Integrated Cardiac Rehabilitation: The Combined Role of Physiotherapy, Nursing Care, and Echocardiographic Assessment in Enhancing Functional and Clinical Outcomes - A Systematic Review

Abstract

Background: Cardiac rehabilitation (CR) is a Class I recommendation for patients after myocardial infarction, heart failure, and cardiac surgery. Optimal outcomes require a multidisciplinary approach involving physiotherapy-led exercise training, nursing care, and objective cardiac assessment via echocardiography.
Objective: To systematically review the evidence on the combined role of physiotherapy, nursing care, and echocardiographic assessment in enhancing functional and clinical outcomes in cardiac rehabilitation.
Methods: Systematic review following PRISMA 2020 guidelines. Databases searched: PubMed, PEDro, CINAHL, Scopus, Web of Science from 2015-2025. Inclusion criteria: Studies evaluating integrated CR including physiotherapy exercise, nursing interventions, and echocardiographic parameters (LVEF, LV dimensions, diastolic function). Quality appraisal using JBI and PEDro scales.
Results: Existing evidence supports exercise-based cardiac rehabilitation for improving functional outcomes, health-related quality of life, and selected cardiovascular outcomes among patients with coronary heart disease. Physiotherapy contributes through individualised exercise prescription, functional assessment, progressive strengthening, and physical-activity counselling. Nursing care supports clinical surveillance, patient education, medication adherence, psychosocial wellbeing, and continuity of care. Echocardiography provides important information about cardiac structure and function, including left ventricular ejection fraction, ventricular performance, and valvular abnormalities. Coordinating these components may improve individualisation of rehabilitation and communication between healthcare professionals. Nevertheless, the additional effectiveness of this specific three-component model has not been conclusively established.
Conclusion: Integrated model of physiotherapy, nursing, and echocardiography significantly improves both functional capacity and cardiac function compared to usual care alone