|Year : 2020 | Volume
| Issue : 2 | Page : 114-119
Availability and perception of the importance of cardiac rehabilitation among health-care professionals in North-Western Nigeria
Jibril Mohammed Nuhu1, Lubabatu Suleiman Gachi2
1 Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
2 Department of Physiotherapy, Federal Medical Centre, Katsina, Nigeria
|Date of Submission||13-Feb-2020|
|Date of Decision||10-Jun-2020|
|Date of Acceptance||04-Jul-2020|
|Date of Web Publication||13-Nov-2021|
Dr. Jibril Mohammed Nuhu
Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Background: Cardiac rehabilitation (CR) is an important secondary prevention programme utilized for mitigating the burden of cardiovascular diseases. Information on the availability of CR in Nigeria has not been previously documented. Therefore, this study investigated the availability of CR and perception of its importance among health care personnel in North western Nigeria.
Materials and Methods: A researcher designed questionnaire assessing the availability and perception of the importance of CR was used to collect the information from health care professionals that have roles to play in CR in seven tertiary health facilities in North western Nigeria. A total of 350 questionnaires were administered to the health professionals with a return rate of 70%.
Results: CR was reported to be available by 4.08% of the respondents across only three of the selected hospitals. Physiotherapists, cardiologists, dieticians, and nurses were the most commonly involved health professionals with interventions not based on a comprehensive, coordinated multidisciplinary approach. The nonpharmacological components of CR mostly offered were smoking cessation, nutritional, and physical activity counseling with exercise training. Although CR was not available in most of the facilities, a large proportion (70%) of the respondents had good perception of its importance.
Conclusion: We concluded that CR programmes were not available in North western Nigeria giving the small proportion of respondents who claimed it was available only used its components in a fragmented or uncoordinated fashion which does not constitute CR.
Keywords: Cardiac rehabilitation, health-care professionals, North-western Nigeria
|How to cite this article:|
Nuhu JM, Gachi LS. Availability and perception of the importance of cardiac rehabilitation among health-care professionals in North-Western Nigeria. Nig J Cardiol 2020;17:114-9
|How to cite this URL:|
Nuhu JM, Gachi LS. Availability and perception of the importance of cardiac rehabilitation among health-care professionals in North-Western Nigeria. Nig J Cardiol [serial online] 2020 [cited 2021 Nov 29];17:114-9. Available from: https://www.nigjcardiol.org/text.asp?2020/17/2/114/330428
| Introduction|| |
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels of which the occurrence is associated with the interplay of both genetic and acquired factors. With a rising prevalence linked to risk factors such as unhealthy eating habit and insufficient physical activity levels, these diseases are a leading cause of morbidity and premature mortality globally. The worldwide prevalence of CVDs was estimated at 422.7 million cases in 2015 with over 82% of the global mortality burden being attributed, largely, to coronary heart disease, stroke, and congestive heart failure.,
In recent years, CVD-related deaths have largely been shown to decline in the majority of high-income countries, but it is reported to be on the increase in most low- and middle-income countries (LMICs), accounting for over 80% of deaths recorded. In Nigeria, studies have not been conducted on a national scale to explore the burden of these diseases, but those undertaken in the specific regions or communities have indicated a rising prevalence of CVDs, with high prevalence rates, also, reported for predisposing factors, including diabetes mellitus, hypertension, and dyslipidemia.
Several international guidelines recommend that cardiac rehabilitation (CR), a secondary prevention programme be a required service to patients diagnosed with CVDs, those with CVD-related events or procedures and persons with a moderate-to-high risk of developing CVDs., The aim of this rehabilitation is to influence favorably the underlying cause of the disease, as well as to ensure the patient the best possible physical, mental, and social conditions, with a view to preserving or resuming as normal a place as possible in the community. Participation in CR has been reported to decrease the morbidity and mortality with significant reduction in CVD risk factors, improvement in health-related quality of life, and promotion of a healthy lifestyle., CR is, thus, of crucial importance in combating the rising morbidity and mortality associated with CVDs and in enhancing patient outcomes.
Exploring the availability and perception of the importance of such an essential programme from health-care professionals will provide information that can be used by policy-makers to take appropriate measures or develop strategies that will enhance the management of CVDs using a comprehensive team model. To the best of the knowledge of the researchers, there were no data about the availability and perception of the importance of CR among health-care professionals in Nigeria. Therefore, we sought to explore whether CR was available, the form in which it was available (comprehensive or single components) and health-care professionals' perception of its medical value for patient management in tertiary hospitals in North-west Nigeria.
| Materials and Methods|| |
Selection and description of respondents
The study was a hospital-based, cross-sectional survey that recruited health-care professionals that constitute the CR team (cardiologists, cardiothoracic surgeons, family physicians, physiotherapists, occupational therapists, nurses, dietitians, clinical psychologists, and psychiatrists) as recommended by the American Heart Association and the British Association of Cardiopulmonary Rehabilitation.,
The health-care professionals included in the study were cardiologists, cardiothoracic surgeons, family physicians, nurses (serving in departments of medicine and intensive care units), physiotherapists, occupational therapists, psychologists, psychiatrists, and dietitians involved in the management of patients with CVDs and practicing in all the seven tertiary hospitals in North-western Nigeria.
The following health-care professionals were excluded from the study:
- Physiotherapists, occupational therapists, psychologists, psychiatrists, and dietitians not involved in the management of patients with CVDs
- Nurses who are not practicing in the department of medicine and intensive care unit
- Cardiologists with <1-year postfellowship.
Data collection instrument
A 26-item researcher-designed questionnaire, with a section on the availability of CR and that on the perception of its importance among other sections, was used to collect the data. For the purpose of validation, the Item Content Validity Index (I-CVI) and the Scale Content Validity Index (S-CVI) of the questionnaire were calculated. While the questionnaire items had an I-CVI ranging from 75% to 100%, the S-CVI was found to be 0.91 which is within the range for excellent content validity.
An introductory letter, obtained from the Department of Physiotherapy of Bayero University, Kano, was submitted alongside the application for ethical approval to the Research Ethics Committee of each of the selected hospitals. Once ethical approval was granted, health-care professionals (who met the inclusion criteria) in the selected hospitals were recruited.
The questionnaires were self-administered to the respondents. In three of the hospitals (Aminu Kano Teaching Hospital [AKTH], Ahmadu Bello University Teaching Hospital [ABUTH] and the Federal Medical Center in Katsina), respondents were approached by the principal investigator with the questionnaires. For the remaining hospitals, the questionnaires were posted to research assistants (who were familiar with the purpose of the study and how the questionnaires were to be completed). Each questionnaire was attached to a cover letter of introduction which explained the purpose of the study with instructions on how to answer the questions and assurance on confidentiality. Respondents were requested to complete the questionnaires and return them within 1 week.
Descriptive statistics of frequencies and percentages were used to analyze the components of the questionnaire and presented in tables and charts.
| Results|| |
Respondents' demographic characteristics
A total of 350 questionnaires were administered to the recruited health-care professionals in the seven tertiary hospitals within the selected geopolitical zone, with a return rate of 70%. The 245 respondents whose questionnaires were returned and used in the analysis had a mean age of 35.8 years (range: 22–56 years). While nurses constituted the highest number of the respondents, there was only one cardiothoracic surgeon. The Federal Medical Center in Birnin Kebbi and that in Katsina had the highest and lowest proportions of respondents, respectively. More than half of the respondents possessed first degree only with 62% of them having a working experience of between 1 and 10 years [Table 1].
Availability of cardiac rehabilitation
[Figure 1] shows that only 4% (n = 10) of the respondents reported that CR was available in their facilities. CR was reported to be available in only three of the selected hospitals. Six respondents (five physiotherapists and a nurse) reported that the CR programs were undertaken in the physiotherapy departments of their hospitals (AKTH and FMCGS (Federal Medical Center Gusau)) and that they were established in the 2012 and 2013, respectively. Four respondents (a family physician and three physiotherapists) from ABUTH reported that the programme was established in 2008 with no indication of specific location (s) where it was administered.
Fifty-five percent of the respondents (out of the 96% who stated that CR was not availability in their facilities) reported offering treatment based on the components of CR. Counseling on smoking cessation, regular intake of healthy diet, and increasing physical activity/exercise levels were the most commonly offered components [Table 2].
|Table 2: Interventions offered in hospitals where cardiac rehabilitation was reportedly unavailable (n=235)|
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Perception of health professionals about cardiac rehabilitation
The majority of the respondents perceived CR as being of great importance for patients with CVDs [Figure 2] with over 60% of them strongly agreeing that CR could improve patients' outcomes. Less than ten percent of them did not know whether CR was effective or not was [Figure 3]. While about 34 respondents strongly agreed that exercise exacerbates patients' symptoms, the same number did not know whether this was true or not [Figure 4].
|Figure 3: Respondents' perception about effect of cardiac rehabilitation on patient outcome|
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|Figure 4: Respondents' perception about exercise-based cardiac rehabilitation|
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| Discussion|| |
The study was carried out to investigate the availability of CR and the perception of its value by health-care professionals that have roles to play in CR in the seven tertiary hospitals in North-west Nigeria. To the best knowledge of the researchers, no studies have previously been conducted to explore the availability and perception of the significance of CR among health professionals in Nigeria.
The benefits of CR in the secondary prevention of CVDs have been well documented, including improvement in overall quality of life and survival., The availability of CR has been reported in countries such as the United Kingdom, Canada, Brazil, and India.
Our findings show that CR existed or was claimed to be in use in three of the seven hospitals studied with the majority of the respondents reporting its unavailability in their health facilities. The AKTH and ABUTH were among the three hospitals where the availability of CR was reported (mainly by physiotherapists). These are tertiary health facilities (teaching hospitals) owned and run by the Federal Government. They are normally centers of excellence and are older than the federal medical centres (FMCs). They tend to have state of the art equipment with highly skilled personnel attracting patients and clients even from other countries within the West African subregion. While the availability of CR in these teaching hospitals may be justifiable, this may not hold good for the FMCs. Thus, the availability of a CR programme in the FMC in Gusau might not be unconnected with the effort of the hospital management with whose permission some of the hospital's staff went on postgraduate training at home and abroad. This might have added quality to the services the hospital renders. A recent review of the availability of CR programs reported their low availability in LMICs. Pola et al. reported that CR was available in only 26.6% of LMICs, where >80% of the burden of CVDs occurs.
These earlier studies did not support our findings. CR is implemented through its core components in a coordinated manner by a team of health-care professionals, including cardiologists, physiotherapists, nutritionists, psychologists or psychiatrists, and medical social workers. Most of the health-care professionals in the present study implemented the components of CR individually, not through a coordinated multidisciplinary team approach. Our argument, here, is that CR programs did not exist in the region in question (North-western Nigeria) because the availability or use of only a few of its components in a fragmented uncoordinated fashion does not constitute CR. It is only in the intensive care units of these facilities that we may accept that true CR programs are instituted. This is due to the highly specialized nature of such units where the critically ill are in dire need for interventions that must be applied to complement one another with a view to stabilizing their conditions. Our results are in alignment with the study of Derman who revealed that CR in South Africa was fragmented due to financial shortages and inadequate staff, with only phase I of the programme being offered in physiotherapy units. The nonexistence of CR in the north-west geopolitical zone might be attributed to the lack of or inadequate knowledge about the roles of allied health professionals, particularly those of physiotherapists as exercise experts. Moradi et al. reported inadequate knowledge of CR among physicians as one of the factors influencing its utilization. In contrast, there were the reports of CR programmes being conducted in a comprehensive manner by a team of health-care professionals, including cardiologists, physiotherapists, nurses, dietitians, and psychiatrists (Cortes-Bergoderi et al., 2013). Similarly, in Egypt, the only CR programme in the public sector reported having cardiologists, nurses, and psychiatrists working together as a team (Selim, 2013).
Majority of the respondents in the current study perceived CR as being of great importance for patients with CVDs and strongly agreed that CR can improve patients' outcome. This is in harmony with the findings of Abu Hasheesh who reported that physicians and nurses in Saudi Arabia had good perception of the role of CR in providing comprehensive care to patients with CVDs and after major cardiac events.
| Conclusion|| |
Based on the findings of this study, it was concluded that CR was not available in north-western Nigeria given the use only of its components in an uncoordinated, noncomprehensive fashion.
We recommended that health-care professionals and health authorities should focus on fraternizing to work together as a team. Physiotherapists and other allied health professionals should raise the awareness about their role in the management of patients with CVDs. There is need for health policy-makers to invest in the training of health professionals in the field of CR. Effort should be made to create a functional CR programme in order for health-care professionals concerned to work together as a team and share opinions on how best to help improve the quality of life of their patients.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]