DEVELOPMENTAL EVALUATION OF A HOMEBASED CARDIAC REHABILTATION EXERCISE PROGRAMME

1
DEVELOPMENTAL EVALUATION OF A HOME-BASED CARDIAC
REHABILTATION EXERCISE PROGRAMME
Innes GMa, Catto SMa, Mansouri Db, Bowman
GMa,MacIntyre PDa. aRoyal Alexandra Hospital,
Paisley bUniversity of Glasgow Glasgow,
Scotland on behalf of the Have a Heart Paisley
Steering Group
INTRODUCTION
RESULTS
STUDY LIMITATIONS

• The Home Based Exercise Programme (HB-ex) is one
  of four Phase III options currently available to
  patients entering Cardiac Rehabilitation at the
  RAH, Paisley
• It was designed to provide a viable exercise
  alternative for those patients unable, or less
  inclined to participate in the Hospital Group
  Exercise Classes (HOSP-ex)
• Since its inception in 2002, clinicians have felt
  that the uptake and completion of this service at
  the RAH has been lower than expected.

• STRENGTHS
• The completer group were significantly older than
  non-completers (66 vs. 59yrs, p0.03)
• From the questionnaire, a significantly greater
  proportion of patients rated the exercise
  component of cardiac rehabilitation as extremely
  important (p0.002)
• A significantly greater proportion of patients
  reported that they felt they were given enough
  information about exercise (p0.005). 100 of the
  patients surveyed said they did not have any
  concerns about exercising at home.
• The flexibility of the programme allowed patients
  to participate in Cardiac Rehabilitation when
  they would not otherwise have been able to.
• Patients were happy with the improvements they
  had made at home. Several mentioned that their
  capacity for exercise had improved and attributed
  this to the exercises that were prescribed.
• Staff support by telephone was reported as being
  very supportive and influenced patients
  enthusiasm to continue with their programme.
• The questionnaire results showed that a
  significantly greater proportion of patients
  thought the level of support was just right
  (plt0.001)
• WEAKNESSES
• The focus groups identified an inability to
  generate an adequate social support network at
  home.
• Patients also mentioned the difficulty
  remembering the correct exercises technique at
  home.
• BARRIERS TO ADHERENCE
• Barriers to adherence were varied. These
  included
• Patient motivation
• Patient confidence in their ability following a
  Cardiac Event. How much they did and how long
  they did it for. This seemed to be most prominent
  in the first few weeks post discharge
• Perception of illness was significant. It
  influenced how quickly they lost enthusiasm in
  exercise
• Perceived lack of Health Professionals support.
  Patients who did not feel that they were given a
  lot of support seemed to stop exercising quicker
  than others. However the level of support was
  judged to be adequate by the majority of patients
  who completed the questionnaire (plt0.001).
• SUGGESTED IMPROVEMENTS FROM FOCUS GROUPS
• A small discussion group, post discharge, to
  alleviate initial fears of being at home. This
  would need to be accessible in patients
  locality. 65 of those who answered the
  questionnaire said the idea was good but 35 of
  those said they wouldnt use.

• Patient recruitment was very difficult especially
  for patients who were referred to HB-ex but did
  not uptake. There were no non-attenders in the
  focus groups and only 3 answered the
  questionnaire.
• It was therefore impossible to explore reasons
  for non uptake or non completion as the study
  sample was too small.

CONCLUSIONS

• Satisfaction with the HB-ex programme was high.
• The provision of this service to those who are
  unable to attend the hospital appears to be
  rewarding
• Adherence levels seemed to vary considerably and
  patients mentioned a waning of enthusiasm over
  time. The degree of decline seemed to be linked
  to two specific variables patients attitudes
  towards their illness, and the support they
  received from the healthcare service.
• Suggested Improvements for adherence to the
  service were
• Locally held discussion group
• An audiovisual aid to the programme
• Home visits by the exercise physiologist
• A six month exercise test post dischargeTwo of
  these suggestions are going to be looked at in
  the future.
• the uptake for HB-ex was higher than the
  HOSP-ex Programme and completion rates were 63
  as apposed to 70 in the HOSP-ex programme
  therefore concluding that the programme was not
  vastly different for Hospitalbased services.
• The programme needs to be administered by more
  than one individual and may be split according to
  patient risk

AIM

• To examine the perceived strengths and weaknesses
  of the HB-ex programme,
• Explore barriers to uptake and completion
• Identify factors to facilitate improvement in
  these areas

METHODS

• DESIGN
• 3 Patient Focus Groups, 1 Staff Focus Group and
  Telephone Questionnaire
• PARTICIPANTS
• 107 patients that had been referred for HB-ex
  were identified from the Cardiac Rehab database
  and the Home Based Database
• 83 (78) up-took the programme
• 55 (51) completed the programme, 66 of
  up-takers
• 28 (26) did not complete, 34 of up-takers
• PROCEDURES
• Patients were identified and then streamed into
  three categories completers, non completers and
  non-uptakers
• Patients were invited to a focus group in one of
  these three categories
• An additional staff focus group was held to
  explore staff perceptions
• Attempts were made to telephone administer the
  questionnaire to all participants not enrolled in
  the focus group or had not previously indicated
  they did not wish to take part (n81). Of these,
  a total of 34 individuals were contactable by
  telephone and 28 of these agreed to take part.
• ANALYSIS
• Between group differences in demographics at
  baseline were identified by One-way ANOVA for
  numerical data, and chi-squared analysis for
  categorical variables
• All focus group audio tapes were transcribed by
  the researchers and then analysed using a coding
  frame
• Attention was devoted to the interactions between
  participants. Common themes were identified and
  any disparities between groups was noted.
• Questionnaire results were analysed as one-sample
  data using chi-squared

REFERENCES

• Oldridge NB Compliance in Cardiac Rehab.
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• Kodis J Smith KM et al. Changes in exercise
  capacity and lipids after clinic versus
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  (pp31-36),2001.
• Miller RN, Haskell WL, Berr RN, DeBusk RF. Home
  versus group exercise training for functional
  capacity after Myocardial infarction.
  Circulation. Vol.107(17)(pp2201-2206),2003. May
  06
• Brubaker PH, Rejeski WJ, Smith MJ et al. A
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  cardiac rehabilitation Effects on blood lipids,
  body composition and functional capacity. Journal
  of Cardiopulmonary Rehabilitation
  Vol.20(1)(pp50-56),2000
• DeBusk RF. Home-Based and Worksite-Based Exercise
  Training for Patients with Coronary Artery
  Disease. Cardiology Clinics 199311(2)285-295

FOR FURTHER INFORMATION
Please contact geraldine.innes_at_rah.scot.nhs.uk