Abstract
BACKGROUND: Decline or inadequate recovery of activities of daily living (ADL) during hospitalization is crucial for clinical prognosis. In this study we investigated the relationship between cardiac rehabilitation (CR) and ADL recovery in patients with cardiovascular disease (CVD), with the aim of exploring associations that may contribute to the development of rehabilitation interventions. METHODS AND RESULTS: This study analyzed consecutive patients hospitalized with CVD. ADL was assessed using the Barthel index (BI) at the commencement of rehabilitation and discharge. As the outcome measure for ADL, relative functional gain: BI effectiveness, calculated as (discharge BI - initial BI) / (100 - initial BI), was adopted in order to compensate ceiling effect of BI. BI effectiveness ≥0.5 defined the ADL recovery group, while <0.5 defined the ADL non-recovery group. Of the 2,938 patients screened, 1,582 (median age 79 years, male 59%) were included after exclusions. The ADL recovery group consisted of 1,162 patients, the ADL non-recovery group, 420 patients. Between-group comparisons and multivariate regression analysis identified age and initial BI as highly significant ADL recovery determinants. Recursive partitioning analysis showed CR volumes of ≥75 min/day for patients ≥75 years and ≥45 min/day for those <75 years with lower initial BI were associated with ADL recovery. These CR volumes also reduced the institutionalization odds ratios (OR=0.42 and OR=0.34, P<0.001) compared to CR volumes <45 min/day. CONCLUSIONS: CR volume was associated with ADL recovery, especially for older patients with low baseline function at admission. Optimizing CR volume based on patient background and condition may contribute to enhance ADL recovery and improved clinical prognosis.