Ethics – Yes. SJH/AMNCH ethics group
Introduction
Stroke and coronary heart disease are the leading cause of death and disability in Ireland¹. Patients following transient ischaemic attack (TIA) and non-disabling stroke (NDS) exhibit the same modifiable risk factors as those with cardiovascular disease, including physical inactivity. There is emerging research that application of the cardiac rehabilitation paradigm is both feasible and effective as a means of secondary prevention for this patient cohort².
Aim
To evaluate the feasibility and effectiveness of a cardiac rehabilitation programme for secondary prevention and risk factor reduction in patients following TIA or NDS, in St. James’ s Hospital (SJH), Dublin.
Participants
Individuals between 3 and 6 months post-stroke were identified from the TIA and secondary prevention clinic. Individuals were deemed eligible if they had a clinical diagnosis of TIA or NDS, were able to walk 10m unaided and spoke and understood English. Exclusion criteria were based on the Irish Association of Cardiac Rehabilitation 2014 guidelines. Six people were recruited to the class and a cardiac stress test was done prior to commencing the programme.
Methods
The programme was modelled on the current cardiac rehabilitation programme in SJH. This included a twice weekly exercise class and a once weekly education component on topics relevant to stroke survivors including healthy eating, physical activity, and fatigue and medication management.
Baseline assessments included the Six-Minute Walk Test (6MWT), the International Physical Activity Questionnaire, the EuroQOL tool, the Hospital Anxiety and Depression Scale and the Fatigue Assessment Scale. These measurements were recorded on week 1 of the programme and again at week 6.
Adverse incidents, ability to complete exercise stations and attendance rates were recorded. A patient satisfaction survey was completed on the last day of the course.
Results
There were no adverse incidents reported during cardiac stress testing or throughout the programme, and all participants were able to complete the standard cardiac rehabilitation circuit-based exercise class hat is currently run in SJH, without modifications. All participants showed increased walking distance in the 6MWT, decreased fatigue and decreased anxiety and depression. The patient satisfaction survey demonstrated positive feedback from all participants (Figure 1.)
Conclusion
Several international trials are currently exploring this research topic³. The local results reported here suggest that a standard cardiac rehabilitation programme is both feasible and effective for patients after TIA and NDS. Feedback from participants was extremely positive.
It is hoped to roll out this service in SJH on a more permanent basis later in 2017.
References
- Irish Heart Foundation (2016). Facts on Heart Disease and Stroke: Irish Heart Foundation. Available at: https://www.irishheartfoundati... [Accessed 16 Nov. 2016]
- Kirk H., Kersten P., Crawford P. & Keens A. (2014) The cardiac model of rehabilitation for reducing cardiovascular risk factors post transient ischaemic attack and stroke: a randomised controlled trial. Clinical Rehabilitation, 28(4), 339-349
- McKay-Lyons M., Gubitz G., Giacomantonio N. & Wightman H.. (2010) Programme of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trial. BMC Neurology.10, 122-131.
