摘要:

Background.Much has been achieved in implementing structured outpatient cardiac rehabilitation (CR) programs in Victoria, Australia, but little is known about the percentage of eligible patients who participate. This study was undertaken to determine the feasibility of establishing a database of CR participants and comparing it to the Victorian Inpatient Minimum Database (VIMD), a routinely collected hospital morbidity data set documenting all admissions to Victorian public and private hospitals. This would enable program participants and nonparticipants to be identified and program participation rates to be calculated.Methods.Data on program participants were collected from a sample of eight CR programs. Records from the VIMD were extracted for the concurrent time period for patients discharged home after acute myocardial infarction (AMI), coronary artery bypass graft (CABG) surgery, and percutaneous transluminal coronary angioplasty (PTCA), and therefore considered eligible to participate. Victorian Inpatient Minimum Database data were aggregated according to program catchment areas. Data were compared for program participants and patients eligible to participate.Results.Seven hundred fifty-eight patients were identified as being eligible to attend; 240 (32%) were identified as participating at least once. Discharged CABG patients participated on average at a rate of 53.1%, compared with 27.2% of AMI patients and only 10.3% of PTCA patients.Conclusions.Despite a comprehensive network of CR programs in Victoria, they are used on average by only a minority of eligible patients. Further work is required to determine barriers to participation to develop strategies to increase participation rates.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Data evaluating the efficacy of traditional cardiac rehabilitation programs to meet patient needs are limited. The authors studied patient-perceived preferences in cardiac rehabilitation programs and desired program elements to evaluate differences by gender or age.Methods.The authors surveyed 199 patients (136 men, 60.0 ± 11.6 years; 63 women, 63.7 ± 12.7 years;P= 0.045) discharged from a tertiary referral hospital with acute myocardial infarction. Participants completed a standardized questionnaire regarding enrollment in rehabilitation and preferences for six program types on a 10-point scale (1 = little or no agreement, 10 = strongly agree).Results.In this study, 54.3% of subjects enrolled in cardiac rehabilitation. Older patients (≥ 65 years) were more likely to enroll in home-based programs compared with younger patients (< 65 years) (11.8% versus 1.4%,P= 0.02). Younger patients preferred a short-term rehabilitation facility more than older patients (7.4 ± 3.5 versus 5.1 ± 4.1 units on the 10-point scale,P= 0.001), and rated the following more favorably than older patients: local health club programs (6.2 ± 3.7 versus 4.5 ± 4.0,P= 0.01), long-term programs (6.5 ± 3.8 versus 4.9 ± 4.2,P= 0.02), and comprehensive programs (6.6 ± 3.7 versus 4.9 ± 2.2,P= 0.02). Younger patients rated the following program elements more favorably compared with older patients: stress management (7.0 ± 3.5 versus 5.7 ± 4.1,P= 0.04), vocational counseling (5.1 ± 3.9 versus 1.9 ± 2.4,P= 0.001), and smoking cessation (4.9 ± 4.4 versus 2.7 ± 3.4,P= 0.001).Conclusions.Program preferences differed significantly by age, but not gender. Older patients enrolled in home-based programs over clinic-based programs. Younger patients rated stress management, vocational counseling, and smoking cessation more favorably than older patients. Strategies to enhance patient participation in cardiac rehabilitation should incorporate patient age and preferences for program types and elements.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Outcomes validate program performance and patient benefits received from cardiac and pulmonary rehabilitation. However, outcomes have little meaning without test standardization and the ability to benchmark data with other programs. The purpose of this article is to demonstrate the feasibility for measuring standardized outcomes in a large number of rehabilitation programs.Methods.The subjects included 928 cardiac patients and 222 pulmonary patients from 35 cardiac and 31 pulmonary rehabilitation programs. The SF-36 Health Survey, patient knowledge test, and 6-minute distance walk were administered before and after completion of the rehabilitation program. The patients completed rehabilitation according to the program guidelines at their respective site.Results.Significant (P< 0.05) improvements were demonstrated for cardiac and pulmonary rehabilitation in each of the eight health concepts within the SF-36. In addition, patient knowledge and distance walked significantly (P< 0.05) improved for both cardiac and pulmonary rehabilitation.Conclusions.Although this study does not document the effectiveness of rehabilitation for patients, it does demonstrate that the collection and analysis of standardized outcomes among many cardiac and pulmonary rehabilitation sites is feasible.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Previous studies have demonstrated high levels of anxiety and depression among patients with chronic obstructive pulmonary disease (COPD). The effects of an outpatient pulmonary rehabilitation (PR) program on psychological morbidity were examined in patients with severe COPD.Methods.Levels of anxiety and depression in 95 patients with severe COPD (FEV1<40% predicted) were measured on entry to an outpatient PR program using the Hospital Anxiety and Depression (HAD) scale. HAD scores were remeasured at the completion of PR (3 months) and at 6 month follow-up. The effects of PR on mean HAD scores and on the number of patients with significant anxiety or depression were determined. Improvements in exercise capacity after PR were compared in patients with high and low HAD scores.Results.Of patients, 35 (29.2%) had significant anxiety at screening and 18 (15%) significant depression. PR produced statistically significant falls in mean HAD scores for anxiety and depression, both of which remained significantly lowered at 6-month follow-up. PR also reduced the number of patients with significant anxiety or depression. Patients with high anxiety levels showed significantly greater improvements in shuttle walk distance than those with low HAD scores.Conclusions.Levels of anxiety and depression were high in a significant minority of this group of patients with severe COPD and were significantly improved by PR. Patients with higher HAD scores had lower baseline shuttle walk distances than those with low HAD scores. Anxious patients showed statistically greater improvements in exercise capacity following PR.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Purpose.The safety of one repetition maximum (1RM) testing for patients with chronic obstructive pulmonary disease (COPD) has not been determined. Therefore, this study was conducted to determine the prevalence of abnormal cardiopulmonary responses, muscle soreness, and muscle injury of patients with moderate to severe COPD in response to 1RM testing.Methods.Twenty pulmonary rehabilitation patients (11 women and 9 men) with moderate or severe COPD participated in this investigation. The 1RM testing was performed using the parallel squat and incline press. Blood pressure, heart rate dyspnea ratings, and oxygen saturation responses were measured immediately following the 1RM procedure. Ratings of muscle soreness and injury were measured immediately after 1RM testing and on days 2 and 7.Results.No injury, significant muscle soreness, or abnormal cardiopulmonary responses occurred as a result of 1RM testing. No gender differences were found for any variable measured in response to 1RM testing.Conclusions.A properly supervised and screened pulmonary rehabilitation population can be 1RM tested without significant muscle soreness, injury, or abnormal cardiopulmonary responses.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Background.Regular exercise increases exercise capacity and physical fitness, but questions remain about the effects of exercise on left ventricle (LV) remodeling after myocardial infarction. This study investigated the effects of moderate to high intensity exercise training on LV remodeling after a first myocardial infarction.Methods.An exercise group of 68 patients in cardiac rehabilitation after a first myocardial infarction had an initial echocardiogram and exercise stress test. Thirty patients completed the 12 weeks of training and had echocardiograms suitable for quantitative analysis. Follow-up echocardiograms and exercise tests were performed. A carefully matched control group of 30 patients with echocardiograms at fixed intervals after myocardial infarction and no formal exercise training were also studied. LV size was expressed as the endocardial surface area-to-body surface area (ESAi), whereas infarct size was characterized by the percent abnormal wall motion (%AWM) by echocardiography using an endocardial surface area mapping technique. Indices of LV shape (sphericity) were also assessed.Results.In the exercise group, no significant changes were seen in ESAi (57.95 ± 13.1 vs 57.80 ± 12.04 cm2/m2) or in %AWM (19.33 ± 15.27 vs 20.11 ± 15.95) from the initial to the final echo. The indices of sphericity were also unchanged. None of these parameters changed in the control group. Within each group was found heterogeneity in LV remodeling. Multivariate regression analysis revealed initial ESAi and initial %AWM to predict change in ESAi over time.Conclusions.In this study of patients with predominately small infarcts, exercise training did not adversely affect LV remodeling after myocardial infarction. Remodeling is heterogeneous and appears related to infarct and LV size.

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1999

数据来源: OVID