Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
Disabil Rehabil. 2022 Jul;44(14):3610-3622. doi: 10.1080/09638288.2021.1874548. Epub 2021 Feb 2.
This qualitative study explored healthcare professionals' views in relation to the potential expansion of cardiac rehabilitation services to include stroke patients, thereby becoming a cardiovascular rehabilitation model.
23 semi-structured interviews were completed with hospital and community-based stroke and cardiac rehabilitation professionals in Switzerland ( = 7) and Ireland ( = 19). The sample comprised physiotherapists, occupational therapists, speech and language therapists, stroke physicians, cardiologists, psychologists, dieticians and nurses. Interviews were audio-recorded and the transcripts were analysed in using inductive Thematic Analysis.
Barriers and facilitators to cardiovascular rehabilitation were captured under four broad themes; (i) Cardiac rehabilitation as "low-hanging fruit," (ii) Cognitive impairment ("the elephant in the room"), (iii) Adapted cardiac rehabilitation for mild stroke, and (iv) Resistance to change.
Hybrid cardiac rehabilitation programmes could be tailored to deliver stroke-specific education, exercises and multidisciplinary expertise. Post-stroke cognitive impairment was identified as a key barrier to participation in cardiac rehabilitation. A cognitive rehabilitation intervention could potentially be delivered as part of cardiac rehabilitation, to address the cognitive needs of stroke and cardiac patients.Implications for rehabilitationThe cardiac rehabilitation model has the potential to be expanded to include mild stroke patients given the commonality of secondary prevention needs.Up to half of stroke survivors are affected by post-stroke cognitive impairment, consequently mild stroke patients may not be such an "easy fit" for cardiac rehabilitation.A cardiovascular programme which includes common rehabilitation modules, in addition to stroke- and cardiac-specific content is recommended.A cognitive rehabilitation module could potentially be added as part of the cardiac rehabilitation programme to address the cognitive needs of stroke and cardiac patients.
本定性研究探讨了医疗保健专业人员对潜在的心脏康复服务扩展的看法，使其成为心血管康复模式，纳入 stroke 患者。
在瑞士（ = 7）和爱尔兰（ = 19）的医院和社区进行了 23 次半结构化访谈，采访对象为物理治疗师、职业治疗师、言语治疗师、中风医生、心脏病专家、心理学家、营养师和护士。访谈进行了录音，并使用归纳主题分析对转录本进行了分析。
四个广泛的主题下捕捉到了心血管康复的障碍和促进因素；（i）心脏康复作为“低挂的果实”，（ii）认知障碍（“房间里的大象”），（iii）轻度中风的适应性心脏康复，以及（iv）对变革的抵制。
混合心脏康复计划可以根据需要进行定制，提供特定于中风的教育、锻炼和多学科专业知识。中风后认知障碍被确定为参与心脏康复的一个关键障碍。认知康复干预措施可以作为心脏康复的一部分来提供，以满足中风和心脏患者的认知需求。
鉴于二级预防需求的共性，心脏康复模式有可能扩展到包括轻度中风患者。多达一半的中风幸存者受到中风后认知障碍的影响，因此轻度中风患者可能不太适合心脏康复。建议采用包括常见康复模块以及中风和心脏特定内容的心血管计划。认知康复模块可以作为心脏康复计划的一部分添加，以满足中风和心脏患者的认知需求。
