PHYSIOTHERAPISTS BARRIERS OF DELIVERING CARDIOPULMONARY REHABILITATION FOR PATIENTS WITH HEART FAILURE: A CROSS-SECTIONAL STUDY

Main Article Content

Dr. Aisha Ijlal
Dr. Hajra Kanwal
Dr. Warda Farooq
Dr. Shafiat Jalalani
Dr. Talha Iqbal
Dr. Nida Waheed
Dr. Syed Uzair Mahmood
Dr. Aqsa Faiz

Keywords

heart failure, barriers, cardiopulmonary rehabilitation, physiotherapists, Pakistan.

Abstract

Heart Failure (HF) poses a significant global health burden, necessitating effective management strategies like Cardiac Rehabilitation (CR) programs. However, low participation rates persist due to various barriers, highlighting the need for understanding physiotherapists perspectives to improve CR utilization. This study aims to assess physiotherapists perceptions of CR and identify barriers they face in providing CR to HF patients in Pakistan. A cross-sectional study involving 200 physiotherapists in Pakistan was conducted, utilizing a questionnaire to assess their perceptions of CR, preferred delivery methods, perceived barriers, and factors influencing referral decisions. Findings reveal that 88% of physiotherapists believe CR improves fitness, with 75% acknowledging its effectiveness in reducing breathlessness. They prefer hospital-supervised programs (75%) focusing on weight and stress management and medication information. Factors influencing CR referrals include low exercise tolerance (80%), patient education (78%), declining activity levels (77%), fatigue (71%), and breathlessness-related mobility issues (70%). Common barriers to CR referrals include lack of standardized protocols (73%), patient refusal and skepticism (73%), limited CR center availability (71%), and shortage of experienced staff (71%). Despite positive perceptions of CR, barriers such as standardized referral protocols, limited center availability, and staff shortages hinder its utilization. Addressing these challenges could enhance CR participation, improve patient outcomes, and mitigate the HF burden in Pakistan.

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References

1. Aldhahir AM, Alhotye M, Alqahtani JS, et al. Physicians’ Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2022 Jan;19(22):15208.
2. Sérvio, Thaianne, Cavalcante, et al. Barriers to cardiac rehabilitation delivery in a low-resource setting from the perspective of healthcare administrators, rehabilitation providers, and cardiac patients. BMC health services research vol. 19,1 615. 2 Sep. 2019, doi:10.1186/s12913-019-4463-9
3. Jain V, Minhas AMK, Morris AA, et al. Demographic and Regional Trends of Heart Failure-Related Mortality in Young Adults in the US, 1999-2019. JAMA Cardiology vol. 7,9 (2022): 900-904. doi:10.1001/jamacardio.2022.2213
4. Savarese G, Lund LH. Global public health burden of heart failure. Cardiac failure review. 2017 Apr;3(1):7.
5. NHS Conditions - Heart Failure. [Internet]. National Health Service (NHS). Available from: https://www.nhs.uk/conditions/heart-failure (accessed on 02/08/2023)
6. Ujala M, Azam N, Khattak TH, Mashhadi SF, Kamran J, Malik AA. Role of Cardiac Rehabilitation in Improving Health Status & Quality of Life of Heart Failure Patients-A Randomized Controlled Trial. Pakistan Armed Forces Medical Journal. 2022 Feb 25;72(SUPPL-1):S16-20.
7. Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. Journal of the American College of Cardiology. 2021 Mar 23;77(11):1454-69.
8. Chun KH, Kang SM. Cardiac Rehabilitation in Heart Failure. International Journal of Heart Failure. 2021 Jan;3(1):1-4.
9. Passantino A, Dalla Vecchia LA, Corrà U, et al. The Future of Exercise-Based Cardiac Rehabilitation for Patients with Heart Failure. Front Cardiovasc Med. 2021 Aug 4; 8:709898. doi: 10.3389/fcvm.2021.709898. PMID: 34422933; PMCID: PMC8371325.
10. A CebrickGrossman J. Cardiac disease, cardiac rehabilitation and barriers to participation - an overview. Nursing and Palliative Care. 2016;1(1):13–7.
11. Amirova A, Lucas R, Cowie MR, Haddad M. Perceived barriers and enablers influencing physical activity in heart failure: A qualitative one-to-one interview study. PloS one. 2022 Aug 4;17(8):e0271743.
12. Kikuchi A, Taniguchi T, Nakamoto K, et al. Feasibility of home-based cardiac rehabilitation using an integrated telerehabilitation platform in elderly patients with heart failure: A pilot study. J Jpn Coll Cardiol. 2021 Jul;78(1):66-71. doi: 10.1016/j.jjcc.2021.01.010.
13. Rengo JL, Savage PD, Barrett T, Ades PA. Cardiac Rehabilitation Participation Rates and Outcomes for Patients with Heart Failure. J Cardiopulm Rehab Prev. 2018;38(1):38-42. doi: 10.1097/HCR.0000000000000252.
14. Nuhu JM, Gachi LS. A qualitative study on barriers to practitioner implementation of cardiac rehabilitation services in a tertiary health facility in Kano, Nigeria. Journal of the Nigeria Society of Physiotherapy. 2021 Jul 31;20(1):8-15.
15. Pulignano G, Tinti MD, Del Sindaco D, et al. Barriers to cardiac rehabilitation access of older heart failure patients and strategies for better implementation. Monaldi Archives for Chest Disease. 2015;84(1-2).
16. Dunlay SM, Witt BJ, Allison TG, et al. Barriers to participation in cardiac rehabilitation. American Heart Journal. 2009 Nov 1;158(5):852-9.
17. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology vol. 70,6 (2017): 776-803. doi:10.1016/j.jacc.2017.04.025
18. Cowie A, Buckley J, Doherty P, et al. Standards and core components for cardiovascular disease prevention and rehabilitation. Heart (British Cardiac Society) vol. 105,7 (2019): 510-515. doi:10.1136/heartjnl-2018-314206
19. Grossman JA. Cardiac disease, cardiac rehabilitation and barriers to participation-an overview.
20. Khushhal A, Alsubaiei M. Barriers to Establishing Outpatient Cardiac Rehabilitation in the Western Region of Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc. 2023 Mar 9;16:653-661. doi:10.2147/JMDH.S398687.