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Raidah F, Ghisi GLM, Anchique CV, Soomro NN, Candelaria D, Grace SL. Promoting cardiac rehabilitation program quality in low-resource settings: Needs assessment and evaluation of the International Council of Cardiovascular Prevention and Rehabilitation's registry quality improvement supports. Int J Cardiol 2024; 404:131962. [PMID: 38484802 DOI: 10.1016/j.ijcard.2024.131962] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/29/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) registries have the potential to support quality improvement (QImp). This study investigated the QImp needs of International CR Registry-participating programs and their evaluation of its' supports. METHODS ICRR offers comparative outcome dashboards and QImp sessions, among other features. In this qualitative study, ICRR data stewards from the 17 active on-boarded CR programs were invited to a focus group held in November 2023 via Teams; stewards not sufficiently-proficient in English were invited to provide written input. Deductive-thematic analysis using NVIVO was undertaken by 2 researchers; member-checking ensued. RESULTS Nine participated, and four provided input, from eight countries. Three themes emerged; saturation was achieved. First, QImp facilitators included training, institutional requirements, dedicated staff, resources in academic centres and ICRR features. Second, QImp barriers included staffing issues, the global nature of the ICRR, and structural challenges in low-resource settings. Finally, ICRR supports for QImp included didactic webinars, hearing from other programs, 1-1 support offered and assessing minimum Certification standards. CONCLUSION ICRR-participating programs are satisfied with QImp supports but encounter challenges, including related to language, staffing and other resources. CR registries should be leveraged and optimized to support CR programs to assess and improve their care quality.
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Affiliation(s)
- Fabbiha Raidah
- Faculty of Health, York University, 4700 Keele St, Toronto M3J 1P3, ON, Canada
| | - Gabriela L M Ghisi
- Faculty of Health, York University, 4700 Keele St, Toronto M3J 1P3, ON, Canada; KITE Research Institute- Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto M5G 2A2, Canada
| | - Claudia V Anchique
- The Cardiology Service, Mediagnostica Tecmedi, Cra. 16 #14-68, Centro-Sur, Duitama, Boyacá, Colombia
| | - Nabila N Soomro
- Department of Physical Medicine and Rehabilitation, Sindh Institute of Physical Medicine and Rehabilitation (SIPMR), Chand Bibi Rd, Near Mujahid Masjid, Deli Colony Ranchore Lane, Karachi, Karachi City, Sindh 74200, Pakistan
| | - Dion Candelaria
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, NSW 2050, Australia
| | - Sherry L Grace
- Faculty of Health, York University, 4700 Keele St, Toronto M3J 1P3, ON, Canada; KITE Research Institute- Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto M5G 2A2, Canada.
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Yunmei D, Yan C, Jiayun G, Grace SL. Translation, cultural adaptation, and psychometric validation of the Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-C) Scale in Simplified Chinese. Chronic Illn 2024:17423953241241764. [PMID: 38529531 DOI: 10.1177/17423953241241764] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND The Provider Attitudes toward CR and Referral (PACRR) scale was translated into Simplified Chinese and psychometric validation ensued. METHODS Brislin's Translation Model was applied, with two independent forward translations followed by back-translation. Experts assessed the face, content and cross-cultural validity of items, and item analysis followed. For validation, 227 physicians from hospitals in 14 Chinese provinces completed the PACRR-C. Structural validity was assessed through exploratory and confirmatory factor analysis. Internal and split-half reliability were assessed. RESULTS Some items were rephrased and one item was deleted. The content validity index for the total scale was 0.965. The correlation coefficients between the 18 items and the total scale ranged between 0.28 and 0.76. Consistent with the English version, four factors were extracted (Cronbach's alpha ranged from 0.671-0.959) through the factor analysis, accounting for 71.21% of the total variance. Split-half reliability was 0.945. The greatest factors impacting physician's CR attitudes were inconvenience of the referral process (3.93 ± 0.65/5); lack of standard referral forms (3.92 ± 0.66), perceiving referral as the responsibility of another clinician (3.89 ± 0.67), and need for support in completing the referral form (3.89 ± 0.64). CONCLUSIONS/SIGNIFICANCE The reliability, as well as content, face, cross-cultural, and structural validity of the 18-item, 4-subscale PACRR-C, were supported.
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Affiliation(s)
- Ding Yunmei
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Cui Yan
- School of Nursing, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Gu Jiayun
- School of Nursing, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Sherry L Grace
- York University, Toronto and KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Canada
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Mamataz T, Virani SA, McDonald M, Edgell H, Grace SL. Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic's and referring provider's perspectives. BMJ Open 2024; 14:e076664. [PMID: 38485484 PMCID: PMC10941180 DOI: 10.1136/bmjopen-2023-076664] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria. DESIGN, SETTING AND PARTICIPANTS Two cross-sectional surveys were administered via research electronic data capture to clinic providers and referrers (eg, cardiologists, family physicians and nurse practitioners) across Canada. MEASURES Twenty-seven criteria selected based on the literature and HF guidelines were tested. Respondents were asked to list any additional criteria. The degree of agreement was assessed (eg, Kappa). RESULTS Responses were received from providers at 48 clinics (37.5% response rate). The most common actual inclusion criteria were newly diagnosed HF with reduced or preserved ejection fraction, New York Heart Association class IIIB/IV and recent hospitalisation (each endorsed by >74% of respondents). Exclusion criteria included congenital aetiology, intravenous inotropes, a lack of specialists, some non-cardiac comorbidities and logistical factors (eg, rurality and technology access). There was the greatest discordance between actual and ideal criteria for the following: inpatient at the same institution (κ=0.14), congenital heart disease, pulmonary hypertension or genetic cardiomyopathies (all κ=0.36). One-third (n=16) of clinics had changed criteria, often for non-clinical reasons. Seventy-three referring providers completed the survey. Criteria endorsed more by referrers than clinics included low blood pressure with a high heart rate, recurrent defibrillator shocks and intravenous inotropes-criteria also consistent with guidelines. CONCLUSIONS There is considerable agreement on the main clinic entry criteria, but given some discordance, two levels of clinics may be warranted. Publicising evidence-based criteria and applying them systematically at referral sources could support improved HF patient care journeys and outcomes.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
| | - Sean A Virani
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Heather Edgell
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
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Solera AR, Supervia M, Medina Inojosa JR, Senon DB, Lopez-Jimenez F, Grace SL. Impact of vaccination education in cardiac rehabilitation on attitudes and knowledge. PLOS Glob Public Health 2024; 4:e0002610. [PMID: 38457378 PMCID: PMC10923443 DOI: 10.1371/journal.pgph.0002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Clinical guidelines recommend influenza vaccination for cardiac patients, and COVID-19 vaccination is also beneficial given their increased risk. Patient education regarding vaccination was developed for cardiac rehabilitation (CR); impact on knowledge and attitudes were evaluated. A single-group pre-post design was applied at a Spanish CR program in early 2022. After baseline assessment, a nurse delivered the 40-minute group education. Knowledge and attitudes were re-assessed. Sixty-one (72%) of the 85 participants were vaccinated for influenza, and 40 (47%) for pneumococcus. Most participants perceived vaccines were important, and that the COVID-19 vaccine specifically was important, with three-quarters not influenced by vaccine myths/misinformation. The education intervention resulted in significant improvements in perceptions of the importance of vaccines (Hake's index 69%), understanding of myths (48%), knowledge of the different types of COVID vaccines (92%), and when they should be vaccinated. Vaccination rates are low despite their importance; while further research is needed, education in the CR setting could promote greater uptake.
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Affiliation(s)
- Andrea Rivera Solera
- Department of Physical Medicine and Rehabilitation, Alcala University, Madrid, Spain
- Department of Physical Medicine and Rehabilitation, Gregorio Marañon Health Research Institute, Gregorio Marañon General University Hospital, Madrid, Spain
| | - Marta Supervia
- Department of Physical Medicine and Rehabilitation, Gregorio Marañon Health Research Institute, Gregorio Marañon General University Hospital, Madrid, Spain
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jose R. Medina Inojosa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - David Bedos Senon
- Department of Physical Medicine and Rehabilitation, Gregorio Marañon Health Research Institute, Gregorio Marañon General University Hospital, Madrid, Spain
| | - Francisco Lopez-Jimenez
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Ghisi GLDM, Hebert AA, Oh P, Colella T, Aultman C, Carvalho C, Nijhawan R, Ross MK, Grace SL. Evidence-informed development of women-focused cardiac rehabilitation education. Heart Lung 2024; 64:14-23. [PMID: 37984099 DOI: 10.1016/j.hrtlng.2023.11.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Despite their differential risk factor burden, context and often different forms of heart disease, cardiac rehabilitation (CR) programs generally do not provide women with needed secondary prevention information specific to them. OBJECTIVE to co-design evidence-informed, theory-based comprehensive women-focused education, building from Health e-University's Cardiac College for CR. METHODS A multi-disciplinary, multi-stakeholder steering committee (N = 18) oversaw the four-phase development of the women-focused curriculum. Phase 1 involved a literature review on women's CR information needs and preferences, phase 2 a CR program needs assessment, phase 3 content development (including determining content and mode, assigning experts to create the content, plain language review and translation), and phase 4 will comprise evaluation and implementation. In phase 2, a focus group was conducted with Canadian CR providers; it was analyzed using Braun and Clarke's iterative approach. RESULTS Nineteen providers participated in the focus group, with four themes emerging: current status of education, challenges to delivering women-focused education, delivery modes and topical resources. Results were consistent with those from our related global survey, supporting saturation of themes. Co-designed educational materials included 19 videos. These were organized across 5 webpages in English and French, specific to tests and treatments, exercise, diet, psychosocial well-being, and self-management. Twelve corresponding session slide decks with notes for clinicians were created, to support program delivery in CR flexibly. CONCLUSION While further evaluation is underway, these open-access CR education resources will be disseminated for implementation, to support women in reducing their risk of cardiovascular sequelae.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Andree-Anne Hebert
- Programme de Prévention Secondaire et Réadaptation Cardiovasculaire, Levis, Canada
| | - Paul Oh
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada; Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Tracey Colella
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada; Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Carolina Carvalho
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Rajni Nijhawan
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Marie-Kristelle Ross
- Programme de Prévention Secondaire et Réadaptation Cardiovasculaire, Levis, Canada
| | - Sherry L Grace
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Canada; Faculty of Health, York University, Toronto, Canada
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Suebkinorn O, Ramos JS, Grace SL, Gebremichael LG, Bulamu N, Pinero de Plaza MA, Dafny HA, Pearson V, Hines S, Dalleck LC, Coombes JS, Hendriks JM, Clark RA, Beleigoli A. Effectiveness of alternative vs traditional exercises on cardiac rehabilitation program utilization in women with or at high risk of cardiovascular disease: a systematic review protocol. JBI Evid Synth 2024; 22:281-291. [PMID: 37435676 DOI: 10.11124/jbies-22-00394] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This review will evaluate the effectiveness of alternative vs traditional forms of exercise on cardiac rehabilitation program utilization and other outcomes in women with or at high risk of cardiovascular disease. INTRODUCTION Exercise-based cardiac rehabilitation programs improve health outcomes in women with or at high risk of cardiovascular disease. However, such programs are underutilized worldwide, particularly among women. Some women perceive traditional gym-based exercise in cardiac rehabilitation programs (eg, typically treadmills, cycle ergometers, traditional resistance training) to be excessively rigorous and unpleasant, resulting in diminished participation and completion. Alternative forms of exercise such as yoga, tai chi, qi gong, or Pilates may be more enjoyable and motivating exercise options for women, enhancing engagement in rehabilitation programs. However, the effectiveness of these alternative exercises in improving program utilization is still inconsistent and needs to be systematically evaluated and synthesized. INCLUSION CRITERIA This review will focus on randomized controlled trials of studies measuring the effectiveness of alternative vs traditional forms of exercise on cardiac rehabilitation program utilization as well as clinical, physiological, or patient-reported outcomes in women with or at high risk of cardiovascular disease. METHODS The review will follow the JBI methodology for systematic reviews of effectiveness. Databases including MEDLINE (Ovid), CINAHL (EBSCOhost), Cochrane CENTRAL, Embase (Ovid), Emcare (Ovid), Scopus, Web of Science, LILACS, and PsycINFO (Ovid) will be searched. Two independent reviewers will screen articles and then extract and synthesize data. Methodological quality will be assessed using JBI's standardized instruments. GRADE will be used to determine the certainty of evidence. REVIEW REGISTRATION PROSPERO CRD42022354996.
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Affiliation(s)
- Orathai Suebkinorn
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Joyce S Ramos
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lemlem G Gebremichael
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Norma Bulamu
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Hila A Dafny
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Vincent Pearson
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
- Flinders Rural and Remote Health NT, Alice Springs, NT, Australia
| | - Lance C Dalleck
- Recreation, Exercise, and Sport Science Department, Western Colorado University, Gunnison, CO, USA
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Jeroen M Hendriks
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
- Centre for Heart Rhythm Disorders, The University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robyn A Clark
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
| | - Alline Beleigoli
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Alice Springs, NT, Australia
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Ghisi GLDM, Supervia M, Turk-Adawi K, Beleigoli A, Contractor A, Mampuya WM, Grace SL. Women-Focused Cardiac Rehabilitation Delivery Around the World and Program Enablers to Support Broader Implementation. CJC Open 2024; 6:425-435. [PMID: 38487061 PMCID: PMC10935990 DOI: 10.1016/j.cjco.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/08/2023] [Indexed: 03/17/2024] Open
Abstract
Background Women are less likely than men to use cardiac rehabilitation (CR); thus, women-focused (W-F) CR was developed. Implementation of W-F CR globally was investigated, as well as barriers and enablers to its delivery. Methods In this cross-sectional study, a survey was administered to CR programs via Research Electronic Data Capture (REDCap) from May to July, 2023. Potential respondents were identified via the International Council of Cardiovascular Prevention and Rehabilitation's network. Results A total of 223 responses were received from 52 of 111 countries (46.8% country response rate) in the world that have any CR, across all 6 World Health Organization regions. Thirty-three programs (14.8%) from 30 countries reported offering any W-F programming. Programs commonly did offer elements preferred by women and recommended, namely, the following: patient choice of session time (n = 151; 70.6%); invitations for informal care providers and/or partners to attend sessions (n = 121; 57.1%); CR staff that have expertise in women and heart diseases (n = 112; 53.3%); separate changerooms for women (n = 38; 52.8%); and discussion of CR referral with patients (n = 112; 52.1%). Main barriers to delivery of W-F exercise were physical resources (n = 33; 14.8%), space (n = 30; 13.5%), and staff time (n = 26; 11.7%) and expertise (n = 33; 10.3%). Main barriers to delivery of W-F education were human resources (n = 114; 51.1%), educational resources (n = 26; 11.7%), and expertise in the content (n = 74; 33.2%). Enablers of W-F education delivery were availability of materials, in multiple modalities, as well as educated staff and financial resources. Conclusions Despite the benefits, W-F CR is not commonly offered globally. Considering the barriers and enablers identified, the International Council of Cardiovascular Prevention and Rehabilitation is developing resources to expand delivery.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE—Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marta Supervia
- Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain
- Mayo Clinic, Rochester, Minnesota, USA
| | - Karam Turk-Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Alline Beleigoli
- Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, New South Wales, Australia
| | | | - Warner M. Mampuya
- Sherbrooke University Hospital Research Centre (CRCHUS), Sherbrooke, Quebec, Canada
| | - Sherry L. Grace
- KITE—Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health, York University, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Mulvagh SL, Colella TJ, Gulati M, Crosier R, Allana S, Randhawa VK, Bruneau J, Pacheco C, Jaffer S, Cotie L, Mensour E, Clavel MA, Hill B, Kirkham AA, Foulds H, Liblik K, Van Damme A, Grace SL, Bouchard K, Tulloch H, Robert H, Pike A, Benham JL, Tegg N, Parast N, Adreak N, Boivin-Proulx LA, Parry M, Gomes Z, Sarfi H, Iwegim C, Van Spall HG, Nerenberg KA, Wright SP, Limbachia JA, Mullen KA, Norris CM. The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 9: Summary of Current Status, Challenges, Opportunities, and Recommendations. CJC Open 2024; 6:258-278. [PMID: 38487064 PMCID: PMC10935707 DOI: 10.1016/j.cjco.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 03/17/2024] Open
Abstract
This final chapter of the Canadian Women's Heart Health Alliance "ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women" presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next steps to further the existing progress that has been made in addressing these knowledge gaps by tackling the remaining outstanding disparities in women's cardiovascular care, with the goal to improve outcomes for women in Canada.
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Affiliation(s)
- Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracey J.F. Colella
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca Crosier
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Jill Bruneau
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Christine Pacheco
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Cotie
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
| | - Emma Mensour
- University of Western Ontario, London, Ontario, Canada
| | | | - Braeden Hill
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Amy A. Kirkham
- KITE-UHN-Toronto Rehabilitation, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiera Liblik
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Andrea Van Damme
- University of Alberta Faculty of Graduate & Postdoctoral Studies, Edmonton, Alberta, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Helen Robert
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - April Pike
- Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Jamie L. Benham
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Tegg
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Nazli Parast
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Najah Adreak
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Zoya Gomes
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hope Sarfi
- Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Research Institute of St Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kara A. Nerenberg
- Departments of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Colleen M. Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Seron P, Oliveros MJ, Marzuca-Nassr GN, Morales G, Román C, Muñoz SR, Gálvez M, Latin G, Marileo T, Molina JP, Navarro R, Sepúlveda P, Lanas F, Saavedra N, Ulloa C, Grace SL. Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350301. [PMID: 38194236 PMCID: PMC10777264 DOI: 10.1001/jamanetworkopen.2023.50301] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/16/2023] [Indexed: 01/10/2024] Open
Abstract
Importance While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. Objective To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. Design, Setting, and Participants This pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021. Interventions Participants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks. Main Outcomes and Measures The primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists. Results A total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, -11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, -0.35% [95% CI, -7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, -3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group). Conclusions and Relevance The results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation. Trial Registration ClinicalTrials.gov Identifier: NCT03881150.
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Affiliation(s)
- Pamela Seron
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Maria Jose Oliveros
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Gabriel Nasri Marzuca-Nassr
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
| | - Gladys Morales
- Facultad de Medicina, Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile
| | - Claudia Román
- Facultad de Medicina, Escuela de Kinesiología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Raúl Muñoz
- Facultad de Medicina, Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile
| | - Manuel Gálvez
- Unidad de Kinesiología, Complejo Hospitalario San José, Santiago, Chile
| | - Gonzalo Latin
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico, Hospital San Borja Arriarán, Santiago, Chile
| | - Tania Marileo
- Unidad de Rehabilitación Cardiaca, Hospital Regional de Antofagasta, Antofagasta, Chile
| | - Juan Pablo Molina
- Servicio de Medicina Física y Rehabilitación, Hospital San Juan de Dios, Santiago, Chile
| | - Rocío Navarro
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Pablo Sepúlveda
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
| | - Fernando Lanas
- Facultad de Medicina, Departamento de Medicina Interna, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | - Nicolás Saavedra
- Facultad de Medicina, Departamento de Ciencias Básicas, Universidad de La Frontera, Temuco, Chile
| | - Constanza Ulloa
- Facultad de Medicina, Departamento de Ciencias de la Rehabilitación, Universidad de La Frontera, Temuco, Chile
| | - Sherry L. Grace
- York University & University Health Network, University of Toronto, Toronto, Ontario, Canada
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Mamataz T, Lee DS, Turk-Adawi K, Hajaj A, Code J, Grace SL. Factors Affecting Healthcare Provider Referral to Heart Function Clinics: A Mixed-Methods Study. J Cardiovasc Nurs 2024; 39:18-30. [PMID: 37669639 DOI: 10.1097/jcn.0000000000001029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics. OBJECTIVE The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic. METHODS An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale. RESULTS Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals ( P s < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns). CONCLUSION Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.
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Turk-Adawi KI, Elshaikh U, Contractor A, Hashmi FA, Thomas E, Raidah F, Grace SL. Development and Evaluation of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) Program Certification for Low-Resource Settings. Int J Gen Med 2023; 16:5199-5214. [PMID: 38021048 PMCID: PMC10643168 DOI: 10.2147/ijgm.s423209] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cardiac rehabilitation (CR) is a proven model of secondary prevention, but new sites, providing quality care, are needed in low-resource settings. This study (1) described the development of International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) Program Certification and (2a) tested its implementation, considering (b) appropriateness of quality standards for these settings. Methods The Steering Committee finalized 13 standards, requiring 70% be met. They are assessed initially through International CR Registry (ICRR) program survey and patient data; if Certification appears possible, a two-hour virtual site assessment is arranged to corroborate. Standard operating procedures for Assessor training were developed. A multi-method pilot study was then undertaken with a quantitative (description of quality indicators) and qualitative (focus groups on MS Teams) component. ICRR sites with post-program data by April 2022 were invited to participate. Two team members independently analyzed focus group transcripts, using a deductive-thematic approach with NVIVO. Results Five CR programs from the Eastern Mediterranean, South-East Asian and American regions participated. Upon application, with some data cleaning, initially four programs were eligible to proceed to virtual site assessment. Ultimately, all five programs were certified, each meeting a minimum of 12/13 standards (peak MET increase and program completion rate were not met by some centres). Four themes resulted from the two focus groups of 13 site data stewards: motivation and benefits (eg, international recognition, additional program resources), logistics (eg, communication, cost, site visit process), the standards and their assessment (eg, balance of rigor and feasibility), and suggestions for improvement (eg, website). Conclusion ICCPR's Program Certification has been demonstrated to be feasible, rigorous, and acceptable. Standards are attainable in low-resource settings. Certified programs reap benefits including additional resources. This first international Certification is suitable for low-resource settings, to complement that from the American and European CR Societies.
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Affiliation(s)
- Karam I Turk-Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Usra Elshaikh
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Aashish Contractor
- Rehabilitation and Sports Medicine, Sir H.N. Reliance Foundation Hospital, Mumbai, India
| | - Farzana Amir Hashmi
- Preventive Cardiology and Rehabilitation, Tabba Heart Institute, Karachi, Pakistan
| | - Emma Thomas
- Centre for Online Health, Centre for Health Services Research, the University of Queensland, Brisbane, Queensland, Australia
| | - Fabbiha Raidah
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE - Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Ghisi GLDM, Kim WS, Cha S, Aljehani R, Cruz MMA, Vanderlei LCM, Pepera G, Liu X, Xu Z, Maskhulia L, Venturini E, Chuang HJ, Pereira DG, Trevizan PF, Kouidi E, Batalik L, Ghanbari Firoozabadi M, Burazor I, Jiandani MP, Zhang L, Tourkmani N, Grace SL. Women's Cardiac Rehabilitation Barriers: Results of the International Council of Cardiovascular Prevention and Rehabilitation's First Global Assessment. Can J Cardiol 2023; 39:S375-S383. [PMID: 37747380 DOI: 10.1016/j.cjca.2023.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers in women, and women's greatest barriers according to enrollment status. METHODS In this cross-sectional study, the English, Simplified Chinese, Arabic, Portuguese, or Korean versions of the Cardiac Rehabilitation Barriers Scale was administered to CR-indicated patients globally via Qualtrics from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation community facilitated participant recruitment. Mitigation strategies were provided and rated. RESULTS Participants were 2163 patients from 16 countries across all 6 World Health Organization regions; 916 (42.3%) were women. Women did not report significantly greater total barriers overall, but did in 2 regions (Americas, Western Pacific) and men in 1 (Eastern Mediterranean; all P < 0.001). Women's barriers were greatest in the Western Pacific (2.6 ± 0.4/5) and South East Asian (2.5 ± 0.9) regions (P < 0.001), with lack of CR awareness as the greatest barrier in both. Women who were unemployed reported significantly greater barriers than those not (P < 0.001). Among nonenrolled referred women, the greatest barriers were not knowing about CR, not being contacted by the program, cost, and finding exercise tiring or painful. Among enrolled women, the greatest barriers to session adherence were distance, transportation, and family responsibilities. Mitigation strategies were rated as very helpful (4.2 ± 0.7/5). CONCLUSIONS CR barriers-men's and women's-vary significantly according to region, necessitating tailored approaches to mitigation. Efforts should be made to mitigate unemployed women's barriers in particular.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Won-Seok Kim
- Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seungwoo Cha
- Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Raghdah Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mayara Moura Alves Cruz
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Brazil
| | | | - Garyfallia Pepera
- Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Thessaly, Greece
| | - Xia Liu
- Chengdu Wanda UPMC Hospital, Chengdu, China
| | - Zhimin Xu
- Shanghai Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lela Maskhulia
- TSMU Sports Medicine and Rehabilitation Clinical Centre, Cardiac Rehabilitation, Tbilisi, Georgia
| | - Elio Venturini
- Department of Cardiac Rehabilitation, Cecina Hospital, Cecina, Italy
| | - Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Danielle Gomes Pereira
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Patricia Fernandes Trevizan
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Thessaloniki, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Repub
| | - Mahdieh Ghanbari Firoozabadi
- Yazd Cardiovascular Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ivana Burazor
- Institute for Cardiovascular Diseases "Dedinje" and Belgrade University, Faculty of Medicine, Belgrade, Serbia
| | | | - Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Nidal Tourkmani
- Rehabilitation Clinic "Mons. G. Calaciura," Biancavilla, Catania, Italy; "Gibiino" Cardiovascular Diagnostic Center, Catania, Italy
| | - Sherry L Grace
- KITE - Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada.
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Jeong S, Kim H, Kim WS, Chang WK, Cha S, Choi E, Kim C, Grace SL, Baek S. Translation, Cultural Adaptation, and Validation of a Korean Version of the Information Needs in Cardiac Rehabilitation Scale. Ann Rehabil Med 2023; 47:403-425. [PMID: 37907232 PMCID: PMC10620489 DOI: 10.5535/arm.23042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE : To translate and culturally adapt the Information Needs in Cardiac Rehabilitation (INCR) questionnaire into Korean and perform psychometric validation. METHODS : The original English version of the INCR, in which patients are asked to rate the importance of 55 topics, was translated into Korean (INCR-K) and culturally adapted. The INCR-K was tested on 101 cardiac rehabilitation (CR) participants at Kangwon National University Hospital and Seoul National University Bundang Hospital in Korea. Structural validity was assessed using principal component analysis, and Cronbach's alpha of the areas was computed. Criterion validity was assessed by comparing information needs according to CR duration and knowledge sufficiency according to receipt of education. Half of the participants were randomly selected for 1 month of re-testing to assess their responsiveness. RESULTS : Following cognitive debriefing, the number of items was reduced to 41 and ratings were added to assess participants' sufficient knowledge of each item. The INCR-K structure comprised eight areas, each with sufficient internal consistency (Cronbach's alpha>0.7). Criterion validity was supported by significant differences in mean INCR-K scores based on CR duration and knowledge sufficiency ratings according to receipt of education (p<0.05). Information needs and knowledge sufficiency ratings increased after 1 month of CR, thus supporting responsiveness (p<0.05). CONCLUSION : The INCR-K demonstrated adequate face, content, cross-cultural, structural, and criterion validities, internal consistency, and responsiveness. Information needs changed with CR, such that multiple assessments of information needs may be warranted as rehabilitation progresses to facilitate patient-centered education.
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Affiliation(s)
- Seungsu Jeong
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Heeju Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunjeong Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, Canada
- KITE Research Institute–Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Taylor RS, Fredericks S, Jones I, Neubeck L, Sanders J, De Stoutz N, Thompson DR, Wadhwa DN, Grace SL. Global perspectives on heart disease rehabilitation and secondary prevention: a scientific statement from the Association of Cardiovascular Nursing and Allied Professions, European Association of Preventive Cardiology, and International Council of Cardiovascular Prevention and Rehabilitation. Eur Heart J 2023; 44:2515-2525. [PMID: 37477626 PMCID: PMC10361025 DOI: 10.1093/eurheartj/ehad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 06/24/2022] [Revised: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 07/22/2023] Open
Abstract
Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and accessibility of secondary preventative and rehabilitative health services have never been more important. Whilst LMICs experience the highest prevalence and mortality rates, the global approach to secondary prevention and cardiac rehabilitation, which mitigates this burden, has traditionally been driven from clinical guidelines emanating from high-income settings. This state-of-the art review provides a contemporary global perspective on cardiac rehabilitation and secondary prevention, contrasting the challenges of and opportunities for high vs. lower income settings. Actionable solutions to overcome system, clinician, programme, and patient level barriers to cardiac rehabilitation access in LMICs are provided.
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Affiliation(s)
- Rod S Taylor
- Former ACNAP Science committee member, Professor of Population Health, School of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Suzanne Fredericks
- ACNAP Science committee member, Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Ian Jones
- ACNAP Science committee member, Professor of Cardiovascular Nursing, Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- ACNAP President, Professor and Head of Cardiovascular Health, Centre for Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
| | - Julie Sanders
- ACNAP Science committee chair, Director of Clinical Research, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, UK
- Clinical Professor of Cardiovascular Nursing, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Noemi De Stoutz
- ESC Patient forum representative, Member of ‘Cuore Matto’ and Global ARCH, Zumikon, Switzerland
| | - David R Thompson
- EAPC representative, Professor of Nursing, School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Deepti N Wadhwa
- ACNAP Young community member, Associate Professor, MVPS College of Physiotherapy, Nashik, India
| | - Sherry L Grace
- ICCPR Immediate past-Chair, Professor, Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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Firoozabadi MG, Mirzaei M, Grace SL, Vafaeinasab M, Dehghani-Tafti M, Sadeghi A, Asadi Z, Basirinezhad MH. Correction: Sex differences in cardiac rehabilitation barriers among non-enrollees in the context of lower gender equality: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:355. [PMID: 37460993 PMCID: PMC10353194 DOI: 10.1186/s12872-023-03385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Affiliation(s)
- Mahdieh Ghanbari Firoozabadi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE- Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mohammadreza Vafaeinasab
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Maryam Dehghani-Tafti
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Abbas Sadeghi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zohre Asadi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Grace SL, Elashie S, Sadeghi M, Papasavvas T, Hashmi F, de Melo Ghisi G, Vargas JL, Al-Hashemi M, Turk-Adawi K. Pilot testing of the International Council of Cardiovascular Prevention and Rehabilitation Registry. Int J Qual Health Care 2023; 35:mzad050. [PMID: 37421311 PMCID: PMC10329404 DOI: 10.1093/intqhc/mzad050] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
The International Council of Cardiovascular Prevention and Rehabilitation developed an International Cardiac Rehabilitation (CR) Registry (ICRR) to support CR programs in low-resource settings to optimize care provision and patient outcomes. This study assessed implementation of the ICRR, site data steward experience with on-boarding and data entry, and patient acceptability. Multimethod observational pilot involves (I) analysis of ICRR data from three centers (Iran, Pakistan, and Qatar) from inception to May 2022, (II) focus group with on-boarded site data stewards (also from Mexico and India), and (III) semistructured interviews with participating patients. Five hundred sixty-seven patients were entered. Based on volumes at each program, 85.6% of patients were entered in ICRR. 99.3% patients approached consented to participate. The average time to enter data at pre- and follow-up assessments by source was 6.8-12.6 min. Of 22 variables preprogram, completion was 89.5%. Among patients with any follow-up data, of four program-reported variables, completion was 99.0% in program completers and 51.5% in none; of 10 patient-reported variables, completion was 97.0% in program completers and 84.8% in none. The proportion of patients with any follow-up data was 84.8% in program completers, with 43.6% of noncompleters having any data entered other than completion status. Twelve data stewards participated in the focus group. Main themes were valuable on-boarding process, data entry, process of engaging patients, and benefits of participation. Thirteen patients were interviewed. Themes were good understanding of the registry, positive experience providing data, and value of lay summary and eagerness for annual assessment. Feasibility and data quality of ICRR were demonstrated.
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Affiliation(s)
- Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE Research Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Sana Elashie
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Theodoros Papasavvas
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Farzana Hashmi
- Department of Rheumatology, Fatima Memorial Hospital & FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Gabriela de Melo Ghisi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
| | - Jorge Lara Vargas
- Servicio de Rehabilitación Cardiaca, Departamento de Cardiocirugía, Centro Médico Nacional 20 de Noviembre, Ciudad de México 03104, México
| | - Mohammed Al-Hashemi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Karam Turk-Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Turk-Adawi K, Supervia M, Ghisi G, Cuenza L, Yeo TJ, Chen SY, Anchique-Santos C, Grace SL. The impact of ICCPR's Global Audit of Cardiac Rehabilitation: where are we now and where do we need to go? EClinicalMedicine 2023; 61:102092. [PMID: 37528847 PMCID: PMC10388569 DOI: 10.1016/j.eclinm.2023.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
| | - Marta Supervia
- Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007, Madrid, Spain
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
| | - Gabriela Ghisi
- KITE Research Institute– Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, M5G2A2, ON, Canada
| | - Lucky Cuenza
- Philippine Heart Center, East Avenue, Quezon City, 1100, Philippines
| | - Tee Joo Yeo
- National University Heart Centre Singapore, National University Health System (NUHS) Tower Block, 1E Kent Ridge, Singapore
| | - Ssu-Yuan Chen
- Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, 24352, Taiwan
| | | | - Sherry L. Grace
- KITE Research Institute– Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, M5G2A2, ON, Canada
- Faculty of Health, York University, 4700 Keele St., Toronto, M3J1P3, ON, Canada
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Firoozabadi MG, Mirzaei M, Grace SL, Vafaeinasab M, Dehghani-Tafti M, Sadeghi A, Asadi Z, Basirinezhad MH. Sex differences in cardiac rehabilitation barriers among non-enrollees in the context of lower gender equality: a cross-sectional study. BMC Cardiovasc Disord 2023; 23:329. [PMID: 37386414 PMCID: PMC10311813 DOI: 10.1186/s12872-023-03331-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite the benefits of cardiac rehabilitation (CR), it remains under-utilized, particularly by women. This study compared CR barriers between non-enrolling men and women in Iran, which has among the lowest gender equality globally. METHODS In this cross-sectional study, CR barriers were assessed via phone interview in phase II non-attenders from March 2017 to February 2018 with the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P). T-tests were used to compare scores, with each of 18 barriers scored out of 5, between men and women. RESULTS 357 (33.9%) of the sample of 1053 were women, and they were older, less educated and less often employed than men. Total mean CRBS scores were significantly greater in women (2.37 ± 0.37) than men (2.29 ± 0.35; effect size[ES] = 0.08, confidence interval[CI]: 0.03-0.13; p < 0.001). The top CR barriers among women were cost (3.35; ES = 0.40, CI:0.23-0.56; P < 0.001), transportation problems (3.24; ES = 0.41, CI:0.25-0.58; P < 0.001), distance (3.21; ES = 0.31, CI:0.15-0.48; P < 0.001), comorbidities (2.97; ES = 0.49, CI:0.34-0.64; P < 0.001), low energy (2.41; ES = 0.29, CI:0.18-0.41; P < 0.001), finding exercise as tiring or painful (2.22; ES = 0.11, CI:0.02-0.21; P = 0.018), and older age (2.27; ES = 0.18, CI:0.07-0.28; P = 0.001). Men rated "already exercise at home or in community" (2.69; ES = 0.23, CI:0.1-0.36; P = 0.001), time constraints (2.18; ES = 0.15, CI:0.07-0.23; P < 0.001) and work responsibilities (2.24; ES = 0.16, CI:0.07-0.25; P = 0.001) as greater CR barriers than women. CONCLUSION Women had greater barriers to CR participation than men. CR programs should be modified to address women's needs. Home-based CR tailored to women's exercise needs and preferences should be considered.
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Affiliation(s)
- Mahdieh Ghanbari Firoozabadi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE- Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mohammadreza Vafaeinasab
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Maryam Dehghani-Tafti
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Abbas Sadeghi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zohre Asadi
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hasan Basirinezhad
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Science, Yazd, Iran
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Gómez-Pérez D, Seron P, Oliveros MJ, Morales Illanes G, Arancibia MJ, Grace SL. Evaluation of counselling materials for hybrid cardiac rehabilitation in a low-resource setting: Perceptions of patients and providers. Patient Educ Couns 2023; 113:107772. [PMID: 37146529 DOI: 10.1016/j.pec.2023.107772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE This study evaluated the usefulness of a booklet as support material for counseling focused on self-efficacy and therapist interaction in the course of counseling in a hybrid CR program (i.e., supervised and unsupervised sessions) developed for low-resource settings. METHODS Counseling material was developed by a multidisciplinary team, with patient input. Using multi-methods, first input from patients from six centers in Chile was sought through a telephone survey (cross-sectional). Second, input from physiotherapists delivering the intervention at all centres was solicited qualitatively through a focus group on Zoom. Content analysis was performed using a deductive-thematic approach. RESULTS Seventy-one patients were included. All (100 %) participants responded that the materials were easy to understand, contained suggestions applicable to daily life, captured their attention and was useful for future questions. The booklet overall was rated 6.7 ± 0.6/7 %, and 98.2 % were satisfied with the counselling. Overall themes from the six deliverers related to the CR intervention (e.g., well manualized protocols for counselling), the deliverer (e.g., expertise to deliver) and patients (e.g., found information useful). CONCLUSION The usefulness of the counseling together with the supporting booklet was established by patients and delivering professionals. PRACTICE IMPLICATIONS Thus, with some final refinement, this resource can be disseminated for use by other Spanish CR programs.
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Affiliation(s)
- Daniela Gómez-Pérez
- Universidad de La Frontera, Facultad de Educación, Ciencias Sociales y Humanidades, Depto. de Psicología & LEDSA, Temuco, Chile
| | - Pamela Seron
- Universidad de La Frontera, Facultad de Medicina, Depto. de Cs. de la Rehabilitación, Temuco, Chile; Universidad de La Frontera, Centro de Excelencia CIGES, Temuco, Chile.
| | - María José Oliveros
- Universidad de La Frontera, Facultad de Medicina, Depto. de Cs. de la Rehabilitación, Temuco, Chile; Universidad de La Frontera, Centro de Excelencia CIGES, Temuco, Chile
| | - Gladys Morales Illanes
- Universidad de La Frontera, Facultad de Medicina, Depto. de Salud Pública & EPICYN, Temuco, Chile
| | - María José Arancibia
- Universidad de La Frontera, Facultad de Medicina, Depto. de Cs. de la Rehabilitación, Temuco, Chile
| | - Sherry L Grace
- Kinesiology & Health Science, York University, Toronto, Canada; KITE Research Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
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Aljehani R, Grace SL, Aburub A, Turk-Adawi K, Ghisi GLDM. Translation, Cross-Cultural Adaptation and Psychometric Validation of the Arabic Version of the Cardiac Rehabilitation Barriers Scale (CRBS-A) with Strategies to Mitigate Barriers. Healthcare (Basel) 2023; 11:healthcare11081196. [PMID: 37108029 PMCID: PMC10138187 DOI: 10.3390/healthcare11081196] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiac rehabilitation (CR) utilization is low, particularly in Arabic-speaking countries. This study aimed to translate and psychometrically validate the CR Barriers Scale in Arabic (CRBS-A), as well as strategies to mitigate them. The CRBS was translated by two bilingual health professionals independently, followed by back-translation. Next, 19 healthcare providers, followed by 19 patients rated the face and content validity (CV) of the pre-final versions, providing input to improve cross-cultural applicability. Then, 207 patients from Saudi Arabia and Jordan completed the CRBS-A, and factor structure, internal consistency, construct, and criterion validity were assessed. Helpfulness of mitigation strategies was also assessed. For experts, item and scale CV indices were 0.8-1.0 and 0.9, respectively. For patients, item clarity and mitigation helpfulness scores were 4.5 ± 0.1 and 4.3 ± 0.1/5, respectively. Minor edits were made. For the test of structural validity, four factors were extracted: time conflicts/lack of perceived need and excuses; preference to self-manage; logistical problems; and health system issues and comorbidities. Total CRBS-A α was 0.90. Construct validity was supported by a trend for an association of total CRBS with financial insecurity regarding healthcare. Total CRBS-A scores were significantly lower in patients who were referred to CR (2.8 ± 0.6) vs. those who were not (3.6 ± 0.8), confirming criterion validity (p = 0.04). Mitigation strategies were considered very helpful (mean = 4.2 ± 0.8/5). The CRBS-A is reliable and valid. It can support identification of top barriers to CR participation at multiple levels, and then strategies for mitigating them can be implemented.
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Affiliation(s)
- Raghdah Aljehani
- Rehabilitation Department, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M4G 2V6, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Aseel Aburub
- Department of Physiotherapy, Applied Science Private University, Amman 11931, Jordan
| | - Karam Turk-Adawi
- College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
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Turk-Adawi K, Ghisi GLM, Tran C, Heine M, Raidah F, Contractor A, Grace SL. First report of the International Council of Cardiovascular Prevention and Rehabilitation's Registry (ICRR). Expert Rev Cardiovasc Ther 2023; 21:357-364. [PMID: 37024997 DOI: 10.1080/14779072.2023.2199154] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Cardiac rehabilitation - programs comprehensively delivering outpatient secondary prevention - is under-available and under-studied in the resource-poor settings where it is needed most. This report summarizes the governance, participating sites, patient characteristics and outcomes, as well as knowledge translation activities during first year of operation of ICCPR's registry, namely the International Cardiac Rehab Registry. METHODS A pilot study was undertaken with five centers, demonstrating feasibility, satisfaction with the on-boarding processes, as well as data quality. RESULTS Fourteen centers have been engaged from all regions but Europe; Data have been entered on >1000 patients (18.1% female; mean age = 57.6), of whom 62.4% completed their programs and 19.9% dropped out for work or clinical reasons. Post-program, completers had significantly better work status, functional capacity, medication adherence, physical activity levels, diet, as well as lower tobacco use than non-completers (all p < 0.05). A site Certification program was developed and piloted, with five centers now recognized for their quality, given they met over 70% of the 13 internationally agreed standards based on Registry data and a virtual site assessment. CONCLUSION Annual assessments have started. Quality improvement activities will soon be underway. We continue to invite new programs, supporting development in resource-poor settings to the benefit of patients served.
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Affiliation(s)
| | - G L M Ghisi
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Research Institute- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - C Tran
- Faculty of Health, York University, Toronto, ON, Canada
| | - M Heine
- UMC Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
| | - F Raidah
- Faculty of Health, York University, Toronto, ON, Canada
| | - A Contractor
- Rehabilitation and Sports Medicine, Sir H.N Reliance Foundation Hospital, Mumbai, India
| | - S L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Research Institute- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Xu Z, de Melo Ghisi GL, Liu X, Cui L, Grace SL. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions. Open Med (Wars) 2023; 18:20230674. [PMID: 37009051 PMCID: PMC10052381 DOI: 10.1515/med-2023-0674] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 03/30/2023] Open
Abstract
The objective of this cross-sectional study was to investigate health management, well-being, and pandemic-related perspectives of chronic disease patients in the context of stringent measures, and associated correlates. A self-report survey was administered during the Omicron wave lockdown in Shanghai, China. Items from the Somatic Symptom Scale (SSS) and Symptom Checklist-90 were administered, as well as pandemic-related items. Overall, 1,775 patients (mostly married females with hypertension) were recruited through a community family physician group. Mean SSS scores were 36.1 ± 10.5/80, with 41.5% scoring in the elevated range (i.e., >36). In an adjusted model, being female, diagnosis of coronary artery disease and arrhythmia, perceived impact of pandemic on life, health condition, change to exercise routine, tolerance of control measures, as well as perception of future and control measures were significantly associated with greater distress. One-quarter perceived the pandemic had a permanent impact on their life, and 44.1% perceived at least a minor impact. One-third discontinued exercise due to the pandemic. While 47.6% stocked up on their medications before the lockdown, their supply was only enough for two weeks; 17.5% of participants discontinued use. Chief among their fears were inability to access healthcare (83.2%), and what they stated they most needed to manage their condition was medication access (65.6%). Since 2020 when we assessed a similar cohort, distress and perceived impact of the pandemic have worsened. Greater access to cardiac rehabilitation in China could address these issues.
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Affiliation(s)
- Zhimin Xu
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200082, China
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, M4G 2R6, Canada
| | - Xia Liu
- Chengdu Wanda UPMC Hospital, Chengdu, 610218, Sichuan Province, China
| | - Lixian Cui
- Division of Arts and Sciences, NYU Shanghai, 200122, Shanghai, China
| | - Sherry L. Grace
- Faculty of Health, York University, 4700 Keele St, North York, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Canada (Drs Ghisi and Grace); MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, School of Health and Well Being, University of Glasgow, Glasgow, United Kingdom (Dr Taylor); Departamento de Ciencias de La Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile (Dr. Seron); and Faculty of Health, York University, Toronto, Canada (Dr Grace)
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Antoniou V, Pasias K, Loukidis N, Exarchou-Kouveli KK, Panagiotakos DB, Grace SL, Pepera G. Translation, Cross-Cultural Adaptation and Psychometric Validation of the Greek Version of the Cardiac Rehabilitation Barriers Scale (CRBS-GR): What Are the Barriers in South-East Europe? Int J Environ Res Public Health 2023; 20:4064. [PMID: 36901075 PMCID: PMC10002300 DOI: 10.3390/ijerph20054064] [Citation(s) in RCA: 6] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/19/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Cardiac Rehabilitation (CR) is a secondary prevention intervention proven to improve quality of life, yet with low participation. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess multi-level barriers to participation. This study aimed at the translation, and cross-cultural adaptation of the CRBS into the Greek language (CRBS-GR), followed by psychometric validation. Some 110 post-angioplasty patients with coronary artery disease (88.2% men, age 65.3 ± 10.2 years) answered the CRBS-GR. Factor analysis was performed to obtain the CRBS-GR subscales/factors. The internal consistency and 3-week test-retest reliability was evaluated using Cronbach's alpha (α) and intraclass correlation coefficient (ICC), respectively. Construct validity was tested via convergent and divergent validity. Concurrent validity was assessed with the Hospital Anxiety and Depression Scale (HADS). Translation and adaptation resulted in 21 items similar to the original version. Face validity and acceptability were supported. Construct validity assessment revealed four subscales/factors, with acceptable overall reliability (α = 0.70) and subscale internal consistency for all but one factor (α range = 0.56-0.74). The 3-week test-retest reliability was 0.96. Concurrent validity assessment demonstrated a small to moderate correlation of the CRBS-GR with the HADS. The greatest barriers were the distance from the rehabilitation center, the costs, the lack of information about CR, and already exercising at home. The CRBS-GR is a reliable and valid tool for identifying CR barriers among Greek-speaking patients.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Konstantinos Pasias
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Nektarios Loukidis
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Kalliopi K. Exarchou-Kouveli
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
| | - Demosthenes B. Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, GR-17671 Athens, Greece
| | - Sherry L. Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Τoronto, ON M3J 1P3, Canada
- KITE Research Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5G 2A2, Canada
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Laboratory, Department of Physiotherapy, School of Health Sciences, University of Thessaly, GR-35100 Lamia, Greece
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Affiliation(s)
- Sherry L Grace
- York University, Faculty of Health, 4700 Keele Street, KaHS Bethune 368, Toronto M3J 1P3, Canada.,KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
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Menezes HJ, D' Souza SRB, Padmakumar R, Babu AS, Rao RR, Kamath VG, Kamath A, Grace SL. Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle-income setting: A randomized controlled trial protocol. Res Nurs Health 2023; 46:13-25. [PMID: 36371623 DOI: 10.1002/nur.22276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.
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Affiliation(s)
- Henita Joshna Menezes
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D' Souza
- Department of Obstetric and Gynecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Ramachandran Padmakumar
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Rohini R Rao
- Department of Computer Applications, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Veena G Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada.,KITE and Director Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Sadeghi M, Turk-Adawi K, Supervia M, Fard MR, Noohi F, Roohafza H, Sarrafzadegan N, Grace SL. Availability and nature of cardiac rehabilitation by province in Iran: A 2018 update of ICCPR's global audit. J Res Med Sci 2023; 28:1. [PMID: 36974111 PMCID: PMC10039098] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 03/29/2023]
Abstract
Background Cardiac rehabilitation (CR) is scantly available in Iran, although it is the cost-benefit strategy in cardiac patients, It has not been established how CR is delivered within Iran. This study aimed to determine: (a) availability, density and unmet need for CR, and (b) nature of CR services in Iran by province. Materials and Methods In this cross-sectional sub-study of the global CR audit, program availability was determined through cardiovascular networks. An online survey was then disseminated to these programs in June 2016-2017 which assessed capacity and characteristics; a paper-based survey was disseminated in 2018 to nonresponding and any new programs. CR density and need was computed based on annual incidence of acute myocardial infarction (AMI) in each province. Results Of the 31 provinces, 12 (38.7%) had CR services. There were 30 programs nationally, all in capital cities; of these, programs in 9 (75.0%) provinces, specifically 22 (73.3%) programs, participated. The national CR density is 1 spot per 7 incident AMI patients/year. Unmet need is greatest in Khuzestan, Tehran and west Azerbaijan, with 44,816 more spots needed/year. Most programs assessed cardiovascular risk factors, and offered comprehensive services, delivered by a multi-disciplinary team, comprised chiefly of nurses, dietitians and cardiologists. Median dose is 14 sessions/program in supervised programs. A third of programs offered home-based services. Conclusion Where programs do exist in IRAN, they are generally delivered in accordance with guidelines. Therefore, we must increase capacity in CR services in all provinces to improve secondary prevention services.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karam Turk-Adawi
- Department of Public Health, QU-Health, Qatar University, Doha, Qatar
| | - Marta Supervia
- Medicina Física y Rehabilitación, Gregorio Marañón Health Research Institute, Gregorio Marañón General University Hospital, Madrid, Spain
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammad Rafati Fard
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereydoun Noohi
- Rajaie Cardiovascular, Medical and Research Center, Iranian Network of Cardiovascular Research, Tehran, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Canada
- KITE-Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
- Address for correspondence: Prof. Sherry L Grace, York University, 4700 Keele Street, Toronto, ON M3J1P3, Canada. E-mail:
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Xu Z, Cui L, Ghisi GLDM, Liu X, Grace SL. Older Adults' Attitudes Regarding COVID-19 and Associated Infection Control Measures in Shanghai and Impact on Well-Being. J Clin Med 2022; 11:jcm11247275. [PMID: 36555893 PMCID: PMC9784737 DOI: 10.3390/jcm11247275] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
This cross-sectional study investigated health management, well-being, and pandemic-related perspectives in Shanghainese adults ≥50 years at the early stages of COVID-19 using a self-report survey in March−April, 2020. Items from the SSS, PHQ-9 and GAD-7 were administered. A total of 1181 primarily married, retired females participated. Many participants had hypertension (44.1%), coronary artery disease (CAD; 17.8%), and diabetes (14.5%). While most (n = 868, 73.5%) were strictly following control measures and perceived they could tolerate >6 months (n = 555, 47.0%) and were optimistic (n = 969, 82.0%). A total of 52 (8.2%) of those with any condition and 19 (3.5%) of those without a condition reported that the pandemic was impacting their health. Somatic symptoms were high (29.4 ± 7.1/36), with sleep/cognitive symptoms highest. Totals of 20.2% and 17.0% of respondents had elevated depressive and anxious symptoms, respectively; greater distress was associated with lower income (p = 0.018), having hypertension (p = 0.001) and CAD (p < 0.001), negative perceptions of global COVID-19 control (p = 0.004), COVID-19 spread (p < 0.001), impact on life/health (p < 0.001), compliance with control measures (p < 0.001), and the toleration of shorter time control measures (p < 0.001) in adjusted analyses. In conclusion, during the initial COVID-19 outbreak, most older adults were optimistic/resilient regarding the epidemic and control measures. However, the distress of older adults was not trivial, particularly in those with health issues.
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Affiliation(s)
- Zhimin Xu
- Cardiology Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Lixian Cui
- Division of Arts and Sciences, New York University Shanghai, Shanghai 200122, China
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON M4G 2R6, Canada
| | - Xia Liu
- Chengdu Wanda UPMC Hospital, Chengdu 610218, China
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute & Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
- Correspondence:
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Ghisi GLDM, Kin SMR, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini R Kin
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Cha S, Grace SL, Han K, Kim B, Paik NJ, Kim WS. Editor's Choice - Effect of Physical Activity and Tobacco Use on Mortality and Morbidity in Patients with Peripheral Arterial Disease After Revascularisation: A Korean Nationwide Population Based Cohort Study. Eur J Vasc Endovasc Surg 2022; 64:417-426. [PMID: 35671938 DOI: 10.1016/j.ejvs.2022.05.047] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effects of physical activity (PA) and tobacco use on adverse clinical outcomes after revascularisation for peripheral arterial disease (PAD) in the Western Pacific region, where PAD cases and tobacco use are among the highest in the world. METHODS This was a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database and included patients who had received revascularisation for PAD between 2010 and 2015. They were categorised as active or inactive based on the number of days per week they engaged in PA and as current or non-tobacco users (self report). The primary outcome was all cause mortality. Secondary outcomes included major adverse outcome (a composite of all cause mortality, myocardial infarction, and stroke) and major adverse limb event (MALE, a composite of amputation and recurrent revascularisation). RESULTS The relatively healthy cohort comprised 8 324 patients (mean age 64.7 years; 76.9% male) following revascularisation for PAD. Among them, 32.7% were inactive and 26.4% were tobacco users. Active patients had better outcomes than inactive patients (all cause mortality adjusted hazard ratio [adjHR] 0.766; 95% CI 0.685 - 0.855, major adverse outcome adjHR 0.795; 95% CI 0.719 - 0.878, MALE adjHR 0.858; 95% CI 0.773 - 0.953). Tobacco users had poorer outcomes than non-users (all cause mortality adjHR 1.279; 95% CI 1.124 - 1.456, major adverse outcome adjHR 1.263; 95% CI 1.124 - 1.418, MALE adjHR 1.291; 95% CI 1.143 - 1.458). CONCLUSION Even after receiving revascularisation for PAD, a sizable proportion of patients were physically inactive and used tobacco, leading to adverse clinical outcomes such as death, cardiovascular morbidity, and amputation in Korea. These modifiable risk factors should be addressed systematically, and a comprehensive approach including supervised exercise programmes and tobacco cessation is needed in patients with PAD.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sherry L Grace
- York University & the University Health Network, Toronto, Canada
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Liu X, Grace SL, Ghisi GLM, Shi W, Shen C, Oh P, Zhang Y. Controlled pilot test of a translated cardiac rehabilitation education curriculum in percutaneous coronary intervention patients in a middle-income country delivered using WeChat: acceptability, engagement, satisfaction and preliminary outcomes. Health Educ Res 2022; 37:314-332. [PMID: 36087021 DOI: 10.1093/her/cyac022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/10/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
In China, despite the rapid increase in percutaneous coronary interventions (PCIs), cardiac rehabilitation (CR) is just burgeoning, leaving a need for comprehensive evidence-based education curricula. This pilot study assessed the acceptability of Simplified Chinese CR education delivered via booklets and videos on WeChat asynchronously and the impact on improving knowledge, risk factors, health behaviors and quality of life. In this pre-post, controlled, observational study, interested PCI patients received the 12-week intervention or usual care and WeChat without education. Participants completed validated surveys, including the Coronary Artery Disease Education-Questionnaire and Self-Management Scale. Acceptability (14 Likert-type items), engagement (minutes per week) and satisfaction were assessed in intervention participants. Ninety-six patients consented to participate (n = 49 intervention), of which 66 (68.8%) completed the follow-up assessments. Twenty-seven (77.1%) retained intervention participants engaged with the materials, rating content as highly acceptable (all means ≥4/5) and satisfactory (2.19 ± 0.48/3); those engaging more with the intervention were significantly more satisfied (P = 0.03). While participants in both groups achieved some improvements, only intervention participants had significant increases in disease-related knowledge, reductions in body mass index and triglycerides, as well as improvements in diet (all P < 0.05). In this first study validating the recently translated CR patient education intervention, acceptability and benefits have been supported.
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Affiliation(s)
- X Liu
- School of Nursing, Shanghai Jiao Tong University, 227 Chongqing South Rd, Shanghai 200025, China
| | - S L Grace
- Faculty of Health, York University, Toronto M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| | - G L M Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - W Shi
- Faculty of Medicine and Health, The University of Sydney Charles Perkins Centre, Sydney 2006, Australia
| | - C Shen
- Cardiology, Shanghai Sixth People's Hospital, 600 Yishan Rd, Shanghai 200233, China
| | - P Oh
- CardiovascularPrevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Y Zhang
- School of Nursing, Shanghai Jiao Tong University, 227 Chongqing South Rd, Shanghai 200025, China
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Abukhadijah HJ, Turk-Adawi KI, Dewart N, Grace SL. Qualitative study measuring the usability of the International Cardiac Rehabilitation Registry. BMJ Open 2022; 12:e064255. [PMID: 36038174 PMCID: PMC9438019 DOI: 10.1136/bmjopen-2022-064255] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is a comprehensive model of secondary preventive care. There is a wide variety in implementation characteristics globally, and hence quality control is paramount. Thus, the International Council of Cardiovascular Prevention and Rehabilitation was urged to develop a CR registry. The purpose of this study was to test the perceived usability of the International Cardiac Rehabilitation Registry (ICRR) to optimise it. DESIGN This was a qualitative study, comprising virtual usability tests using a think-aloud method to elicit feedback on the ICRR, while end-users were entering patient data, followed by semistructured interviews. SETTING Ultimately, 12 tests were conducted with CR staff (67% female) in low-resource settings from a variety of disciplines in all regions of the world but Europe before saturation was achieved. PRIMARY OUTCOME MEASURE Participants completed the System Usability Scale. Interviews were transcribed verbatim except to preserve anonymity, and coded using NVIVO by two researchers independently. The Unified Theory of Acceptance and Use of Technology 2 informed analysis. RESULTS The ICRR was established as easy to use, relevant, efficient, with easy learnability, operability, perceived usefulness, positive perceptions of output quality and high end-user satisfaction. System usability was 83.75, or 'excellent' and rated 'A'. Four major themes were deduced from the interviews: (1) ease of approvals, adoption and implementation; (2) benefits for programmes, (3) variables and their definitions, as well as (4) patient report and follow-up assessment. Based on participant observation and utterances, suggestions for changes to the ICRR were implemented, including to the programme survey, on-boarding processes, navigational instructions, inclusion of programme logos, direction on handling unavailable data and optimising data completeness, as well as policies for authorship and programme certification. CONCLUSIONS With usability of the ICRR optimised, pilot testing shall ensue.
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Affiliation(s)
- Hana J Abukhadijah
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Karam I Turk-Adawi
- Department of Public Health,College of Health Sciences,QU Health, Qatar University, Doha, Qatar
| | - Nora Dewart
- Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network,University of Toronto, Toronto, Ontario, Canada
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Miralles-Resurreccion KV, Grace SL, Cuenza LR. Trends in cardiac rehabilitation enrollment post-coronary artery bypass grafting upon implementation of automatic referral in Southeast Asia: A retrospective cohort study. J Cardiovasc Thorac Res 2022; 14:84-89. [PMID: 35935385 PMCID: PMC9339729 DOI: 10.34172/jcvtr.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cardiac rehabilitation (CR) is an effective but underutilized intervention. Strategies have been identified to increase its use, but there is paucity of data testing them in low-resource settings. We sought to determine the effect of automatic referral post-coronary artery bypass graft (CABG) surgery on CR enrollment.
Methods: This is a retrospective cohort study assessing cardiac patients referred to CR at a tertiary center in Southeast Asia from 2013 to 2019. The paper-based pathway was introduced at the end of 2012. The checklist with automatic CR referral on the third day post-operation prompted a nurse to educate the patient about CR, initiate phase 1 and encourage enrollment in phase 2. Patients who were not eligible for the pathway for administrative or clinical reasons were referred at the discretion of the attending physician (i.e., usual care). Enrollment was defined as attendance at≥1 CR visit. Results: Of 4792 patients referred during the study period, 394 enrolled in CR. Significantly more patients referred automatically enrolled compared to usual care (225 [11.8%] vs. 169 [5.8%]; OR=2.2, 95% CI=1.8-2.7), with increases up to 23.4% enrollment in 2014 (vs. average enrollment rate of 5.9% under usual referral). Patients who enrolled following automatic referral were significantly younger and more often employed (both P<0.001); no other differences were observed. Conclusion: In a lower-resource, Southeast Asian setting, automatic CR referral is associated with over two times greater enrollment in phase 2 CR, although efforts to maintain this effect are required.
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Affiliation(s)
| | - Sherry L. Grace
- York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada
| | - Lucky R. Cuenza
- Section of Cardiac Rehabilitation, Philippine Heart Center, Quezon City, Philippines
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McCleary N, Ivers NM, Schwalm JD, Witteman HO, Taljaard M, Desveaux L, Bouck Z, Grace SL, Grimshaw JM, Presseau J. Impacts of two behavior change interventions on determinants of medication adherence: process evaluation applying the health action process approach and habit theory alongside a randomized controlled trial. J Behav Med 2022; 45:659-673. [PMID: 35596020 DOI: 10.1007/s10865-022-00327-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Investigating the mechanisms of behavior change interventions provides a more fulsome understanding of how and why interventions work (or don't work). We assessed mechanisms of two interventions (mailouts alone, and mailouts plus telephone support, informed by the Health Action Process Approach (HAPA) and Habit Theory), designed to increase medication adherence after myocardial infarction. We conducted a process evaluation alongside a pragmatic trial. Medication adherence was assessed via self-report at 12-months in the trial, and participants in all trial groups were invited to contemporaneously complete an additional questionnaire assessing targeted mechanisms (HAPA constructs and automaticity). We used multiple regression-based mediation models to investigate indirect effects. Of 589 respondents, 497 were analyzed (92 excluded due to missing data). Mailouts plus telephone support had statistically significant but small effects on intention, social support, action planning, coping planning, and automaticity. There were no indirect effects of interventions on medication adherence via these constructs. Therefore, while this intervention led to changes in proposed mechanisms, these changes were not great enough to lead to behavior change. Refinements (and subsequent evaluation) of the interventions are warranted, and our findings indicate that this could involve offering more intensive support to form plans and identify cues for taking medications, in addition to providing physical supports to encourage self-monitoring, feedback, and habit formation. Trial registration: ClinicalTrials.gov: NCT02382731.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - J-D Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Division of Cardiology, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,Department of Family and Emergency Medicine, Laval University, Québec City, QC, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada.,KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Babu AS, Heald FA, Contractor A, Ghisi GLM, Buckley J, Mola A, Atrey A, Lopez-Jimenez F, Grace SL. Building Capacity Through ICCPR Cardiovascular Rehabilitation Foundations Certification (CRFC): EVALUATION OF REACH, BARRIERS, AND IMPACT. J Cardiopulm Rehabil Prev 2022; 42:178-182. [PMID: 34840246 DOI: 10.1097/hcr.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
PURPOSE The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) developed an online Cardiovascular Rehabilitation Foundations Certification (CRFC; https://globalcardiacrehab.com/Certification) in October 2017, to build cardiac rehabilitation (CR) delivery capacity in low-resource settings based on their guidelines. Herein we evaluate its reach globally, barriers to its completion, as well as satisfaction and impact of the course among those completing it. METHODS The country of origin of all applicants was tallied. An online survey was developed for learners who completed the CRFC (completers), and for those who applied but did not yet complete the program (noncompleters), administered using Google Forms. RESULTS With regard to reach, 236 applications were received from 23/203 (11%) countries in the world; 51 (22%) were from low- or middle-income countries. A total of 130 (55%) have completed the CRFC; mean scores on the final examination were 88.3 ± 7.1%, with no difference by country income classification (P= .052). Sixteen (22%) noncompleters and 37 (34%) completers responded to the survey. Barriers reported by noncompleters were time constraints, cost, and technical issues. Overall satisfaction (scale 1-5) with the CRFC was high (4.49 ± 0.51); most completers would highly recommend the CRFC to others (4.30 ± 0.66), and perceived that the information provided will contribute to their work and/or the care of their patients (4.38 ± 0.89); 29 (78%) had used the information from the CRFC in their practice. CONCLUSIONS The reach of the CRFC still needs to be broadened, in particular in low-resource settings. Learners are highly satisfied with the certification, and its impacts on CR practice are encouraging. Input has been implemented to improve the CRFC.
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Affiliation(s)
- Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India (Dr Babu); Faculty of Health, York University, Toronto, Ontario, Canada (Drs Heald and Grace); Centre for Rehabilitation Medicine and Sports Medicine, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India (Dr Contractor); KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada (Drs Heald, Ghisi, and Grace); Institute of Medicine, University Centre Shrewsbury, Shrewsbury, England (Dr Buckley); Langone Medical Center, New York University, New York City, New York (Dr Mola); Independent researcher, Toronto, Ontario, Canada (Dr Atrey); Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Dr Lopez-Jimenez); and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada (Dr Grace)
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Redfern J, Gallagher R, O’Neil A, Grace SL, Bauman A, Jennings G, Brieger D, Briffa T. Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future. Front Cardiovasc Med 2022; 9:842567. [PMID: 35571195 PMCID: PMC9091441 DOI: 10.3389/fcvm.2022.842567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
Contemporary myocardial infarction (MI) care and management has evolved dramatically since the 1950's; yet outpatient rehabilitation remains underutilized. Deepening our understanding of the origins and history of cardiac rehabilitation highlights a contemporary shift required for policy and practice related to secondary prevention of coronary disease in light of societal changes as well as medical, digital and surgical advancements. Contemporary "cardiac rehabilitation" began when bed rest and physical inactivity was recommended and commonplace for MI survivors. Today, most patients who survive an MI, undergo reperfusion therapy, a short inpatient stay and are discharged with minimal physical morbidity. Despite this, the majority of modern day programs continue to be structured in the same way they have been for the past 50 years and this model has become incongruent with the contemporary context, especially in the COVID-19 era. This review aims to describe the historical foundations of cardiac rehabilitation to inform solutions and meet the demands of contemporary MI management. Delivering health systems reform to address modernization is current healthcare challenge where a united and interdisciplinary effort is needed.
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Affiliation(s)
- Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Adrienne O’Neil
- School of Medicine, IMPACT Institute, Deakin University, Geelong, VIC, Australia
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Garry Jennings
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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Heald FA, de Araújo Pio CS, Liu X, Theurel FR, Pavy B, Grace SL. Evaluation of an Online Course in 5 Languages for Inpatient Cardiac Care Providers on Promoting Cardiac Rehabilitation: REACH, EFFECTS, AND SATISFACTION. J Cardiopulm Rehabil Prev 2022; 42:103-108. [PMID: 34793364 DOI: 10.1097/hcr.0000000000000619] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Evidence proves that health care providers should promote cardiac rehabilitation (CR) to patients face-to-face to increase CR enrollment. An online course was designed to promote this at the bedside; it is evaluated herein in terms of reach, effect on knowledge, attitudes, discussion self-efficacy and practices, and satisfaction. METHODS Design was observational, one-group pre- and post-test. Some demographics were requested from learners taking all language versions of the 20-min course: English, Portuguese, French, Spanish, and simplified Chinese, available at: https://globalcardiacrehab.com/CR-Utilization. Investigator-generated items in the pre- and post-test and evaluation survey administered using Google Forms were based on Kirkpatrick's training evaluation model. RESULTS The course was initiated by 522 learners from 33 of 203 (16%) countries; most commonly female (n = 341, 65%) nurses (n = 180, 34%) from high-income countries (n = 259, 57%) completing the English (n = 296, 57%) and Chinese (n = 108, 21%) versions. A total of 414 (79%) learners completed the post-test and 302 (58%) completed the evaluation. Median CR attitudes were 5 of 5 on the Likert scale at pre-test, suggesting some selection bias. Mean CR knowledge ([7.22 ± 2.14]/10), discussion self-efficacy ([3.86 ± 0.85]/5), and practice ([4.13 ± 1.11]/5) significantly improved after completion of the course (all P < .001). Satisfaction was high regardless of language version ([4.44 ± 0.64]/5; P = .593). CONCLUSIONS This free, open-access course is effective in increasing CR knowledge, self-efficacy, and encouragement practices among participating inpatient cardiac providers, with high satisfaction. While testing impact on actual CR use is needed, it should be more broadly disseminated to increase reach, in an effort to increase patient enrollment in CR, to reduce morbidity and mortality.
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Affiliation(s)
- Fiorella A Heald
- Faculty of Health, York University, Toronto, Ontario, Canada (Drs Heald and Grace); KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Ontario, Canada (Drs Heald, Santiago de Araújo Pio, Rivera Theurel, and Grace); School of Nursing, Shanghai Jiao Tong University, Shanghai, China (Ms Liu); Department of Cardiac Rehabilitation, Hospital Loire-Vendée-Océan, Machecoul, France (Dr Pavy); and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada (Dr Grace)
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Oliveros MJ, Serón P, Buitrago-García D, Grace SL. Cardiac rehabilitation effectiveness for coronary artery disease by clinical era: trial sequential analysis. Eur J Prev Cardiol 2022; 29:e18-e21. [PMID: 33624075 DOI: 10.1093/eurjpc/zwaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/14/2022]
Affiliation(s)
- María-José Oliveros
- Departamento Medicina Interna-Centro de Excelencia CIGES, Facultad de Medicina, Universidad de La Frontera, Claro Solar #115, Temuco, Chile
| | - Pamela Serón
- Departamento Medicina Interna-Centro de Excelencia CIGES, Facultad de Medicina, Universidad de La Frontera, Claro Solar #115, Temuco, Chile
| | - Diana Buitrago-García
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Calle Rumipamba s/n, Quito, Ecuador.,Epidemiología Clínica, Fundación Universitaria de Ciencias de la Salud-FUCS, Carrera 54 No.67A - 80, Bogotá, Colombia
| | - Sherry L Grace
- Faculty of Health, York University, 4700 Keele Street, Toronto, Ontario, Canada.,KITE, University Health Network, University of Toronto, 550 University Ave, Toronto, Ontario, Canada
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Rangel-Cubillos DM, Vega-Silva AV, Corzo-Vargas YF, Molano-Tordecilla MC, Peñuela-Arévalo YP, Lagos-Peña KM, Jácome-Hortúa AM, Villamizar-Jaimes CJ, Grace SL, Dutra de Souza HC, Angarita-Fonseca A, Sánchez-Delgado JC. Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives. Int J Environ Res Public Health 2022; 19:ijerph19041911. [PMID: 35206100 PMCID: PMC8872241 DOI: 10.3390/ijerph19041911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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: 11/30/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 01/27/2023]
Abstract
Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 ± 1.6), distance (2.6 ± 1.6) and transportation (2.5 ± 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.
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Affiliation(s)
- Diana Marcela Rangel-Cubillos
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Andrea Vanessa Vega-Silva
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Yully Fernanda Corzo-Vargas
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Maria Camila Molano-Tordecilla
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Yesica Paola Peñuela-Arévalo
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Karen Mayerly Lagos-Peña
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | - Adriana Marcela Jácome-Hortúa
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
| | | | - Sherry L. Grace
- Faculty of Health, York University, Toronto, ON M3J 1P3, Canada;
- KITE-Toronto Rehab Institute, & Director of Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M4G 1R7, Canada
| | - Hugo Celso Dutra de Souza
- Laboratory of Physiology and Cardiovascular Physioterapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Correspondence: (H.C.D.d.S.); or (J.C.S.-D.)
| | - Adriana Angarita-Fonseca
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
- Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, QC J9X 5E4, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Juan Carlos Sánchez-Delgado
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga 680003, Colombia; (D.M.R.-C.); (A.V.V.-S.); (Y.F.C.-V.); (M.C.M.-T.); (Y.P.P.-A.); (K.M.L.-P.); (A.M.J.-H.); (A.A.-F.)
- Laboratory of Physiology and Cardiovascular Physioterapy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Grupo de Investigación Ser Cultura y Movimiento, Universidad Santo Tomás-Bucaramanga, Santander 680001, Colombia
- Correspondence: (H.C.D.d.S.); or (J.C.S.-D.)
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Heald FA, Marzolini S, Colella TJF, Oh P, Nijhawan R, Grace SL. Profile of women choosing mixed-sex, women-only, and home-based cardiac rehabilitation models and impact on utilization. Women Health 2022; 62:98-107. [DOI: 10.1080/03630242.2021.2023247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fiorella A. Heald
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tracey J. F. Colella
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rajni Nijhawan
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Mamataz T, Ghisi GLM, Pakosh M, Grace SL. Outcomes and Cost of Women-Focused Cardiac Rehabilitation: A Systematic Review and Meta-analysis. Maturitas 2022; 160:32-60. [DOI: 10.1016/j.maturitas.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 01/16/2023]
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Heald FA, Marzolini S, Colella TJF, Oh P, Nijhawan R, Grace SL. Women's outcomes following mixed-sex, women-only, and home-based cardiac rehabilitation participation and comparison by sex. BMC Womens Health 2021; 21:413. [PMID: 34911506 PMCID: PMC8672337 DOI: 10.1186/s12905-021-01553-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/16/2021] [Accepted: 11/26/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite women's greater need for cardiac rehabilitation (CR), they are less likely to utilize it. Innovative CR models have been developed to better meet women's needs, yet there is little controlled, comparative data assessing the effects of these models for women. This study compared outcomes in women electing to participate in mixed-sex, women-only, or home-based CR, and a matched sample of men. METHODS In this retrospective study, electronic records of CR participants in Toronto who were offered the choice of program model between January 2017 and July 2019 were analyzed; clinical outcomes comprised cardiorespiratory fitness, risk factors and psychosocial well-being. These were assessed at intake and post-6-month program and analyzed using general linear mixed models. RESULTS There were 1181 patients (727 women [74.7% mixed, 22.0% women-only, 3.3% home-based]; 454 age and diagnosis-matched men) who initiated CR; Cardiorespiratory fitness among women was higher at initiation of mixed-sex than women-only (METs 5.1 ± 1.5 vs 4.6 ± 1.3; P = .007), but no other outcome differences were observed. 428 (58.9%) women completed the programs, with few women retained in the home-based model limiting comparisons. There were significant improvements in high-density lipoprotein cholesterol (P = .001) and quality of life (P = .001), and lower depressive symptoms (P = .030) as well as waist circumference (P = .001) with mixed-sex only. VO2peak was significantly higher at discharge in mixed-sex than women-only (estimate = 1.67, standard error = 0.63, 95% confidence interval = 0.43-2.91). CONCLUSION Participation in non-gender-tailored women-only CR was not advantageous as expected. More research is needed, particularly including women participating in home-based programs.
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Affiliation(s)
- Fiorella A Heald
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Susan Marzolini
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tracey J F Colella
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paul Oh
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Rajni Nijhawan
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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Winnige P, Filakova K, Hnatiak J, Dosbaba F, Bocek O, Pepera G, Papathanasiou J, Batalik L, Grace SL. Validity and Reliability of the Cardiac Rehabilitation Barriers Scale in the Czech Republic (CRBS-CZE): Determination of Key Barriers in East-Central Europe. Int J Environ Res Public Health 2021; 18:ijerph182413113. [PMID: 34948722 PMCID: PMC8701715 DOI: 10.3390/ijerph182413113] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East-Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech language (CRBS-CZE) and identified the main CR barriers. Consecutive cardiac in/out-patients were approached from January 2020 for 18 months, of whom 186 (89.9%) consented. In addition to sociodemographic characteristics, participants completed the 21-item CRBS-CZE (response options 1-5, with higher scores representing greater barriers), and their CR utilization was tracked. Forty-five (24.2%) participants enrolled in CR, of whom 42 completed the CRBS a second time thereafter. Factor analysis revealed four factors, consistent with other CRBS translations. Internal reliability was acceptable for all but one factor (Cronbach's alpha range = 0.44-0.77). Mean total barrier scores were significantly higher in non-enrollers (p < 0.001), decreased from first and second administration in these enrollers (p < 0.001), and were lower in CR completers (p < 0.001), supporting criterion validity. There were also significant differences in barrier scores by education, geography, tobacco use, among other variables, further supporting validity. The biggest barriers to enrolment were distance, work responsibilities, lack of time, transportation problems, and comorbidities; and the greatest barriers to adherence were distance and travel. Several items were considered irrelevant at first and second administration. Other barriers included wearing a mask during the COVID-19 pandemic. The study demonstrated sufficient validity and reliability of CRBS-CZE, which supports its use in future research.
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Affiliation(s)
- Petr Winnige
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
| | - Katerina Filakova
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
| | - Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
| | - Otakar Bocek
- Department of Internal Cardiology Medicine, University Hospital Brno, 62500 Brno, Czech Republic;
| | - Garyfallia Pepera
- Physiotherapy Department, Faculty of Health Sciences, University of Thessaly, 35100 Lamia, Greece;
| | - Jannis Papathanasiou
- Department of Medical Imaging, Allergology & Physiotherapy, Faculty of Dental Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Department of Kinesitherapy, Faculty of Public Health, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Ladislav Batalik
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (K.F.); (J.H.); (F.D.)
- Correspondence:
| | - Sherry L. Grace
- Faculty of Health, York University & KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON M3J 1P3, Canada;
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Chang IS, Boger J, Mak S, Grace SL, Arcelus A, Chessex C, Mihailidis A. Load Distribution Analysis for Weight and Ballistocardiogram Measurements of Heart Failure Patients using a Bed Scale. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:7369-7372. [PMID: 34892800 DOI: 10.1109/embc46164.2021.9629849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ballistocardiogram (BCG) is an emerging tool with the potential to monitor heart failure (HF) patients. A close association of the weight to the BCG as an intermediate signal source requires a careful design, where events such as saturation of the weight signal can result in the loss of the BCG. This work closely examined the factors around the weight while load cells placed under each support of a bed collected the BCG (e.g., body weight, distribution over the four supports of the bed). Following the calibration of weights based on the location of the polls, the study examined the ratios of loads in head-foot and lateral directions. The head-foot ratio was also correlated to the height. Twelve non-obese HF patients were recruited, and the weight and BCG were appropriately measured, where the average error of the weight measurements was 0.45 ± 0.30%. The mean ratio of the loads between head to foot sensors was 3.2 ± 0.7 with a maximum ratio of 4.5, showing that the head-ward sensors supported greater body weight. The ratio of the loads between the right to left sensors was 1.2 ± 0.1. The height and the head-to-foot ratio had an inverse correlation (r = 0.52). Based on the analysis, the head-ward sensors should have a higher capacity of up to three times that of the foot-ward sensors to prevent any signal saturation. Mobility issues were observed in some subjects, attributing to the lateral imbalance. These novel findings based on the end-users (i.e., HF population) may allow better allocation of conditioning resources to obtain the BCG (e.g., optimally adjusted sensitivity).
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Medina-Inojosa JR, Grace SL, Supervia M, Stokin G, Bonikowske AR, Thomas R, Lopez-Jimenez F. Dose of Cardiac Rehabilitation to Reduce Mortality and Morbidity: A Population-Based Study. J Am Heart Assoc 2021; 10:e021356. [PMID: 34612055 PMCID: PMC8751887 DOI: 10.1161/jaha.120.021356] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence‐based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs). Methods and Results This is an historical cohort study of all patients who had coronary artery disease and who initiated supervised CR between 2002 and 2012 from a single major CR center. CR dose was defined as number of visits including exercise and patient education. Follow‐up was performed using record linkage from the Rochester Epidemiology Project. MACEs included acute myocardial infarction, unstable angina, ventricular arrhythmias, stroke, revascularization, or all‐cause mortality. Dose was analyzed in several ways, including tertiles, categories, and as a continuous variable. Cox models were adjusted for factors associated with dose and MACE. The cohort consisted of 2345 patients, who attended a mean of 12.5±11.1 of 36 prescribed sessions. After a mean follow‐up of 6 years, 695 (29.65%) patients had a MACE, including 231 who died. CR dose was inversely associated with MACE (hazard ratio, 0.66 [95% CI]; 0.55–0.91) in those completing ≥20 sessions, when compared with those not exposed to formal exercise sessions (≤1 session; log‐rank P=0.007). We did not find evidence of nonlinearity (P≥0.050), suggesting no minimal threshold nor ceiling. Each additional session was associated with a lower rate of MACE (fully adjusted hazard ratio, 0.98 [95% CI, 0.97–0.99]). Greater session frequency was also associated with lower MACE risk (fully adjusted hazard ratio, 0.74 [95% CI, 0.58–0.94]). Conclusions CR reduces MACEs, but the benefit appears to be linear, with greater risk reduction with higher doses, and no upper threshold.
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Affiliation(s)
- Jose R Medina-Inojosa
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN.,Division of Epidemiology Department of Quantitative Health SciencesMayo Clinic Rochester MN
| | - Sherry L Grace
- KITE & Peter Menk Cardiac Centre University Health NetworkUniversity of Toronto Toronto Ontario Canada.,Faculty of Health York University Toronto Ontario Canada
| | - Marta Supervia
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN.,Gregorio Marañón Health Research InstituteGregorio Marañón General University Hospital Madrid Spain
| | - Gorazd Stokin
- International Clinical Research Center St. Anne University Hospital Brno Czech Republic
| | - Amanda R Bonikowske
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN
| | - Randal Thomas
- Division of Preventive Cardiology Department of Cardiovascular Medicine Mayo Clinic MN
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Chacin-Suarez A, Grace SL, Anchique-Santos C, Supervia M, Turk-Adawi K, Britto RR, Scantlebury DC, Araya-Ramirez F, Gonzalez G, Benaim B, Fernandez R, Hol J, Burdiat G, Salmon R, Lomeli H, Mamataz T, Medina-Inojosa JR, Lopez-Jimenez F. Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A Global Comparison. Am Heart J 2021; 240:16-27. [PMID: 34058163 DOI: 10.1016/j.ahj.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/07/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. METHODS In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. RESULTS ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). CONCLUSION In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.
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Affiliation(s)
| | - Sherry L Grace
- York University & University Health Network (KITE & Peter Munk Cardiac Centre), University of Toronto, Canada
| | | | - Marta Supervia
- Mayo Clinic, Rochester, MN; Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | | | | | | | | | - Briseida Benaim
- Asociación Cardiovascular Centro-occidental (ASCARDIO), Barquisimeto, Venezuela
| | | | | | | | | | - Hermes Lomeli
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, México
| | - Taslima Mamataz
- York University & University Health Network (KITE & Peter Munk Cardiac Centre), University of Toronto, Canada
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Mamataz T, Ghisi GLM, Pakosh M, Grace SL. Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review. BMC Cardiovasc Disord 2021; 21:459. [PMID: 34556036 PMCID: PMC8458788 DOI: 10.1186/s12872-021-02267-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background Women do not participate in cardiac rehabilitation (CR) to the same degree as men; women-focused CR may address this. This systematic review investigated the: (1) nature, (2) availability, as well as (3a) utilization of, and (b) satisfaction with women-focused CR. Methods Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception to May 2020. Primary studies of any design were included. Adult females with any cardiac diseases, participating in women-focused CR (i.e., program or sessions included ≥ 50% females, or was 1-1 and tailored to women’s needs) were considered. Two authors rated citations for inclusion. One extracted data, including study quality rated as per the Mixed-Methods Assessment Tool (MMAT), which was checked independently by a second author. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guideline. Results 3498 unique citations were identified, with 28 studies (53 papers) included (3697 women; ≥ 10 countries). Globally, women-focused CR is offered by 40.9% of countries that have CR, with 32.1% of programs in those countries offering it. Thirteen (46.4%) studies offered women-focused sessions (vs. full program), 17 (60.7%) were women-only, and 11 (39.3%) had gender-tailoring. Five (17.9%) programs offered alternate forms of exercise, and 17 (60.7%) focused on psychosocial aspects. With regard to utilization, women-focused CR cannot be offered as frequently, so could be less accessible. Adherence may be greater with gender-tailored CR, and completion effects are not known. Satisfaction was assessed in 1 trial, and results were equivocal. Conclusions Women-focused CR involves tailoring of content, mode and/or sex composition. Availability is limited. Effects on utilization require further study. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02267-0.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gabriela L M Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. .,Peter Munk Cardiac Centre, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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Ghanbari-Firoozabadi M, Mirzaei M, Nasiriani K, Hemati M, Entezari J, Vafaeinasab M, Grace SL, Jafary H, Sadrbafghi SM. Cardiac Specialists' Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting. Rehabil Process Outcome 2021; 9:1179572720936648. [PMID: 34497466 PMCID: PMC8282146 DOI: 10.1177/1179572720936648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Cardiac 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. Aim: This study investigated cardiac specialists’ perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral. Methods: In 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. Results: Four 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. Conclusions: Barriers 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.
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Affiliation(s)
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Khadijeh Nasiriani
- Mother and Newborn Health Research Center, School of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mozhgan Hemati
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Jamal Entezari
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada.,KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Hasan Jafary
- Health Policy and Management Research Center, Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Liu X, Grace SL, Ding B, Liang L, Xu Z, Zhang Y. Cardiac Rehabilitation Perceptions Among Healthcare Providers in China: A Mixed-Methods Study. Altern Ther Health Med 2021; 27:82-91. [PMID: 33891566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Cardiac rehabilitation (CR) in China has not been widely adopted for a variety of reasons, including healthcare provider (HCP)s' lack of awareness and beliefs. OBJECTIVE To explore HCP's perceptions of CR in China. METHODS An exploratory, sequential design was used in this mixed-methods study. Face-to-face semi-structured interviews were performed; this was followed by a cross-sectional survey. SETTING The interviews were conducted in a university-affiliated hospital and a rehabilitation hospital in Shanghai. The survey was conducted in the cardiac departments of primary, secondary, or tertiary hospitals in Shanghai or Yunnan Province, China. PARTICIPANTS Saturation was achieved upon interviewing 13 HCPs (5 doctors, and 8 nurses). A total of 610 HCPs (185 doctors [30.5%], 417 nurses [68.8%]) completed the survey. RESULTS Analysis of the interviews revealed 4 themes: the perceived value of CR, the need for pro-CR policy, variability in CR awareness, and obstacles to CR delivery. HCP approaches to the treatment of patients with cardiac conditions did not universally include exercise training (only approximately 60% of HCPs), or all other recommended domains of secondary prevention, and assessment of the major risk factors was quite low. Familiarity with CR was moderate (48.7%). HCPs perceived that philosophies of Traditional Chinese Medicine (TCM) were highly compatible with, and could add value to, CR. HCP approaches to secondary preventive care and CR perceptions varied significantly according to their highest level of education, clinical profession, job seniority, type of hospital where they worked, whether the hospital had a CR program and the hospital's location. CONCLUSION HCPs recognize the value of CR, particularly considering secondary preventive care practices were not comprehensive. Education is needed to improve HCPs CR awareness.
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Grace SL. Cardiac rehabilitation in Poland: residential program completion high, resulting in tobacco cessation, but need for capacity and referral urgent. Pol Arch Intern Med 2021; 131:610-611. [PMID: 34463079 DOI: 10.20452/pamw.16060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada; KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Ontario, Canada.
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