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The purpose of this study is to investigate the effect of an early, coordinated rehabilitation intervention for patients with severe heart failure in NYHA class III and IV with a ejection fraction of <40% of normal cardiac function measured on frequency of readmissions, physical ability and participation in activities of daily living and quality of life.
Approximately 400,000 Danes live today with heart disease. Disease severity is crucial for patients quality of life. Patients with severe heart disease often struggle with everyday life, characterized by reduced physical capacity, tendency to depression and anxiety to perform everyday activities that may provoke symptoms.
A large proportion of patients who are offered cardiac rehabilitation deselect that offer. Of the patients who do participate, more than 50% stop the rehabilitation ahead of time. A large group of patients with severe heart failure and classified in NYHA Class III and IV, deselect the offer because of lack of energy to participate in cardiac rehabilitation or is when specified by a medical assessment discharged from the hospital without the offer of training or any other form of rehabilitation.
The offer of rehabilitation for patients with severe heart failure is lacking as it is today. This study assesses the effectiveness of an early home based rehabilitation program that complements the general psycho-social support, symptom-oriented and preventive medical treatment that these patients always have the option to get.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Early homebased rehabilitation | Experimental | After discharge from the hospital patients are offered a homebased rehabilitation program lasting 6 weeks. |
|
| control group: Ususal care | Experimental | After discharge from the hospital the patients are offered the usual symptom-oriented and preventive medical care and psychosocial support |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Early homebased rehabilitation after hospital admission | Other | Training begins 3-5 days after discharge from hospital, performed by an occupational therapist and a physiotherapist from Gentofte Hospital in the first two weeks. From week three to six the training will be carried out by an occupational therapist and a physiotherapist from the local municipality (Gentofte municipality and Lyngby Taarbæk municipality). Training will take place at home twice a week for 6 weeks, each session lasting 45 minutes. The intervention is individualized and focuses on functional physical and compensatory training to help the patient to manage everyday life at home. A training program will be provided and the patient will be instructed to do the exercises every day |
| Measure | Description | Time Frame |
|---|---|---|
| Readmission due to heart failure | assessed one year after inclusion |
| Measure | Description | Time Frame |
|---|---|---|
| Physical capacity | measured by the Morton Mobility Index, Timed Up & Go and Modified Sit to Stand Test | Assessed at baseline, after 6 weeks, after 6 month and after one year |
| Activity of Daily Living |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Laura Staun Valentiner, Master in health scien | Contact | + 45 39 77 39 51 | laura.risted.staun.valentiner@regionh.dk | |
| Carsten Juhl, Ph.D.stud | Contact | + 45 39 77 39 51 | carsten.juhl@regionh.dk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital Gentofte, | Copenhagen | Gentofte | 2900 | Denmark |
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| Usual care | Other | After discharge from the hospital the patients are offered the usual symptom-oriented and preventive medical care and psychosocial support |
|
Recorded at an ADL interview to assess the performance of everyday activities
| Assessed at baseline, after 6 weeks, after 6 month and after one year |
| Number of total hospital admissions | at baseline, after 6 weeks, after 6 month and after one year |
| Exercise Compliance | registration of exercise | at baseline, after 6 weeks, after 6 month and after one year |
| Anxiety and depression | measured by Hospital Anxiety and Depression Scale (HAD) | at baseline, after 6 weeks, after 6 month and after one year |
| Quality of life | measured by The Minnesota Living with Heart Failure Questionnaire | at baseline, after 6 weeks, after 6 month and after one year |
| Number of patients who starts outpatient cardiac rehabilitation after intervention (municipality or hospital) | at 6 weeks, after 6 month and after one year |
| ID | Term |
|---|---|
| D006333 | Heart Failure |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| D000203 | Activities of Daily Living |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
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