Mental and psychosocial health and health related quality of life before and after cardiac rehabilitation: a prospective cohort study with comparison to specific population norms

Abstract

Background Data on mental health improvement after cardiac rehabilitation (CR) are contradictory. The aim was to examine the mental and psycho-social health of patients admitted to our rehabilitation center following hospital treatment for acute coronary syndrome, before and after multidisciplinary CR. Methods Outcome was measured at admission and discharge by the 36-Item Short Form Survey (SF-36), the Symptom Checklist-90 Revised (SCL-90R), the Coping Strategy Questionnaire (CSQ) and the 6-min-walking distance test. The patients’ health status was compared with norms of sex-, age- and comorbidity-matched data from the German general population. Score differences from norms were measured by standardized mean differences (SMDs); health changes were quantified by standardized effect sizes (ESs). Their importance for comprehensive assessment was quantified by explorative factor analysis. Results Of n = 70 patients followed-up (male: 79%; mean age: 66.6 years), 79% had ≥ 3 comorbidities. At baseline, SF-36 Physical functioning (SMD = − 0.75), Role physical (− 0.90), Social functioning (SMD = − 0.44), and Role emotional (SMD = − 0.45) were significantly worse than the norm. After CR, almost all scores significantly improved by ES = 0.23 (SCL-90R Interpersonal sensitivity) to 1.04 (SF-36 Physical functioning). The strongest factor (up to 41.1% explained variance) for health state and change was the mental health domain, followed by function & pain (up to 26.3%). Conclusions Normative deficits in physical and psycho-social health were reported at baseline. After CR, at follow-up, all scores, except phobia, showed significant improvement. The comprehensive measurement of bio-psycho-social health should not be limited to depression and anxiety but include, especially, the somatization and social participation dimensions.

Relationship between subjectively-rated and objectively-tested physical function across six different medical diagnoses

“…They were referred by their family physician or a medical specialist to a specialized inpatient rehabilitation intervention tailored to their main medical diagnosis. The 6 cohorts comprised: ( i ) patients with whiplash-associated disorders (WAD) ( n = 71) who participated in the Zurzach Interdisciplinary Cervical Spine (Halswirbelsäule) concept (ZIHKo) ( 16 ); ( ii ) patients with low back pain ( n = 121) and ( iii ) those with fibromyalgia ( n = 84) who were treated in the Zurzach Interdisciplinary Pain (Schmerz) Program (ZISP) ( 17 ); ( iv ) patients with lower limb lipoedema ( n = 27) and ( v ) those with lymphoedema ( n = 78) of the lower extremity who took part in a complex physical decongestive therapy programme ( 18 ); and ( vi ) patients, who, after hospital treatment for acute coronary syndrome, participated in a multidisciplinary cardiac rehabilitation programme (post-acute coronary syndrome (post-ACS); n = 64) ( 19 ).…”

“…The inclusion criteria for each programme together with the details of medical treatment can be found in the published reports on the individual cohorts (16)(17)(18)(19). Differences between the numbers of participants (n) included in the previous studies and in the current study are the result of the continuous recruitment of patients according to the inclusion criteria described in each publication.…”

“…Data were collected on the day of patients' admission to the clinic (baseline) before the start of their treatment, and before their discharge from the clinic at the end of the treatment (follow-up). Sociodemographic data were recorded at admission on a standardized form used in many previous studies (9,(16)(17)(18)(19)(20). Comorbidities were retrieved from the patient's medical history.…”

The State of Cardiac Rehabilitation in Saudi Arabia: Barriers, Facilitators, and Policy Implications

“…Depression, anxiety, and fear of future cardiac events are common psychological challenges faced by heart patients [ 64 , 65 ]. A prospective cohort study demonstrated that engaging in CR led to noteworthy enhancements in mental and psychosocial health, along with improvements in health-related quality of life [ 66 ]. Similarly, another study highlighted the promising role of CR as a multidisciplinary approach in reducing depression and anxiety while enhancing overall quality of life [ 67 ].…”