Participation in Society in Patients With Coronary Artery Disease Before and After Cardiac Rehabilitation

Published:February 05, 2015DOI:



      To assess changes in participation in society (frequency, restrictions, satisfaction) during and after cardiac rehabilitation (CR) and to assess associations between participation and heath-related quality of life (HRQOL).


      Prospective cohort study.


      Outpatient CR center.


      Patients with coronary artery disease (N=121; mean age, 57y; 96 men [79%]).


      Multidisciplinary CR.

      Main Outcome Measures

      Participation in society was assessed with the Utrecht Scale for Evaluation of Rehabilitation-Participation and HRQOL with the MacNew Heart Disease health-related quality of life questionnaire. All measurements were performed pre-CR, post-CR, and 1 year after the start of CR.


      Frequency of participation did not change during and after CR. The proportion of patients experiencing restrictions in participation decreased from 69% pre-CR to 40% post-CR (P<.001) and 29% at 1 year (P<.001 vs post-CR). Pre-CR, 71% of patients were dissatisfied with their participation. This improved to 49% post-CR (P<.001) and 53% at 1 year (P<.001 vs pre-CR). Experienced restrictions explained 5% to 7% of the improvement in HRQOL during CR and satisfaction with participation explained 10% to 19%.


      Participation in society improves in patients undergoing CR. Despite these improvements, the presence of coronary artery disease is associated with persistent restrictions and dissatisfaction with participation. Because experienced restrictions and dissatisfaction are related to changes in HRQOL it is important to address these aspects of participation during CR.


      List of abbreviations:

      CAD (coronary artery disease), CR (cardiac rehabilitation), GEE (generalized estimating equation), HRQOL (health-related quality of life), OR (odds ratio), USER-Participation (Utrecht Scale for Evaluation of Rehabilitation-Participation)
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