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cardiac rehabilitation, quality of life, self-efficacy



  1. Gardner, Jacqueline K. MS
  2. McConnell, Timothy R. PhD
  3. Klinger, Troy A. MS
  4. Herman, Carolyn P. BSN
  5. Hauck, Carol A. RN
  6. Laubach, , Charles A. Jr MD


PURPOSE: Outcome measurement research has extended beyond traditional clinical and physiologic parameters to include psychosocial aspects. Accordingly, the purpose of this study was to investigate quality-of-life (QOL) and self-efficacy disparities for gender and diagnoses during participation in cardiac rehabilitation.


METHODS: For this study, 472 patients (114 women and 358 men) were stratified by gender and then again by diagnosis to include surgical revascularization, myocardial infarction, and percutaneous coronary intervention. Measures obtained at baseline and at the end of the study assessed quality of life (QOL-o = total score), including emotional (QOL-e) and limitation (QOL-l) domains; self-efficacy (SE-o = total score), including ambulatory (SE-a) and muscular (SE-m) domains; and caloric expenditure.


RESULTS: Both self-efficacy and QOL were greater at the end of the study across genders (P < .05). The men had greater self-efficacy values for all domains (P < .05). There was a significant gender-time interaction for QOL-e (P < .05) among the women, and for QOL-o, QOL-l, and all self-efficacy domains (P < .05) among the surgical revascularization patients. Percutaneous coronary intervention patients had higher self-efficacy scores throughout. Caloric expenditure was a consistent positive predictor of self-efficacy and QOL-e (P < .05).


CONCLUSIONS: Quality of life and self-efficacy improve during cardiac rehabilitation across gender and diagnoses. Female and revascularized patients present with low QOL and self-efficacy scores initially, but improvements in scores similar to or greater than the men can be expected. Because the self-efficacy scores of percutaneous coronary intervention patients are higher and their physical limitations are less prohibitive, these patients can be progressed more aggressively. Improvements in self-efficacy scores parallel caloric expenditure increases.


Quality of life (QOL) is a multifaceted concept that incorporates the way a patient's life is affected by an illness and its management. Quality of life, however, is more than personal health status. It also involves a sense of well-being and life satisfaction; the maintenance of physical, emotional, and intellective function; and the ability to participate in valued activities. Patient perceptions and expectations are useful because they often differ from those of healthcare providers. Moreover, perceived health status has a more accurate impact on work performance than objectively measured functional capacity and correlates best with mortality risk, particularly in the elderly. 1


Self-efficacy measures self-confidence for performing a given activity or task and represents an individual's perceptions or beliefs about how capable he or she is of performing that specific activity or task. 2 Whereas an individual's self-perceived confidence may vary, the level of self-efficacy reliably predicts whether a specific activity will be attempted. 3 Additionally, the likelihood of patients engaging in selected activities is determined as much by the patients' belief in their own ability as by objectively measured exercise tolerance. 4


Much research has focused on gender differences with respect to a multitude of cardiac treatments, interventions, and outcomes, with documented distinctions as they relate to the care and management of heart disease. 5 Likewise, the greater frequency of medical complications, coupled with diminished psychosocial adjustment, implies that women may have a poorer QOL than men during recovery and rehabilitation. 6 Moreover, women in cardiac rehabilitation display sociodemographic and clinical characteristics (older age, higher prevalence of coronary disease risk factors, more likelihood of living alone) that may place them at a higher risk of cardiovascular mortality and morbidity than their male counterparts. 7 Finally, program attendance and dropout rates appear to be worse among women.


Besides gender, another concern for cardiac rehabilitation professionals involves outcome variations associated with differing diagnoses. Surgical revascularization patients tend to start cardiac rehabilitation programs at a lower functional capacity because of their surgical convalescence, but progress more rapidly than patients with myocardial infarction. 8


A more recent addition to cardiac rehabilitation includes patients receiving percutaneous coronary intervention. Because the hospital stay and recovery after intervention frequently is abbreviated, this group would be expected to demonstrate preserved functional capabilities and to begin cardiac rehabilitation at higher activity levels than either the surgical or the myocardial infarction groups. On the basis of the preceding observations, the percutaneous coronary intervention group would be expected to report higher perceptions of QOL and self-efficacy.


In addition to the more commonly measured physiologic outcomes, the design and framework for this study extended traditional measurement 9 to include gender- and diagnoses-related trends for QOL, including emotional and limitation domains, as well as gender- and diagnoses-related trends for self-efficacy, including ambulatory and muscular domains, during participation in a 12-week cardiac rehabilitation program. A secondary intent was to determine whether caloric expenditure is predictive of QOL or self-efficacy.


The authors hypothesized that women will have lower QOL and self-efficacy scores than men, but will have similar rates of improvements in scoring; that patients undergoing surgical revascularization will have lower QOL and self-efficacy scores at baseline, but will demonstrate greater improvement in scores than the myocardial infarction and percutaneous coronary intervention groups; and that caloric expenditure will positively predict self-efficacy and QOL scores.