Physiotherapy intervention in outpatient cardiovascular rehabilitation in patients after aortic valve surgery

    Authors

    Abstract

    **Introduction:** The aortic valve implantation is immediately followed by the first phase of cardiovascular rehabilitation (CVR). The first follow-up by a cardiac surgeon, which is common in 6-8 weeks after the surgical intervention, is followed by the continued rehabilitation by including the patients in some of the inpatient or outpatient CVR programs, provided there are no contraindications present. (1) The aim of the paper is to present the results of physiotherapy (PT) interventions in patients after aortic valve surgery involved in the outpatient CVR program in the Institute for Cardiovascular Diseases Prevention and Rehabilitation in Zagreb. **Patients and Methods:** We retrospectively analyzed the data from the medical charts of all patients after aortic valve surgery involved in the outpatient CVR program in the Polyclinic during the period from 10th January 2012 who ceased to participate in the program by 6th October 2016. The performance of the CVR in the Institute (2) and the presentation of PT interventions (2, 3) have already been described. The time period from the surgical intervention to involvement in the program, the presence of problems during the training and frequency of participation in the training affect the accomplishment of short-term and long-term PT goals which is shown by descriptive statistics in the groups of subjects by gender. **Results:** During the period of the study, a total of 53 patients, of whom 35 (66%) men and 18 (34%) women underwent the CVR program. The study results of the success of performing PT interventions are shown in **Table 1****.** ### Table 1: Physiotherapy interventions in patients after aortic valve surgery undergoing outpatient cardiovascular rehabilitation. | | **Men (n=35)** | **Women (n=18)** | **Total (N=53)** | | --- | --- | --- | --- | | **Number of days till involvement in the program** | | | | | Average number | 156 | 146 | 153 | | Minimum number | 48 | 51 | 48 | | Maximum number | 763 | 440 | 763 | | **Number of participations in the interval cardiovascular training** | | | | | >35 | 11.4% (4/35) | 16.7% (3/18) | 13.2% (7/53) | | 24-35 | 34.3% (12/35) | 50.0% (9/18) | 39.6% (21/53) | | 13-23 | 20.0% (7/35) | 16.7% (3/18) | 18.9% (10/53) | | <13 | 34.3% (12/35) | 16.7% (3/18) | 28.3% (15/53) | | **Discomforts during the program** | | | | | No discomforts | 34.3% (12/35) | 44.4% (8/18) | 37.7% (20/53) | | Cardiovascular | 25.7% (9/35) | 0% (0/18) | 16.9% (9/53) | | Noncardiovascular | 28.6% (10/35) | 33.3% (6/18) | 30.2% (16/53) | | Cardiovascular and noncardiovascular | 11.4% (4/35) | 22.2% (4/18) | 15.1% (8/53) | | **Rehabilitation conditioning during the program** | | | | | Increase in stress | 28.6% (10/35) | 27.8% (5/18) | 28.3% (15/53) | | Decrease in stress | 0% (0/35) | 0% (0 /18) | 0% (0/53) | | **Accomplishment of physiotherapy goals** | | | | | Short-term goals accomplished | 80.0% (28/35) | 89.0% (16/18) | 83.0% (44/53) | | Long-term goals accomplished | 60.0% (21/35) | 83.3% (15/18) | 67.9% (36/53) | **Conclusion:** The patients with aortic valve operated in Croatia start with the outpatient CVR program late, on the average after 5 months following the surgical intervention. A small number of problems have resulted in a large number of participation in the interval cardiovascular training in patients and therefore more successful accomplishment of short-term and long-term PT goals of the CVR program. Since this is a study in one CVR center, it is necessary to examine the effect in a larger group, as well as in patients with other indications for outpatient CVR.

    Keywords

    aortic valve cardiac surgery, physiotherapy intervention, outpatient cardiovascular rehabilitation

    DOI

    https://doi.org/10.15836/ccar2016.630

    Literature

    1. Association of Chartered Physiotherapists in Cardiac Rehabilitation. Early Activity After Cardiac Surgery 2016. Available at: (20. 10. 2016). http://acpicr.com/sites/default/files/Early%20Activity%20After%20Cardiac%20Surgery%202016%20-%20Booklet%20-%20A4_1.pdf
    2. Ivanuša M, Narančić Skorić K, Glavaš Vražić S, Kruhek Leontić D, Heinrich M, Mažuran Brkljačić L, et al. 2. Outpatient Cardiovascular Rehabilitation in Croatia. Cardiol Croat. 2015;10(1-2):28–42. https://doi.org/10.15836/ccar.2015.28
    3. Muminović Ž, Brkljačić Mažuran L, Dražić-Balov J, Glavaš Vražić S, Ivanuša M. I am active, therefore I am: physiotherapy interventions in cardiovascular rehabilitation. Cardiol Croat. 2016;11(10-11):548–9. https://doi.org/10.15836/ccar2016.548
    Cardiologia Croatica
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    Physiotherapy intervention in outpatient cardiovascular rehabilitation in patients after aortic valve surgery

    Extended Abstract
    Issue12
    Published
    Pages630-631
    PDF via DOIhttps://doi.org/10.15836/ccar2016.630
    aortic valve cardiac surgery
    physiotherapy intervention
    outpatient cardiovascular rehabilitation

    Authors

    Jadranka Dražić-BalovORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Žaklina MuminovićORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Gabrijela ĆurićORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Kristina Narančić SkorićORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia
    Mario Ivanuša*ORCIDInstitute for Cardiovascular Prevention and Rehabilitation, Zagreb, Croatia

    *Correspondence email: mivanusa@gmail.com

    Abstract

    **Introduction:** The aortic valve implantation is immediately followed by the first phase of cardiovascular rehabilitation (CVR). The first follow-up by a cardiac surgeon, which is common in 6-8 weeks after the surgical intervention, is followed by the continued rehabilitation by including the patients in some of the inpatient or outpatient CVR programs, provided there are no contraindications present. (1) The aim of the paper is to present the results of physiotherapy (PT) interventions in patients after aortic valve surgery involved in the outpatient CVR program in the Institute for Cardiovascular Diseases Prevention and Rehabilitation in Zagreb. **Patients and Methods:** We retrospectively analyzed the data from the medical charts of all patients after aortic valve surgery involved in the outpatient CVR program in the Polyclinic during the period from 10th January 2012 who ceased to participate in the program by 6th October 2016. The performance of the CVR in the Institute (2) and the presentation of PT interventions (2, 3) have already been described. The time period from the surgical intervention to involvement in the program, the presence of problems during the training and frequency of participation in the training affect the accomplishment of short-term and long-term PT goals which is shown by descriptive statistics in the groups of subjects by gender. **Results:** During the period of the study, a total of 53 patients, of whom 35 (66%) men and 18 (34%) women underwent the CVR program. The study results of the success of performing PT interventions are shown in **Table 1****.** ### Table 1: Physiotherapy interventions in patients after aortic valve surgery undergoing outpatient cardiovascular rehabilitation. | | **Men (n=35)** | **Women (n=18)** | **Total (N=53)** | | --- | --- | --- | --- | | **Number of days till involvement in the program** | | | | | Average number | 156 | 146 | 153 | | Minimum number | 48 | 51 | 48 | | Maximum number | 763 | 440 | 763 | | **Number of participations in the interval cardiovascular training** | | | | | >35 | 11.4% (4/35) | 16.7% (3/18) | 13.2% (7/53) | | 24-35 | 34.3% (12/35) | 50.0% (9/18) | 39.6% (21/53) | | 13-23 | 20.0% (7/35) | 16.7% (3/18) | 18.9% (10/53) | | <13 | 34.3% (12/35) | 16.7% (3/18) | 28.3% (15/53) | | **Discomforts during the program** | | | | | No discomforts | 34.3% (12/35) | 44.4% (8/18) | 37.7% (20/53) | | Cardiovascular | 25.7% (9/35) | 0% (0/18) | 16.9% (9/53) | | Noncardiovascular | 28.6% (10/35) | 33.3% (6/18) | 30.2% (16/53) | | Cardiovascular and noncardiovascular | 11.4% (4/35) | 22.2% (4/18) | 15.1% (8/53) | | **Rehabilitation conditioning during the program** | | | | | Increase in stress | 28.6% (10/35) | 27.8% (5/18) | 28.3% (15/53) | | Decrease in stress | 0% (0/35) | 0% (0 /18) | 0% (0/53) | | **Accomplishment of physiotherapy goals** | | | | | Short-term goals accomplished | 80.0% (28/35) | 89.0% (16/18) | 83.0% (44/53) | | Long-term goals accomplished | 60.0% (21/35) | 83.3% (15/18) | 67.9% (36/53) | **Conclusion:** The patients with aortic valve operated in Croatia start with the outpatient CVR program late, on the average after 5 months following the surgical intervention. A small number of problems have resulted in a large number of participation in the interval cardiovascular training in patients and therefore more successful accomplishment of short-term and long-term PT goals of the CVR program. Since this is a study in one CVR center, it is necessary to examine the effect in a larger group, as well as in patients with other indications for outpatient CVR.

    Literature

    1. 1.
      Association of Chartered Physiotherapists in Cardiac Rehabilitation. Early Activity After Cardiac Surgery 2016. Available at: (20. 10. 2016).Link
    2. 2.
      Ivanuša M, Narančić Skorić K, Glavaš Vražić S, Kruhek Leontić D, Heinrich M, Mažuran Brkljačić L, et al. 2. Outpatient Cardiovascular Rehabilitation in Croatia. Cardiol Croat. 2015;10(1-2):28–42.DOI
    3. 3.
      Muminović Ž, Brkljačić Mažuran L, Dražić-Balov J, Glavaš Vražić S, Ivanuša M. I am active, therefore I am: physiotherapy interventions in cardiovascular rehabilitation. Cardiol Croat. 2016;11(10-11):548–9.DOI