Traditional vs extended hybrid cardiac rehabilitation based on the continuous care model for patients who have undergone coronary artery bypass surgery in a middle-income country: A randomized controlled trial

dc.contributor.authorPakrad, Fatemeh
dc.contributor.authorahmadi, fazlollah
dc.contributor.authorGrace, Sherry
dc.contributor.authoroshvandi, khodayar
dc.contributor.authorKazemnejad, Anoshirvan
dc.date.accessioned2022-02-18T20:14:10Z
dc.date.available2022-02-18T20:14:10Z
dc.date.issued2021-11
dc.description.abstractObjective: To compare traditional (1-month supervised) vs hybrid cardiac rehabilitation (CR; usual care) with an additional 3 months offered remotely based on the continuous care model (intervention) in patients who have undergone coronary artery bypass graft (CABG). Design: Randomized controlled trial, with blinded outcome assessment. Setting: A major heart center in a middle-income country. Participants: Of 107 eligible patients who were referred to CR during the period of study, 82.2% (N=88) were enrolled (target sample size). Participants were randomly assigned 1:1 (concealed; 44 per parallel arm). There was 92.0% retention. Interventions: After CR, participants were given a mobile application and communicated biweekly with the nurse from months 1-4 to control risk factors. Main outcome measures: Quality of life (QOL, Short Form-36, primary outcome); functional capacity (treadmill test); and the Depression, Anxiety and Stress Scale were evaluated pre-CR, after 1 month, and 3 months after CR (end of intervention), as well as rehospitalization. Results: The analysis of variance interaction effects for the physical and mental component summary scores of QOL were <.001, favoring intervention (per protocol); there were also significant increases from pre-CR to 1 month, and from 1 month to the final assessment in the intervention arm (P<.001), with change in the control arm only to 1 month. The effect sizes were 0.115 and 0.248, respectively. Similarly, the interaction effect for functional capacity was significant (P<.001), with a clinically significant 1.5 metabolic equivalent of task increase in the intervention arm. There were trends for group effects for the psychosocial indicators, with paired t tests revealing significant increases in each at both assessment points in the intervention arm. At 4 months, there were 4 (10.3%) rehospitalizations in the control arm and none in intervention (P=.049). Intended theoretical mechanisms were also affected by the intervention. Conclusions: Extending CR in this accessible manner, rendering it more comprehensive, was effective in improving outcomes.en_US
dc.description.sponsorshipThe authors thank the Vice-Chancellor for Research and Technology of the Tarbiat Modares University for approving and supporting this work (No. IR.MODARES.REC.1397.183). We would like to thank the staff of Farshchian Heart Center for their collaboration with this work.en_US
dc.identifier.citationPakrad, F., Ahmadi, F., Grace, S. L., Oshvandi, K., & Kazemnejad, A. (2021). Traditional vs extended hybrid cardiac rehabilitation based on the continuous care model for patients who have undergone coronary artery bypass surgery in a middle-income country: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 102(11), 2091–2101.e3. https://doi.org/10.1016/j.apmr.2021.04.026en_US
dc.identifier.issn0003-9993
dc.identifier.issn1532-821X
dc.identifier.urihttps://doi.org/10.1016/j.apmr.2021.04.026en_US
dc.identifier.urihttp://hdl.handle.net/10315/39005
dc.language.isoenen_US
dc.publisherArchives of Physical Medicine and Rehabilitationen_US
dc.rights© 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.articlehttps://doi.org/10.1016/j.apmr.2021.04.026en_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectCardiac rehabilitationen_US
dc.subjectContinuity of patient careen_US
dc.subjectCoronary artery bypass surgeryen_US
dc.subjectQuality of lifeen_US
dc.subjectTelemedicineen_US
dc.subjectSecondary preventionen_US
dc.subjectGlobal Healthen_US
dc.subjectRandomized controlled trialen_US
dc.subjectHealth services accessibilityen_US
dc.subjectNursing modelsen_US
dc.titleTraditional vs extended hybrid cardiac rehabilitation based on the continuous care model for patients who have undergone coronary artery bypass surgery in a middle-income country: A randomized controlled trialen_US
dc.typeArticleen_US

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