Measuring Behavioral Outcomes in Cardiopulmonary Rehabilitation

Abstract

Outcome measurement in cardiopulmonary rehabilitation is required for optimal assessment of program quality, effectiveness of treatments, and evaluation of patient progress. Recent position statements from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), American College of Cardiology, American Heart Association, American Thoracic Society, and American College of Chest Physicians have provided state-of-the-art information on the importance of assessing performance and outcome measures for optimal program effectiveness. Such measures are also required for AACVPR program certification. To meet current standards of practice, the AACVPR developed an Outcomes Matrix that includes 4 domains: Health, Clinical, Behavioral, and Service. Although the Clinical and Health domains have been most commonly used in outcome reporting (eg, 6-minute walk test, quality-of-life survey scores), behavioral measures have received less attention, primarily because they have been perceived as being more difficult to measure and quantify over time. This statement describes 5 common behavioral outcome measures: smoking cessation, medication use, supplemental oxygen use, exercise habits, and nutritional behaviors. Sample questions and calculations for each of these behavioral measures are also provided. By using these measures at program entry and completion, cardiac and pulmonary rehabilitation practitioners can effectively track and document behavioral changes over time for physicians, third-party insurance providers, or hospital administrators and thus demonstrate the effectiveness of exercise and educational interventions on patient overall health and well-being.

Traditional Versus Hybrid Outpatient Cardiac Rehabilitation

“…Each level of intensity has a corresponding value which is multiplied by the frequency of PA. Scores greater than 24 represent sufficient levels of PA such that health benefits are derived. Diet and smoking status were assessed via self-report 24 ; 1 item each, as this was the common measurement protocol used by COACH and the Canadian Cardiac Rehab Registry. Participants were asked "how many servings of fruits and vegetables do you consume in a day?"…”

Patient assessment and selection for pulmonary rehabilitation

“…Patients' tobacco use status should be determined, to enable provision of cessation‐focused education and/or referral to a tobacco cessation specialist where needed . Patient knowledge and self‐efficacy, performance of ADL, fatigue, exacerbations, hospitalizations and healthcare utilization, multidimensional measures such as the Body mass index, airflow Obstruction, Dyspnea, Exercise capacity (BODE) index, behavioural outcomes (such as medication and/or oxygen adherence), coping styles and patient satisfaction are other important areas to consider and measure in PR where possible. Programme enrolment and uptake, session adherence, completion versus dropout, adverse events and programme costs should also be recorded and tracked …”

A systematic review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change?

“…The 5 behaviors were: smoking, physical activity, dietary habits, response to cardiac symptoms, and medication adherence. These behavioral outcomes were chosen because they are related to better health outcomes in cardiac patients [3][4][5]19].…”