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European Journal of Physical and Rehabilitation Medicine 2013 December;49(6):775-83


lingua: Inglese

Outcomes associated with cardiac rehabilitation participation in patients with musculoskeletal comorbidities

Marzolini S. 1, 2, Leung Y. W. 3, Alter D. A. 1, 4, 5, 6, Wu G. 7, Grace S. L. 1, 8, 9

1 Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; 2 Institute of Medical Science University of Toronto, Toronto, Canada; 3 Psychosocial Oncology and Palliative Care Program University Health Network and Department of Psychiatry University of Toronto, Toronto, Canada; 4 Institute for Clinical Evaluative Sciences, Toronto, Canada; 5 Keenan Research Centre Li Ka Shing Knowledge Institute, Toronto, Canada; 6 Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; 7 York Central Hospital, Toronto, Canada; 8 University of Toronto, Toronto, Canada; 9 Faculty of Health, York University, Toronto, Canada


Background: Individuals with coronary artery disease (CAD) and musculoskeletal comorbidities (MSKCs) have much to gain from physical activity, yet are less likely to be referred to cardiac rehabilitation (CR) than those without MSKCs. Whether patients with MSKCs achieve demonstrated benefits of CR participation such as improved quantity and quality-of-life remains unknown.
Aim: To compare all-cause mortality, major acute cardiovascular events (MACEs), quality-of-life and psychosocial well-being in patients with CAD and coexisting MSKCs by CR participation.
Design: Prospective and observational study in which patients were administered a questionnaire in the hospital and 1 year later. The cohort was linked to provincial databases.
Setting: Eleven hospitals in Ontario, Canada.
Population: CAD patients (N.=1680).
Methods: CAD inpatients were administered a questionnaire assessing sociodemographic and clinical characteristics. Clinical data were extracted from charts. CR participation, quality-of-life, depressive symptoms, functional status, and physical activity behavior were measured 1 year later by questionnaire. The cohort was linked to provincial administrative databases to ascertain mortality and MACEs for a median of 2.7 years post-index cardiac hospitalization. Associations of CR participation with outcomes were tested after adjustment for differences in participation propensity.
Results: Of study participants, 50.7% (851/1680) had MSKCs and of those with MSKCs, 49.8% (424/851) participated in CR. Patients with MSKCs who participated in CR had greater physical quality-of-life (P<0.03) and lower mortality than those with MSKCs who did not attend CR, after adjusting for propensity for CR participation (1.4% vs. 4%; participant vs. non-participants, P=0.03) — non-participants’ hazard ratio 3.91 [95%CI,1.23-12.36]). There were no differences for MACEs.
Conclusion: Among those with MSKCs, participation in CR is associated with survival benefit and better physical quality-of-life compared to non-participants.
Clinical Rehabilitation Impact: Our findings showing the high prevalence of MSKCs in those with CAD and the benefits of CR, add to the literature that will provide the basis for exploration of initiatives to improve care for those with CAD and MSKC, and to overcome barriers to improved outcomes and reduced death. These results will help to guide focused research to optimize complex outpatient care in this group, including increasing the utilization of CR.

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