Identifying Specific Elements Necessary for a Pediatric Cardiac Rehabilitation Program: An e-Delphi Study

Abstract

Encouraging children and adolescents with congenital heart disease (CHD) to participate in regular exercise is an essential component in helping them rise toward their full potential physically, socially, and emotionally. Identifying appropriate tools and resources that promote healthy and active lifestyles specifically for this population are currently lacking and must be developed. Cardiac rehabilitation programs are an effective modality with beneficial clinical outcomes for adult patients with coronary heart disease, however these programs are scarce for the CHD pediatric population and not well defined. PURPOSE: The purpose of this study was to identify relevant content for the development and structure of a pediatric cardiac rehabilitation curriculum for young patients with CHD using a consensus approach. METHODS: A three-round e-Delphi study among CHD and pediatric exercise physiology (EP) experts was conducted. In the first round, experts provided opinions in a closed- and open-ended electronic questionnaire to identify specific elements necessary for inclusion in a Pediatric Cardiac Rehab Program. In the second round, experts were asked to re-rate the same items after feedback and summary data was provided from round one. In the third round, the same experts were asked to re-rate items that did not reach consensus from round two. RESULTS: 47 experts were contacted via e-mail to participate on the Delphi panel. 37 consented, 35 completed round one, 29 completed round two and 28 completed the final round. After the third round, consensus was reached in 55 of 60 (92%) questionnaire items. Experts identified specific elements across four domains: exercise training, education, outcome metrics and self-confidence to be included in a Pediatric Cardiac Rehab Curriculum. CONCLUSION: This study established consensus toward the ideal program structure, exercise training principles, educational content, patient outcome measures and self-confidence promotion. By identifying the key components within each domain, there is potential to benchmark recommended standards and practice guidelines for the development of a Pediatric Cardiac Rehab curriculum to be used healthcare team members for optimizing the health and wellness of pediatric CHD patients.