title: Participation in society in patients with coronary artery disease before and after cardiac rehabilitation.
abstract: OBJECTIVE
  To assess changes in participation in society (frequency, restrictions, satisfaction) during and after cardiac rehabilitation (CR) and to assess associations between participation and heath-related quality of life (HRQOL).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Outpatient CR center.
  
  
  METHODS
  Patients with coronary artery disease (N=121; mean age, 57y; 96 men [79%]).
  
  
  METHODS
  Multidisciplinary CR.
  
  
  METHODS
  Participation in society was assessed with the Utrecht Scale for Evaluation of Rehabilitation-Participation and HRQOL with the MacNew Heart Disease health-related quality of life questionnaire. All measurements were performed pre-CR, post-CR, and 1 year after the start of CR.
  
  
  RESULTS
  Frequency of participation did not change during and after CR. The proportion of patients experiencing restrictions in participation decreased from 69% pre-CR to 40% post-CR (P<.001) and 29% at 1 year (P<.001 vs post-CR). Pre-CR, 71% of patients were dissatisfied with their participation. This improved to 49% post-CR (P<.001) and 53% at 1 year (P<.001 vs pre-CR). Experienced restrictions explained 5% to 7% of the improvement in HRQOL during CR and satisfaction with participation explained 10% to 19%.
  
  
  CONCLUSIONS
  Participation in society improves in patients undergoing CR. Despite these improvements, the presence of coronary artery disease is associated with persistent restrictions and dissatisfaction with participation. Because experienced restrictions and dissatisfaction are related to changes in HRQOL it is important to address these aspects of participation during CR.
authors: Capri Cardiac Rehabilitation Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: n.terhoeve@erasmusmc.nl.
authors: Nienke
authors: N
authors: Ter Hoeve
authors: Capri Cardiac Rehabilitation Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Myrna E
authors: ME
authors: van Geffen
authors: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Marcel W
authors: MW
authors: Post
authors: Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Henk J
authors: HJ
authors: Stam
authors: Capri Cardiac Rehabilitation Center, Rotterdam, The Netherlands.
authors: Madoka
authors: M
authors: Sunamura
authors: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Ron T
authors: RT
authors: van Domburg
authors: Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Rita J
authors: RJ
authors: van den Berg-Emons
mesh_terms: D003324:Coronary Artery Disease / Q000523:psychology* / Q000534:rehabilitation*; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D011446:Prospective Studies; D011788:Quality of Life; D058992:Social Participation; D011795:Surveys and Questionnaires
keywords: Coronary artery disease; Rehabilitation; Social participation