Abstract
Background: To help clarify a potential barrier to cardiac rehabilitation (CR) participation we sought to examine the association between musculoskeletal limitations (MSLs) and CR enrollment and participation.Methods: Consecutive CR eligible individuals hospitalized for a cardiac event (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass graft) between the months of November 2007 and May 2008, were asked to complete a mailed survey within 2 weeks after hospital discharge, assessing demographic factors, Patient Health Questionnaire (PHQ-9), participation in CR and MSLs through a validated MSLs screening tool. CR enrollment rates were compared between patients with and without MSLs.Results: Three hundred and twenty-one (37%) of patients contacted responded to our survey, including 228 males (71%), with a mean age 68 ± 10.8 years, of whom 98% were Caucasian. Eighty-two percent of responders reported a musculoskeletal disorder at the time of hospital discharge. Arthritis was the most frequent diagnosis (45%). Muscle or joint pain sufficient to limit the ability to do moderate exercise was reported in 52% of the respondents. Problems with balance affected 37%, of whom 45% reported a fall within the previous year. No significant difference in CR enrollment was observed in respondents with and without MSLs [OR = 0.98, 95% CI (0.88–1.09), p = 0.750]. Similar results were found when severity and number of MSLs were taken into account. However, we found that when compared to those without MSLs, the presence of MSLs was associated with lower CR participation (OR = 0.80, 95%, CI: 0.65–0.97, p = 0.0252).Conclusion: Despite a high prevalence of MSLs among CR-eligible patients, we found no association between MSLs and CR enrollment. However, patients with MSLs attended significantly fewer CR sessions as compared to patients without them. CR programs should consider providing additional support and interventions to patients with MSLs in order to optimize their adherence to prescribed CR sessions.
Highlights
Cardiac rehabilitation (CR) is a cost-effective and integral component of the continuum of care for cardiac patients [1, 2] that improves functional status and psychological health [1], and reduces morbidity, re-hospitalization and mortality rates [3]
We found that when compared to those without Musculoskeletal limitations (MSLs), the presence of MSLs was associated with lower CR participation (OR = 0.80, 95%, CI: 0.65–0.97, p = 0.0252)
We found that MSLs were not associated with lower enrollment in a CR program (Table 4), but they were associated with lower CR session attendance
Summary
Cardiac rehabilitation (CR) is a cost-effective and integral component of the continuum of care for cardiac patients [1, 2] that improves functional status and psychological health [1], and reduces morbidity, re-hospitalization and mortality rates [3]. CR that was later established in clinical practice guidelines as a Class I recommendation [4, 5] for patients with a wide range of cardiac conditions. Musculoskeletal limitations (MSLs) are common in the general population and prevalent in patients with coronary artery disease [8, 9]. They are a major source of disability, immobility and dependence [10,11,12,13], yet little is known about their potential impact on CR participation. To help clarify a potential barrier to cardiac rehabilitation (CR) participation we sought to examine the association between musculoskeletal limitations (MSLs) and CR enrollment and participation
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