Health Care Administrators' Cardiac Rehabilitation Attitudes (HACRA) in North and South America and the Development of a Scale to Assess Them.

BACKGROUND: Cardiac rehabilitation (CR) is insufficiently available; even less so in low-resource settings. Health care administrators (HAs) are responsible for ensuring CR programs are offered and resourced. This study compared HA CR attitudes in North and South America, the contextual factors associated with these attitudes, and developed a scale/survey to assess them with global applicability. METHODS: Data were retrospectively analysed from three cross-sectional studies: in (1) 195 HAs from Canada (i.e., North America), (2) 44 HAs from seven South American countries, and (3) 43 HAs from Brazil (all South America). Contextual and perceptual/attitudinal items (five-point Likert scale, with higher scores indicating more positive attitudes) were compared by region. Psychometric properties of items were tested. A literature review was performed, and items generated for content validation by experts. RESULTS: The most negative CR attitudes related to government funding models (mean=2.46±1.14/5), and that patients have responsibility for their disease management (3.03±1.25). North American HAs rated their institutions' perceptions of the importance of CR (p<0.001) and quality of the local program (p<0.001) higher than their South American counterparts, but rated the utility of CR in lowering length of stay (p<0.001), promoting behaviour change (p<0.05) and the need for more government funding (p<0.05) lower, among others. Total attitude scores were positively associated with CR knowledge/awareness in both cohorts (all p<0.01). North American HAs more often perceived CR should be funded by hospitals (p<0.001) than South Americans. A 39-item HA CR Attitudes (HACRA-R) scale was developed. CONCLUSIONS: Health care administrators' perceptions vary by context, which could impact CR resourcing.

Functional capacity of patients with chronic stroke based upon their physical activity levels / Capacidade funcional de indivíduos pós-acidente vascular cerebral crônico baseada nos níveis de atividade física

Introduction: People with stroke commonly show low levels of physical activity and reduced functional capacity, independent of the severity of the impairments. The use of simple measures that are able to produce transferable information from clinical practice to life in society is crucial within clinic contexts. Objective: To compare the functional capacity of patients with chronic stroke based upon their physical activity levels. Methods: For this cross sectional study, functional capacity and levels of physical activity were assessed by the Duke Activity Status Index (DASI) and the adjusted activity score (AAS) of the Human Activity Profile (HAP), respectively. One-way analysis of variance (ANOVA), followed by LSD post-hoc tests were employed to investigate differences between the physical activity groups regarding their DASI scores. Results: Fifty-one individuals with mean age 58.8 ± 13.5 and a mean time since the onset of stroke of 25.5 ± 13.9 months participated. According to their HAP AAS, 18 individuals were classified as impaired, 28 as moderately active, and five as active. Between-group differences were observed for the DASI scores [F(2,48)=13.72; p < 0.01]. Conclusion: Increases in functional capacity were observed with increases in physical activity levels.(AU)

Introdução: Indivíduos pós acidente vascular cerebral (AVC) geralmente apresentam baixos níveis de atividade física e redução da capacidade funcional, independente da gravidade. O uso de medidas simples, capazes de transferir informações da prática clínica para a vida em sociedade, é crucial dentro do contexto clínico. Objetivo: Comparar a capacidade funcional dos indivíduos com AVC crônico estratificados pelo nível de atividade física. Métodos: Para este estudo transversal, a capacidade funcional e os níveis de atividade física foram avaliados pelo Duke Activity Status Index (DASI) e pelo escore de atividade ajustado (EAA) do Perfil de Atividade Humana (PAH), respectivamente. Análise de variância One-way (ANOVA), seguida de testes post-hoc LSD foram realizados para investigar diferenças entre os níveis de atividade física considerando os escores do DASI. Resultados: Cinquenta e um indivíduos com idade média de 58,8 ± 13,5 anos e tempo médio pós AVC de 25,5 ± 13,9 meses participaram. De acordo com o EAA PAH, 18 indivíduos foram classificados como inativos, 28 como moderadamente ativos, e 5 como ativos. Diferenças entre-grupos foram observadas para os escores do DASI [F(2,48) = 13,72; p < 0,01]. Conclusão: Aumentos na capacidade funcional foram observados com aumentos nos níveis de atividade física. (AU)

Relationships between self-reported and performance-based measures of functional capacity in individuals with chronic stroke.

[Purpose] The aim of this study was to investigate the associations between self-reported and valid performance-based measures of functional capacity in individuals with chronic stroke. [Subjects and Methods] Self-reported measures of functional capacity of 31 individuals with chronic stroke were assessed by the Duke Activity Status Index scores, whereas performance-based measures were assessed by the distance covered (in meters) and oxygen consumption (relative oxygen consumption, in ml·kg(-1)·min(-1) ) during the six-minute walking test. [Results] The subjects had a mean age of 58.6±13 years and a mean time since the onset of stroke of 28.3±15.1 months. They had a mean Duke Activity Status Index of 27.3±14.4, mean distance covered of 325.2±140.2 m, and mean relative oxygen consumption of 9.6±2.3 ml·kg(-1)·min(-1) . Significant, positive, and moderate to good correlation coefficients were found between the Duke Activity Status Index scores and the distance covered during the six-minute walking test (r=0.68). Significant, positive, and fair associations were also found between the Duke Activity Status Index scores and relative oxygen consumption values obtained during the six-minute walking test (r=0.45). [Conclusion] The findings of the present study support the clinical use of the Duke Activity Status Index as a tool to assist in clinical evaluations of functional capacity of individuals with chronic stroke.