Journal of Rehabilitation Medicine 51-2 | Page 61

J Rehabil Med 2019; 51: 136–143 ORIGINAL REPORT EARLY PHYSICAL AND PSYCHO-EDUCATIONAL REHABILITATION IN PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING: A RANDOMIZED CONTROLLED TRIAL Ida Elisabeth HØJSKOV, PhD 1,2 , Philip MOONS, PhD 3,4 , Ingrid EGEROD, PhD 5 , Peter Skov OLSEN, Dr. Med. Sci 1 , Lau Caspar THYGESEN, PhD 6 , Niels Viggo HANSEN, PhD 7 , Søren LA COUR, MPH, Kristina Hindhede BECH, MSPT 8 , Britt BORREGAARD, MPQM 8 , CHRISTIAN GLUUD, Dr Med Sci 9 , Per WINKEL, Dr Med Sci 9 , Jane LINDSCHOU, MSc 9 and Selina KIKKENBORG BERG, PhD 1 From the 1 Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, University of Copenhagen, 2 Department of Nursing, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark, 3 Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium, 4 Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden, 5 Intensive Care Unit, Rigshospitalet, Copenhagen University Hospital, 6 National Institute of Public Health, University of Southern Denmark, Copenhagen, 7 Interacting Minds Center, Aarhus University, Aarhus, 8 Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense and 9 Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Objectives: Rehabilitation of patients following coro- nary artery bypass grafting (CABG) has been widely studied; however, research into early rehabilitation after CABG is sparse. The aim of this trial was to as- sess the impact of early rehabilitation, compared with usual care in patients following CABG. Design: Randomized controlled trial. Patients: A total of 326 patients treated with CABG. Methods: Patients treated with CABG were randomi- zed 1:1 to 4 weeks of comprehensive early rehabili- tation or usual care. The primary outcome was the Six Minute Walk Test (6MWT). Secondary outcomes were mental health and physical activity (Medical Outcome Study Short Form; SF-12); anxiety and de- pression (Hospital Anxiety and Depression Scale; HADS); physical and emotional scores; sleep (Pitts- burgh Sleep Quality Index; PSQI); pain (Örebro Mus- culoskeletal Screening Questionnaire; ÖMSQ) and muscle endurance (Sit-To-Stand test). Results: Sixteen patients dropped out. No significant differences between groups in the primary outcome (6MWT) were found after 4 weeks (p  = 0.27). For se- condary outcomes the odds ratio of HADS-D ≥ 8 de- creased in favour of the experimental intervention (p  = 0.04). There was non-adherence to parts of the intervention. Per-protocol analysis showed differen- ces between groups for the 6MWT (p  = 0.02) and the Sit-To-Stand test (p  = 0.046). Conclusion: In general, the intervention had no ef- fect on the 6MWT, or secondary outcomes, except for depressive symptoms. However, in adherent par- ticipants, the intervention had a positive effect for the primary and several secondary outcomes. Key words: rehabilitation post-CABG; phase 1 rehabilitation; early rehabilitation; coronary artery bypass grafting; physical exercise; psycho-education. Accepted Oct 2, 2018; Epub ahead of print Nov 28, 2018 J Rehabil Med 2019; 51: 136–143 Correspondence address: Ida Elisabeth Højskov, Department of Car- diothoractic Surgery, Rigshospitalet, University of Copenhagen, The Heart Centre, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. E- mail: [email protected] LAY ABSTRACT This trial investigated the effects of an early rehabilita- tion programme in addition to usual care for patients undergoing heart bypass surgery. The programme con- sisted of exercise training and 4 planned nurse consul- tations in the period from admission to 4 weeks after surgery. The programme was tested by 163 patients undergoing heart bypass surgery, compared with a si- milar number of patients who followed usual care alone. The trial did not show any effect of the programme on physical function, but there was a positive effect in re- ducing depressive symptoms in the rehabilitation group. Although the rehabilitation programme was scheduled, adherence was low. The reason for lack of efficacy could be poor adherence to the programme, as patients who followed the programme significantly improved in terms of physical functioning 4 weeks after surgery. The re- sults provide important information for health professio- nals for refining early rehabilitation programmes after heart bypass surgery. C ardiac rehabilitation is differentiated into 3 main phases: in-hospital (phase 1); early outpatient (phase 2), and long-term outpatient (phase 3) cardiac rehabilitation (1). Clinical recommendations for phase 1 rehabilitation for patients undergoing coronary artery bypass graft (CABG) surgery are few, and are based on sparse evidence from trials with small sample sizes and non-representative trial populations (2, 3). Patients with chronic conditions can receive surgical treatment (3); however, the postoperative period can be challen- ging, with physical and psychological problems and symptoms such as anxiety and depression, immobility issues, respiratory complications, insufficient sleep, and fatigue (4–6). Exercise training after hospital discharge has demon- strated positive benefits (7), and it seems reasonable to start exercise training immediately after CABG surgery (8). Trials have demonstrated improvements in outcomes, measured by pulmonary complications This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm doi: 10.2340/16501977-2499 Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977