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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Barriers to participation in a phase II cardiac rehabilitation programme
Y M W Mak1, W K Chan, C S S Yue
1Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital, Kwun Tong, Hong Kong.
Insights
Most cardiac patients (79%) did not proceed to phase II cardiac rehabilitation due to physical unfitness, scheduling conflicts, or medical interventions. Overcoming these barriers is crucial for improving cardiac rehabilitation participation.
Area of Science:
- Cardiology
- Rehabilitation Medicine
- Public Health
Background:
- Cardiac rehabilitation programs are vital for patient recovery and secondary prevention.
- Phase II cardiac rehabilitation builds upon initial recovery, focusing on exercise and lifestyle changes.
- Participation rates in cardiac rehabilitation programs can be suboptimal, necessitating investigation into barriers.
Purpose of the Study:
- To identify the primary barriers preventing patients from participating in phase II cardiac rehabilitation.
- To explore potential strategies for enhancing patient engagement in phase II cardiac rehabilitation programs.
Main Methods:
- A prospective study was conducted at a regional hospital in Hong Kong.
- Cardiac patients enrolled in a phase I cardiac rehabilitation program were followed.
- Reasons for non-participation in the subsequent phase II program were systematically recorded.
Main Results:
- A significant majority of patients (79%) did not advance to phase II cardiac rehabilitation.
- Physical unfitness (49%), including lower limb issues and comorbidities (e.g., cerebrovascular accident, renal failure), was a major obstacle.
- Other barriers included postponed interventions (13%), physician-related protocol failures (7%), work/time conflicts (16%), and patient-reported reasons like financial constraints and fear.
Conclusions:
- A substantial proportion of cardiac patients face significant barriers to phase II cardiac rehabilitation participation.
- Addressing physical limitations, optimizing scheduling, and improving physician adherence to protocols are essential.
- Further research is needed to develop effective interventions to overcome these identified obstacles and improve program uptake.
Objectives:
To identify barriers to participation in a phase II cardiac rehabilitation programme and measures that may enhance participation.
Design:
Prospective study.
Setting:
Regional hospital, Hong Kong.
Patients:
Cardiac patients recruited for a phase I cardiac rehabilitation programme from July 2002 to January 2003.
Main Outcome Measures:
Reasons for not participating in a phase II cardiac rehabilitation programme.
Results:
Of the 193 patients recruited for a phase I cardiac rehabilitation programme, 152 (79%) patients, with a mean age of 70.3 years (standard deviation, 11.9 years), did not proceed to phase II programme. Eleven (7%) deaths occurred before commencement of phase II and 74 (49%) patients were considered physically unfit. Reasons for the latter included fractures, pain, or degenerative changes in the lower limbs (24%), and co-morbidities such as cerebrovascular accident (19%), chronic renal failure (11%), congestive heart failure (9%), and unstable angina (8%). Phase II rehabilitation was postponed until after completion of scheduled cardiac interventions in 13% of patients. Failure of physicians to arrange the pre-phase II exercise stress test as per protocol was reported in 7% of patients. Other reasons were reported: work or time conflicts (16%), non-compliance with cardiac treatment (5%), financial constraints (4%), self-exercise (3%), fear after exercise stress testing (3%), and patients returning to their original cardiologists for treatment (3%).
Conclusions:
A significant (79%) proportion of patients did not proceed to a phase II cardiac rehabilitation programme for a variety of reasons. These included physical unfitness, work or time conflicts, and need to attend scheduled cardiac interventions. Further studies are required to determine how to overcome obstacles to cardiac rehabilitation.
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