# Cross-Sectional Study of Rehabilitation Training Intensity and Physical Restraints in Patients With Cardiovascular Disease and Neurocognitive Disorders in Acute Care Hospitals

## TL;DR

This study examines how rehabilitation intensity and physical restraints are used in patients with cardiovascular disease and neurocognitive disorders in acute care hospitals.

## Contribution

The study identifies associations between treatment types, dementia care team rounds, and physical restraint use in cardiovascular disease patients with neurocognitive disorders.

## Key findings

- Patients receiving invasive treatments had more dementia care team rounds, suggesting prolonged neurocognitive disorders.
- Stronger physical restraints were associated with high-intensity rehabilitation training.
- No significant differences in neurocognitive disorder episodes or training intensity were found between treatment groups.

## Abstract

Background

Previous studies have reported the characteristics of rehabilitation therapy and physical restraint use in patients with neurocognitive disorders during the acute phase, based on three years of clinical records from dementia care team rounds at our hospital. The incidence of neurocognitive disorders varies by disease group, and the degree of physical restraint is significantly associated with the intensity of the rehabilitation therapy. Among the disease groups addressed in this study, we were particularly interested in cardiovascular diseases. In patients with cardiovascular disease, which is associated with high clinical acuity and disease severity, the presence of neurocognitive disorders may affect the prognosis. This study aimed to clarify the incidence of neurocognitive impairment (including delirium) in patients with cardiovascular disease and its characteristics with respect to rehabilitation therapy and physical restraint.

Methods

We examined data from dementia care team rounds conducted between July 1, 2021, and October 7, 2024, to identify relationships between clinicopathological characteristics, rehabilitation therapy, and physical restraint status. Cardiovascular diseases were classified into nine subgroups: ischemic diseases; arrhythmia; heart failure; valvular heart disease; acute pericarditis; aortic diseases; peripheral vascular diseases; and renal, carotid, and subclavian artery diseases. The treatment modalities were categorized as conservative management, pacemaker implantation (PM), percutaneous coronary intervention (PCI), minimally invasive surgery (MIS; including endovascular aneurysm repair and endovascular thoracic aortic repair), thoracotomy, and laparotomy. Cognitive function was assessed weekly, and patients whose neurocognitive disorders improved sufficiently were excluded from the dementia care team. Chi-square (χ²) tests were used to assess the associations between the variables.

Results

A total of 101 patients with cardiovascular disease underwent 379 rounds. Significant differences in treatment selection were observed between the disease groups (p < 0.0001). Significant differences in the number of dementia rounds were also observed between treatment groups, with more rounds occurring in patients who received invasive treatment (p = 0.019). No significant differences in the number of neurocognitive disorder episodes, training intensity, or physical restraint intensity were identified between the treatment groups. Patients who received stronger physical restraints generally underwent high-intensity training (p = 0.015).

Conclusions

Patients with cardiovascular diseases who received more invasive treatments generally received more dementia care team rounds, suggesting a possible association with prolonged neurocognitive disorders. Most patients who were subjected to stronger physical restraints could undergo intensive rehabilitation, suggesting that increased staffing levels could reduce the need for physical restraints.