Patient autonomy in cardiac inpatient rehabilitation-A COVID-19-specific exploratory trend study

The COVID-19 outbreak has changed nearly all societal domains, including medical rehabilitation. Social distancing measures impacted patients as well as health professionals during the rehabilitation process. Enhancing patient participation should not be forgotten during exceptional situations, as restrictive measures are related to the self-determination of patients.

In this exploratory trend study, we aimed to examine the association between COVID-19 restrictions with patients' motivation, their perception of the patient-provider-relationship, their participation in the rehabilitation process and their current state of health at the beginning of their rehabilitation.

Adopting an exploratory approach, we compared data from a convenience sample of two different groups of patients, who stayed at a cardiac rehabilitation clinic at two different time periods: before the COVID-19 lockdown of rehabilitation clinics (n = 128) and after reopening during the COVID-19 period (n = 137). We used questionnaires on motivation for rehabilitation, patient-provider-relationship, patient activation and perceived state of health. We conducted t-tests and regression analysis to determine whether there were differences by gender, age, heart failure status, preferred form of decision-making (shared/not-shared) and time of rehabilitation (before/during COVID-19) related to the outcome variables.

Participants evaluated the quality of the patient-provider-relationship in a better way after the reopening of the rehabilitation clinics during the COVID-19 period (p < 0.05), their motivation, participation in the rehabilitation process and their current state of health at the beginning of their rehabilitation was comparable to the group before the COVID-19 lockdown of rehabilitation clinics. Differences in scepticism concerning the treatment and the quality of the patient-provider-relationship were related (p < 0.05) to age and the preferred form of decision-making. Differences in active participation were related (p < 0.05) to sex and differences in the perceived state of health (p < 0.05) to a heart failure diagnosis.

Treatment providers could use the time patients spend in isolation after arrival to prepare them for virtual goal-setting conversations to enhance patient participation in exceptional situations.