Translation and evaluation of a comprehensive educational program for cardiac rehabilitation patients in Latin America: A multi-national, longitudinal study.
Gabriela Lima de Melo Ghisi, Sherry L Grace, Claudia V Anchique and 11 others
PMID 33097358WHAT IT FOUND
In three Latin American cardiac rehabilitation programs, Spanish Cardiac College education with supervised exercise and home exercise prescription increased knowledge from 13.64 to 15.38 of 20 points, held at 6 months.
No control group, so the contribution of education cannot be separated from exercise.
Key findings
01In three Latin American cardiac rehabilitation programs, total knowledge rose from 13.64 to 15.38 of 20 points after Cardiac College education, supervised exercise and home exercise prescription, and was 15.41 at 6-month follow-up.
02Participants who received Cardiac College education alongside supervised exercise and home exercise prescription had mean steps per day rise from 7752.43 to 9180.39, and the proportion reaching 7500 steps increased from 47.8% to 64.2% post-CR and 70.0% at 6 months.
03Attendance at education sessions remained associated with post-CR knowledge after adjustment for education level and pre-CR knowledge.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
No randomisation, control or comparison group was used, so the study cannot show that Cardiac College education caused the improvements; supervised exercise, home exercise prescription, natural recovery, informal education and practice effects remain possible explanations. Participants were recruited from three Latin American cardiac rehabilitation centers and excluded if they lacked Spanish-language proficiency or had visual, cognitive or serious psychiatric conditions. Generalizability is limited to similar CR programs and patients who could complete surveys. Centers did not track individual participant recruitment and response rate, so selection bias cannot be established. Follow-up fell to 121 participants. Retained versus lost groups differed by income, bypass surgery, obesity, dyslipidemia and smoking. This introduced retention bias. Attendance to education sessions was 65.2 ± 26.9%, and 65 (26.1%) participants dropped out of CR. The translation used only one translation version because of budget restrictions, despite best practice recommending more than one.
Declared interests
The work was supported by Toronto Rehab Foundation. The authors reported no declarations of interest.
The easy way to misread this
Do not read the increases in knowledge, health literacy, steps and diet as proof that Cardiac College caused them. The study had no randomisation and no control or comparison group, so supervised exercise alone, natural recovery, informal education or practice effects could explain the gains.