Abstract
Aim: The vast majority of evidence relating to the efficacy of cardiac rehabilitation is based on studies of white, middle-class males with myocardial infarction. There is a dearth of evidence relating to other subgroups of patients, such as those who have undergone coronary artery bypass surgery, older patients and women. This raises significant issues for clinical practice. Routine clinical practice entails providing a cardiac rehabilitation service for a range of individuals of different ages and with various forms of coronary heart disease. Bearing in mind the limited evidence available, how do we know if a specific programme is equally appropriate for differing sub-groups of patients? This clinical question provides an opportunity to undertake empirical investigation. The aim of the present study is to make use of the opportunities afforded by routine clinical practice as a basis for the investigation of issues that are both theoretically well motivated and relevant to everyday clinical practice. The specific questions are: (1) Can a standard cardiac rehabilitation programme show evidence of benefit for older as well as younger patients? (2) Can a standard rehabilitation programme show evidence of benefit for coronary artery bypass graft patients as well as myocardial infarction patients? (3) Is there any evidence of differences in outcome for men and women, taking into account the other variables described in (1) and (2)? And, finally, (4) Can standard cardiac rehabilitation show evidence of benefit for patients with varying degrees of psychological morbidity? Data were collected over a twelve month period on physical and psychosocial baseline and outcome function, as part of routine clinical practice. These were then examined for evidence of change within patients, over time and between different sub-groups of patients. The data were analysed statistically using a variety of methods, including cluster analysis, regression analysis, chi-square, t-tests and non-parametric statistics. Implications for clinical practice are discussed.