Of the three research articles, two were quantitative studies, and one was a systematic review. The Birmingham Rehabilitation Uptake Maximization study compared the outcomes of HBCR and CBCR in terms of cardiac risk factors, and adherence to rehabilitation 12 months after recruitment post-MI, PTCA, or CABG (Jolly, Lip, Taylor, Raftery, Mant, Lane, Greenfield, & Stevens, 2009). The second study, General Health Improvement, reviewed the overall benefits of continuing cardiac rehabilitation at home. The Cochrane Systematic Review evaluated morbidity/mortality, health-related quality of life, cost-effectiveness, and modifiable cardiac risk factors in patients with coronary heart disease between home-based versus center-based programs in either the short term (3-12 months) or longer term (up to 24 months) (Taylor, Dalal, Jolly, Moxham, Zawada, 2010).
The Birmingham Rehabilitation Uptake Maximization Study (BRUM) conducted a randomized controlled trial and parallel economic evaluation comparing home-based with center-based cardiac rehabilitation (Jolly, Lip, Taylor, Raftery, Mant, Lane, Greenfield, & Stevens, 2009). The authors hypothesized that a home-based program can be an effective alternative to center-based programs and not have lesser outcomes, improve uptake and adherence, and be comparably cost-effective. They had 525 participants who were of low- moderate risk post-MI and revascularization patients, and were allocated either in a HBCR or CBCR. They included patients if they were referred in the two-year period from February 1, 2002 to the CR program in 1of 4 hospitals in the West Midlands health region following an MI, PTCA, or CABG within the previous 12 weeks and were not considered high risk for a home-based program. Both of the rehabilitation programs included exercise, relaxation, education, and lifestyle counseling.
The 4 center-based programs varied in length, including 9 sessions at weekly intervals, 12 sessions over 8 weeks, and 24 individualized sessions over 12 weeks. Patient exercised to 65-75% of their predicted maximal heart rate, and the exercise sessions took 25-40 minutes counting warm-up and cool-down. In comparison, the home-based program comprised of a Heart Manual, three home visits (at 10 days, 6 weeks, and 12 weeks) and telephone communication at 3 weeks. Those who had a MI were discharged home with the Heart Manual or an adapted version for revascularization patients. Additional visits were made as needed by the rehabilitation nurse. All the rehab nurses had to attend a two-day training course managed by the creators of the Heart Manual. The manual guides patients to build up their exercise steadily to achieve a minimum of 15 minutes of moderately intense activity daily (Jolly, Lip, Taylor, Raftery, Mant, Lane, Greenfield, & Stevens, 2009).
Then, the data collected were completed by all eligible patients’ post-MI/PTCA/CABG. Baseline data were collected in the beginning prior to randomization and...