Clinical Outcomes Following Postacute Comprehensive Rehabilitative Care in Patients with Cardiopulmonary Disease

Cardiopulmonary diseases are among the top five global health burdens. As the life-preserving ability of disease management increases, the burden of these diseases is shifting from that of acute to chronic, and many need postacute rehabilitative care for disease exacerbations and postsurgical recovery. Because the segment of the population affected by cardiopulmonary disease is burgeoning, the need for understanding postacute clinical outcomes in this group is increasing. This review summarizes existing evidence regarding the effects of postacute inpatient rehabilitation in patients with major cardiovascular and pulmonary conditions. We conducted a literature search from January 1965 to March 2008 in Medline and the Cochrane Controlled Trials Register. One of the following outcomes measures had to be reported: mortality, morbidity, physical function assessments related to mobility, subsequent hospitalizations, return to work, or cost of care. All studies had to include patients with specific cardiopulmonary diagnosis classifications. In addition, recent evidence regarding comparative outcomes in different postacute care settings (inpatient rehabilitation, skilled nursing facility, home health) and the effect of therapy intensity are presented. The limited data on the outcomes following comprehensive inpatient rehabilitation in cardiopulmonary patients indicate that consistent improvements can be expected in physical function, mobility, and disease symptoms by discharge. Additional benefits of rehabilitation include the alleviation of depression and increased quality of life. The setting for optimal inpatient rehabilitation, however, is still unclear, but preliminary data suggest that higher volumes of therapy likely generate more favorable outcomes such as discharge to home and independent mobility.