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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery
V Racca1, M Di Rienzo, P Mazzini
1Cardiology Rehabilitation Department, S. Maria Nascente Institute IRCCS, Don Carlo Gnocchi Foundation, Milan, Italy - vracca@dongnocchi.it.
Insights
This study introduces the International Classification of Functioning, Disability and Health (ICF) approach for evaluating heart surgery patients in cardiac rehabilitation. The ICF-based assessment successfully measured functional improvements, demonstrating its feasibility and utility in enhancing patient care.
Area of Science:
- Rehabilitation Medicine
- Health Services Research
Background:
- Heart surgery frequently leads to inpatient cardiac rehabilitation admissions.
- The International Classification of Functioning, Disability and Health (ICF) approach has not been previously applied to evaluate post-heart surgery patients.
Purpose of the Study:
- To evaluate and quantify functionality in cardiac patients post-heart surgery using an ICF-based approach for the first time.
- To determine the feasibility and utility of the ICF approach in cardiac rehabilitation settings.
Main Methods:
- An observational study was conducted in an inpatient cardiac rehabilitation unit.
- Fifty heart surgery patients were assessed using a practical ICF-core set at the beginning (T1) and end (T2) of rehabilitation.
- Interviews were conducted by physicians, physiotherapists, and psychologists.
Main Results:
- Significant decreases in ICF body function, structure, activity, and participation scores were observed from T1 to T2 (P<0.001).
- Environmental facilitator scores also decreased significantly (P=0.0051).
- Correlations were found between ICF scores and clinical measures like Barthel's index, NYHA class, plasma Cr-P, Conley scale, and SpO2.
Conclusions:
- ICF-based data provided functional insights consistent with patients' clinical progress.
- The ICF-core set effectively quantified improvements in body functions and activities, including areas often overlooked in standard cardiac rehabilitation.
- This approach documented functional improvements in cardiac patients undergoing rehabilitation.
Background:
Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery.
Aim:
The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation.
Design:
Observational study.
Setting:
In-patients cardiac Rehabilitation Unit in Milan.
Population:
Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7±12.5 years).
Methods:
We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) RESULTS: The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (P<0.001). The environmental code scores significantly decreased in the case of facilitators between T1 and T2 (P=0.0051), but not in the case of barriers. There were significant correlations between the ICF body function scores and Barthel's index (ρ=0.381; P=0.006), NYHA class (ρ=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (ρ=0.306; P=0.02), and between the activity/participation codes and SpO2 (ρ=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters.
Conclusion:
The ICF-based data provided functional information that was consistent with the patients' clinical course.
Clinical Rehabilitation Impact:
The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.
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