Impact of reduced group size on patient adherence and functional outcomes in cardiac rehabilitation: insights from a COVID-19 pandemic natural experiment.
Rachael M Chait, Julia Ossi, Brett M Colbert and 5 others
PMID 39323429WHAT IT FOUND
Switching to one-on-one cardiac rehabilitation sessions raised completion rates from 21% to 75%.
Functional outcomes for those who completed were unchanged. The shift to individual care may solve adherence problems, but workforce costs remain a barrier.
Key findings
01Completion rates rose from 21% in group sessions to 75% in one-on-one sessions.
02Improvements in functional capacity (6-minute walk test) were similar between the two groups for patients who completed the program.
03The patient-to-provider ratio dropped significantly from 2.8 to 0.4, driven by fewer patients and more staff per session.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a natural experiment, not a randomised controlled trial, so unmeasured confounders such as patient risk tolerance or changes in barrier mitigation during the pandemic cannot be ruled out. The sample size was small and unequal (204 vs 51), and the study was conducted at a single tertiary care center. The post-COVID-19 group had fewer patients overall, which may reflect selection bias among those willing or able to attend during the pandemic. The study did not measure the cost or workforce feasibility of maintaining one-on-one sessions. Socioeconomic status and patient risk tolerance were not assessed.
Declared interests
The authors declare financial support from various NIH grants (R01HL152453, R01HL142066, etc.). No commercial conflicts of interest are reported.
The easy way to misread this
Do not assume one-on-one care is universally superior or feasible. The study was conducted at a single center that added staff to support the lower patient-to-provider ratio, and the observed benefits may be influenced by unmeasured pandemic-related factors such as patient risk tolerance.