Phase-1 Cardiac Rehabilitation in Acute Heart Failure: Development of an Early Mobilization Algorithm Through Delphi Consensus

Akhila Satyamurthy, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India (Ms Satyamurthy, Dr Babu).
Ramachandran Padmakumar, Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India (Drs Padmakumar, Dr Prabhu, and Dr Paramasivam).
Mukund A. Prabhu, Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India (Drs Padmakumar, Dr Prabhu, and Dr Paramasivam).
Sivadasanpillai Harikrishnan, Department of Cardiology, Sree Chitra Tirunal Institute of Medical Science & Technology, Thiruvananthapuram, India (Dr Harikrishnan).
Panniyammakal Jeemon, Achutha Menon Center for Health Sciences, Sree Chitra Tirunal Institute of Medical Science & Technology, Thiruvananthapuram, India (DrJeemon).
Aashish Contractor, Rehabilitation and Sports Medicine, Sir H. N. Reliance Foundation Hospital, Mumbai, India (Dr Contractor).
Cemal Ozemek, Department of Physical Therapy, University of Illinois, Chicago, Illinois (Dr Ozemek).
Eryn Bryant, Heart Failure Transition of Care Program, The Ohio State University Wexner Medical Centre, Columbus, Ohio (Dr Bryant).
Ghisi Glm, KITE Research Institute, University Health Network, Toronto, Canada (Dr Ghisi).
Ganesh Paramasivam, Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India (Drs Padmakumar, Dr Prabhu, and Dr Paramasivam).
Jonathan Myers, Division of Cardiology, VA Palo Alto Health Care System and Stanford University (Dr Myers).
Kushal Madan, Cardiac Rehabilitation, Dharma Vira Heart Centre Sir Ganga Ram Hospital, New Delhi, India (Dr Madan).
Marta Supervia, Department of Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute Dr Esquerdo, Madrid, Spain (Dr Supervia).
Norman R. Morris, Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Australia (Dr Morris).
Peter H. Brubaker, Department of Health and Exercise Science, Faculty Athletic Representative, Wake Forest University, Winston-Salem, North Carolina (Dr Brubaker).
Ronel Roos, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (Dr Roos).
Stephanie Hiser, Department of Health, Human Function & Rehabilitation Sciences, George Washington University, DC (Dr Hiser).
Susan Hanekom, Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (Dr Hanekom).
Tee Joo Yeo, Cardiac Rehabilitation Unit Department of Cardiology, National University Heart Centre, Singapore, Singapore (Dr Yeo).
Vishal Shanbhag, Department of Critical care, Kasturba Medical College, Manipal Academy of Higher education, Manipal, Karnataka, India (Dr Shanbhag).
Abraham Samuel Babu, Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India (Ms Satyamurthy, Dr Babu).

Document Type

Journal Article

Publication Date

11-24-2025

Journal

Journal of cardiopulmonary rehabilitation and prevention

DOI

10.1097/HCR.0000000000000978

Keywords

Delphi method; acute heart failure; early mobilization

Abstract

PURPOSE: Literature on early mobilization and exercise training in patients recovering from acute heart failure (AHF) is promising. However, there lacks uniformity in the time of initiation, exercise prescription, safety criteria, and termination criteria. Thus, the aim was to develop a mobilization algorithm for patients recovering from AHF. METHODS: A modified web-based Delphi process was undertaken involving 15 panelists from across the globe. In Round 1, new variables, modifications to suggested variables, and agreement-disagreement within the panelists were obtained. In Round 2, agreement on a 5-point Likert scale was obtained. In Round 3, the algorithm was compiled, and excluded statements were discussed via web-based calls. The new variables were grouped into themes via an inductive process. The level of agreement and rating for each statement were analyzed using descriptive statistics, including frequency and percentages. We used Kappa statistics to examine the level of agreement between the panelists for each criterion. The consensus criterion was defined a priori as statements with a mean rating of ≥4 on the 5-point Likert scale by ≥70% of the panelists and Kendall's coefficient of concordance (W) of ≥0.3 between panelists. RESULTS: From Round 1, 54 new variables were obtained. More than two-thirds (118/170, 69%) of statements reached consensus and reported a fair level of agreement between panelists (W ≥ 0.3). The final algorithm with all its criteria received a 100% (13/13) consensus. CONCLUSION: Physician-referral criteria, physiotherapy assessment process, exercise prescription, safety criteria, and termination criteria were formulated for early mobilization and exercise training for patients recovering from AHF.

Department

Health, Human Function, and Rehabilitation Sciences

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