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• Predictors and causes of cardiac rehabilitation participation: Not one and the same…
  Alexander M Clark
  Published on: 31 January 2005

• Published on: 31 January 2005

  Predictors and causes of cardiac rehabilitation participation: Not one and the same…

  • Alexander M Clark, Assistant Professor
  • Other Contributors:
    • Paul D MacIntyre

  Dear Editor,

  Jackson and colleagues [1] review of the predictors of cardiac rehabilitation participation addresses a serious international health problem. However, throughout, the review conflates prediction with causality- a confusion that has significant implications for the clarity of its recommendations for practice.

  While a number of common predictors of participation are identified by the review...

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  Dear Editor,

  Jackson and colleagues [1] review of the predictors of cardiac rehabilitation participation addresses a serious international health problem. However, throughout, the review conflates prediction with causality- a confusion that has significant implications for the clarity of its recommendations for practice.

  While a number of common predictors of participation are identified by the review (most notably physician’s endorsement, age and sex), these are presented as causes of participation in the subsequent discussion. This confusion is maintained in the conclusion that ‘obstacles’ such as age, sex and educational attainment ‘cannot be changed.’ As these are predictors and not themselves obstacles, their identification provides evidence of which patient groups are excluded but does not identify the causes of low participation in women, older adults and low income groups. Our own work has shown in a national study of Scotland [2] that, though age may predict lower cardiac rehabilitation participation, the actual causes of this pattern are complex and related to limited program capacity, resources and flexibility. To improve participation in older patients these underlying health systems factors should be addressed.

  Secondly, by focusing on single factors, the review fails to identify the complex ways in which factors interact in the individual patient to influence not only willingness but also capacity to participate. Beneath even the seemingly straightforward single reasons voiced by patients for non-attendance, such as a lack of transport, we have shown that there lies a web of complex cost-benefit calculations, perceptions and values [3]. Again, to increase participation, these underlying factors must be understood and addressed.

  Identifying predictors can assist the targeting of additional intervention to increase attendance. However, attempts to increase participation in cardiac rehabilitation will only be successful, if clinicians focus on the systems and individual factors that causally inhibit attendance in defined populations.

  References

  (1). Jackson L, Leclerc J, Erksine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence patterns. Heart 2005;91:10-14.

  (2). Clark AM, Sharp C, MacIntyre PD. The role of age in moderating access to cardiac rehabilitation in Scotland. Ageing and Society 2002;22:501-515.

  (3). Clark AM, Barbour RS, White M, MacIntyre PD. Promoting participation in cardiac rehabilitation : Patients' choices and experiences. Journal of Advanced Nursing 2004;47(1):5-14.

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  Conflict of Interest:
  None declared.

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