School of Kinesiology and Health Science
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Browsing School of Kinesiology and Health Science by Author "386e6f74d2ecf80e20beae2ad49d73d0"
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Item Open Access A Prospective Examination of Patterns and Correlates of Exercise Maintenance in Coronary Artery Disease Patients(Springer Verlag, 2007) Ceccato, Natalie; Stewart, Donna Eileen; Grace, Sherry L.; Leung, YvonneItem Open Access Access to cardiac rehabilitation among South Asian patients by referral method: A qualitative study(2010-05) Grewal, Keerat; Leung, Yvonne; Safai, Parissa; Stewart, Donna Eileen; Anand, Sonia; Gupta, Milan; Parsons, Cynthia; Grace, Sherry L.OBJECTIVES: South Asians (SA) suffer an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, SA are among the least likely to participate. ‘Automatic’ referral increases CR utilization and may reduce access inequalities. METHODS: This study qualitatively explored whether CR referral knowledge/access varied by referral method among SA patients. Participants were SA cardiac patients from Ontario hospitals. Each hospital refers to CR through one of four methods: automatically through paper or electronically; through discussion with allied health professionals (liaison referral); or through usual referral at physician discretion. Data was collected via interviews and analyzed using Interpretive-descriptive analysis. RESULTS: Four themes emerged: 1) importance of pre-discharge CR discussions with health care providers; 2) limited knowledge of CR; 3) ease of referral process as facilitator of CR attendance; 4) participants’ need for personal autonomy over decision to attend CR. CONCLUSION: Liaison referral was perceived to be the most suitable method of referral for participants. It facilitated communication between patients and providers, ensuring improved CR understanding. Automatic referral may be less suited for this population, due to reduced patient-provider communication.Item Open Access Cardiac rehabilitation referral strategies: effects on referral and enrollment(2010-02) Gravely-Witte, Shannon; Leung, Yvonne; Nariani, Rajiv; Tamim, Hala; Oh, Paul; Grace, Sherry L.Despite recommendations in clinical practice guidelines, evidence suggests cardiac rehabilitation (CR) utilization following indicated cardiac events is 15-20%. Referral strategies such as automatic referral have been advocated to improve CR utilization. This Review evaluated the effects of referral strategies on CR referral and enrollment. Referral strategies were categorized as ‘automatic’ based on use of electronic health records or systematic discharge order sets, as ‘liaison’ based on discussions with allied healthcare providers, or ‘other’. The highest rates of CR referral were achieved in studies implementing automatic referral orders, where referral reached 85%. The highest rates of CR enrollment were achieved with a combination of automatic and liaison methods (78% and 86%). Although there were some null findings, overall results suggest that innovative referral strategies significantly increase CR utilization. Automatic referral methods, such as the ‘Get With the Guidelines’ initiative, show promise for improving referral rates. The additional incorporation of a CR discussion resulted in enrollment rates that are double the rates seen after usual referral. While further investigation is needed, institutions should evaluate their CR referral practice in light of these findings.Item Open Access Effects of cardiac rehabilitation referral strategies on referral and enrollment rates(Nature Publishing Group, 2010-02) Gravely-Witte, Shannon; Leung, Yvonne; Nariani, Rajiv; Tamim, Hala; Oh, Paul; Chan, Victoria; Grace, Sherry L.Despite recommendations in clinical practice guidelines, evidence suggests that utilization of cardiac rehabilitation (CR) following indicated cardiac events is low. Referral strategies, such as automatic referral, have been advocated to improve CR utilization. In this Review, we evaluate the effects of referral strategies on rates of CR referral and enrollment. Referral strategies are categorized as ‘automatic’ (the use of electronic health records or systematic discharge order sets), as ‘liaison’ (discussions with allied healthcare providers), or as ‘other’ (for example, the use of motivational letter to patients). The highest rates of CR referral have been achieved in studies implementing automatic referral orders, whereas the highest rates of CR enrollment have resulted from a combination of automatic and liaison methods. Overall, innovative referral strategies significantly increase CR utilization. While further investigation is needed, institutions should evaluate their CR referral practice in light of these findings.Item Open Access Gender differences in motivations and perceived effects of Mind-Body Therapy (MBT) practice and views on integrative cardiac rehabilitation among acute coronary syndrome patients: Why do women use MBT?(Elsevier Science B.V., Amsterdam, 2008-12) Grace, Sherry L.; Stewart, Donna Eileen; Grewal, Keerat; Leung, YvonneBackground: Over one-third of cardiac patients practice Mind-Body Therapy (MBT), particularly women. Considering women are less likely to engage in conventional physical activity, few studies have examined why MBT is well-accepted by women. Objectives: To qualitatively explore gender differences in the motivations for, and perceived effects of MBT, and the inter-relationships among alternative and conventional physical activities and secondary prevention programs. Methods: A random subsample of 16 participants (8 female) who reported practicing MBT in a larger study of 661 cardiac patients was interviewed until theme saturation was achieved. Audiotapes were transcribed and coded based on interpretive-descriptive technique within Nvivo-7 software. An audit trail and second coder were utilized to ensure the transparency and validity of results. After main themes emerged, the data were split by gender to identify differences for each theme. Results: Five themes emerged: (1) promotes positive well-being, (2) physical health benefits, (3) intrinsic and extrinsic motivations, (4) proactive health orientation, and (5) MBT as a preferred complementary and/or alternative physical activity. Men more often expressed preference for MBT for increased positive mood and cardiac-specific benefits, whereas women emphasized stress reduction, increasing self-efficacy, and physical activity, and were eager to see MBT offered in cardiac rehabilitation (CR). Conclusions: Both male and female users perceived substantial psychosocial and physical benefits of MBT practice. MBT addresses some of women's common barriers to CR.Item Open Access Geographic Issues in Cardiac Rehabilitation Utilization: A Narrative Review.(2010-11) Leung, Yvonne; Brual, Janette; Macpherson, Alison; Grace, Sherry L.Objective: The purpose of this study was to review the current evidence regarding the relationship between geographic indicators and cardiac rehabilitation (CR) utilization among coronary heart disease (CHD) patients. Results: Seventeen articles were identified for inclusion, where nine studies assessed rurality, 10 studies assessed travel time / distance, and two of these studies assessed both. Nine of the 17 studies (52.9%) showed a significant negative relationship between geographic barrier and CR use. Four of the 17 studies (23.5%) showed a null relationship, while four studies (23.5%) showed mixed findings. Inconsistent findings identified appeared to be related to restricted geographic range, regional density, and socioeconomic status. Conclusions: Overall, 52.9% of the identified studies reported a significant negative relationship between geographic indicators and CR utilization. This relationship appeared to be particularly consistent in North American and Australian settings, but somewhat less so in the United Kingdom where there is greater population density and availability of public transport.Item Open Access Post-traumatic growth among cardiac outpatients: Degree comparison with other chronic illness samples and correlates.(2010-07) Leung, Yvonne; Gravely-Witte, Shannon; Macpherson, Alison; Irvine, Jane; Stewart, Donna Eileen; Grace, Sherry L.This study evaluated the sociodemographic, clinical and behavioral correlates of Post-Traumatic Growth (PTG) in coronary artery disease (CAD) patients, and the degree of PTG compared to other patient groups. Using a prospective design, 1497 CAD outpatients completed a survey assessing potential PTG correlates. 1268 responded to a 9-month follow-up survey assessing PTG. Significant correlates of greater PTG were being non-white, having lower income, functional status, and depressive symptoms, greater social support, and positive illness perceptions. The degree of PTG was equivalent to that of cardiac patients in other countries, but was lower than that of breast cancer and multiple sclerosis patients.Item Open Access Posttraumatic Growth in Coronary Artery Disease Outpatients: Relationship to Degree of Trauma and Health Service Use(2012-04) Leung, Yvonne; Alter, David; Prior, Peter; Stewart, Donna Eileen; Irvine, Jane; Grace, Sherry L.Objectives Posttraumatic growth (PTG) is frequently reported after the strike of a serious medical illness. The current study sought to: 1) assess the relationship between degree of cardiac “threat” and PTG one year post-hospitalization; and 2) to explore the association between PTG and healthcare utilization. Methods In a cohort study, 2636 cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey,; clinical data were extracted from charts. One year later, 1717 of these outpatients completed a postal survey, which assessed PTG and healthcare utilization. Morbidity data were obtained retrospectively through probabilistic linkage to administrative data. The predicted risk of recurrent events for each participant was calculated using a logistic regression model, based on participants’ sociodemographic and clinical characteristics. The relationship among PTG, trauma and health service use was examined with multiple regression models. Results Greater PTG was significantly related to greater predicted risk of recurrent events (p<.001), but not the actual rate of recurrent events (p=.117). Moreover, greater PTG was significantly related to more physician visits (p=.006), and cardiac rehabilitation program enrolment (p=.001) after accounting for predicted risk and sociodemographic variables. PTG was not related to urgent healthcare use. Conclusions Greater PTG was related to greater objective risk of morbidity but not actual morbidity, suggesting that contemplation about the risk of future health problems may spur PTG. Moreover, greater PTG was associated with seeking non-urgent healthcare. Whether this translates to improved health outcomes warrants future study.Item Open Access The impact of pre-morbid and post-morbid depression onset on mortality and cardiac morbidity among coronary heart disease patients: A meta-analysis.(2012-10) Leung, Yvonne; Flora, David; Gravely, Shannon; Irvine, Jane; Carney, Robert; Grace, Sherry L.Background: Depression is associated with increased cardiac morbidity and mortality in the general population and in coronary heart disease (CHD) patients. Recent evidence suggests that patients with new-onset depression post-CHD diagnosis have worse outcomes than those who had previous or recurrent depression. This meta-analysis investigated timing of depression onset in established CHD and CHD-free cohorts to determine what timeframe is associated with greater mortality and cardiac morbidity. Methodology/Principal Findings: The MEDLINE, EMBASE, and PsycINFO databases were searched systematically to identify articles examining depression timeframe which specified an endpoint of all-cause mortality, cardiac mortality, re-hospitalization, or major adverse cardiac events (MACEs). A meta-analysis was conducted to estimate effect sizes by timeframe of depression. Twenty-two prospective cohort studies were identified. Nine studies investigated pre-morbid depression in CHD-free cohorts in relation to cardiac death. Thirteen studies in CHD-patient samples examined new-onset depression in comparison to previous or recurrent depression. The pooled effect size (risk ratio) was 0.76 (95% CI 0.48-1.19) for history of depression only, 1.79 (95% CI 1.45-2.21) for pre-morbid depression onset, 2.11 (95% CI 1.66-2.68) for post-morbid or new depression onset, and 1.59 (95% CI 1.08-2.34) for recurrent depression Conclusions/Significance: Both pre-morbid and post-morbid depression onsets are potentially hazardous, and the question of timing may be irrelevant with respect to adverse cardiac outcomes. However, the combination of pre-morbid depression with the absence of depression at the time of a cardiac event (i.e., historical depression only) is not associated with such outcomes, and deserves further investigation.Item Open Access The prevalence and correlates of mind-body therapy practices in acute coronary syndrome patients(Elsevier, 2008-10) Leung, Yvonne; Tamim, H.; Stewart, Donna Eileen; Arthur, H.M.; Grace, Sherry L.Objectives: While the benefits of mind-body therapy (MBT) for cardiac secondary prevention continues to be investigated, the prevalence of such practices by cardiac patients is not well known. The aim of this study was to quantitatively examine the prevalence of MBT practice and its sociodemographic, clinical, psychosocial and behavioral correlates among patients with acute coronary syndrome (ACS). Methods: Six hundred and sixty-one ACS in-patients (75% response rate) recruited from three hospitals completed a demographic survey, and clinical data were extracted from charts. Four hundred and sixty five patients (81% retention rate; 110 (23.7%) female) responded to an 18month post-discharge survey that queried about MBT use and its correlates. Results: One hundred and sixty-three (35.1%) ACS patients practised MBT in their lifetime, and 118 (25.4%) were currently practising. MBT users were more often women (OR = 2.98), nonwhite (OR = 2.17), had higher levels of education (OR = 2.22), past smokers (OR = 3.33), reported poorer mental health (OR =2.15), and engaged in more exercise (OR =1.65). Conclusion: One-third of ACS patients practised some form of MBT. The greater MBT practice among female ACS patients is noteworthy, given their generally lower physical activity and lower receipt of evidence-based treatments including cardiac rehabilitation. In addition, there is some evidence that MBT can promote mental well-being, and thus such practice might reduce risk related to negative affect in cardiac patients.