QUALITY INDICATORS IN PEDIATRIC CARDIAC REHABILITATION PROGRAMS: A SCOPING REVIEW
Abstract
Background: Pediatric cardiac rehabilitation (CR) is essential for optimizing recovery and long-term outcomes in children with congenital heart disease. However, implementation of pediatric CR programs faces numerous challenges, specifically inconsistent quality measures and barriers to access. Understanding these factors is crucial for enhancing care delivery. Objective: This scoping review aims to map and synthesize existing literature on pediatric CR and find quality indicators used to evaluate these programs, identify gaps, inform future research and clinical practice. Methods: A scoping review was conducted following PRISMA-ScR guidelines. Databases PubMed, Scopus, and Cochrane Library were searched for studies published between 2020-2025 on pediatric CR. Eligible studies included qualitative, quantitative, and mixed methods research involving pediatric populations (<18 years). Data was charted on identified quality indicators (structure, process, outcome measures). Results were synthesized thematically. Results: The review included 12 studies from diverse geographic and clinical settings. Quality indicators identified ranged from physical and functional capacity outcomes to program structure measures such as multidisciplinary teams and individualized care plans. Additionally, barriers to implementation such as psychosocial factors, referral practices, accessibility and health literacy were identified. Few studies used standardized frameworks for program planning, revealing inconsistency and evidence gaps in monitoring pediatric CR quality. Conclusion: Pediatric cardiac rehabilitation programs face multifaceted barriers that limit equitable access and program effectiveness. Quality indicators are variably applied with no consensus standard, highlighting a critical need for standardized quality frameworks. Addressing these gaps can improve patient outcomes and optimize pediatric CR delivery Keywords: Pediatric cardiac rehabilitation, congenital heart disease