Hartrevalidatie : over het bepalen en voorspellen van herstel

Many studies on cardiac rehabilitation have preceded the one described in this thesis. However, they have not yet led to the scientific recognition of the value of cardiac rehabilitation. A review of the literature forces us to draw the conclusion that cardiac rehabilitation has reached an impasse. Cardiac rehabilitation programmes have largely been developed on the basis of clinical practise. The programmes therefore differ in nature, form and content and consequently are almost impossible to compare. This situation makes it difficult to draw scientific conclusions on the value of cardiac rehabilitation, for whom it is effective and in what form. In addition, there are two other problems. Firstly, differences exist between the methods of measuring effect or recovery due to the lack of consensus about the definition of recovery and effect. Secondly, when researchers examine the group effect, they do not consider the fact that cardiac rehabilitation is probably not beneficial to everyone. If mean group values are always measured, the positive results of patients who did benefit from the treatment will be lost against those of the patients who did not gain by it, or might even be reversed. · In our study design, the problems encountered in the literature were taken into consideration (the lack of an operational definition for recovery and the bias towards group effects). The study took place at three recognized Dutch cardiac rehabilitation centres in order to find out what type of patients benefitted from the (physical) cardiac rehabilitation programme offered at a particular centre. The study population comprised cardiac patients who were referred in 1986 for cardiac rehabilitation at the Rijnlands Zee Hospitium (RZH) in Katwijk, the Rehabilitation Institute Muiderpoort (RIM) in Amsterdam and the Rotterdam Foundation for Cardiac Rehabilitation (RSCR). The first measurement was performed directly before the rehabilitation period on 370 patients; 316 participated in the second measurement directly after the rehabilitation period; and 310 in the third measurement nine months after completion of the programme.

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