STRUCTURED ABSTRACTPurpose-Despite the established benefits of cardiac rehabilitation (CR), it remains significantly underutilized. It is unknown whether patient barriers to enrollment and adherence are addressed by offering choice of program type. The purpose of this study was to examine barriers to participation in CR by program type (site vs. home-based), and the relation of these barriers to degree of program participation and exercise behavior.Method-1809 cardiac patients from 11 hospitals across Ontario completed a sociodemographic survey in-hospital, and clinical data were extracted from charts. They were mailed a follow-up survey one year later, which included the Cardiac Rehabilitation Barriers Scale and the Physical Activity Scale for the Elderly. Participants were also asked whether they attended CR, the type of program model attended, and the percentage of prescribed sessions completed.Results-Overall, 939 (51.9%) patients participated in CR, with 96 (10.2%) participating in a home-based program. Home-based participants reported significantly greater CR barriers compared to site-based participants (p<0.001), including distance. Mean barrier scores were significantly and negatively related to session completion and physical activity among site-based (ps<0.05), but not home-based CR participants (p>0.05). To address many of the CR barriers such as lack of transportation access and distance to program facilities, home-based CR programs have been developed. Home-based CR programs offer the same core CR components as site-based programs, 5,6 but communication occurs through telephone or internet contact, education occurs through provision of written materials, and exercise is undertaken in the patient's community environment. Home-based and site-based programs do not differ in terms of mortality rates, cardiac events, exercise capacity, smoking cessation, or health-related quality of life. 7
Conclusion-ThePatients reporting greater barriers to CR use are significantly less likely to enrol, and are more likely to dropout, ultimately not achieving the health benefits of CR. 8 Yet, many patient barriers to CR could be addressed by appropriate allocation to site or home-based programs, although this has yet to be investigated. Thus, the objectives of this study were to:(1) describe and compare barriers to participation, and (2) investigate whether these barriers are related to (a) program adherence (percentage of site or phone CR sessions attended) and (b) exercise behavior, among patients participating in site versus home-based CR programs.
METHOD Design and ProcedureThis is a secondary analysis of a larger study 9 for which cardiac in-patients from 11 hospitals in Ontario were recruited. CR services were provided through provincial healthcare at no cost to patients (although patients pay for transportation and/or parking at each visit). Ethics approval was granted from all participating institutions. After obtaining consent, clinical data were extracted from medical charts, and a self-report survey was prov...