Combined generic-specialist multimorbidity rehabilitation post acute cardiac event

Cowie, Aynsley; McKay, Janet; Keenan, Alison

doi:10.12968/bjca.2018.13.7.340

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…The Healthy and Active Rehabilitation Programme (HARP) was established in Ayrshire, Scotland, in 2015 (reF. 79 ). The HARP model was developed to focus specifically on deprived and rural communities and those with high unscheduled care demand (that is, cardiac or pulmonary disease, cancer, stroke, diabetes and/or a high risk of falls).…”

Section: • Development and Evaluation Of Affordable And Sustainable C...mentioning

confidence: 99%

The role of cardiac rehabilitation in improving cardiovascular outcomes

2021

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Cardiac rehabilitation is a complex intervention that includes exercise training, physical activity promotion, health education, cardiovascular risk management and psychological support, personalized to the individual needs of patients with diagnosed heart disease 1 (Fig. 1). In addition to secondary prevention and improvement in cardiovascular prognosis, a focus of modern cardiac rehabilitation has been the drive to improve patient wellbeing and health-related quality of life [2][3][4] .Introduced in the late 1960s, the recommendation for the provision of cardiac rehabilitation was, at that time, confined to low-risk patients who had survived an acute myocardial infarction (MI). With the development of an evidence base over the past two decades supporting the benefits of cardiac rehabilitation, contemporary clinical guidelines now routinely recommend the referral to comprehensive cardiac rehabilitation across a wider range of cardiac diagnoses, including acute coronary syndrome, heart failure with reduced ejection fraction (HFrEF) and coronary revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery).An important emphasis of contemporary guidelines, including the 2020 position statement from the European Association of Preventive Cardiology (EAPC) 5 , the 2017 guidance from the British Association for Cardiovascular Prevention and Rehabilitation 6 and the 2020 position statement from the Secondary Prevention and Rehabilitation Section of EAPC, is the importance of quality assurance in cardiac rehabilitation delivery 7 (Box 1). Key quality assurance elements include the involvement of a multidisciplinary team (including cardiologists, general practitioners and physicians with special interest, nurse specialists, physiotherapists, dietitians and psychologists) trained in the core competencies and effective delivery of the various core elements of a comprehensive cardiac rehabilitation programme (that is, exercise training and promotion, risk factor and self-management education, and psychological support) 1,6 , following a detailed initial assessment of the patient. Initially, cardiac rehabilitation was primarily practised as an exercise training intervention alone 8 . Although exercise training remains a central component of cardiac rehabilitation, the comprehensive model

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Section: • Development and Evaluation Of Affordable And Sustainable C...mentioning

confidence: 99%

The role of cardiac rehabilitation in improving cardiovascular outcomes

2021

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“…The impetus behind much of this policy development is the demand to meet the forecast increase in LTCs, including cancer, in a health system which may not receive significant additional future investment (Dieleman et al, 2017;Macmillan Cancer Support, 2015). Rehabilitation models for people diagnosed with multi-morbidity, or more than one LTC, are already showing promise in terms of clinical outcomes, cost-savings and participant acceptability (Barker et al, 2018;Cowie, McKay, & Keenan, 2018). Models such as these, have the potential to unlock capacity from within the local health system and provide more equitable access to rehabilitation for a wider population (Longley et al, 2017).…”

Section: Re-defining Peer Group Identitymentioning

confidence: 99%

Understanding the Importance of Therapeutic Relationships in the Development of Self-Management Behaviours After Cancer Rehabilitation: A Qualitative Mixed-Methods Study

Wilkinson¹

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This Professional Practice Doctorate research explored the importance and impact of therapeutic relationships in the development of sustainable self-management behaviours during cancer rehabilitation. This research aimed to evidence the need to preserve person-centred cancer rehabilitation. It aimed to protect local services from organisational pressures to rationalise rehabilitation through standardised, protocol driven practice. Therapeutic relationships are an important aspect of multi-disciplinary healthcare practice. However, they receive inversely proportionate attention in the research literature. Where research exists, it has often focused on elements of the relationship, rather the entire relationship. This is likely reflective of the complexity of therapeutic relationships. This research was undertaken in three phases alongside clinical practice. An integrative literature review was completed in parallel to semi-structured interviews, and a Modified Delphi Technique. The results confirmed the underlying assumption that the local cancer rehabilitation service was effective in supporting the development of self-management behaviours. Participants perceived professionals’ characteristics and behaviours to be a significant barrier or enabler to the development of therapeutic relationships. Therapeutic relationships were found to have significant roles or functions at different stages of cancer rehabilitation. On completion of cancer rehabilitation, the dissolution of therapeutic relationships was not consistently well managed by professionals, resulting in residual dependency or alienation. Poor participant experiences of previous therapeutic relationships may explain poor early engagement in rehabilitation, protracted rehabilitation duration and poor self-management outcomes. These findings provide insight for decision-making around cancer rehabilitation service design and workforce skills development. This research sets the foundation for future studies to measure the impact of therapeutic relationships on self-management outcomes. These insights could also inform the design and evaluation of learning opportunities for professionals, optimising the management of therapeutic relationships. Future research would focus on how to support professionals to meet the long-term needs of people affected by cancer and other LTCs.

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Personalised rehabilitation for cardiac and pulmonary patients with multimorbidity: Time for implementation?

Taylor

Singh

2020

European Journal of Preventive Cardiology

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Combined generic-specialist multimorbidity rehabilitation post acute cardiac event

Cited by 5 publications

References 12 publications

The role of cardiac rehabilitation in improving cardiovascular outcomes

The role of cardiac rehabilitation in improving cardiovascular outcomes

Understanding the Importance of Therapeutic Relationships in the Development of Self-Management Behaviours After Cancer Rehabilitation: A Qualitative Mixed-Methods Study

Personalised rehabilitation for cardiac and pulmonary patients with multimorbidity: Time for implementation?

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