Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail: Secondary Analysis of a Randomized Trial

Michel S Terbraak; Lotte Verweij; Patricia Jepma; Marike van der Schaaf; Harald T Jørstad; Ron J G Peters; Bianca M Buurman; Wilma J M Scholte Op Reimer

doi:10.1093/ptj/pzag020

Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail: Secondary Analysis of a Randomized Trial

Michel S Terbraak
, Lotte Verweij
, Patricia Jepma
, Marike van der Schaaf
, Harald T Jørstad
, Ron J G Peters
, Bianca M Buurman
, Wilma J M Scholte Op Reimer

Amsterdam University of Applied Sciences (AUAS)

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

IMPORTANCE: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilized by older patients. Home-based CR potentially improves utilization, yet its effectiveness in older patients who are frail remains understudied.

OBJECTIVE: The objective of this study was to investigate the effects of a transitional-care integrated home-based CR program on physical functioning in older patients who are frail after CVD hospitalization.

DESIGN: This was a prespecified secondary analysis of physical functioning at the 6-month follow-up in the Cardiac Care Bridge multicenter randomized trial.

SETTING: A home-based setting was used.

PARTICIPANTS: The study participants were patients who were frail and ≥ 70 years old after CVD hospitalization.

INTERVENTION: The intervention was transitional care followed by physical therapist led home-based CR and community nurse visits.

MAIN OUTCOMES AND MEASURES: The primary physical function outcome was the Short Physical Performance Battery (SPPB) in cases with complete follow-up data. Secondary outcomes included the 2-minute step test, grip strength, and Amsterdam Linear Disability Scale. Sensitivity analyses included an intention-to-treat analysis by multiple imputation of the full cohort.

RESULTS: In total, 85 of 153 participants in the intervention group and 85 of 153 participants in the control group were analyzed (mean age = 82.6 [SD = 6.3] years; 46% men; median of 2 [interquartile range = 1-4] comorbidities). At the 6-month follow-up, more participants in the intervention group than in the control group demonstrated SPPB improvement (61% vs 51%) or maintenance (29% vs 12%), and fewer deteriorated (11% vs 37%). The mean SPPB values at 6 months were 6.3 (SD = 0.3) and 5.5 (SD = 0.2), respectively, with a mean difference of 0.8 (95% CI = 0.0 to 1.6), favoring the intervention group. No between-group differences were observed in the 2-minute step test, grip strength, or Amsterdam Linear Disability Scale.

CONCLUSIONS: Among older patients who were frail and had CVD, a comprehensive transitional-care program with integrated home-based CR resulted in clinically relevant improvements in physical functioning.

RELEVANCE: The results substantiate the effectiveness of home-based CR in older patients who are frail and have CVD.

Original language	English
Journal	Physical Therapy
DOIs	https://doi.org/10.1093/ptj/pzag020
Publication status	E-pub ahead of print - 6 Mar 2026

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Terbraak, M. S., Verweij, L., Jepma, P., van der Schaaf, M., Jørstad, H. T., Peters, R. J. G., Buurman, B. M., & Scholte Op Reimer, W. J. M. (2026). Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail: Secondary Analysis of a Randomized Trial. Physical Therapy. Advance online publication. https://doi.org/10.1093/ptj/pzag020

@article{0567158c137a489c9f61ed3784cc7a31,

title = "Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail: Secondary Analysis of a Randomized Trial",

abstract = "IMPORTANCE: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilized by older patients. Home-based CR potentially improves utilization, yet its effectiveness in older patients who are frail remains understudied.OBJECTIVE: The objective of this study was to investigate the effects of a transitional-care integrated home-based CR program on physical functioning in older patients who are frail after CVD hospitalization.DESIGN: This was a prespecified secondary analysis of physical functioning at the 6-month follow-up in the Cardiac Care Bridge multicenter randomized trial.SETTING: A home-based setting was used.PARTICIPANTS: The study participants were patients who were frail and ≥ 70 years old after CVD hospitalization.INTERVENTION: The intervention was transitional care followed by physical therapist led home-based CR and community nurse visits.MAIN OUTCOMES AND MEASURES: The primary physical function outcome was the Short Physical Performance Battery (SPPB) in cases with complete follow-up data. Secondary outcomes included the 2-minute step test, grip strength, and Amsterdam Linear Disability Scale. Sensitivity analyses included an intention-to-treat analysis by multiple imputation of the full cohort.RESULTS: In total, 85 of 153 participants in the intervention group and 85 of 153 participants in the control group were analyzed (mean age = 82.6 [SD = 6.3] years; 46\% men; median of 2 [interquartile range = 1-4] comorbidities). At the 6-month follow-up, more participants in the intervention group than in the control group demonstrated SPPB improvement (61\% vs 51\%) or maintenance (29\% vs 12\%), and fewer deteriorated (11\% vs 37\%). The mean SPPB values at 6 months were 6.3 (SD = 0.3) and 5.5 (SD = 0.2), respectively, with a mean difference of 0.8 (95\% CI = 0.0 to 1.6), favoring the intervention group. No between-group differences were observed in the 2-minute step test, grip strength, or Amsterdam Linear Disability Scale.CONCLUSIONS: Among older patients who were frail and had CVD, a comprehensive transitional-care program with integrated home-based CR resulted in clinically relevant improvements in physical functioning.RELEVANCE: The results substantiate the effectiveness of home-based CR in older patients who are frail and have CVD.",

author = "Terbraak, \{Michel S\} and Lotte Verweij and Patricia Jepma and \{van der Schaaf\}, Marike and J{\o}rstad, \{Harald T\} and Peters, \{Ron J G\} and Buurman, \{Bianca M\} and \{Scholte Op Reimer\}, \{Wilma J M\}",

note = "{\textcopyright} The Author(s) 2026. Published by Oxford University Press on behalf of the American Physical Therapy Association.",

year = "2026",

month = mar,

day = "6",

doi = "10.1093/ptj/pzag020",

language = "English",

journal = "Physical Therapy",

issn = "0031-9023",

publisher = "Oxford University Press",

}

Terbraak, MS, Verweij, L, Jepma, P, van der Schaaf, M, Jørstad, HT, Peters, RJG, Buurman, BM & Scholte Op Reimer, WJM 2026, 'Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail: Secondary Analysis of a Randomized Trial', Physical Therapy. https://doi.org/10.1093/ptj/pzag020

Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail: Secondary Analysis of a Randomized Trial. / Terbraak, Michel S; Verweij, Lotte; Jepma, Patricia et al.
In: Physical Therapy, 06.03.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Effects of Home-Based Cardiac Rehabilitation Integrated in the Cardiac Care Bridge Transitional Care Program on the Physical Functioning of Older Patients Who Are Frail

T2 - Secondary Analysis of a Randomized Trial

AU - Terbraak, Michel S

AU - Verweij, Lotte

AU - Jepma, Patricia

AU - van der Schaaf, Marike

AU - Jørstad, Harald T

AU - Peters, Ron J G

AU - Buurman, Bianca M

AU - Scholte Op Reimer, Wilma J M

PY - 2026/3/6

Y1 - 2026/3/6

N2 - IMPORTANCE: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilized by older patients. Home-based CR potentially improves utilization, yet its effectiveness in older patients who are frail remains understudied.OBJECTIVE: The objective of this study was to investigate the effects of a transitional-care integrated home-based CR program on physical functioning in older patients who are frail after CVD hospitalization.DESIGN: This was a prespecified secondary analysis of physical functioning at the 6-month follow-up in the Cardiac Care Bridge multicenter randomized trial.SETTING: A home-based setting was used.PARTICIPANTS: The study participants were patients who were frail and ≥ 70 years old after CVD hospitalization.INTERVENTION: The intervention was transitional care followed by physical therapist led home-based CR and community nurse visits.MAIN OUTCOMES AND MEASURES: The primary physical function outcome was the Short Physical Performance Battery (SPPB) in cases with complete follow-up data. Secondary outcomes included the 2-minute step test, grip strength, and Amsterdam Linear Disability Scale. Sensitivity analyses included an intention-to-treat analysis by multiple imputation of the full cohort.RESULTS: In total, 85 of 153 participants in the intervention group and 85 of 153 participants in the control group were analyzed (mean age = 82.6 [SD = 6.3] years; 46% men; median of 2 [interquartile range = 1-4] comorbidities). At the 6-month follow-up, more participants in the intervention group than in the control group demonstrated SPPB improvement (61% vs 51%) or maintenance (29% vs 12%), and fewer deteriorated (11% vs 37%). The mean SPPB values at 6 months were 6.3 (SD = 0.3) and 5.5 (SD = 0.2), respectively, with a mean difference of 0.8 (95% CI = 0.0 to 1.6), favoring the intervention group. No between-group differences were observed in the 2-minute step test, grip strength, or Amsterdam Linear Disability Scale.CONCLUSIONS: Among older patients who were frail and had CVD, a comprehensive transitional-care program with integrated home-based CR resulted in clinically relevant improvements in physical functioning.RELEVANCE: The results substantiate the effectiveness of home-based CR in older patients who are frail and have CVD.

AB - IMPORTANCE: Older patients hospitalized for cardiovascular disease (CVD) are at risk of physical function decline and adverse health outcomes. Cardiac rehabilitation (CR) improves physical functioning but is underutilized by older patients. Home-based CR potentially improves utilization, yet its effectiveness in older patients who are frail remains understudied.OBJECTIVE: The objective of this study was to investigate the effects of a transitional-care integrated home-based CR program on physical functioning in older patients who are frail after CVD hospitalization.DESIGN: This was a prespecified secondary analysis of physical functioning at the 6-month follow-up in the Cardiac Care Bridge multicenter randomized trial.SETTING: A home-based setting was used.PARTICIPANTS: The study participants were patients who were frail and ≥ 70 years old after CVD hospitalization.INTERVENTION: The intervention was transitional care followed by physical therapist led home-based CR and community nurse visits.MAIN OUTCOMES AND MEASURES: The primary physical function outcome was the Short Physical Performance Battery (SPPB) in cases with complete follow-up data. Secondary outcomes included the 2-minute step test, grip strength, and Amsterdam Linear Disability Scale. Sensitivity analyses included an intention-to-treat analysis by multiple imputation of the full cohort.RESULTS: In total, 85 of 153 participants in the intervention group and 85 of 153 participants in the control group were analyzed (mean age = 82.6 [SD = 6.3] years; 46% men; median of 2 [interquartile range = 1-4] comorbidities). At the 6-month follow-up, more participants in the intervention group than in the control group demonstrated SPPB improvement (61% vs 51%) or maintenance (29% vs 12%), and fewer deteriorated (11% vs 37%). The mean SPPB values at 6 months were 6.3 (SD = 0.3) and 5.5 (SD = 0.2), respectively, with a mean difference of 0.8 (95% CI = 0.0 to 1.6), favoring the intervention group. No between-group differences were observed in the 2-minute step test, grip strength, or Amsterdam Linear Disability Scale.CONCLUSIONS: Among older patients who were frail and had CVD, a comprehensive transitional-care program with integrated home-based CR resulted in clinically relevant improvements in physical functioning.RELEVANCE: The results substantiate the effectiveness of home-based CR in older patients who are frail and have CVD.

U2 - 10.1093/ptj/pzag020

DO - 10.1093/ptj/pzag020

M3 - Article

C2 - 41786620

SN - 0031-9023

JO - Physical Therapy

JF - Physical Therapy

ER -