Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers?
Abstract Background People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use. Objective The aim of this study was to examine eligibility for CR; enrollment, ad...
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| Veröffentlicht in: | Physical therapy 2020-01, Vol.100 (1), p.44-56 |
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| creator | Marzolini, Susan Fong, Karen Jagroop, David Neirinckx, Jennifer Liu, Jean Reyes, Rina Grace, Sherry L Oh, Paul Colella, Tracey J F |
| description | Abstract
Background
People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use.
Objective
The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use.
Design
This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada.
Methods
Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators.
Results
Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%).
Limitations
Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes.
Conclusions
An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of intere |
| doi_str_mv | 10.1093/ptj/pzz149 |
| format | Article |
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Background
People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use.
Objective
The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use.
Design
This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada.
Methods
Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators.
Results
Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%).
Limitations
Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes.
Conclusions
An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.</description><identifier>ISSN: 0031-9023</identifier><identifier>EISSN: 1538-6724</identifier><identifier>DOI: 10.1093/ptj/pzz149</identifier><identifier>PMID: 31588512</identifier><language>eng</language><publisher>CARY: Oxford University Press</publisher><subject><![CDATA[Aged ; Ambulatory Care ; Cardiac Rehabilitation - methods ; Cardiac Rehabilitation - statistics & numerical data ; Cardiovascular disease ; Eligibility Determination ; Enrollments ; Exercise Therapy - statistics & numerical data ; Female ; Health Care Surveys ; Health Services Accessibility - statistics & numerical data ; Humans ; Life Sciences & Biomedicine ; Male ; Middle Aged ; Mobility Limitation ; Multivariate Analysis ; Ontario ; Orthopedics ; Partnerships ; Patient Compliance - statistics & numerical data ; Patient Participation - statistics & numerical data ; Patient Selection ; Physical therapists ; Prospective Studies ; Regression Analysis ; Rehabilitation ; Science & Technology ; Socioeconomic Factors ; Stroke ; Stroke Rehabilitation - statistics & numerical data ; Time]]></subject><ispartof>Physical therapy, 2020-01, Vol.100 (1), p.44-56</ispartof><rights>2019 American Physical Therapy Association 2020</rights><rights>2019 American Physical Therapy Association.</rights><rights>COPYRIGHT 2020 Oxford University Press</rights><rights>2019 American Physical Therapy Association</rights><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>22</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000518533000005</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c588t-c4651119030f8f53ee5d5323797341e47332fd3d5204ef1878a6f1f4ef4370e53</citedby><cites>FETCH-LOGICAL-c588t-c4651119030f8f53ee5d5323797341e47332fd3d5204ef1878a6f1f4ef4370e53</cites><orcidid>0000-0001-8764-6258 ; 0000-0002-3186-400X ; 0000-0002-0603-6958 ; 0000-0001-7063-3610</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,1586,27931,27932,28255,28256</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31588512$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marzolini, Susan</creatorcontrib><creatorcontrib>Fong, Karen</creatorcontrib><creatorcontrib>Jagroop, David</creatorcontrib><creatorcontrib>Neirinckx, Jennifer</creatorcontrib><creatorcontrib>Liu, Jean</creatorcontrib><creatorcontrib>Reyes, Rina</creatorcontrib><creatorcontrib>Grace, Sherry L</creatorcontrib><creatorcontrib>Oh, Paul</creatorcontrib><creatorcontrib>Colella, Tracey J F</creatorcontrib><title>Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers?</title><title>Physical therapy</title><addtitle>PHYS THER</addtitle><addtitle>Phys Ther</addtitle><description>Abstract
Background
People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use.
Objective
The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use.
Design
This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada.
Methods
Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators.
Results
Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%).
Limitations
Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes.
Conclusions
An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.</description><subject>Aged</subject><subject>Ambulatory Care</subject><subject>Cardiac Rehabilitation - methods</subject><subject>Cardiac Rehabilitation - statistics & numerical data</subject><subject>Cardiovascular disease</subject><subject>Eligibility Determination</subject><subject>Enrollments</subject><subject>Exercise Therapy - statistics & numerical data</subject><subject>Female</subject><subject>Health Care Surveys</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mobility Limitation</subject><subject>Multivariate Analysis</subject><subject>Ontario</subject><subject>Orthopedics</subject><subject>Partnerships</subject><subject>Patient Compliance - statistics & numerical data</subject><subject>Patient Participation - statistics & numerical data</subject><subject>Patient Selection</subject><subject>Physical therapists</subject><subject>Prospective Studies</subject><subject>Regression Analysis</subject><subject>Rehabilitation</subject><subject>Science & Technology</subject><subject>Socioeconomic Factors</subject><subject>Stroke</subject><subject>Stroke Rehabilitation - statistics & numerical data</subject><subject>Time</subject><issn>0031-9023</issn><issn>1538-6724</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>ARHDP</sourceid><sourceid>EIF</sourceid><recordid>eNqV0t1u0zAUB_AIgdgY3PAAKBJC4mPZ7Jy4cbhBXdWNSRVIG4jLyE2OW3eJHWxH-3gCHht3LUOdKjTii1jx7xwdxf8oeknJASUFHHZ-cdjd3NCseBTtUgY8GeRp9jjaJQRoUpAUdqJnzi0IITTPiqfRDlDGOaPpbvRr3KiZmqpG-ev9eKytaZoWtd-Pha7jkWm7Br0yOjYyHl-hrZTD5Eg4DIfC1kpU8RnOxW0DcQuPQwdzqfQsPvfWXOC984_xj7nw8dBi7OcYHwlrFVr36Xn0RIrG4Yv1ey_6fjz-NvqcTL6enI6Gk6QKI_ukygaMUloQIJJLBoisZpBCXuSQUcxygFTWULOUZCgpz7kYSCrDPoOcIIO96O2qb2fNzx6dL1vlKmwaodH0rkyBhKqCFjTQ1_fowvRWh-nKNAMCOXBgf9VMNFgqLY23olo2LYcDCoQRkvKgki1qhhqtaIxGqcLnDX-wxYdVY6uqrQXvNgqC8XjlZ6J3rjw9P_sP--XBlp9MNu37la2scc6iLDurWmGvS0rKZVTLENVyFdWAX63_bj9tsb6jf7IZwIcVuMSpka5SqCu8YyHMjHIGQJbP8hr4w_VoHcaR6bUPpW9Wpabv_jXxb0LqDQY</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Marzolini, Susan</creator><creator>Fong, Karen</creator><creator>Jagroop, David</creator><creator>Neirinckx, Jennifer</creator><creator>Liu, Jean</creator><creator>Reyes, Rina</creator><creator>Grace, Sherry L</creator><creator>Oh, Paul</creator><creator>Colella, Tracey J F</creator><general>Oxford University Press</general><general>Oxford Univ Press</general><scope>17B</scope><scope>AOWDO</scope><scope>ARHDP</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>ISN</scope><scope>ISR</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8764-6258</orcidid><orcidid>https://orcid.org/0000-0002-3186-400X</orcidid><orcidid>https://orcid.org/0000-0002-0603-6958</orcidid><orcidid>https://orcid.org/0000-0001-7063-3610</orcidid></search><sort><creationdate>20200101</creationdate><title>Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers?</title><author>Marzolini, Susan ; Fong, Karen ; Jagroop, David ; Neirinckx, Jennifer ; Liu, Jean ; Reyes, Rina ; Grace, Sherry L ; Oh, Paul ; Colella, Tracey J F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c588t-c4651119030f8f53ee5d5323797341e47332fd3d5204ef1878a6f1f4ef4370e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Ambulatory Care</topic><topic>Cardiac Rehabilitation - methods</topic><topic>Cardiac Rehabilitation - statistics & numerical data</topic><topic>Cardiovascular disease</topic><topic>Eligibility Determination</topic><topic>Enrollments</topic><topic>Exercise Therapy - statistics & numerical data</topic><topic>Female</topic><topic>Health Care Surveys</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mobility Limitation</topic><topic>Multivariate Analysis</topic><topic>Ontario</topic><topic>Orthopedics</topic><topic>Partnerships</topic><topic>Patient Compliance - statistics & numerical data</topic><topic>Patient Participation - statistics & numerical data</topic><topic>Patient Selection</topic><topic>Physical therapists</topic><topic>Prospective Studies</topic><topic>Regression Analysis</topic><topic>Rehabilitation</topic><topic>Science & Technology</topic><topic>Socioeconomic Factors</topic><topic>Stroke</topic><topic>Stroke Rehabilitation - statistics & numerical data</topic><topic>Time</topic><toplevel>online_resources</toplevel><creatorcontrib>Marzolini, Susan</creatorcontrib><creatorcontrib>Fong, Karen</creatorcontrib><creatorcontrib>Jagroop, David</creatorcontrib><creatorcontrib>Neirinckx, Jennifer</creatorcontrib><creatorcontrib>Liu, Jean</creatorcontrib><creatorcontrib>Reyes, Rina</creatorcontrib><creatorcontrib>Grace, Sherry L</creatorcontrib><creatorcontrib>Oh, Paul</creatorcontrib><creatorcontrib>Colella, Tracey J F</creatorcontrib><collection>Web of Knowledge</collection><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science - Social Sciences Citation Index – 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Social Sciences Citation Index</collection><collection>Web of Science Primary (SCIE, SSCI & AHCI)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Physical therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marzolini, Susan</au><au>Fong, Karen</au><au>Jagroop, David</au><au>Neirinckx, Jennifer</au><au>Liu, Jean</au><au>Reyes, Rina</au><au>Grace, Sherry L</au><au>Oh, Paul</au><au>Colella, Tracey J F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers?</atitle><jtitle>Physical therapy</jtitle><stitle>PHYS THER</stitle><addtitle>Phys Ther</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>100</volume><issue>1</issue><spage>44</spage><epage>56</epage><pages>44-56</pages><issn>0031-9023</issn><eissn>1538-6724</eissn><abstract>Abstract
Background
People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use.
Objective
The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use.
Design
This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada.
Methods
Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators.
Results
Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%).
Limitations
Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes.
Conclusions
An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.</abstract><cop>CARY</cop><pub>Oxford University Press</pub><pmid>31588512</pmid><doi>10.1093/ptj/pzz149</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-8764-6258</orcidid><orcidid>https://orcid.org/0000-0002-3186-400X</orcidid><orcidid>https://orcid.org/0000-0002-0603-6958</orcidid><orcidid>https://orcid.org/0000-0001-7063-3610</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Physical therapy, 2020-01, Vol.100 (1), p.44-56 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Web of Science - Social Sciences Citation Index – 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Alma/SFX Local Collection |
| subjects | Aged Ambulatory Care Cardiac Rehabilitation - methods Cardiac Rehabilitation - statistics & numerical data Cardiovascular disease Eligibility Determination Enrollments Exercise Therapy - statistics & numerical data Female Health Care Surveys Health Services Accessibility - statistics & numerical data Humans Life Sciences & Biomedicine Male Middle Aged Mobility Limitation Multivariate Analysis Ontario Orthopedics Partnerships Patient Compliance - statistics & numerical data Patient Participation - statistics & numerical data Patient Selection Physical therapists Prospective Studies Regression Analysis Rehabilitation Science & Technology Socioeconomic Factors Stroke Stroke Rehabilitation - statistics & numerical data Time |
| title | Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers? |
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