Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Physiother Theory Pract. 2024 Feb;40(2):366-376. doi: 10.1080/09593985.2022.2114052. Epub 2022 Sep 1.
Information on standards including structure- and process-based metrics and how exercise-based cardiac rehabilitation (EBCR) is delivered in relation to guidelines is lacking. The aims of the study were to evaluate standards and adherence to guidelines at Swedish CR centers and to conduct a cost analysis of the physiotherapy-related activities of EBCR.
EBCR standards at all 78 CR centers in Sweden in 2016 were surveyed. The questions were based on guideline-recommended core components of EBCR for patients after a myocardial infarction (MI). The cost analysis included the identification, quantification, and valuation of EBCR-related cost items. Patients were offered a pre-discharge consultation with a physiotherapist at n = 61, 78% of the centers. A pre-exercise screening visit was routinely offered at n = 64, 82% of the centers, at which a test of aerobic capacity was offered in n = 58, 91% of cases, most often as a cycle ergometer exercise test n = 55, 86%. A post-exercise assessment was offered at n = 44, 56% of the centers, with a functional test performed at n = 30, 68%. Almost all the centers n = 76, 97% offered supervised EBCR programs. The total cost of delivering physiotherapy-related activities of EBCR according to guidelines was approximately 437 euro (4,371 SEK) per patient. Delivering EBCR to one MI patient required 11.25 hours of physiotherapy time.
While the overall quality of EBCR programs in Sweden is high, there are several areas of potential improvement to reach the recommended European standards across all centers. To improve the quality of EBCR, further compliance with guidelines is warranted.
缺乏有关包括基于结构和过程的指标以及与指南相关的运动为基础的心脏康复（EBCR）实施情况的标准信息。本研究的目的是评估瑞典 CR 中心的标准和对指南的遵循情况，并对 EBCR 中与物理治疗相关的活动进行成本分析。
对瑞典所有 78 家 CR 中心 2016 年的 EBCR 标准进行了调查。这些问题是基于指南为心肌梗死（MI）后患者推荐的 EBCR 的核心内容。成本分析包括 EBCR 相关成本项目的识别、量化和估值。61%的中心为 n = 61 的患者提供出院前与物理治疗师的咨询，64%的中心常规提供运动前筛查就诊，在 n = 64 的中心，在其中 91%的情况下提供有氧运动能力测试，最常见的是 n = 55 的踏车运动试验，86%。n = 44 的中心提供运动后评估，56%的中心进行功能测试，30 个中心，68%。几乎所有的中心 n = 76，97%都提供监督 EBCR 计划。根据指南提供与物理治疗相关的 EBCR 活动的总成本约为每位患者 437 欧元（4371 瑞典克朗）。为每位 MI 患者提供 EBCR 服务需要 11.25 小时的物理治疗时间。
尽管瑞典 EBCR 计划的总体质量很高，但要在所有中心达到推荐的欧洲标准，仍有几个潜在的改进领域。为了提高 EBCR 的质量，有必要进一步遵守指南。
