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Is residential rehabilitation better (or as good as) ambulatory rehabilitation?

Comment by Paul Dendale, EACPR Cardiac Rehabilitation Section

Medium term effects of cardiac rehabilitation in Germany: systematic review and meta-analysis of results from national and international trials
Oskar Mittag, Susanne Schramm, Stephan Böhmen, Angelika Hüppe,Thorsten Meyer, Heiner Raspe
EJCPR, August 2011 18: 587-693


In this systematic review, the authors discuss an important question about the organisation of cardiac rehabilitation.
In Germany all patients have the right to 3-4 weeks of residential rehabilitation after admission for infarction or CABG. This residential rehabilitation is done in beautifully equipped rehab clinics, situated in green areas of the country. The aim is to submerge the patient in a few weeks of healthy living, with education, counselling, sports etc.
This contrasts with the ambulatory rehabilitation programs in many other countries which last longer but are less intense. As the cost of residential rehabilitation is significantly higher, it is surprising to see that very few good randomised trial data are available to prove its effects.

The study therefore analysed all published data on residential rehabilitation, also cohort studies, and compared them to the published literature on ambulatory rehabilitation.
The results of the study were highly surprising: not only are the data on outcome of residential rehabilitation less good than those of ambulatory rehabilitation, but in some cases even poorer than the usual care groups of ambulatory studies!

Of course this study is not the definitive answer to the question of how to organise CR most efficiently. But it certainly is an open invitation to the residential rehabilitation centres to start randomised trials to prove their efficacy.