joanne Dollard
- Spencer Gulf Rural Health School, University of South Autralia - Whyalla Campus, Nicolson Avenue, Whyalla Norrie, SA 5608, Australia.
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Matata BM, Williamson SA. A Review of Interventions to Improve Enrolment and Adherence to Cardiac Rehabilitation Among Patients Aged 65 Years or Above. Curr Cardiol Rev 2017; 13:252-262. [PMID: 28699488 PMCID: PMC5730958 DOI: 10.2174/1574884712666170710094842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This review provides an overview and quality assessment of existing interventions, assessing the intervention types that are most effective at increasing enrolment and adherence to cardiac rehabilitation in older patients aged ≥65 years Methods: The review of the literature was performed using electronic databases to search for randomised controlled trials that aimed to increase enrolment and/or adherence to cardiac rehabilitation in older patients aged ≥65 years. The main key words were cardiac rehabilitation, enrolment, adherence and older patients. Studies were included if; (1) the intervention targeted improving enrolment and/or adherence to at least one of the following components of the cardiac rehabilitation programme: exercise, education or maintaining lifestyle changes; (2) assess the effectiveness of an intervention on increasing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (3) include measures for assessing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (4) the study included patients with a mean age of ≥65 years who were deemed eligible to participate in a cardiac rehabilitation programme. Included studies could be published in any language and there were no date restrictions for included studies. Studies focusing on pharmaceutical adherence were not included for the purpose of this review. RESULTS Seven studies were included, with four investigating enrolment (1944 participants) and three assessing adherence to intervention programmes (410 participants). Three studies (1919 participants) reported higher enrolment to cardiac rehabilitation in the intervention group. Two studies that reported increases in enrolment to cardiac rehabilitation were deemed to have an unclear or high risk of bias. All three studies (410 participants) reported better adherence to cardiac rehabilitation in the intervention group when compared to the control group. Two studies that reported better completion of cardiac rehabilitation were deemed to have an unclear or high risk of bias. No formal meta-analysis was conducted due to the observed multiple heterogeneity among outcome measures, the low number of included studies and variability in study designs. CONCLUSION This review found only weak evidence to suggest that interventions can increase enrolment or adherence to cardiac rehabilitation programmes for patients aged ≥65 years, therefore no practice recommendations could be made and further high-quality research is needed in this population group.
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Affiliation(s)
- Bashir M. Matata
- Liverpool Heart & Chest Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
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McKee G, Bannon J, Kerins M, FitzGerald G. Changes in diet, exercise and stress behaviours using the stages of change model in cardiac rehabilitation patients. Eur J Cardiovasc Nurs 2016; 6:233-40. [PMID: 17158092 DOI: 10.1016/j.ejcnurse.2006.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 10/16/2006] [Accepted: 10/17/2006] [Indexed: 10/23/2022]
Abstract
The behavioural changes initiated during Phase III cardiac rehabilitation programmes were recorded using Prochaska and Diclemente's “stages of change” model. This study aimed to ascertain if changes were initiated, maintained or further developed during Phase III programmes and 6 months after the programmes with a view to ascertaining the usefulness of this tool in providing stage matched individualised care. The risk factors examined were: exercise, diet and stress. The stages were recorded quantitatively and were numerically designated a value of 1–5. The results were analysed using SPSS. The sample number was one hundred and eighty seven patients. Significant improvements were made by the end of the programme (6 or 8 weeks) indicating that most patients had modified their behaviour during the programme. There was no significant additional improvement in the risk factors 6 months later. These results are a further indication of the need for support post Phase III programmes. Patients entered Phase III rehabilitation at different stages in their risk behaviours and with regard to exercise this stage at commencement influences the final stage achieved. “Stages of change” is a useful simple method of recording behavioural change and this type of routine monitoring of a patient could be used effectively as part of the individual care plan during the programme.
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Affiliation(s)
- Gabrielle McKee
- Trinity College Dublin School of Nursing and Midwifery, Dublin 2, Ireland.
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Carless D, Douglas K, Fox K, McKenna J. An Alternative View of Psychological Well-Being in Cardiac Rehabilitation: Considering Temperament and Character. Eur J Cardiovasc Nurs 2016; 5:237-43. [PMID: 16687254 DOI: 10.1016/j.ejcnurse.2006.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 03/18/2006] [Accepted: 03/28/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research suggests that personality is related to recovery from cardiac events, yet few conceptions of personality provide hope or possibility of improvement for patients with the least adaptive personality types. Psychobiological theory of personality has potential in this regard, but, to date, no research has investigated temperament and character in cardiac settings. AIM To explore relationships between temperament, character and psychological well-being among cardiac patients. METHOD Self-report questionnaires were distributed to a convenience sample of 81 cardiac patients to obtain data on personality (TCI [Cloninger CR, Przybeck T, Svrakic D, & Wetzel RD. The Temperament and Character Inventory (TCI): A guide to its development and use. St Louis (MO), Center for Psychobiology of Personality, Washington University;1994]), anxiety and depression (HADS [Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6): 361-70]) and satisfaction with life [Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49(1):71-5]. RESULTS The interaction of two personality dimensions (harm avoidance and self-directedness) was significantly related to measures of psychological well-being. Patients with low self-directedness combined with high harm avoidance reported significantly higher levels of anxiety, depression and lower levels of satisfaction with life. CONCLUSION This exploratory study suggests that psychobiological theory of personality may be useful for practitioners in cardiac rehabilitation seeking to identify patients at risk of poor psychological well-being.
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Affiliation(s)
- David Carless
- Carnegie Research Institute, Leeds Metropolitan University, Beckett's Park Campus, Leeds, LS6 3QS, England, United Kingdom.
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Abstract
Cardiac rehabilitation programmes are intended to enhance the effect of acute treatment actions and to prevent risk factors, thus leading to an improvement in the patient's well being and recovery. Accordingly, all cardiac rehabilitation activities do not take place at the same time, which is the reason why the nurse's role changes in character over time. The aim of this paper is, therefore, to highlight the role of the nurse in cardiac rehabilitation programmes. The nurse's multiple roles in cardiac rehabilitation have a 'spider in the web-like' character and, depending on the phase of the patient's recovery, he/she acts as a container, a counsellor, a coach and an educator. To implement a successful cardiac rehabilitation, the nurse needs to have improved evaluation tools in clinical practice as well as to be self-critical and serve as a good role model. Finally, the cardiac rehabilitation nurse has to have a four-fold comprehensive perspective of the cardiac rehabilitation concept; an impact perspective, a timing perspective, a lifespan perspective, and a personal perspective.
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Affiliation(s)
- Bengt Fridlund
- School of Social and Health Sciences, Halmstad University, P.O. Box 823, 30118, Halmstad, Sweden
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Abstract
BACKGROUND Cardiac rehabilitation (CR) is grossly underused, with major inequities in access. However, use of CR and predictors of initiation in England where CR contracting is available is unknown. The aims were (1) to investigate CR utilization rates in England, and (2) to determine sociodemographic and clinical factors associated with CR initiation including social deprivation. METHODS AND RESULTS Data from the National Audit of CR, between January 2012 and November 2015, were used. Utilization rates overall and by deprivation quintile were derived. Logistic regression was performed to identify predictors of initiation among enrollees, using the Huber-White-sandwich estimator robust standard errors method to account for the nested nature of the data. Of the 234 736 (81.5%) patients referred to CR, 141 648 enrolled, 97 406 initiated CR, and of those initiating, 37.2% completed a program of ≥8 weeks duration. The significant characteristics associated with CR initiation were younger age (odds ratio [OR] 0.98, 95% CI 0.98-0.99), having a partner (OR 1.31, 95% CI 1.17-1.48), not being employed (OR 0.86, 95% CI 0.77-0.96), not having diabetes mellitus (OR 0.84, 95% CI 0.77-0.92), greater anxiety (OR 1.02, 95% CI 1.003-1.04), not being a medically managed myocardial infarction patient (OR 0.57, 95% CI 0.42-0.76), and having had coronary artery bypass graft surgery (OR 1.64, 95% CI 1.09-2.47). CONCLUSIONS CR enrollment does not meet English National Health Service targets; however it compares with that in other countries. Evidence-based approaches increasing CR enrollment and initiation should be applied, focusing on the identified characteristics associated with CR initiation, specifically older, single, employed individuals with diabetes mellitus and those not revascularized.
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Affiliation(s)
| | - Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada University Health Network University of Toronto, Canada
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Abstract
Aim: European cardiologists agree that cardiac rehabilitation (CR) should be offered as an integrated part of cardiac care, and CR guidelines have been published. The authors aimed to ascertain the potential for expanding CR coverage at hospitals in Denmark. Method: A cross-sectional questionnaire study was conducted among all hospitals receiving acute cardiac patients (n=67). The response rate was 79%, with no differences according to catchment area, number of beds, or geographical location. The hospitals were classified as having full CR if all core components (physical training, psychosocial support, dietary counselling, smoking cessation, and pharmaceutical risk factor management) were available during each of three phases: (I) in hospital; (II) outpatient; and (II) community-based services. Results: Many hospitals offered one or more of the CR components during phases I and II: physical training (77%; 77%), psychosocial support (89%; 79%), dietary counselling (85%; 89%), smoking cessation (94%; 68%), and clinical control by a physician (100%; 93%). The content varied greatly. Full phase I CR was offered at 57% (95% confidence interval (95% CI): 44—70%) of the hospitals and 47% (95% CI: 34—60%) offered full phase II CR. Phase III CR was very rare (2% (95% CI: 0—6%). The numbers of patients receiving CR was not registered. Conclusion: Marked progress was made in the 1990s in implementing CR; nevertheless, the services are far from fully expanded. Denmark has great potential for improving CR services, as do most other European countries. CR activities need to be registered at Danish hospitals.
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Affiliation(s)
- Ann-Dorthe O Zwisler
- Unit of Cardiac Rehabilitation, Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark.
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Benzer W, Platter M, Oldridge NB, Schwann H, Machreich K, Kullich W, Mayr K, Philippi A, Gassner A, Dörler J, Höfer S. Short-term patient-reported outcomes after different exercise-based cardiac rehabilitation programmes. ACTA ACUST UNITED AC 2016; 14:441-7. [PMID: 17568246 DOI: 10.1097/hjr.0b013e32802bf7ae] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An objective of exercise-based cardiac rehabilitation is improvement in patient-reported outcomes such as health-related quality of life as well as anxiety and depressive symptoms. There are no direct comparisons of the effectiveness of inpatient and outpatient exercise-based cardiac rehabilitation programmes on patient-reported outcomes. METHODS In this non-randomized study we collected patient-reported outcomes data with the MacNew Heart Disease health-related quality of life questionnaire and the Hospital Anxiety and Depression Scale at baseline, 1 month and again 3 months after admission to exercise-based cardiac rehabilitation in a cohort of 216 consecutive patients enrolled either in a 4-week inpatient exercise-based cardiac rehabilitation (n=62) or a 3-month outpatient exercise-based cardiac rehabilitation (n=87) and in a usual care group (n=67) to document the natural course in patient-reported outcome variables without exercise-based cardiac rehabilitation. RESULTS Although MacNew health-related quality of life scores improved more with inpatient than outpatient exercise-based cardiac rehabilitation by month 1, the improvement was still significant in both groups at month 3 and also in the usual care group when compared to baseline. The health-related quality of life scores in the inpatient group, however, decreased between month 1 and 3 whereas they continued to improve in the outpatient group. The significant reduction in both anxiety and depressive symptoms in both exercise-based cardiac rehabilitation groups by month 1 was maintained at month 3 only with outpatient exercise-based cardiac rehabilitation. No significant changes over the 3 months were observed in the usual care group. CONCLUSION Significant improvements of 1-month patient-reported outcomes are achieved in patients attending inpatient as well as outpatient exercise-based cardiac rehabilitation when compared with no exercise-based cardiac rehabilitation. In contrast to inpatient exercise-based cardiac rehabilitation, however, outpatient exercise-based cardiac rehabilitation leads to a further improvement of patient-reported outcomes. These results suggest that, if patients have to be admitted for inpatient exercise-based cardiac rehabilitation, this programme should be followed by an outpatient exercise-based cardiac rehabilitation to further improve and stabilize these patient-reported outcome variables.
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Affiliation(s)
- Werner Benzer
- Department of Interventional Cardiology, Academic Hospital, Austria.
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Hughes AR, Mutrie N, Macintyre PD. Effect of an exercise consultation on maintenance of physical activity after completion of phase III exercise-based cardiac rehabilitation. ACTA ACUST UNITED AC 2016; 14:114-21. [PMID: 17301636 DOI: 10.1097/hjr.0b013e3280116485] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many patients do not maintain physical activity levels after completion of phase III exercise-based cardiac rehabilitation. DESIGN This study determined the effect of an exercise consultation on maintenance of physical activity and cardiorespiratory fitness 12 months after completion of a phase III exercise programme. Seventy cardiac patients were randomized to the experimental (exercise consultation and exercise information) or control groups (exercise information only). METHODS Outcomes recorded at baseline, 6 and 12 months were: physical activity (stage of change, 7-day recall, accelerometer), cardiorespiratory fitness, lipids, quality of life, anxiety and depression. RESULTS Both groups were regularly active at baseline. The between-group difference for the change in total activity (min/week) assessed by the 7-day recall was significant from baseline to 12 months [98% confidence interval (CI) -295, -20]. Total activity was maintained in the experimental group (98% CI -63, 154) and significantly decreased in the control group (115 min/week; 98% CI -228, -28) from baseline to 12 months. The between-group difference for the change in accelerometer counts/week was not significant from baseline to 6 (98% CI -1 143 720, 607 430) or 12 months (98% CI -1 131 128, 366 473). A comparable, significant decrease in peak oxygen uptake occurred from baseline to 12 months in experimental (1.8 ml/kg per min; 98% CI -3.2, -0.3) and control participants (2.3 ml/kg per min; -3.8, -0.8). Lipids, quality of life, anxiety and depression were normal at baseline and did not significantly change in either group over time. CONCLUSION Exercise consultation was effective in maintaining self-reported physical activity, but not peak oxygen uptake, for 12 months after completion of phase III.
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Affiliation(s)
- Adrienne R Hughes
- University of Glasgow, Division of Developmental Medicine, Yorkhill Hospitals, Scotland.
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Hamilton S, Mills B, McRae S, Thompson S. Cardiac Rehabilitation for Aboriginal and Torres Strait Islander people in Western Australia. BMC Cardiovasc Disord 2016; 16:150. [PMID: 27412113 PMCID: PMC4942995 DOI: 10.1186/s12872-016-0330-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people. METHODS Cardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people. RESULTS Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services. CONCLUSION The under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed.
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Affiliation(s)
- Sandra Hamilton
- />Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Belynda Mills
- />Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Shelley McRae
- />National Heart Foundation of Australia, 334 Rokeby Road, Subiaco, WA 6009 Australia
| | - Sandra Thompson
- />Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
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Abstract
This study determined the effectiveness of a self-efficacy intervention designed to improve selfefficacy and physical activity in older adults postcardiac event. An experimental three-group design tested the intervention, with treatment groups receiving 1 of 2 supportive telephone protocols (theory-based self-efficacy coaching or attention control). Outcome variables included selfefficacy expectations for physical activity (PA), self-reported PA, and PA performance (distance walked in 6 minutes). The self-efficacy intervention was effective in demonstrating greater PA performance when compared to the attention control intervention, and PA self-efficacy was significantly correlated with both measures of PA. There were significant main effects of time for PA self-efficacy and distance walked, and a significant interaction effect on the distance walked because of time and treatment condition. Although the self-efficacy intervention did not show a direct effect on level of PA self-efficacy as hypothesized, there was an indirect interaction effect on distance walked and physical activity confidence.
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Abstract
A cornerstone of treatment for hypercholesterolemia is dietary therapy. However, maintaining adherence to the therapeutic diet has been difficult for patients. There is evidence that self-efficacy is a predictor of positive behavior change like that involved in or necessary for initiating or maintaining recommended diet therapy for cholesterol reduction. This paper reports on two studies guided by Bandura's self-efficacy theory. The first study focuses on development and initial psychometric evaluation of an instrument measuring self-efficacy for adhering to a cholesterol-lowering diet in a sample of 44 cardiac rehabilitation patients; the second establishes psychometric properties of the instrument in a sample of 228 subjects treated for hypercholesterolemia. In both studies, subgroups completed the instrument a second time to provide data on the instrument's temporal stability. The Cholesterol-Lowering Diet Self-Efficacy Scale consists of 33 statements, some with branches for a total of 56 items. The scale measures several components of the eating habits domain related to adhering to a cholesterol-lowering eating plan, and shows good reliability and validity. Reported self-efficacy is related to prior persistence and past success in modifying and maintaining dietary changes, and also to concurrent measures of dietary adherence behaviors. The scale is psychometrically sound thus far and seems adequate in identifying success in achieving and maintaining a cholesterol-lowering eating plan.
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Affiliation(s)
- Lora E Burke
- University of Pittsburgh, School of Nursing, 415 Victoria Building, Pittsburgh, PA 15261, USA.
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Davidson PM, Daly J, Hancock K, Moser D, Chang E, Cockburn J. Perceptions and Experiences of Heart Disease: A Literature Review and Identification of a Research Agenda in Older Women. Eur J Cardiovasc Nurs 2016; 2:255-64. [PMID: 14667481 DOI: 10.1016/s1474-5151(03)00056-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Following diagnosis of heart disease women have poorer health related outcomes compared with men. Nursing science lacks well-evaluated interventions to address the specific rehabilitative needs of older women with heart disease. This paper seeks to inform the development of nursing intervention studies by a review of published studies on the experiences and rehabilitative needs of older women with heart disease. METHODS The CINAHL, MEDLINE, FAMILY and PsychINFO databases were searched, identifying literature published from 1982 and written in English. Keywords used were women, old* (old, older) women, elderly women and: heart disease, heart failure, cardiac and rehabilitation. Hand searching of nursing and medical textbooks also occurred. These searches resulted in over 120 articles that met the criteria of describing experiences, perceptions, psychological responses and support rehabilitative needs of older women. RESULTS Older women present with symptoms that are different from those derived from a male-dominated research agenda and further there is a paucity of data related to evaluation of interventions tailored to the needs of women. Key themes emerging from the literature review include not only that older women compared with men have a poorer prognosis and experience greater disability moreover they: (1). are at a higher risk of psychosocial distress; (2). have a greater need for instrumental support and social support; (3). have an altered perception of risk; and (4). demonstrate the need for specific rehabilitation programs, tailored to their needs. CONCLUSION Future research should develop and evaluate intervention studies that better meet the unique needs of older women with heart disease. Particular emphasis needs to be on psychosocial aspects, given evidence that identify these are major concerns for women.
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Affiliation(s)
- Patricia M Davidson
- School of Nursing, Family & Community Health, College of Social & Health Sciences, University of Western Sydney, Locked Bag 1797, Penrith DC 1797, NSW, Australia.
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Stewart RA. More flexible approaches are needed to improve cardiac rehabilitation. N Z Med J 2016; 129:7-9. [PMID: 27355163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ralph Ah Stewart
- Consultant Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand.
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Swardfager W, Yang P, Herrmann N, Lanctôt KL, Shah BR, Kiss A, Oh PI. Depressive symptoms predict non-completion of a structured exercise intervention for people with Type 2 diabetes. Diabet Med 2016. [PMID: 26220364 DOI: 10.1111/dme.12872] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To quantify the impact of depressive symptoms on completion of exercise-based rehabilitation for Type 2 diabetes management. METHODS Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale in a prospective cohort of consecutive patients with Type 2 diabetes entering a 6-month hybrid (home- and clinic-based) exercise rehabilitation programme. Attendance at exercise sessions was monitored and programme completion/non-completion was ascertained. RESULTS Of the programme participants (n=624, mean age 55.6±10.5 years, 47% male), 26.8% endorsed significant depressive symptoms (depression score ≥16) and 68.1% completed the intervention, attending 54.6±30.0% of supervised exercise sessions. Baseline depressive symptoms (depression scale score ≥16) increased the risk of non-completion [hazard ratio 1.49 (95% CI 1.10-2.03); P = 0.010], and predicted fewer sessions attended (β=-2.1, P= 0.002) in adjusted models. A depression score threshold of ≥10 (48.4% of participants) predicted non-completion [hazard ratio 1.60 (95% CI 1.19-2.17); P= 0.002) with optimum accuracy. Non-completions resulting from lack of interest (18.9 vs. 11.0%; P= 0.026) and medical complications (14.6 vs. 6.6%; P= 0.006) were more common among participants with depression scores ≥10. Greater hazard ratios for depression scores ≥10 were observed in subgroups not currently using insulin [hazard ratio 1.70 (95% CI 1.24-2.33); P= 0.001), or an antidepressant [hazard ratio 1.83 (95% CI 1.32-2.54); P<0.001]. CONCLUSIONS Depressive symptoms were highly prevalent among participants with Type 2 diabetes entering exercise-based rehabilitation, and even mild depressive symptoms posed a significant barrier to completion. Depression screening may help target additional supports to facilitate completion of exercise interventions for people with Type 2 diabetes.
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Affiliation(s)
- W Swardfager
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - P Yang
- University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - N Herrmann
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - K L Lanctôt
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - B R Shah
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - A Kiss
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - P I Oh
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- University Health Network Toronto Rehabilitation Institute, Toronto, ON, Canada
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Chieffo C, Vigorito C. Il Monaldi Archives: un rinnovato strumento di comunicazione ed informazione della Cardiologia Riabilitativa. Monaldi Arch Chest Dis 2016; 66:1-2. [PMID: 17125039 DOI: 10.4081/monaldi.2006.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Griffo R. Il Programma GICR 2006-2008: continuità ed innovazione. Monaldi Arch Chest Dis 2016; 66:235-7. [PMID: 17312840 DOI: 10.4081/monaldi.2006.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gayda M, Ribeiro PAB, Juneau M, Nigam A. Comparison of Different Forms of Exercise Training in Patients With Cardiac Disease: Where Does High-Intensity Interval Training Fit? Can J Cardiol 2016; 32:485-94. [PMID: 26927863 DOI: 10.1016/j.cjca.2016.01.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 12/12/2022] Open
Abstract
In this review, we discuss the most recent forms of exercise training available to patients with cardiac disease and their comparison or their combination (or both) during short- and long-term (phase II and III) cardiac rehabilitation programs. Exercise training modalities to be discussed include inspiratory muscle training (IMT), resistance training (RT), continuous aerobic exercise training (CAET), and high-intensity interval training (HIIT). Particular emphasis is placed on HIIT compared or combined (or both) with other forms such as CAET or RT. For example, IMT combined with CAET was shown to be superior to CAET alone for improving functional capacity, ventilatory function, and quality of life in patients with chronic heart failure. Similarly, RT combined with CAET was shown to optimize benefits with respect to functional capacity, muscle function, and quality of life. Furthermore, in recent years, HIIT has emerged as an alternative or complementary (or both) exercise modality to CAET, providing equivalent if not superior benefits to conventional continuous aerobic training with respect to aerobic fitness, cardiovascular function, quality of life, efficiency, safety, tolerance, and exercise adherence in both short- and long-term training studies. Finally, short-interval HIIT was shown to be useful in the initiation and improvement phases of cardiac rehabilitation, whereas moderate- or longer-interval (or both) HIIT protocols appear to be more appropriate for the improvement and maintenance phases because of their high physiological stimulus. We now propose progressive models of exercise training (phases II-III) for patients with cardiac disease, including a more appropriate application of HIIT based on the scientific literature in the context of a multimodal cardiac rehabilitation program.
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Affiliation(s)
- Mathieu Gayda
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada.
| | - Paula A B Ribeiro
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Martin Juneau
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada
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Mignault-Laplante R, Bourque PÉ, Pakzad S. [No available]. Can J Cardiovasc Nurs 2016; 26:33-40. [PMID: 27382670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the area of cardiac rehabilitation, little attention has been given to phase III (maintenance phase), as compared to phase II (rehabilitation phase). Studies on the maintenance phase have highlighted the importance of maintaining the newly acquired healthy living habits in order to continue benefitting from them and prevent the recurrence of cardiovascular diseases and mortality. However, these studies have revealed disturbing dropout rates, from 25 to 50%. There is little research on the factors associated with the maintenance of the new healthy living habits after completing phase II of a cardiac rehabilitation program. This study innovates by measuring riskfactors and quality of life, as predictors of exercise maintenance. The goal of this project is to verify which variables are linked to the maintenance of physical activity during phase III. The sample of the study is composed of 529 patients who completed, between 2005 and 2012, phase II of the cardiac rehabilitation program, called Coeur en sant, offered by the Université de Moncton. The main results show that patients at risk of not maintaining their physical activity are younger, male, with only afew risk factors and a lower score on the quality of physical life scale, particularly with respect to the physical role and general health components.
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Zhang S. [Development tendency of domestic professional cardiac rehabilitation: clinical practice situation from today to tomorrow]. Zhonghua Xin Xue Guan Bing Za Zhi 2016; 44:3-4. [PMID: 26813544 DOI: 10.3760/cma.j.issn.0253-3758.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Grace SL, Oh PI, Marzolini S, Colella T, Tan Y, Alter DA. Observing temporal trends in cardiac rehabilitation from 1996 to 2010 in Ontario: characteristics of referred patients, programme participation and mortality rates. BMJ Open 2015; 5:e009523. [PMID: 26537501 PMCID: PMC4636616 DOI: 10.1136/bmjopen-2015-009523] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We sought to describe temporal trends in the sociodemographic and clinical characteristics of participants referred to cardiac rehabilitation (CR), and its effect on programme participation and all-cause mortality over 14 years. SETTING A large CR centre in Toronto, Canada. PARTICIPANTS Consecutive patients between 1996 and 2010. PRIMARY AND SECONDARY OUTCOME MEASURES Referrals received were deterministically linked to administrative data, to complement referral form abstraction. Out-of-hospital deaths were identified using vital statistics. Patients were tracked until 2012, and mortality was ascertained. Percentage attendance at prescribed sessions was also assessed. RESULTS There were 29,171 referrals received, of which 28,767 (98.6%) were successfully linked, of whom 22,795 (79.2%) attended an intake assessment. The age of the referred population steadily increased, with more females, less affluent and more single patients referred over time (p<0.001). More patients were referred following percutaneous coronary intervention and less following coronary artery bypass graft surgery (p<0.001). The number of comorbidities decreased (p<0.001). Hypertension increased over time (p<0.001), yet the control of cholesterol steadily improved over time. The proportion of smokers decreased over time (p<0.001). Participation in CR significantly declined, and there were no significant changes in mortality. 3-year mortality rates were less than 5%. CONCLUSIONS Characteristics of referred patients tended to reflect broader trends in risk factors and cardiovascular disease burden. Physicians appear to be referring more sociodemographically diverse patients to CR; however, programmes may need to better adapt to engage these patients to fully participate. More complex patients should be referred, using explicit criteria-based referral processes.
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Affiliation(s)
- Sherry L Grace
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada
| | - Paul I Oh
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada
| | - Tracey Colella
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yongyao Tan
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada
| | - David A Alter
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institution, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Salzwedel A, Reibis R, Wegscheider K, Eichler S, Buhlert H, Kaminski S, Völler H. Cardiopulmonary exercise testing is predictive of return to work in cardiac patients after multicomponent rehabilitation. Clin Res Cardiol 2015; 105:257-67. [PMID: 26377430 DOI: 10.1007/s00392-015-0917-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Return to work (RTW) is a pivotal goal of cardiac rehabilitation (CR) in patients after acute cardiac event. We aimed to evaluate cardiopulmonary exercise testing (CPX) parameters as predictors for RTW at discharge after CR. METHODS We analyzed data from a registry of 489 working-age patients (51.5 ± 6.9 years, 87.9 % men) who had undergone inpatient CR predominantly after percutaneous coronary intervention (PCI 62.6 %), coronary artery bypass graft (CABG 17.2 %), or heart valve replacement (9.0 %). Sociodemographic and clinical parameters, noninvasive cardiac diagnostic (2D echo, exercise ECG, 6MWT) and psychodiagnostic screening data, as well as CPX findings, were merged with RTW data from the German statutory pension insurance program and analyzed for prognostic ability. RESULTS During a mean follow-up of 26.5 ± 11.9 months, 373 (76.3 %) patients returned to work, 116 (23.7 %) did not, and 60 (12.3 %) retired. After adjustment for covariates, elective CABG (HR 0.68, 95 % CI 0.47-0.98; p = 0.036) and work intensity (per level HR 0.83, 95 % CI 0.73-0.93; p = 0.002) were negatively associated with the probability of RTW. Exercise capacity in CPX (in Watts) and the VE/VCO2-slope had independent prognostic significance for RTW. A higher work load increased (HR 1.17, 95 % CI 1.02-1.35; p = 0.028) the probability of RTW, while a higher VE/VCO2 slope decreased (HR 0.85, 95 % CI 0.76-0.96; p = 0.009) it. CPX also had prognostic value for retirement: the likelihood of retirement decreased with increasing exercise capacity (HR 0.50, 95 % CI 0.30-0.82; p = 0.006). CONCLUSION CPX is a valid tool for assessing patients' ability to return to work. Therefore, it may be an essential part of functional assessment during CR for predicting participation in employment.
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Affiliation(s)
- Annett Salzwedel
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany
| | - Rona Reibis
- Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Eichler
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany
| | - Hermann Buhlert
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Stefan Kaminski
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
| | - Heinz Völler
- Center of Rehabilitation Research, University of Potsdam, Am Neuen Palais 10, Haus 12, 14469, Potsdam, Germany.
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany.
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Racca V, Di Rienzo M, Mazzini P, Ripamonti V, Gasti G, Spezzaferri R, Modica M, Ferratini M. ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery. Eur J Phys Rehabil Med 2015; 51:457-468. [PMID: 25184802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery. AIM The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation. DESIGN Observational study. SETTING In-patients cardiac Rehabilitation Unit in Milan. POPULATION Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7±12.5 years). METHODS We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) RESULTS: The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (P<0.001). The environmental code scores significantly decreased in the case of facilitators between T1 and T2 (P=0.0051), but not in the case of barriers. There were significant correlations between the ICF body function scores and Barthel's index (ρ=0.381; P=0.006), NYHA class (ρ=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (ρ=0.306; P=0.02), and between the activity/participation codes and SpO2 (ρ=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters. CONCLUSION The ICF-based data provided functional information that was consistent with the patients' clinical course. CLINICAL REHABILITATION IMPACT The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.
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Affiliation(s)
- V Racca
- Cardiology Rehabilitation Department, S. Maria Nascente Institute IRCCS, Don Carlo Gnocchi Foundation, Milan, Italy -
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Taylor R. Strengthening evidence for benefits of cardiac rehabilitation highlighted in Cochrane reviews. Eur Heart J 2015; 36:952-953. [PMID: 26082960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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