Cardiac Rehabilitation Completion Study: Barriers and Potential Solutions.
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ABSTRACT:
SUBMITTER: Supervia M
PROVIDER: S-EPMC9794120 | biostudies-literature | 2022 Sep
REPOSITORIES: biostudies-literature
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Cardiac Rehabilitation Completion Study: Barriers and Potential Solutions.
Supervia Marta M Medina-Inojosa Jose J Martinez-Jarreta Begoña B Lopez-Jimenez Francisco F Vickers Kristen K Terzic Carmen M CM Thomas Randal J RJ
Journal of cardiopulmonary rehabilitation and prevention 20220901 5
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Project description:Cardiac rehabilitation (CR) services improve various clinical outcomes in patients with cardiovascular disease, but such services are underutilized, particularly in women. The aim of this study was to identify evidence-based barriers and solutions for CR participation in women. A literature search was carried out using PubMed, EMBASE, Cochrane, OVID/Medline, and CINAHL to identify studies that have assessed barriers and/or solutions to CR participation. Titles and abstracts were screened, and then the full-text of articles that met study criteria were reviewed. We identified 24 studies that studied barriers to CR participation in women and 31 studies that assessed the impact of various interventions to improve CR referral, enrollment, and/or completion of CR in women. Patient-level barriers included lower education level, multiple comorbid conditions, non-English native language, lack of social support, and high burden of family responsibilities. We found support for the use of automatic referral and assisted enrollment to improve CR participation. A small number of studies suggest that incentive-based strategies, as well as home-based programs, may contribute to improving CR attendance and completion rates. A systematic approach to CR referral, including automatic CR referral, may help overcome barriers to CR referral in women and should be implemented in clinical practice. However, more studies are needed to help identify the best methods to improve CR attendance and completion of CR rates in women.
| S-EPMC5597478 | biostudies-literature
Project description:BackgroundMany patients do not meet the recommended levels of physical activity after completing a cardiac rehabilitation (CR) program. Wearable activity trackers and mobile phone apps are promising potential self-management tools for maintaining physical activity after CR completion.ObjectiveThis study aims to evaluate the acceptability of a wearable device, mobile app, and push messages to facilitate physical activity following CR completion.MethodsWe used semistructured interviews to assess the acceptability of various mobile technologies after participation in a pilot randomized controlled trial. Intervention patients in the randomized controlled trial wore the Fitbit Charge 2, used the Movn mobile app, and received push messages on cardiovascular disease prevention and physical activity for over 2 months. We asked 26 intervention group participants for feedback about their experience with the technology and conducted semistructured individual interviews with 7 representative participants. We used thematic analysis to create the main themes from individual interviews.ResultsOur sample included participants with a mean age of 66.7 (SD 8.6) years; 23% (6/26) were female. Overall, there were varying levels of satisfaction with different technology components. There were 7 participants who completed the satisfaction questionnaires and participated in the interviews. The Fitbit and Movn mobile app received high satisfaction scores of 4.86 and 4.5, respectively, whereas push messages had a score of 3.14 out of 5. We identified four main themes through the interviews: technology use increased motivation to be physically active, technology use served as a reminder to be physically active, recommendations for technology to improve user experience, and desire for personal feedback.ConclusionsBy applying a wearable activity tracker, mobile phone app, and push messages, our study showed strong potential for the adoption of new technologies by older adults to maintain physical activity after CR completion. Future research should include a larger sample over a longer period using a mixed methods approach to assess the efficacy of technology use for promoting long-term physical activity behavior in older adults.
| S-EPMC8446842 | biostudies-literature
Project description:Graphical AbstractAdherence to cardiac rehabilitation following a primary event has been demonstrated to improve quality of life, increase functional capacity, and decrease hospitalizations and mortality. Mobile technologies offer an opportunity to improve both the quality and utilization of cardiac rehabilitation, and recent clinical studies investigated this technology. This literature review summarizes the current use of mobile health, wearable activity monitors (WAMs), and other multi-component technologies deployed to support home-based virtual cardiac rehabilitation. The methodology was adapted from the Cochrane Handbook for Systematic Reviews of Interventions. We identified 2094 records, of which 113 were eligible for qualitative analysis. Different virtual cardiac rehabilitation solutions were implemented in the studies: (i) multi-component interventions in 48 studies (42.5%), (ii) WAMs in 27 studies (23.9%), (iii) web-based communications solutions, and (iv) mobile apps, both in 19 studies (16.4%). Functional capacity was the most frequently reported primary outcome (k = 37, 32.7%), followed by user adherence/compliance (k = 35, 31.0%), physical activity (k = 27, 23.9%), and quality of life (k = 14, 12.4%). Studies provided a mixed assessment of the efficacy of virtual cardiac rehabilitation in attaining either significant improvements over baseline or significant improvements in outcomes compared with conventional rehabilitation. Efficacy outcomes with virtual cardiac rehabilitation sometimes improve on the centre-based outcomes; however, superior clinical efficacy may not necessarily be the only outcome of interest. The promise of virtual cardiac rehabilitation includes the potential for increased user adherence and longer-term patient engagement. If these outcomes can be improved, that would be a significant justification for using this technology.
| S-EPMC10039430 | biostudies-literature
Project description:BackgroundDespite the high burden of frailty among cardiac rehabilitation (CR) participants, it is unclear which frailty-related deficits are related to program completion.MethodsData from a single-centre exercise- and education-based CR program were included. A frailty index (FI) based on 25 health deficits was constructed. Logistic regression was used to estimate the odds of CR completion based on the presence of individual FI items. The odds of completion for cumulative deficits related to biomarkers, body composition, quality of life, as well as a composite of traditional and non-traditional cardiovascular risk factor domains were examined.ResultsA total of 3,756 individuals were included in analyses. Eight of 25 FI variables were positively associated with program completion while 8 others were negatively associated with completion. The variable with the strongest positive association was the food frequency questionnaire score (OR 1.27 (95% CI 1.14, 1.41), whereas the deficit with strongest negative association was a decline in health over the last year (OR 0.74 (95% CI 0.58, 0.93). An increased number of cardiovascular deficits were associated with an increased odds of CR completion (OR per 1 deficit increase 1.16 (95% CI 1.11, 1.22)). A higher number of traditional CR deficits were predictive of CR completion (OR 1.22 (95% CI 1.16, 1.29)), but non-traditional measures predicted non-completion (OR 0.95 (95% CI 0.92, 0.97)).ConclusionA greater number of non-traditional cardiovascular deficits was associated with non-completion. These data should be used to implement intervention to patients who are most vulnerable to drop out to maximize retention.
| S-EPMC9854083 | biostudies-literature
Project description:BackgroundCardiac rehabilitation (CR) has proven health benefits and, according to international guidelines, CR must be offered to all eligible patients. Studies have reported lower uptake of CR among migrants, and migrants are known to face several barriers in their access to healthcare, of which language is the most common. The aim of this study is to examine the provision of CR core components for migrants; and the role of language barriers in the provision of CR in Danish hospitals and municipalities.MethodsThis is a descriptive study based on repeated nationwide surveys conducted in 2013 and 2015 by the Danish Cardiac Rehabilitation Database. The surveys collected information on provision and organization of CR in hospitals (n = 35) and municipalities (n = 98) in Denmark. The survey in 2015 had additional items related to migrants, such as provision of interpreter services and multilingual information material.ResultsNot all CR core components were provided by hospitals to non-Danish speaking patients. There was no improvement from 2013 to 2015. Hospitals had full coverage (19/19) of interpreter services compared to 84% (26/31) of municipalities. Provision of multilingual information material was low in hospitals 32% (6/19) and in municipalities 3% (1/31).ConclusionThis study found language-related barriers in migrants' access to CR, in the form of inadequate provision of CR core components for non-Danish speaking patients at some Danish hospitals and suboptimal provision of interpreter services in municipalities. The findings call for increased attention to language barriers and further studies are needed to map the extent of the problem.
| S-EPMC6458700 | biostudies-literature
Project description:IntroductionPeople with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia are unable to access rehabilitation for promoting function and quality of life. Conducted in Australia, this study was designed to (1) explore barriers to access to dementia rehabilitation and (2) identify solutions that improve access to rehabilitation.MethodsPeople living with dementia (n = 5) and care partners (n = 8) and health professionals (n = 13) were recruited nationally. Experience-based codesign across three virtual workshops was used to understand barriers and design solutions to improve access to rehabilitation treatments. Socio-ecological analyses, using the Levesque Access to Health care framework, were applied to findings regarding barriers and to aid selection of solutions.ResultsThere was high attendance (92.3%) across the three workshops. Barriers were identified at a user level (including lack of knowledge, transport, cost and difficulty navigating the health, aged care and disability sectors) and health service level (including health professional low dementia knowledge and negative attitudes, inequitable funding models and non-existent or fragmented services). Solutions focused on widespread dementia education and training, including ensuring that people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co-ordinators know how to refer to and deliver rehabilitation interventions. Dementia care navigators, changes to Australia's public funding models and specific dementia rehabilitation programmes were also recommended.ConclusionsBarriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole-community and systems approach to ensure change.Patient or public contributionPeople with living experience (preferred term by those involved) were involved at two levels within this research. A Chief Investigator living with dementia was involved in the design of the study and writing of the manuscript. People with living experience, care partners and service providers were participants in the codesign process to identify barriers and design potential solutions.
| S-EPMC11422665 | biostudies-literature
Project description:BackgroundCardiovascular diseases are one of the leading causes of mortality globally. Cardiac rehabilitation (CR) programs are crucial for patients recovering from cardiac events, as they help reduce the risk of recurrent events and support patient recovery. The patient's journey in CR spans the stages before, during, and after the program. Patients have to progress through each stage of CR programs successfully to complete the entire CR journey and get the full benefits of CR programs, but numerous barriers within this journey can hinder patient progression.ObjectiveThis study aims to explore the barriers to progression at all stages of the CR patient journey from the perspectives of health care providers involved in CR care.MethodsThis qualitative study involved semistructured interviews with health care providers involved in CR care from July 2023 to January 2024. A purposive maximal variation sampling method was used to target providers with diverse demographics and specialties. Snowball sampling was used to recruit participants, leveraging the existing networks of participants. Each interview lasted between 30 and 45 minutes. Interviews were recorded, transcribed verbatim, and analyzed using an inductive thematic analysis approach. Data analysis was conducted from August 2023 to February 2024.ResultsTen health care providers, comprising 7 females and 3 males, were interviewed. Their roles included physician, program director, nurse manager, clinical manager, nurse coordinator, nurse, physiotherapist, and kinesiologist. The analysis identified four overarching themes related to barriers to progression in the CR journey: (1) patients not being referred to CR programs, (2) patients not enrolling in CR programs, (3) patients dropping out of CR programs, and (4) patients' lack of adherence to lifestyle changes post-CR programs.ConclusionsIn light of the growing interest in technological interventions in CR programs, we proposed 4 potential technological solutions to address the barriers to progression identified in our analysis. These solutions aim to provide a foundation for future research to guide the development of effective technologies and enhance patient progression within the CR journey.
| S-EPMC11890148 | biostudies-literature
Project description:ObjectivesHome-based rehabilitation programmes (H-RPs) could facilitate the implementation of pulmonary rehabilitation prior to resection for non-small cell lung cancer (NSCLC), but their feasibility has not been evaluated. The aim of this study was to identify determinants of non-completion of an H-RP and the factors associated with medical events occurring 30 days after hospital discharge.DesignA prospective observational study.InterventionAll patients with confirmed or suspected NSCLC were enrolled in a four-component H-RP prior to surgery: (i) smoking cessation, (ii) nutritional support, (iii) physiotherapy (at least one session/week) and (iv) home cycle-ergometry (at least three times/week).OutcomesThe H-RP was defined as 'completed' if the four components were performed before surgery.ResultsOut of 50 patients included, 42 underwent surgery (80% men; median age: 69 (IQR 25%-75%; 60-74) years; 64% Chronic Obstructive Pulmonary Disease (COPD); 29% type 2 diabetes). Twenty patients (48%) completed 100% of the programme. The median (IQR) duration of the H-RP was 32 (19; 46) days. Multivariate analysis showed polypharmacy (n=24) OR=12.2 (95% CI 2.0 to 74.2), living alone (n=8) (single vs couple) OR=21.5 (95% CI 1.4 to >100) and a long delay before starting the H-RP (n=18) OR=6.24 (95% CI 1.1 to 36.6) were independently associated with a risk of non-completion. In univariate analyses, factors associated with medical events at 30 days were H-RP non-completion, diabetes, polypharmacy, social precariousness and female sex.ConclusionFacing multiple comorbidities, living alone and a long delay before starting the rehabilitation increase the risk of not completing preoperative H-RP.Trial registration numberNCT03530059.
| S-EPMC7878140 | biostudies-literature
Project description:BackgroundCardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively.AimThis study investigated cardiac specialists' perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral.MethodsIn this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n = 9 and n = 10, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group.ResultsFour themes emerged: "physician factors," "center factors," "patient factors," and "cultural factors." Regarding "physician factors," most participants mentioned shortage of time. Regarding "center factors," most participants mentioned poor physician-patient-center coordination. In "patient factors," the subcategories that arose were socioeconomic challenges and clinical condition of the patients. "Cultural factors" related to lack of belief in behavioral/preventive medicine.ConclusionsBarriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.
| S-EPMC8282146 | biostudies-literature
Project description:Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
| S-EPMC3538498 | biostudies-literature