Skip to main content Accessibility help

The Process of Patient Engagement in Cardiac Rehabilitation: A Model-Centric Systematic Review

  • Sepideh Jahandideh (a1), Elizabeth Kendall (a2), Samantha Low-Choy (a3), Kenneth Donald (a4) and Rohan Jayasinghe (a5)...


This study aimed to compile existing evidence about the proposed relationships among variables at three stages of the model of therapeutic engagement (MTE): patient intention to engage in cardiac rehabilitation (CR), CR initiation, and sustained engagement. This model has not been tested in any rehabilitation setting. Therefore, this systematic literature review is key to future research and application of MTE to predict and enhance patient engagement in CR. Model-centric systematic literature reviews have been conducted for each stage of the MTE. A coherent approach to understanding and monitoring the process of patient engagement in CR is absent. Few relevant studies included in the model-centric reviews met the criteria: eight in stage 1, four in stage 2, and six in stage 3 of the MTE. In total, the tenets of the MTE were supported in patient intention to engage in CR. However, there was less evidence quantifying the proposed relationships among variables that impact on CR initiation and sustained engagement. There is a scarcity of research examining rehabilitation engagement in depth to better understand the complicated process contributing to behavioural outcomes. No decision-support models currently exist to alert patients and healthcare provider to the factors that influence non-engagement.


Corresponding author

Correspondence author: Sepideh Jahandideh, School of Medicine & Menzies Health Institute Queensland, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus, Griffith University QLD 4222, Australia. Email:


Hide All
Alexander, LJ and Wagner, LC (2006) How cardiac rehabilitation relates to quality of life. Rehabilitation Nursing 31, 155165.
Araya-Ramírez, F, Briggs, KK, Bishop, SR, Miller, CE, Moncada-Jiménez, J and Grandjean, PW (2010) Who Is likely to benefit from phase II cardiac rehabilitation? Journal of Cardiopulmonary Rehabilitation and Prevention 30, 93100.
Bakker, EC, Nijkamp, MD, Sloot, C, Berndt, NC and Bolman, CAW (2015) Intention to abstain from smoking among cardiac rehabilitation patients: The role of attitude, self-efficacy, and craving. Journal of Cardiovascular Nursing 30, 172179.
Bennett, P, Mayfield, T, Norman, P, Lowe, R and Morgan, M (1999) Affective and social-cognitive predictors of behavioural change following first myocardial infarction. British Journal of Health Psychology 4, 247256.
Blanchard, CM, Arthur, HM and Gunn, E (2015) Self-efficacy and outcome expectations in cardiac rehabilitation: Associations with women's physical activity. Rehabilitation Psychology 60, 5966.
Blanchard, CM, Reid, RD, Morrin, LI, McDonnell, L, McGannon, K, Rhodes, RE, … Edwards, N (2009) Does protection motivation theory explain exercise intentions and behavior during home-based cardiac rehabilitation? Journal of Cardiopulmonary Rehabilitation and Prevention 29, 188192.
Bright, FAS, Kayes, NM, Worrall, L and McPherson, KM (2015) A conceptual review of engagement in healthcare and rehabilitation. Disability & Rehabilitation 37, 643654.
Broadbent, E, Ellis, CJ, Thomas, J, Gamble, G and Petrie, KJ (2009) Further development of an illness perception intervention for myocardial infarction patients: A randomized controlled trial. Journal of Psychosomatic Research 67, 1723.
Chan, DSK, Chau, JPC and Chang, AM (2005) Acute coronary syndromes: Cardiac rehabilitation programmes and quality of life. Journal of Advanced Nursing 49, 591599.
Cox, NS, Oliveira, CC, Lahham, A and Holland, AE (2017) Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: A systematic review using the theoretical domains framework. Journal of Physiotherapy 63, 8493.
de Melo Ghisi, GL, Abdallah, F, Grace, SL, Thomas, S and Oh, P (2014) A systematic review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change? Patient Education and Counseling 95, 160174.
Dohnke, B, Nowossadeck, E and Müller-Fahrnow, W (2010) Motivation and participation in a phase III cardiac rehabilitation programme: An application of the health action process approach. Research in Sports Medicine 18, 219235.
Dunlay, SM, Pack, QR, Thomas, RJ, Killian, JM and Roger, VL (2014) Participation in cardiac rehabilitation, readmissions, and death after acute myocardial infarction. American Journal of Medicine 127, 538546.
Gardiner, FW, Nwose, EU, Regan, E, Park, BK, Bwititi, PT, Crockett, J and Wang, L (2018) Outpatient cardiac rehabilitation: Patient perceived benefits and reasons for non-attendance. Collegian 25, 479485
Higgins, J and Green, S (Eds.). (2011) Cochrane handbook for systematic reviews of interventions (Version 5.1.0). The Cochrane Collaboration.
Hutchinson, P, Meyer, A and Marshall, B (2015) Factors Influencing Outpatient Cardiac Rehabilitation Attendance. Rehabilitation Nursing 40, 360367.
Johnson, NA and Heller, RF (1998) Prediction of patient nonadherence with home-based exercise for cardiac rehabilitation: The role of perceived barriers and perceived benefits. Preventive Medicine 27, 5664.
Jolly, K, Taylor, R, Lip, GYH, Greenfield, S, Raftery, J, Mant, J, … Stevens, A (2007) The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: Cost-effectiveness and patient adherence. Health Technology Assessment 11, 11.
Lequerica, AH and Kortte, K (2010) Therapeutic engagement: A proposed model of engagement in medical rehabilitation. American Journal of Physical Medicine and Rehabilitation 89, 415422.
Marzolini, S, Mertens, DJ, Oh, PI and Plyley, MJ (2010) Self-reported compliance to home-based resistance training in cardiac patients. European Journal of Cardiovascular Prevention & Rehabilitation 17, 3549.
Medley, AR and Powell, T (2010) Motivational interviewing to promote self-awareness and engagement in rehabilitation following acquired brain injury: A conceptual review. Neuropsychological Rehabilitation 20, 481508.
Naghavi, M, Wang, H, Lozano, R, Davis, A, Liang, X and Zhou, M (2015) GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117171.
Oldridge, NB (1997) Outcome assessment in cardiac rehabilitation: Health-related quality of life and economic evaluation. Journal of Cardiopulmonary Rehabilitation 17, 179194.
Petit Francis, L, Spaulding, E, Turkson-Ocran, R.-A. and Allen, J (2017) Randomized trials of nurse-delivered interventions in weight management research: A systematic review. Western Journal of Nursing Research 39, 11201150.
Pickering, C, Grignon, J, Steven, R, Guitart, D and Byrne, J (2015) Publishing not perishing: How research students transition from novice to knowledgeable using systematic quantitative literature reviews. Studies in Higher Education 40, 17561769.
Scane, K, Alter, D, Oh, P and Brooks, D (2012) Adherence to a cardiac rehabilitation home program model of care: A comparison to a well-established traditional on-site supervised program. Applied Physiology, Nutrition, and Metabolism 37, 206213.
Selzler, A.-M., Rodgers, WM, Berry, TR and Stickland, MK (2016) The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabilitation Psychology 61, 380388.
Smart, E, Aulakh, A, McDougall, C, Rigby, P and King, G (2017) Optimizing engagement in goal pursuit with youth with physical disabilities attending life skills and transition programs: An exploratory study. Disability and Rehabilitation 39, 20292038.
Sniehotta, FF, Gorski, C and Araújo-Soares, V (2010) Adoption of community-based cardiac rehabilitation programs and physical activity following phase III cardiac rehabilitation in Scotland: A prospective and predictive study. Psychology & Health 25, 839854.
Sniehotta, FF, Scholz, U and Schwarzer, R (2005) Bridging the intention-behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychology & Health 20, 143160.
Sullivan, KA, White, KM, Young, RM and Scott, C (2009) Predicting behaviour to reduce stroke risk in at-risk populations: The role of beliefs. International Journal of Therapy and Rehabilitation 16, 488496.
Tovar, M, Walker, JL and Rew, L (2018) Factors associated with physical activity in Latina Women: A systematic review. Western Journal of Nursing Research 40, 270297. Los Angeles, CA: Sage Publications.
van't Wout Hofland, J, Moulaert, V, van Heugten, C and Verbunt, J (2018) Long-term quality of life of caregivers of cardiac arrest survivors and the impact of witnessing a cardiac event of a close relative. Resuscitation 128, 198203.
Verberne, D, Moulaert, V, Verbunt, J and van Heugten, C (2018) Factors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study. Resuscitation 123, 5157.
Watchie, J (2009) Cardiovascular and pulmonary physical therapy: A clinical manual. St Louis, MO: Saunders Elsevier.


Type Description Title
Supplementary materials

Jahandideh et al. supplementary material
Table S1

 Unknown (12 KB)
12 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed