Effectiveness of home-based cardiac rehabilitation for special needs patients


Krystyna Cholowski,
School of Nursing and Midwifery,
University of Newcastle,
Australia 2308.
E-mail: krystyna.cholowski@ newcastle.edu.au


Background.  The benefits of cardiac rehabilitation programmes have been well documented including reductions in mortality, improved physical performance, and improved quality of life. However, a large number of special needs patients often fail to access these programmes. Of particular concern are elderly patients with chronic illness and disability.

Aims.  To evaluate the effectiveness of a home-based cardiac rehabilitation programme in improving health outcomes and rehabilitation access for special-needs patients.

Design.  Using a one-group pre and post-test quasi-experimental design 40 elderly patients recently discharged from hospital following a cardiac event completed the Short Form Health Survey, the Angina Quiz, and the Exercise Assessment Questionnaire prior to undertaking home-based rehabilitation. The rehabilitation programme consisted of four community nursing contacts over a 9-week period primarily aimed at individual patient education and carer support.

Analysis.  Descriptive statistics provided analysis for demographic data. Repeated measures multivariate analysis of variance ( manova ) were computed to examine changes in health-state and practices.

Results.  Significant positive changes were found for measures of quality of life, knowledge of angina, and exercise tolerance. Additionally, the higher levels of participation and completion by older women was encouraging. Development of carer competence through an improved knowledge base and nursing support was also evident.

Limitations.  While theoretically defensible positive outcomes were found these results need to be replicated in a larger study. Similarly, the limitations imposed by a single group pretest, post-test design suggest that claims of generalizablity need to be limited to the specific variables measured in this study.

Conclusion.  The study demonstrated medium term positive health outcomes. These positive findings suggest that home-based rehabilitation using larger samples of older patients with comorbidities, and using randomized comparative group designs, may be a fruitful area in future research.