School of Kinesiology and Health Science
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Browsing School of Kinesiology and Health Science by Author "577e0c31c9dd9943116edc29a46d63a0"
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Item Open Access Cardiac Rehabilitation Component Attendance and Impact of Intervening Clinical Events, as Well as Disease Severity and Risk Factor Burden(Journal of Cardiopulmonary Rehabilitation and Prevention, 2021-01) Grace, Sherry; Prior, Peter; Mamataz, Taslima; Hartley, Tim; Oh, Paul; suskin, nevillePurpose: To examine: (1) the rate of clinical events precluding cardiac rehabilitation (CR) continuation, (2) CR attendance by component in those without events, and (3) the association between disease severity (eg, tobacco use, diabetes, and depression) and component attendance (eg, exercise, diet, stress management, and tobacco cessation). Methods: Retrospective analysis of electronic records of the CR program in London, Ontario, from 1999 to 2017. Patients in the supervised program are offered exercise sessions 2 times/wk with a minimum of 48 prescribed sessions tailored to patient need. Patients attending ≥1 session without major factors that would limit their exercise ability were included. Intervening events were recorded, as was component attendance. Results: Of 5508 enrolled, supervised patients, 3696 did not have a condition that could preclude exercise. Of those enrolled, one-sixth (n = 912) had an intervening event; these patients were less likely to work, more likely to have medical risk factors, had more severe angina and depression, and lower functional capacity. The remaining cohort attended a mean of 26.5 ± 21.3 sessions overall (median = 27; 19% attending ≥48 sessions), including 20.5 ± 17.4 exercise sessions (median = 21). After exercise, the most common components attended were individual dietary and psychological counseling. Patients with more severe angina and depressive symptoms as well as tobacco users attended significantly fewer total sessions, but more of some specific components. Conclusions: In one-sixth of patients, CR attendance and completion are impacted by clinical factors beyond their control. Many patients are taking advantage of components specific to their risk factors, buttressing the value of individually tailored, menu-based programming.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.