{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T04:02:13Z","timestamp":1769313733069,"version":"3.49.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T00:00:00Z","timestamp":1726012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cardiac rehabilitation (CR) adherence and functional outcomes were measured after COVID-19 regulations reduced group sizes to one-on-one, modeling a natural experiment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis using a natural experiment model measured participants in 12 weeks of CR during the 17 months before and after a COVID-19-related closure was conducted. The age, sex, race, ethnicity, and referral diagnoses of the pre-COVID-19 closure and post-COVID-19 closure groups were analyzed using a student's unpaired T-test. Adherence (completion rate of CR) and functional outcomes [change in six-minute walk test (6MWT)] were assessed between the two groups using unpaired two-tailed student T tests in GraphPad Prism and confidence intervals were calculated with the Baptista-Pike method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 204 patients in the pre-COVID-19 group and 51 patients in the post-COVID-19 group, due to the smaller group sizes in the post-COVID-19 group, with no significant differences in baseline characteristics between the groups. The pre-COVID-19 group had a higher patient-to-provider ratio [2.8 patients\/provider (SD 0.74)] relative to the post-COVID-19 group [0.4 patients\/provider (SD 0.12); <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.0001]. The post-COVID-19 group had a higher completion rate than pre-COVID-19 group [75% vs. 21%; OR 10.9 (95% CI, 5.3\u201321.3, <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.0001)]. Among those that completed CR, there was no significant difference between groups in 6MWT improvement [+377.9\u2005ft. (<jats:italic>n<\/jats:italic>\u2009=\u200947; SD 275.67\u2005ft.) vs. +346.9\u2005ft. (<jats:italic>n<\/jats:italic>\u2009=\u200938; SD 196.27\u2005ft.); <jats:italic>p\u2009<\/jats:italic>=\u20090.59].<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The reduction in group size to one-on-one was associated with 10 times higher odds of CR completion. Among those that completed CR, functional outcomes were not influenced by group size. Thus, pursuit of one-on-one sessions may improve CR adherence.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fresc.2024.1465790","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T05:14:20Z","timestamp":1726031660000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of reduced group size on patient adherence and functional outcomes in cardiac rehabilitation: insights from a COVID-19 pandemic natural experiment"],"prefix":"10.3389","volume":"5","author":[{"given":"Rachael M.","family":"Chait","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Ossi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett 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