REVISION OF THE DUTCH PHYSICAL THERAPY CARDIAC REHABILITATION GUIDELINE: INCORPORATING NOVEL CARE PATHWAYS AND TAILORED PROGRAMS

D. Conijn¹, R.J. Achttien¹, T.M. Eijsvogels², I.C. Schaffers³, N.M. Swart¹

¹Royal Dutch Society for Physiotherapy (KNGF), Department of Quality, Amersfoort, Netherlands, ²Radboud Institute for Health Sciences, Radboud University Medical Center, Department of Physiology, Nijmegen, Netherlands, ³Cesar and Mensendieck and Exercise Therapy Association (VvOCM), Department of Quality and Science, Utrecht, Netherlands

Background: The Dutch physical therapy Cardiac Rehabilitation guideline was launched in 2011. Since then, new transmural care pathways were introduced and tailored care emerged in daily practice to improve the uptake and completion rates of cardiac rehabilitation.

Purpose: Due to the changes in the daily practice of cardiac rehabilitation in patients with coronary artery disease and chronic heart failure, a revision of the guideline was necessary. The updated guideline will contain evidence-based recommendations about the content and personalization of cardiac rehabilitation.

Methods: A guideline panel and review group with representatives of relevant stakeholders (for example physical therapists, general practitioners, cardiologists, patient representatives and healthcare insurers) was composed. Using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group, research questions for narrative or systematic reviews were formulated after focus groups with physical therapists and consultation of experts. The evidence was synthesized by providing the estimates of the effect size for each outcome and the certainty of the evidence. A strong or conditional recommendation for or against an intervention or contributing factor was formulated by the panel, based on the evidence together with relevant considerations, as described in the GRADE evidence to decision framework.

Results: Our preliminary results are;
a) Barriers and facilitators to the adherence and completion of cardiac rehabilitation have been identified.
b) Recommendations concerning the tailored care modalities are formulated, i.e., behavior-oriented treatment (in patients with lower social economic status), telerehabilitation and on the frequency, intensity, type, and time (FITT factors) of the exercise therapy.
c) Specific recommendations on conditions of transmural care are formulated. The revisited guideline for patients with coronary artery disease and chronic heart failure will be published at the end of 2023.

Conclusions: Based on scientific evidence, patient preferences and considerations (overall certainty of the evidence, balance of benefits and harms/burden, outcome importance, costs/resources, inequity, feasibility, acceptability), easy to use recommendations are formulated to stimulate guideline adherence among physical therapists.

Implications: Nationwide implementation is necessary to enhance novel care pathways and tailored care and achieve uniform optimal health care for patients.
Implementation of the guideline will consist of offering e-learning and training to physical therapists. Additionally, the content of the guideline will be communicated through several clinical journals for healthcare professionals. A widely supported and implemented guideline will contribute to more effective and uniform treatment strategies by physical therapists and other healthcare professionals.

Funding acknowledgements: The Dutch Ministry of Health, Wellbeing and Sports funded development of this guideline

Keywords:
Cardiac rehabilitation
Guideline

Topics:
Cardiorespiratory
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No

Reason: No ethical approval is required in guideline-development