In our latest round-up on research based articles, Janet Wright looks at a home plan that can help patients after heart failure and Katherine Jones asks questions about research and physiotherapy practice.
Home plan can help after heart failure
Cardiac rehabilitation (CR) has proved its worth. But many people, especially with heart failure, miss out on these programmes of exercise, education and counselling.
Earlier research has shown that structured home-based CR programmes – with clear objectives, monitoring and follow-up – are as effective as traditional classes. Studies mainly covered low-risk patients who had had a heart attack or undergone coronary bypass surgery or insertion of a stent.
However, patients are often reluctant to join in classes. And few centres have specialist programmes for people with heart failure.
So researchers looked at latest evidence, finding 17 suitable studies that compared home-based versus centre-based CR for 2,172 patients on four continents. These included four trials covering 315 patients with heart failure.
The team found similar improvements in clinical outcomes and quality of life, whether CR was followed at home or at a centre.
‘What matters may be the quality, structure and availability of the follow-up rather than the location,’ the authors report.
They found CR was just as good for people with heart failure as the other patients and call for it to be more widely available.
‘Cardiac rehabilitation … can prevent premature cardiovascular death, reduce hospital admissions and improve health-related quality of life, something that has never been accomplished for the majority of patients,’ say the authors. Buckingham SA et al. Home-based versus centre-based cardiac rehabilitation: abridged Cochrane systematic review and meta-analysis, Open Heart 2016; 3: - open access.
Why is this review important?
Evidence from earlier systematic reviews supports guidelines that recommend cardiac rehabilitation (CR) for various groups of people with coronary heart disease. However, the 2016 review shows that many people who could benefit are still not taking up CR.
What are the implications for research and physiotherapy practice?
The authors comment that the intensity of the CR programme seemed to differ substantially between home and centre-based arms. However, they found that home- and centre-based CR had similar benefits, at an equivalent cost, for those with heart failure and following myocardial infarction and revascularisation.
These findings are consistent with evidence from an earlier Cochrane review, which largely related to intervention for myocardial infarction and revascularisation (Dalal HM et al. BMJ 2010).
In the context of access and patient choice, the 2016 review authors say the findings 'strongly support the further roll-out of home-based CR programmes'.
Nevertheless, they were unable to pool data on programme adherence, owing to the variation in its definition and measurement. This may require further consideration in future research, in addition to the need for more studies lasting longer than a year across different patient groups.by CSP research adviser Katherine Jones
Comments and conclusions
- Exercise therapy for temporomandibular joint dysfunction can reduce pain and increase the range of motion in the jaw, but provides no significant improvement in function, says a systematic review. Dickerson SM et al. Clinical Rehabilitation 2016.
- Resistance training can improve exercise capacity and muscle strength in middle-aged and older people with coronary artery disease, say researchers. It can also increase mobility in older patients with the common heart condition. The team analysed 22 trials with a total of 1,095 participants. Yamamoto S et al. Journal of Cardiology 2016.
- Vestibular rehabilitation therapy ‘shows promise’ as a treatment for people with persistent vertigo and balance problems after concussion, a systematic review shows. Murray DA et al. British Journal of Sports Medicine 2016.
AuthorJanet Wright and CSP research adviser Katherine Jones
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