Abstract
This prospective observational study investigates the changes people with chronic cardiac conditions may experience after discharged from cardiac rehabilitation. The findings advance OT practitioners’ knowledge on short-term and long-term changes in physical activity and participation level, cognition, motivation, and fatigue and understanding of OT roles for people with chronic cardiac conditions who are postacute and postcardiac rehabilitation.
Primary Author and Speaker: Young Joo Kim
Additional Authors and Speakers: Jonathan Reeve, Deena Walters, Molly Young
Contributing Authors: Patricia Crane, Joseph Houmard, Damon Swift
The aim of this study is to investigate the short- and long-term changes in body function and performance and participation in daily activities in people with chronic cardiac conditions during and after cardiac rehabilitation (CR).
The number of people with chronic cardiac conditions has increased nationally over the years, and this has been the leading cause of death for the US population (Heron & Anderson, 2016). CR has been shown to reduce cardiovascular risks and improve functional capacity, mood status, and quality of life (Anderson et al., 2016; Servey & Stephens, 2016). However, changes in body function, such as mood, cognition, and motivation; and activity performance and participation after discharge from CR have been rarely studied all together.
We used a prospective observational design where assessments were completed three different times.
Inclusion criteria are adults 1) whose primary diagnosis for CR is myocardial infarction, heart failure, percutaneous coronary intervention, coronary artery diseases, and/or chronic cardiac conditions; 2) currently admitted to CR program; and 3) who do not plan to return to the maintenance program after the current CR program. Clinicians in two outpatient CR clinics in Greater Greenville, NC are providing referrals.
Twenty-five participants are assessed three times in our department lab: 1) at the end of CR, 2) 4 weeks after the discharge from CR, and 3) 12 weeks after the discharge from CR. Some outcome measures include Cogstate (cognition), Physical Activity and Leisure Motivation Scale (motivation), PROMIS-Fatigue (fatigue), Six-minute Walk Test (cardiovascular function), ActiGraph GT9X (physical activity level), Performance Assessment of Self-care Skills (performance in instrumental activities of daily living [IADLs]), and Participation Objective Participation Subjective (participation in IADLs).
IBM SPSS 24 will be used for the data analyses. We will use repeated analysis of variance with an alpha level of .05 followed by post-hoc tests with Bonferroni corrections. In addition, we will calculate effect sizes d for all outcome measures.
We found mixed outcomes from two participants during the feasibility testing stage. Between the end of CR and 4-week post-CR, working memory speed and delayed recall improved, but working memory accuracy decreased. In addition, activity motivation (151 to 156 out of 200 being best motivation) and cardiovascular function improved (487m -> 517m). Lastly, physical activity level decreased (7,640 steps to 7,094 steps), and independence and adequacy in performance in IADLs improved (2.94 to 2.96 and 2.30 to 2.70 out of 3 being best performance, respectively).
We are collecting more data needed to examine the statistical significance and degrees of the differences among Times. Future studies should include participants who never received CR, longer follow-ups, and multi-state recruitment.
This study may advance the knowledge on short-term and long-term changes in functional outcomes in people with chronic cardiac conditions who received CR. In addition, these findings will help identify unique roles of occupational therapy in long-term management for people with chronic cardiac conditions to improve their participation in daily activities.
The outcomes of this study closely relate to Research Priority of “health behaviors to prevent and manage chronic conditions.” We are investigating changes of occupations and client factors in the population with chronic cardiac conditions for which more research evidence related to occupational therapy interventions is urgently needed.
Heron, M., & Anderson, R. N. (2016). Changes in the leading cause of death: Recent patters in heart disease and cancer mortality. NCHS data brief, no 254. Haattsville, MD: National Center for Health Statistics.
Anderson, L., Thompson, D. R., Oldridge, N., Zwisler, A., Rees, K., Martin, N., & Taylor, R. S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, 1.
Servey, J. T., & Stephens, M. (2016). Cardiac Rehabilitation: Improving function and reducing risks. American Family Physician, 94(1), 37-43.