Components of organizational models for comprehensive rehabilitation at the stage of medical and social expertise in patients after cardiac surgery: systematic review and meta-analysis



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Abstract

The aim of this study was a qualitative and quantitative analysis and synthesis of data on the effectiveness of components of organizational models for comprehensive cardiac rehabilitation (CR), with the goal of their further integration into the stage of medical and social expertise (MSE) in patients who have undergone cardiac surgery. The systematic review and meta-analysis were conducted based on PRISMA-2020 guidelines. A structured clinical question (PICOS) was formulated prior to the review. The search for relevant sources was performed in electronic bibliographic databases (PubMed, EMBASE (via Wiley Online Library), Science Direct, Google Scholar, eLIBRARY) for publications from 2015–2025. Randomized (RCT) and non-randomized (nRCT) controlled trials, as well as observational studies (retrospective and prospective cohort studies) were included in the review. After multi-stage selection, 20 studies were included in the review, some of which were pooled in a meta-analysis using a random-effects model. Risk of bias assessment was performed using the Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle-Ottawa Scale (NOS). A meta-analysis of 7 RCTs (n=547) demonstrated a statistically significant increase in the distance walked in the 6-minute walk test (6MWT) in groups undergoing comprehensive rehabilitation: mean difference (MD) = 35.4 m (95% CI: 22.1; 48.7; p <0.001), with statistical heterogeneity assessed as moderate (I²=42%). Analysis of 3 RCTs (n=324) revealed a trend towards reduced risk of re-hospitalizations: pooled odds ratio (OR) = 0.65 (95% CI: 0.42; 1.01; p=0.054). Based on analysis of 3 RCTs (n=417), there was no statistically significant improvement in quality of life (according to SF-36/SF-12 questionnaires): standardized mean difference (SMD) = -0.17 (95% CI: -0.39; 0.05; p=0.13). The results confirm the clinical significance of structured CR programs with organizational, staffing, and technological components for improving functional outcomes. To optimize the MSE process, it is recommended to integrate multidisciplinary assessment, standardized tools (6MWT), and telemedicine technologies. This integration would help overcome fragmented care and improve the objectivity of expert decisions. Limitations include variability among the included studies and a lack of data on long-term outcomes.

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About the authors

Yurii A. Trusov

Samara State Medical University, Samara

Email: yu.a.trusov@samsmu.ru
ORCID iD: 0000-0001-6407-3880
SPIN-code: 3203-5314
Scopus Author ID: 1061179

assistant of the Department of Propaedeutics of Internal Diseases with a course of cardiology, cardiologist

Russian Federation, Samara, Russia

Elena S. Pochtarkina

Samara State Medical University, Samara

Author for correspondence.
Email: pochtalena9@mail.ru
ORCID iD: 0009-0007-0100-4002
Russian Federation, Samara, Russia

Milana L. Durieva

North Caucasus State Academy, Cherkessk

Email: mduriyeva@mail.ru
ORCID iD: 0009-0003-1810-2777
Cherkessk, Russia

Radima S. Genishbieva

North Caucasus State Academy, Cherkessk

Email: genishbiyeva@internet.ru
ORCID iD: 0009-0007-5719-9806
Russian Federation, Cherkessk, Russia

Bella Z. Afashagova

North Caucasus State Academy, Cherkessk

Email: bella.afashagova.07@mail.ru
ORCID iD: 0009-0003-5411-621X
Russian Federation, Cherkessk, Russia

Dinara R. Khubieva

North Caucasus State Academy, Cherkessk

Email: dinara2502@bk.ru
ORCID iD: 0009-0006-9688-9896
Russian Federation, Cherkessk, Russia

Elmira R. Khubieva

North Caucasus State Academy, Cherkessk

Email: elmira2106@bk.ru
ORCID iD: 0009-0005-1583-6294
Russian Federation, Cherkessk, Russia

Liana A. Ortobaeva

North Caucasus State Academy, Cherkessk

Email: ortobaeva09o@icloud.com
ORCID iD: 0009-0004-2331-6953
Russian Federation, Cherkessk, Russia

Alina B. Borlakova

North Caucasus State Academy, Cherkessk

Email: borlakovaalina7@gmail.com
ORCID iD: 0009-0006-0190-0520
Russian Federation, Cherkessk, Russia

Albina R. Dukhova

Kuban State Medical University, Krasnodar

Email: duhova.albina6759@yandex.ru
ORCID iD: 0009-0003-8559-6121
Russian Federation, Krasnodar, Russia

Sofia S. Lesniak

Kuban State Medical University, Krasnodar

Email: sofya.lesnyak@yandex.ru
ORCID iD: 0009-0003-8177-2116
Russian Federation, Krasnodar, Russia

Polina M. Golub

Kuban State Medical University, Krasnodar

Email: gpolinna@mail.ru
ORCID iD: 0009-0008-4283-2442
Russian Federation, Krasnodar, Russia

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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