Abstract
Background: The prevalence and morbidity and mortality rates of Coronary Heart Disease (CHD) continue to increase towards epidemic proportions in the Kingdom of Saudi Arabia (KSA). Despite advances in cardiac surgery, no established out-patient programmes of Cardiac Rehabilitation (CR) are currently in place for CHD patients in the KSA.Aim of the study: To evaluate the effectiveness of a home-based CR (Home CR) programme using individualized exercise (Physiotools-R), and a Hospital CR programme (out-patient phase), compared to standard care of home instructions on physical function, physiological and psychological status, body composition and the quality of life of the CHD participants post Coronary Artery Bypass Graft (CABG) surgery.
Methods: 73 post-CABG surgery participants were randomly assigned to one of three groups: A Hospital CR group (n=25), a Home CR group (n=24) and a control group (n=24). Outcome measures included the Incremental Shuttle Walk Test(ISWT), Metabolic Equivalent Tasks (METs), psychosocial outcomes and body composition, which were recorded at baseline, after eight weeks of CR intervention, and 4 weeks after the end of the intervention.
Intervention: The Hospital CR programme comprised group based Aerobic Circuit Training and the Home CR comprised a structured individualised exercise programme. Each programme included a 2-hour session, 3 times a week for 8 weeks, followed by a 4-week post intervention follow-up. The control group followed standard care, comprising usual advice on post-operation precautions.
Results: The ISWT distance covered showed a statistically significant increase in both intervention groups (Hospital and Home) after 8 weeks of CR intervention. The Hospital group walking distance increased by 71 +9. 19m and the Home group by 66±0.58m. The ISWT distance covered by the control group increased by 3 ±1.39m(p=0. 103), but was not statistically significant. No statistically significant differences were found between the two intervention groups (p>0. 05). However, both intervention groups showed a greater increase in distance covered than the control group (p=0.001). Four weeks after the end of the intervention, the Home CR group showed a continuing statistically significant improvement in primary outcome measures (ISWT, METs, HADS-A, HADS-D and SF-36 mean scores) whilst the Hospital and Control group showed significant reduction in outcome measures(p=0. 001).
Discussion: Results confirm that an 8-week programme of Cardiac Rehabilitation was equally effective when carried out at Home or in a Hospital setting, when assessed using primary outcome measures including functional capacity, physiological well-being and quality of life. In addition, continued and sustained improvement was observed in primary outcome measures in the Home CR group at the 4-week post intervention follow up, whilst there was a decline in the Hospital and control groups. This sustained improvement in outcomes in the Home CR group may have been due to increased self-motivation and a stronger locus of control.
Conclusion: Home CR can be as effective as Hospital CR when undertaken as an 8-week programme of structured intervention. Home and Hospital CR lead to an improvement in functional capacity, physiological and psychological well-being and quality of life for CHD patients, post-CABG surgery. At the 4-week postintervention follow-up, the Home CR group showed greater sustained improvement on primary outcome measures compared to both the Hospital CR and control groups. These findings should inform the design and implementation of future CR services among CABG patients in KSA.
| Date of Award | 2019 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Morag Thow (Supervisor), Brian Ellis (Supervisor) & Chris Seenan (Supervisor) |