Effects of home-based cardiac rehabilitation integrated in the cardiac care bridge transitional care program on the physical functioning of older patients who are frail: secondary analysis of a randomized trial.
Michel S Terbraak, Lotte Verweij, Patricia Jepma, Marike van der Schaaf, Harald T Jørstad, Ron J G Peters, Bianca M Buurman, Wilma J M Scholte Op Reimer
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引用次数: 0
Abstract
Importance: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilized by older patients. Home-based CR potentially improves utilization, yet its effectiveness in older patients who are frail remains understudied.
Objective: The objective of this study was to investigate the effects of a transitional-care integrated home-based CR program on physical functioning in older patients who are frail after CVD hospitalization.
Design: This was a prespecified secondary analysis of physical functioning at the 6-month follow-up in the cardiac care bridge multicenter randomized trial.
Setting: A home-based setting was used.
Participants: The study participants were patients who were frail and ≥70 years old after CVD hospitalization.
Intervention: The intervention was transitional care followed by physical therapist led home-based CR and community nurse visits.
Main outcomes and measures: The primary physical function outcome was the Short Physical Performance Battery (SPPB) in cases with complete follow-up data. Secondary outcomes included the 2-min step test, grip strength, and Amsterdam Linear Disability Scale. Sensitivity analyses included an intention-to-treat analysis by multiple imputation of the full cohort.
Results: In total, 85 of 153 participants in the intervention group and 85 of 153 participants in the control group were analyzed (mean age = 82.6 [SD = 6.3] years; 46% men; median of 2 [interquartile range = 1-4] comorbidities). At the 6-month follow-up, more participants in the intervention group than in the control group demonstrated SPPB improvement (61% vs 51%) or maintenance (29% vs 12%), and fewer deteriorated (11% vs 37%). The mean SPPB values at 6 months were 6.3 (SD = 0.3) and 5.5 (SD = 0.2), respectively, with a mean difference of 0.8 (95% CI = 0.0-1.6), favoring the intervention group. No between-group differences were observed in the 2-min step test, grip strength, or Amsterdam Linear Disability Scale.
Conclusions: Among older patients who were frail and had CVD, a comprehensive transitional-care program with integrated home-based CR resulted in clinically relevant improvements in physical functioning.
Relevance: The results substantiate the effectiveness of home-based CR in older patients who are frail and have CVD.
期刊介绍：
Physical Therapy (PTJ) engages and inspires an international readership on topics related to physical therapy. As the leading international journal for research in physical therapy and related fields, PTJ publishes innovative and highly relevant content for both clinicians and scientists and uses a variety of interactive approaches to communicate that content, with the expressed purpose of improving patient care. PTJ"s circulation in 2008 is more than 72,000. Its 2007 impact factor was 2.152. The mean time from submission to first decision is 58 days. Time from acceptance to publication online is less than or equal to 3 months and from acceptance to publication in print is less than or equal to 5 months.
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