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Pakrad F, Jahandideh S, Oshvandi K, Majidi L, Khazaei S, Pakrad B. Comparing the effect of the Model of Therapeutic Engagement in cardiac rehabilitation on the sense of coherence and adherence to treatment: a randomized clinical trial. Disabil Rehabil 2024; 46:3007-3016. [PMID: 37497869 DOI: 10.1080/09638288.2023.2239143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE The study aimed to compare the effectiveness of a traditional cardiac rehabilitation (CR) program with an enhanced program incorporating the model of therapeutic engagement (MTE) and extended remote support for patients undergoing coronary artery bypass graft (CABG) patients. MATERIALS AND METHODS In a randomized controlled trial, 88 CABG patients were assigned to experimental and control groups. The experimental group received integrated MTE cardiac rehabilitation, and assessments were conducted at three time points: pre-CR, one month later, and three months post-CR. The study measured medication adherence (MARS-5) and sense of coherence (SoC-13) scales. RESULTS The study found no significant differences in demographic factors between the experimental and control groups. However, significant differences were observed in MARS and individuals' SoC scores over time in the experimental group, with notable improvements (p < 0.001). The control group showed significant changes only up to one month. Group effects were evident, with consistent increases in the experimental group's outcomes at each assessment point. CONCLUSION Integrating the MTE into CR programs offers benefits in terms of medication adherence and individuals' sense of coherence, which warrants further investigation and clinical implementation.
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Affiliation(s)
- Fatemeh Pakrad
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sepideh Jahandideh
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Khodayar Oshvandi
- Department of Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Lobat Majidi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Research Centre for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Pakrad
- Department of exercise physiology, Farhangian University, Hamadan, Iran
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Liu X, Grace SL, Ghisi GLM, Shi W, Shen C, Oh P, Zhang Y. Controlled pilot test of a translated cardiac rehabilitation education curriculum in percutaneous coronary intervention patients in a middle-income country delivered using WeChat: acceptability, engagement, satisfaction and preliminary outcomes. HEALTH EDUCATION RESEARCH 2022; 37:314-332. [PMID: 36087021 DOI: 10.1093/her/cyac022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/10/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
In China, despite the rapid increase in percutaneous coronary interventions (PCIs), cardiac rehabilitation (CR) is just burgeoning, leaving a need for comprehensive evidence-based education curricula. This pilot study assessed the acceptability of Simplified Chinese CR education delivered via booklets and videos on WeChat asynchronously and the impact on improving knowledge, risk factors, health behaviors and quality of life. In this pre-post, controlled, observational study, interested PCI patients received the 12-week intervention or usual care and WeChat without education. Participants completed validated surveys, including the Coronary Artery Disease Education-Questionnaire and Self-Management Scale. Acceptability (14 Likert-type items), engagement (minutes per week) and satisfaction were assessed in intervention participants. Ninety-six patients consented to participate (n = 49 intervention), of which 66 (68.8%) completed the follow-up assessments. Twenty-seven (77.1%) retained intervention participants engaged with the materials, rating content as highly acceptable (all means ≥4/5) and satisfactory (2.19 ± 0.48/3); those engaging more with the intervention were significantly more satisfied (P = 0.03). While participants in both groups achieved some improvements, only intervention participants had significant increases in disease-related knowledge, reductions in body mass index and triglycerides, as well as improvements in diet (all P < 0.05). In this first study validating the recently translated CR patient education intervention, acceptability and benefits have been supported.
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Affiliation(s)
- X Liu
- School of Nursing, Shanghai Jiao Tong University, 227 Chongqing South Rd, Shanghai 200025, China
| | - S L Grace
- Faculty of Health, York University, Toronto M3J 1P3, Canada
- KITE-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| | - G L M Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, University of Toronto, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - W Shi
- Faculty of Medicine and Health, The University of Sydney Charles Perkins Centre, Sydney 2006, Australia
| | - C Shen
- Cardiology, Shanghai Sixth People's Hospital, 600 Yishan Rd, Shanghai 200233, China
| | - P Oh
- CardiovascularPrevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, 347 Rumsey Road, Toronto, Ontario M4G 2R6, Canada
| | - Y Zhang
- School of Nursing, Shanghai Jiao Tong University, 227 Chongqing South Rd, Shanghai 200025, China
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Shi W, Ghisi GLM, Zhang L, Hyun K, Pakosh M, Gallagher R. Systematic review, meta‐analysis and meta‐regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. J Clin Nurs 2022. [DOI: 10.1111/jocn.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Gabriela L. M. Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Ling Zhang
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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Hirani S, Gowani A, Sajjad S, Kennedy M, Norris CM. Psychosocial interventions and mental health in patients with cardiovascular diseases living in low and middle-income countries: A systematic review protocol. PLoS One 2022; 17:e0271955. [PMID: 35901048 PMCID: PMC9333280 DOI: 10.1371/journal.pone.0271955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this review is to evaluate the effectiveness of psychosocial interventions on mental health outcomes in adult patients with Cardiovascular Diseases (CVDs) living in low- and middle-income countries (LMICs). INTRODUCTION Mental health issues are highly prevalent among patients with CVDs leading to poor disease prognosis, self-care/ management, and Quality of Life (QOL). In the context of LMICs, where the disease burden and treatment gap are high and resources are inadequate for accessing essential care, effective psychosocial interventions can make significant contributions for improving mental health and reducing mental health problems among patients who live with cardiovascular diseases. INCLUSION CRITERIA This review will include studies published between 2010 and 2021 that evaluated the effect of psychosocial interventions on mental health outcomes (resilience, self-efficacy, QOL, depression and anxiety) on adult patients (aged ≥18 years) with any cardiovascular diseases using experimental and quasi experimental designs. METHODS The search will be conducted from the following databases: MEDLINE via OVID (1946-Present), EMBASE via OVID (1974 -Present), Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost (1936-Present), PsycINFO via OVID (1806-Present), Scopus via Elsevier (1976-Present), and Cochrane Library via Wiley (1992-Present). Data will be critically appraised using standard tools and extracted by two reviewers and disagreement will be solved by the third reviewer. Meta-analysis will be performed, if possible, otherwise, data will be synthesized in narrative and tabular forms. DISCUSSION The findings of this review will provide a key insight into contextually relevant psychosocial interventions for promoting mental health of patients with CVDs living in LMICs. The review findings will be potentially useful for health care providers and researchers to implement such interventions not only for reducing the burden of mental health issues but also for improving the overall well-being among patients with chronic illnesses. SYSTEMATIC REVIEW REGISTRATION NUMBER Prospero-CRD42020200773.
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Affiliation(s)
- Saima Hirani
- School of Nursing, Faculty of Applied Science, The University of British Columbia, Vancouver, Canada
| | - Ambreen Gowani
- School of Nursing & Midwifery, Faculty of Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Sehrish Sajjad
- School of Nursing & Midwifery, Faculty of Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Megan Kennedy
- Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Colleen M. Norris
- Faculty of Nursing, Public Health, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. Postreanimationsbehandlung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00892-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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6
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Feng YY, Chaves GSS, Shi W, Pakosh M, Zhang L, Gallagher R, Oh P, Ghisi GLDM. Education interventions in Chinese cardiac patients on health behaviours, disease-related knowledge, and health outcomes: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2021; 104:1018-1029. [PMID: 33349505 DOI: 10.1016/j.pec.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to summarize and synthesize the available evidence in adult Chinese cardiac patients to determine the effect of education interventions on health behaviours, disease-related knowledge, self-efficacy, depressive symptoms, anxiety symptoms, health-related quality of life, morbidity, and mortality. METHODS Seven databases were searched from database inception until January 2020 for randomized controlled trials. Characteristics of education interventions were described and random-effects meta-analysis was performed where feasible. RESULTS Overall, 18 randomized controlled trials were included in this systematic review and suggested that education interventions are effective in improving patients' physical activity, dietary habits, medication behaviour, disease-related knowledge, and health-related quality of life. Meta-analysis of two studies demonstrated benefit on physical activity (standardized mean difference [SMD] 1.27, 95% confidence interval [CI] 1.06-1.48; participants = 422; I2 = 0%), dietary habits (SMD 0.76, 95%CI 0.44-1.08; participants = 422; I2 = 61%), and medication behaviour (mean difference [MD] 0.31, 95%CI 0.17-0.46; participants = 422; I2 = 28%). CONCLUSION This study supports the benefits of education interventions for adult Chinese cardiac patients on health behaviours, disease-related knowledge, and health-related quality of life. Future studies should characterize their education interventions in detail to facilitate reproducibility and comparison. PRACTICE IMPLICATIONS This study identified the need for studies on the outcome of alcohol consumption and in Chinese immigrant populations.
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Affiliation(s)
- Yu Yang Feng
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Gabriela S S Chaves
- School of Kinesiology and Health Sciences, York University, Toronto, Canada.
| | - Wendan Shi
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Ling Zhang
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Robyn Gallagher
- Charles Perkins Centre, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47:369-421. [PMID: 33765189 PMCID: PMC7993077 DOI: 10.1007/s00134-021-06368-4] [Citation(s) in RCA: 453] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
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Affiliation(s)
- Jerry P. Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL UK
- Royal United Hospital, Bath, BA1 3NG UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique R. M. Moulaert
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
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Sławska A, Siudak Z. Nurse-managed education: the effectiveness of secondary prevention after acute coronary syndromes and the prevalence and predictors of dropout from a cardiac rehabilitation programme. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:46-53. [PMID: 33868417 PMCID: PMC8039924 DOI: 10.5114/aic.2021.104767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Education programmes are now very often used to limit the consequences associated with a steady increase in the incidence of cardiovascular disease. It is important to assess the effectiveness of these programmes and the reasons why people drop out. AIM To evaluate the effects of intensive education of patients undergoing acute invasive cardiology procedures compared to the control group (patients educated in a classical way). MATERIAL AND METHODS Randomized trial. Measurements of body weight and body composition: during hospital stay, at 45 and 180 days after acute coronary syndrome. We used a self-prepared questionnaire, LOR-T and a TANITA BC1000 body composition analyser. RESULTS The sample consisted of 73 patients aged 48 to 89 years. Men constituted 58.9% of the participants. 43.8% of the respondents appeared for a follow-up visit after 45 days, and after 180 days 32.8% came. Body weight, body mass index (BMI), and health condition of the patients did not change significantly during the study. 67.1% of respondents dropped out from the nurse-managed cardiac education programme. People who were in better health, smoking, without comorbidities, having a heart attack, living far from the place of education more often dropped out from follow-up visits. CONCLUSIONS Patient education proved ineffective. Body weight, BMI, and health condition of the subjects, both at the time of inclusion and during the long-term evaluation, were very unfavourable.
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Affiliation(s)
| | - Zbigniew Siudak
- Department of Internal Medicine, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Podvorica E, Bekteshi T, Oruqi M, Kalo I. Education of the Patients Living with Heart Disease. Mater Sociomed 2021; 33:10-15. [PMID: 34012343 PMCID: PMC8116090 DOI: 10.5455/msm.2021.33.10-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patient education can be defined as the process of improving knowledge and skills in order to influence the attitudes and behaviour required to maintain or improve health or health style. AIM Education of the patients living with heart disease from ambulatory nurse education for the effectiveness on awareness on life style. METHODS A quasi experimental study was conducted in Specialist Cardiology Ambulance D&D in Pristina among 100 patients. A complete clinical and laboratory measurements before and after the process of patient education (at 30, 60 and 90 days) were performed. The clinical outcome was nutrition, body mass index, blood pressure, lipid, diabetic profile and physical activity. The pre-post tested (validity, reliability and pilot testing) structured questionnaire were used for data collection. RESULTS All patients underwent education sessions by an experienced education nurse on 30, 60 and 90 days. At 90 days follow up, the BMI was decreased: Pre-education (29.01±5.46), Post-education (27.72±4.71), t- 5.999 p<0.0001, glycaemic level Pre-education (6.50±2.15) and Post-education (6.02±1.63), t- 4.157, p<0.0001 was decreased, HbA1c in Pre-education (6.23±2.06) and Post-education (5.72±1.44) t- 4.036 p<0.0001 respectively. The lipid profile was also changed at the 90 days follow-up: cholesterol, triglyceride and LDL-C were decreased (p<0.0001 for all), whereas HDL-C was increased (p<0.0001), by educational program at 90 days follow up. Whereas, blood pressure remains unchanged. CONCLUSION Heart disease management programme where patient's education is an important component, have been shown to be effective in increasing knowledge, self-care and self-management patients living with heart disease.
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Affiliation(s)
- Elvana Podvorica
- Faculty of Medical Technical Sciences, Department of Nursing. Tirana
| | - Tefik Bekteshi
- Department of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosovo, Pristina
| | - Musa Oruqi
- College Rezonanca-Department of Nursing, Pristina, Kosovo
| | - Isuf Kalo
- Faculty of Medical Technical Sciences, Department of Nursing. Tirana
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Rathore S, Kumar B, Tehrani S, Khanra D, Duggal B, Chandra Pant D. Cardiac rehabilitation: Appraisal of current evidence and utility of technology aided home-based cardiac rehabilitation. Indian Heart J 2020; 72:491-499. [PMID: 33357636 PMCID: PMC7772588 DOI: 10.1016/j.ihj.2020.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiac rehabilitation (CR) is an evidence-based intervention that uses exercise training, health behaviour modification, medication adherence and psychological counselling to improve secondary prevention outcomes in patients with cardiovascular disease. CR programs reduce morbidity and mortality rates in adults with ischemic heart disease, following coronary intervention, heart failure, or cardiac surgery. These are significantly underused, with only a minority of eligible patients participating in CR in India. Novel delivery strategies and CR endorsement by healthcare organizations are urgently needed to improve participation. One potential strategy is home-based CR (HBCR). Differing from centre-based CR services, which are provided in a medically supervised facility, HBCR relies on remote coaching with indirect exercise supervision. It is provided mostly or entirely outside of the traditional centre-based setting and could be facilitated by the aid of technology and web based applications. The purpose of this appraisal is to identify the core components, efficacy, strengths, limitations, evidence gaps, and research necessary to guide the future delivery of HBCR. This appears to hold promise in expanding the use of CR to eligible patients. Additional research and demonstration projects are needed to clarify, strengthen, and extend the HBCR evidence base for key subgroups, including older adults, women, underrepresented minority groups, and people in remote and rural areas. HBCR may be a reasonable option for a selected group of patients and could be a game changer in low- and middle-income countries who are eligible for CR.
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Affiliation(s)
- Sudhir Rathore
- Department of Cardiology, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK; Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Shana Tehrani
- Department of Cardiology, Frimley Health NHS Foundation Trust, Camberley, Surrey, UK
| | - Dibbendhu Khanra
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhanu Duggal
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Dinesh Chandra Pant
- Department of Medicine, Krishna Hospital and Research Centre, Haldwani, Uttarakhand, India
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Ghisi GLDM, Rouleau F, Ross MK, Dufour-Doiron M, Belliveau SL, Brideau JR, Aultman C, Thomas S, Colella T, Oh P. Effectiveness of an Education Intervention Among Cardiac Rehabilitation Patients in Canada: A Multi-Site Study. CJC Open 2020; 2:214-221. [PMID: 32695971 PMCID: PMC7365818 DOI: 10.1016/j.cjco.2020.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although patient education is considered a core component of cardiac rehabilitation (CR) programs, to our knowledge, no educational program designed for CR has been standardized in Canada. This absence of standardization may be due to a lack of reliable resources to educate these patients. The objective of this study was to assess the effectiveness of an education intervention in improving knowledge and health behaviours among CR patients in 3 sites in Canada. METHODS CR patients were exposed to an evidence- and theoretically based comprehensive education intervention. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. All outcomes were assessed pre- and post-CR. Paired t tests were used to investigate variable changes between pre- and post-CR, Pearson correlation coefficients were used to determine the association between knowledge and behaviours, and linear regression models were computed to investigate differences in overall post-CR knowledge based on participant characteristics. RESULTS A total of 252 patients consented to participate, of whom 158 (63.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in exercise, food intake, and self-efficacy (P < 0.05). Results showed a significant positive correlation between post-CR knowledge and food intake (r = 0.203; P = 0.01), self-efficacy (r = 0.201; P = 0.01), and health literacy (r = 0.241; P = 0.002). Education level (unstandardized beta = -2.511; P = 0.04) and pre-CR knowledge (unstandardized beta = 0.433; P < 0.001) were influential in changing post-CR knowledge. CONCLUSION In this first-ever multi-site study focusing on patient education for CR patients in Canada, the benefits of an education intervention have been supported.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Fanny Rouleau
- Programme PREV Prévention Secondaire et Réadaptation Cardiovasculaire, Lévis, Quebec, Canada
| | - Marie-Kristelle Ross
- Programme PREV Prévention Secondaire et Réadaptation Cardiovasculaire, Lévis, Quebec, Canada
| | - Monique Dufour-Doiron
- Réseau de santé Vitalité Health Network, Programme Cœur en santé/Cardiac Wellness Program, Moncton, New Brunswick, Canada
| | - Sylvie L Belliveau
- Réseau de santé Vitalité Health Network, Programme Cœur en santé/Cardiac Wellness Program, Moncton, New Brunswick, Canada
| | - Jean-René Brideau
- Réseau de santé Vitalité Health Network, Programme Cœur en santé/Cardiac Wellness Program, Moncton, New Brunswick, Canada
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Scott Thomas
- Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Tracey Colella
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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12
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In-Hospital Mortality in Patients Receiving Percutaneous Coronary Intervention According to Nurse Staffing Level: An Analysis of National Administrative Health Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113799. [PMID: 32471103 PMCID: PMC7313060 DOI: 10.3390/ijerph17113799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 11/26/2022]
Abstract
The increasing incidence of ischemic heart disease is concomitantly increasing percutaneous coronary intervention (PCI) treatments. Adequate nurse staffing has enhanced quality of care and this study was conducted to determine the relationship between survival-related PCI treatment and the level of nursing staff who care for patients admitted to receive PCI. National Health Insurance claims data from 2014 to 2015 for 67,927 patients who underwent PCI in 43 tertiary hospitals were analyzed. The relationships of nurse staffing in intensive care units (ICUs) and general wards with survival after PCI were investigated using logistic regression analyses with a generalized estimation model. The in-hospital mortality rate in ICUs was lower in hospitals with first-grade nurse staffing {odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.23–0.48}, second-grade nurse staffing (OR = 0.55, 95% CI = 0.40–0.77), or third-grade nurse staffing (OR = 0.71, 95% CI = 0.53–0.95) than in hospitals with fifth-grade nurse staffing. Nurse staffing in general wards was not related to in-hospital mortality due to PCI treatment. This study found that nurse staffing in PCI patients requiring short-term intensive care significantly affected patient survival. An understanding of the importance of managing the ICU nursing workforce for PCI treatment is required.
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Liu J, Alam SS, Guhabiswas R, Waajid MS, Chakrabarty S, Das Purkayastha R, Popat R, Gupta R. Impact of a family caregiver training program in Kolkata, India on post-operative health perceptions and outcomes of cardiothoracic surgical patients. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abreu A. In-hospital psychological intervention in cardiac rehabilitation following acute coronary syndrome: Brief is better than nothing. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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In-hospital psychological intervention in cardiac rehabilitation following acute coronary syndrome: Brief is better than nothing. Rev Port Cardiol 2019; 38:369-372. [DOI: 10.1016/j.repc.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database Syst Rev 2019; 3:CD010748. [PMID: 30869157 PMCID: PMC6416827 DOI: 10.1002/14651858.cd010748.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND People with coronary heart disease (CHD) often require prolonged absences from work to convalesce after acute disease events like myocardial infarctions (MI) or revascularisation procedures such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Reduced functional capacity and anxiety due to CHD may further delay or prevent return to work. OBJECTIVES To assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention. SEARCH METHODS We searched the databases CENTRAL, MEDLINE, Embase, PsycINFO, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC, and LILACS through 11 October 2018. We also searched the US National Library of Medicine registry, clinicaltrials.gov, to identify ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) examining return to work among people with CHD who were provided either an intervention or usual care. Selected studies included only people treated for MI or who had undergone either a CABG or PCI. At least 80% of the study population should have been working prior to the CHD and not at the time of the trial, or study authors had to have considered a return-to-work subgroup. We included studies in all languages. Two review authors independently selected the studies and consulted a third review author to resolve disagreements. DATA COLLECTION AND ANALYSIS Two review authors extracted data and independently assessed the risk of bias. We conducted meta-analyses of rates of return to work and time until return to work. We considered the secondary outcomes, health-related quality of life and adverse events among studies where at least 80% of study participants were eligible to return to work. MAIN RESULTS We found 39 RCTs (including one cluster- and four three-armed RCTs). We included the return-to-work results of 34 studies in the meta-analyses.Person-directed, psychological counselling versus usual careWe included 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants' disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. We do not know if these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). We also do not know if psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).Person-directed, work-directed counselling versus usual careFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers' fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD -7.52 days, 95% CI -20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).Person-directed, physical conditioning interventions versus usual careNine studies examined the impact of exercise programmes. Compared to usual care, we do not know if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD -7.86 days, 95% CI -29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95% CI 0.35 to 2.80; two studies; moderate-certainty evidence).Person-directed, combined interventions versus usual careWe included 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return-to-work rates at six to 12 months' follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). We do not know if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD -40.77, 95% CI -67.19 to -14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).Work-directed, interventionsWe found no studies exclusively examining strictly work-directed interventions at the workplace. AUTHORS' CONCLUSIONS Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, we found no evidence of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects.
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Affiliation(s)
- Janice Hegewald
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
| | - Uta E Wegewitz
- Federal Institute for Occupational Safety and Health (BAuA)Division 3: Work and HealthNöldnerstr. 40‐42BerlinGermanyD‐10317
| | - Ulrike Euler
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
| | - Jaap L van Dijk
- Dutch Institute of Clinical Occupational MedicineHilversumNetherlands
| | - Jenny Adams
- Baylor Hamilton Heart and Vascular HospitalCardiac Rehabilitation Unit411 N Washington, Suite 3100DallasTexasUSA75218
| | - Alba Fishta
- Federal Institute for Occupational Safety and Health (BAuA)Evidence Based Medicine, OH ManagementNöldnerstr. 40‐42BerlinGermanyD‐10317
| | - Philipp Heinrich
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
| | - Andreas Seidler
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
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Santos RZD, Ghisi GLM, Bonin CDB, Chaves G, Haase CM, Britto RR, Benetti M. Validation of the Brazilian Version of CADE-Q II to Assess Knowledge of Coronary Artery Disease Patients. Arq Bras Cardiol 2018; 112:78-84. [PMID: 30570063 PMCID: PMC6317624 DOI: 10.5935/abc.20180244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background The Coronary Artery Disease Education Questionnaire (CADE-Q), an instrument
aimed at assessing patients’ knowledge about coronary artery disease (CAD),
was originally developed and psychometrically validated in Brazil. It was
later translated, cross-culturally adapted, and validated to English.
Although both versions demonstrated good reliability and validity, new
studies in the area have pointed out the need of implementing the CADE-Q
with other components of cardiac rehabilitation (CR) programs, such as
psychologic factors, which had not been considered in previous version and
were added in the subsequent, adapted version. Thus, a second version of
CADE-Q was developed in English, the CADE-Q II. Objective to translate, culturally adapt and psychometrically validate the CADE-Q II in
Brazilian Portuguese. Methods After translation and review by a Committee of specialists in CR, a version
in Brazilian Portuguese was generated and tested in 307 patients in CR.
Test-retest reliability was assessed by intraclass correlation coefficient
(ICC) in 49 patients; internal consistency was assessed using Cronbach’s
alpha (α); and, criterion validity was assessed regarding patients’
educational level and family income. The level of significance adopted for
all tests was 5%. Results After the ICC analysis, 4 items were excluded. The questionnaire was
considered internally consistent (α > 0.7). Associations were
found between the mean total scores and the variables schooling (p <
0.001) and income (p < 0.001). Median total score was 53 (14) points
corresponding to 65.4% of the total possible score. Conclusion The Portuguese version of the CADE-Q II showed sufficient reliability,
consistency and validity, supporting its use in future studies.
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Affiliation(s)
| | | | | | - Gabriela Chaves
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | - Clarissa Machado Haase
- Centro da Ciência da Saúde e do Esporte - Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | | | - Magnus Benetti
- Centro da Ciência da Saúde e do Esporte - Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
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Ghisi GLDM, Chaves GSS, Loures JB, Bonfim GM, Britto R. Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV). Arq Bras Cardiol 2018; 111:841-849. [PMID: 30281691 PMCID: PMC6263460 DOI: 10.5935/abc.20180169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background Patient education is an essential part of cardiovascular patients' care
targeting self-management behavior to reduce risk factors and subsequent
events. Herein, a short and reliable tool to assess patients' knowledge in
Brazil is warranted. Objectives To translate, culturally-adapt and psychometrically validate the Portuguese
version of the Coronary Artery Disease Education Questionnaire Short Version
(CADE-Q SV). Methods The Portuguese CADE-Q SV - translated and culturally-adapted - was reviewed
by five bilingual experts in cardiovascular disease. This version was then
pre-tested in 21 patients, and clarity of items was checked using a
Likert-type scale ranging from 1 = not clear to 10 = very clear. It was then
psychometrically tested in 200 cardiovascular patients (41%women; mean age =
58.4 ± 11.6 years old). The internal consistency was assessed using
Kuder-Richardson-20 (KR-20) and Cronbach's alpha, test-retest reliability
through intraclass correlation coefficient (ICC), factor structure using
confirmatory factor analysis, and construct validity regarding educational
level, family income, and time of diagnosis. Results All questions were considered clear by patients (clarity range:7.8-9.6).
KR-20 was 0.70. All ICC values were > 0.70. Factor analysis revealed 6
factors, all internally consistent. Construct validity was supported by
significant differences in total scores by educational level and family
income (p < 0.001). The overall mean was 13.08 ± 2.61. The area
with the highest knowledge was risk factors and the lowest was psychosocial
risk. Conclusions The Portuguese CADE-SV was demonstrated to have good validity and
reliability. This tool can be applicable in clinical and research settings,
assessing cardiovascular patients' knowledge as part of an education
programming.
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Affiliation(s)
| | | | | | | | - Raquel Britto
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
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Lennon RP, Claussen KA, Kuersteiner KA. State of the Heart: An Overview of the Disease Burden of Cardiovascular Disease from an Epidemiologic Perspective. Prim Care 2018; 45:1-15. [PMID: 29406937 DOI: 10.1016/j.pop.2017.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular diseases are prevalent worldwide and have significant impact on morbidity, mortality, and overall health care costs. Common risk factors include obesity, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, and smoking. Both modifiable and nonmodifiable risks should be accounted for when evaluating and managing patients with cardiovascular diseases. The complex nature of cardiovascular disease is not fully understood. Therefore, primary care physicians must balance what is known, what is suspected, and each patient's individual preferences to create an optimal treatment plan.
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Long L, Anderson L, Dewhirst AM, He J, Bridges C, Gandhi M, Taylor RS. Exercise-based cardiac rehabilitation for adults with stable angina. Cochrane Database Syst Rev 2018; 2:CD012786. [PMID: 29394453 PMCID: PMC6491173 DOI: 10.1002/14651858.cd012786.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND A previous Cochrane review has shown that exercise-based cardiac rehabilitation (CR) can benefit myocardial infarction and post-revascularisation patients. However, the impact on stable angina remains unclear and guidance is inconsistent. Whilst recommended in the guidelines of American College of Cardiology/American Heart Association and the European Society of Cardiology, in the UK the National Institute for Health and Care Excellence (NICE) states that there is "no evidence to suggest that CR is clinically or cost-effective for managing stable angina". OBJECTIVES To assess the effects of exercise-based CR compared to usual care for adults with stable angina. SEARCH METHODS We updated searches from the previous Cochrane review 'Exercise-based cardiac rehabilitation for patients with coronary heart disease' by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, DARE, CINAHL and Web of Science on 2 October 2017. We searched two trials registers, and performed reference checking and forward-citation searching of all primary studies and review articles, to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a follow-up period of at least six months, which compared structured exercise-based CR with usual care for people with stable angina. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors also independently assessed the quality of the evidence using GRADE principles and we presented this information in a 'Summary of findings' table. MAIN RESULTS Seven studies (581 participants) met our inclusion criteria. Trials had an intervention length of 6 weeks to 12 months and follow-up length of 6 to 12 months. The comparison group in all trials was usual care (without any form of structured exercise training or advice) or a no-exercise comparator. The mean age of participants within the trials ranged from 50 to 66 years, the majority of participants being male (range: 74% to 100%). In terms of risk of bias, the majority of studies were unclear about their generation of the randomisation sequence and concealment processes. One study was at high risk of detection bias as it did not blind its participants or outcome assessors, and two studies had a high risk of attrition bias due to the numbers of participants lost to follow-up. Two trials were at high risk of outcome reporting bias. Given the high risk of bias, small number of trials and participants, and concerns about applicability, we downgraded our assessments of the quality of the evidence using the GRADE tool.Due to the very low-quality of the evidence base, we are uncertain about the effect of exercise-based CR on all-cause mortality (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.18 to 5.67; 195 participants; 3 studies; very low-quality evidence), acute myocardial infarction (RR 0.33, 95% CI 0.07 to 1.63; 254 participants; 3 studies; very low-quality evidence) and cardiovascular-related hospital admissions (RR 0.14, 95% CI 0.02 to 1.1; 101 participants; 1 study; very low-quality evidence). We found low-quality evidence that exercise-based CR may result in a small improvement in exercise capacity compared to control (standardised mean difference (SMD) 0.45, 95% CI 0.20 to 0.70; 267 participants; 5 studies, low-quality evidence). We were unable to draw conclusions about the impact of exercise-based CR on quality of life (angina frequency and emotional health-related quality-of-life score) and CR-related adverse events (e.g. skeletomuscular injury, cardiac arrhythmia), due to the very low quality of evidence. No data were reported on return to work. AUTHORS' CONCLUSIONS Due to the small number of trials and their small size, potential risk of bias and concerns about imprecision and lack of applicability, we are uncertain of the effects of exercise-based CR compared to control on mortality, morbidity, cardiovascular hospital admissions, adverse events, return to work and health-related quality of life in people with stable angina. Low-quality evidence indicates that exercise-based CR may result in a small increase in exercise capacity compared to usual care. High-quality, well-reported randomised trials are needed to assess the benefits and harms of exercise-based CR for adults with stable angina. Such trials need to collect patient-relevant outcomes, including clinical events and health-related quality of life. They should also assess cost-effectiveness, and recruit participants that are reflective of the real-world population of people with angina.
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Affiliation(s)
- Linda Long
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
| | - Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
| | - Alice M Dewhirst
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
| | - Jingzhou He
- Royal Devon & Exeter NHS Foundation Trust HospitalCardiologyExeterUK
| | - Charlene Bridges
- University College LondonFarr Institute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Manish Gandhi
- Royal Devon & Exeter NHS Foundation Trust HospitalCardiologyExeterUK
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchExeterUK
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Liu XL, Shi Y, Willis K, Wu CJJ, Johnson M. Health education for patients with acute coronary syndrome and type 2 diabetes mellitus: an umbrella review of systematic reviews and meta-analyses. BMJ Open 2017; 7:e016857. [PMID: 29042383 PMCID: PMC5652525 DOI: 10.1136/bmjopen-2017-016857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This umbrella review aimed to identify the current evidence on health education-related interventions for patients with acute coronary syndrome (ACS) or type two diabetes mellitus (T2DM); identify the educational content, delivery methods, intensity, duration and setting required. The purpose was to provide recommendations for educational interventions for high-risk patients with both ACS and T2DM. DESIGN Umbrella review of systematic reviews and meta-analyses. SETTING Inpatient and postdischarge settings. PARTICIPANTS Patients with ACS and T2DM. DATA SOURCES CINAHL, Cochrane Library, Joanna Briggs Institute, Journals@Ovid, EMBase, Medline, PubMed and Web of Science databases from January 2000 through May 2016. OUTCOMES MEASURES Clinical outcomes (such as glycated haemoglobin), behavioural outcomes (such as smoking), psychosocial outcomes (such as anxiety) and medical service use. RESULTS Fifty-one eligible reviews (15 for ACS and 36 for T2DM) consisting of 1324 relevant studies involving 2 88 057 patients (15 papers did not provide the total sample); 30 (58.8%) reviews were rated as high quality. Nurses only and multidisciplinary teams were the most frequent professionals to provide education, and most educational interventions were delivered postdischarge. Face-to-face sessions were the most common delivery formats, and many education sessions were also delivered by telephone or via web contact. The frequency of educational sessions was weekly or monthly, and an average of 3.7 topics was covered per education session. Psychoeducational interventions were generally effective at reducing smoking and admissions for patients with ACS. Culturally appropriate health education, self-management educational interventions, group medical visits and psychoeducational interventions were generally effective for patients with T2DM. CONCLUSIONS Results indicate that there is a body of current evidence about the efficacy of health education, its content and delivery methods for patients with ACS or T2DM. These results provide recommendations about the content for, and approach to, health education intervention for these high-risk patients.
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Affiliation(s)
- Xian-Liang Liu
- Tenth People's Hospital, Tongji University, Shanghai, China
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, QLD, Australia
- School of Nursing, Jinggangshan University, Ji'An, China
| | - Yan Shi
- Tenth People's Hospital, Tongji University, Shanghai, China
| | - Karen Willis
- Melbourne Health, La Trobe University, Melbourne, Victoria, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
- Royal Brisbane and Women's Hospital (RBWH), Australia
- Mater Medical Research Institute-University of Queensland (MMRI-UQ), Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
- Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
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Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, Lennie TA, Lindenfeld J, Mitchell JE, Treat-Jacobson DJ, Webber DE. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. J Am Heart Assoc 2017; 6:e006997. [PMID: 28860232 PMCID: PMC5634314 DOI: 10.1161/jaha.117.006997] [Citation(s) in RCA: 273] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
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Postreanimationsbehandlung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Anderson L, Brown JP, Clark AM, Dalal H, Rossau HK, Bridges C, Taylor RS. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev 2017; 6:CD008895. [PMID: 28658719 PMCID: PMC6481392 DOI: 10.1002/14651858.cd008895.pub3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and improve prognosis. Cardiac rehabilitation is a complex multifaceted intervention which aims to improve the health outcomes of people with CHD. Cardiac rehabilitation consists of three core modalities: education, exercise training and psychological support. This is an update of a Cochrane systematic review previously published in 2011, which aims to investigate the specific impact of the educational component of cardiac rehabilitation. OBJECTIVES 1. To assess the effects of patient education delivered as part of cardiac rehabilitation, compared with usual care on mortality, morbidity, health-related quality of life (HRQoL) and healthcare costs in patients with CHD.2. To explore the potential study level predictors of the effects of patient education in patients with CHD (e.g. individual versus group intervention, timing with respect to index cardiac event). SEARCH METHODS We updated searches from the previous Cochrane review, by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials registries, previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied. SELECTION CRITERIA 1. Randomised controlled trials (RCTs) where the primary interventional intent was education delivered as part of cardiac rehabilitation.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with a diagnosis of CHD. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on the above inclusion criteria. One author extracted study characteristics from the included trials and assessed their risk of bias; a second review author checked data. Two independent reviewers extracted outcome data onto a standardised collection form. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. Heterogeneity amongst included studies was explored qualitatively and quantitatively. Where appropriate and possible, results from included studies were combined for each outcome to give an overall estimate of treatment effect. Given the degree of clinical heterogeneity seen in participant selection, interventions and comparators across studies, we decided it was appropriate to pool studies using random-effects modelling. We planned to undertake subgroup analysis and stratified meta-analysis, sensitivity analysis and meta-regression to examine potential treatment effect modifiers. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro GDT) to create summary of findings tables. MAIN RESULTS This updated review included a total of 22 trials which randomised 76,864 people with CHD to an education intervention or a 'no education' comparator. Nine new trials (8215 people) were included for this update. We judged most included studies as low risk of bias across most domains. Educational 'dose' ranged from one 40 minute face-to-face session plus a 15 minute follow-up call, to a four-week residential stay with 11 months of follow-up sessions. Control groups received usual medical care, typically consisting of referral to an outpatient cardiologist, primary care physician, or both.We found evidence of no difference in effect of education-based interventions on total mortality (13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%); random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality evidence). Individual causes of mortality were reported rarely, and we were unable to report separate results for cardiovascular mortality or non-cardiovascular mortality. There was evidence of no difference in effect of education-based interventions on fatal and/or non fatal myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%) versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very low quality of evidence). However, there was some evidence of a reduction with education in fatal and/or non-fatal cardiovascular events (2 studies, 310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36, 95% CI 0.23 to 0.56; low quality evidence). There was evidence of no difference in effect of education on the rate of total revascularisations (3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus 381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low quality evidence). There was evidence of no difference between groups for all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%) versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low quality evidence). Although some health-related quality of life (HRQoL) domain scores were higher with education, there was no consistent evidence of superiority across all domains. AUTHORS' CONCLUSIONS We found no reduction in total mortality, in people who received education delivered as part of cardiac rehabilitation, compared to people in control groups (moderate quality evidence). There were no improvements in fatal or non fatal MI, total revascularisations or hospitalisations, with education. There was some evidence of a reduction in fatal and/or non-fatal cardiovascular events with education, but this was based on only two studies. There was also some evidence to suggest that education-based interventions may improve HRQoL. Our findings are supportive of current national and international clinical guidelines that cardiac rehabilitation for people with CHD should be comprehensive and include educational interventions together with exercise and psychological therapy. Further definitive research into education interventions for people with CHD is needed.
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Affiliation(s)
- Lindsey Anderson
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
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Holtrop JS, Luo Z, Piatt G, Green LA, Chen Q, Piette J. Diabetic and Obese Patient Clinical Outcomes Improve During a Care Management Implementation in Primary Care. J Prim Care Community Health 2017. [PMID: 28645227 PMCID: PMC5932733 DOI: 10.1177/2150131917715536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. Methods: In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization. Targeted patients included diabetic patients with a hemoglobin A1c >9% and nondiabetic obese patients. Clinical values tracked were A1c, blood pressure, low-density lipoprotein, microalbumin, and weight. Results: Clinically important improvements were demonstrated in the intervention versus comparison practices, with diabetic patients improving A1c control and obese patients experiencing weight loss. There was a 12% relative increase in the proportion of patients meeting the clinical target of A1c <7% (95% CI, 3%-20%), and 26% of obese nondiabetic patients in chronic care management practices lost 5% or more of their body weight as compared with 10% of comparison patients (adjusted relative improvement, 15%; CI, 2%-28%). Conclusions: These findings add to the growing evidence-base for the effectiveness of care management as an effective clinical practice with regard to improving diabetes- and obesity-related outcomes.
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Affiliation(s)
| | - Zhehui Luo
- 2 Michigan State University College of Human Medicine, East Lansing, MI, USA
| | | | - Lee A Green
- 4 University of Alberta School of Medicine, Edmonton, Alberta, Canada
| | - Qiaoling Chen
- 2 Michigan State University College of Human Medicine, East Lansing, MI, USA.,5 Kaiser Permanente Southern California, Pasadena, CA, USA
| | - John Piette
- 3 University of Michigan, Ann Arbor, MI, USA.,6 Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
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Goss F, Brachmann J, Hamm CW, Haerer W, Reifart N, Levenson B. High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study. Vasc Health Risk Manag 2017; 13:127-137. [PMID: 28435280 PMCID: PMC5388240 DOI: 10.2147/vhrm.s119490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy. Participating centers (36 hospitals, 60 office-based cardiologists) included a total of 1,003 patients with ACS (ST-segment elevation myocardial infarction [STEMI] 44.3%, non-ST-segment elevation myocardial infarction [NSTEMI] 39.5%, unstable angina pectoris [UA] 15.2%, and unspecified 1.0%). During follow-up, treatment rates with cardiac medication remained high in all groups, with dual antiplatelet therapy in 91.0% at 3 months, 90.0% at 6 months, and 82.8% at 12 months, respectively. Twelve months after the inclusion, a total of 798 patients (79.6%) still participated in the program. Eighteen patients (1.8%) had died after discharge from hospital (6 in the STEMI, 12 in the NSTEMI group), while for 58 the status was unknown (5.8%). Based on a conservative approach that considered patients with unknown status as dead, 1-year mortality was 7.6%. Recurrent cardiac events were noted in 14.9% at 1 year, with an about equal distribution across STEMI and NSTEMI patients. In conclusion, patients’ acceptance of the ProAcor program as determined by adherence rates over time was high. Treatment rates of recommended medications used for patients with coronary heart disease were excellent. The 1-year mortality rate was comparatively low.
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Affiliation(s)
| | | | | | | | - Nicolaus Reifart
- Kardiologische Praxis Prof. Reifart & Partner, Bad Soden, Germany
| | - Benny Levenson
- Kardiologische Gemeinschaftspraxis und Herzkatheterlabor Berlin-Charlottenburg, Berlin, Germany
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Anderson L, Nguyen TT, Dall CH, Burgess L, Bridges C, Taylor RS. Exercise-based cardiac rehabilitation in heart transplant recipients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [PMID: 28375548 DOI: 10.1002/14651858.cd012264] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heart transplantation is considered to be the gold standard treatment for selected patients with end-stage heart disease when medical therapy has been unable to halt progression of the underlying pathology. Evidence suggests that aerobic exercise training may be effective in reversing the pathophysiological consequences associated with cardiac denervation and prevent immunosuppression-induced adverse effects in heart transplant recipients. OBJECTIVES To determine the effectiveness and safety of exercise-based rehabilitation on the mortality, hospital admissions, adverse events, exercise capacity, health-related quality of life, return to work and costs for people after heart transplantation. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to June 2016. We also searched two clinical trials registers and handsearched the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of parallel group, cross-over or cluster design, which compared exercise-based interventions with (i) no exercise control (ii) a different dose of exercise training (e.g. low- versus high-intensity exercise training); or (iii) an active intervention (i.e. education, psychological intervention). The study population comprised adults aged 18 years or over who had received a heart transplant. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on pre-specified inclusion criteria. Disagreements were resolved by consensus or by involving a third person. Two review authors extracted outcome data from the included trials and assessed their risk of bias. One review author extracted study characteristics from included studies and a second author checked them against the trial report for accuracy. MAIN RESULTS We included 10 RCTs that involved a total of 300 participants whose mean age was 54.4 years. Women accounted for fewer than 25% of all study participants. Nine trials which randomised 284 participants to receive exercise-based rehabilitation (151 participants) or no exercise (133 participants) were included in the main analysis. One cross-over RCT compared high-intensity interval training with continued moderate-intensity training in 16 participants. We reported findings for all trials at their longest follow-up (median 12 weeks).Exercise-based cardiac rehabilitation increased exercise capacity (VO2peak) compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36; N = 284; studies = 9; moderate quality evidence). There was evidence from one trial that high-intensity interval exercise training was more effective in improving exercise capacity than continuous moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N = 16; 1 study). Four studies reported health-related quality of life (HRQoL) measured using SF-36, Profile of Quality of Life in the Chronically Ill (PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF. Due to the variation in HRQoL outcomes and methods of reporting we were unable to meta-analyse results across studies, but there was no evidence of a difference between exercise-based cardiac rehabilitation and control in 18 of 21 HRQoL domains reported, or between high and moderate intensity exercise in any of the 10 HRQoL domains reported. One adverse event was reported by one study.Exercise-based cardiac rehabilitation improves exercise capacity, but exercise was found to have no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients whose health is stable.There was no evidence of statistical heterogeneity across trials for exercise capacity and no evidence of small study bias. The overall risk of bias in included studies was judged as low or unclear; more than 50% of included studies were assessed at unclear risk of bias with respect to allocation concealment, blinding of outcome assessors and declaration of conflicts of interest. Evidence quality was assessed as moderate according to GRADE criteria. AUTHORS' CONCLUSIONS We found moderate quality evidence suggesting that exercise-based cardiac rehabilitation improves exercise capacity, and that exercise has no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients. Cardiac rehabilitation appears to be safe in this population, but long-term follow-up data are incomplete and further good quality and adequately-powered trials are needed to demonstrate the longer-term benefits of exercise on safety and impact on both clinical and patient-related outcomes, such as health-related quality of life, and healthcare costs.
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Affiliation(s)
- Lindsey Anderson
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
| | - Tricia T Nguyen
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
| | - Christian H Dall
- Dept. of Cardiology, Dept. of Physical Therapy and IOC Sports Institute Copenhagen, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen, Denmark
| | - Laura Burgess
- Cardiac Rehabilitation, Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Charlene Bridges
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London, UK, NW1 2DA
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
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Anderson L, Nguyen TT, Dall CH, Burgess L, Bridges C, Taylor RS. Exercise-based cardiac rehabilitation in heart transplant recipients. Cochrane Database Syst Rev 2017; 4:CD012264. [PMID: 28375548 PMCID: PMC6478176 DOI: 10.1002/14651858.cd012264.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heart transplantation is considered to be the gold standard treatment for selected patients with end-stage heart disease when medical therapy has been unable to halt progression of the underlying pathology. Evidence suggests that aerobic exercise training may be effective in reversing the pathophysiological consequences associated with cardiac denervation and prevent immunosuppression-induced adverse effects in heart transplant recipients. OBJECTIVES To determine the effectiveness and safety of exercise-based rehabilitation on the mortality, hospital admissions, adverse events, exercise capacity, health-related quality of life, return to work and costs for people after heart transplantation. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO) and Web of Science Core Collection (Thomson Reuters) to June 2016. We also searched two clinical trials registers and handsearched the reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of parallel group, cross-over or cluster design, which compared exercise-based interventions with (i) no exercise control (ii) a different dose of exercise training (e.g. low- versus high-intensity exercise training); or (iii) an active intervention (i.e. education, psychological intervention). The study population comprised adults aged 18 years or over who had received a heart transplant. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on pre-specified inclusion criteria. Disagreements were resolved by consensus or by involving a third person. Two review authors extracted outcome data from the included trials and assessed their risk of bias. One review author extracted study characteristics from included studies and a second author checked them against the trial report for accuracy. MAIN RESULTS We included 10 RCTs that involved a total of 300 participants whose mean age was 54.4 years. Women accounted for fewer than 25% of all study participants. Nine trials which randomised 284 participants to receive exercise-based rehabilitation (151 participants) or no exercise (133 participants) were included in the main analysis. One cross-over RCT compared high-intensity interval training with continued moderate-intensity training in 16 participants. We reported findings for all trials at their longest follow-up (median 12 weeks).Exercise-based cardiac rehabilitation increased exercise capacity (VO2peak) compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36; N = 284; studies = 9; moderate quality evidence). There was evidence from one trial that high-intensity interval exercise training was more effective in improving exercise capacity than continuous moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; N = 16; 1 study). Four studies reported health-related quality of life (HRQoL) measured using SF-36, Profile of Quality of Life in the Chronically Ill (PLC) and the World Health Organization Quality Of Life (WHOQoL) - BREF. Due to the variation in HRQoL outcomes and methods of reporting we were unable to meta-analyse results across studies, but there was no evidence of a difference between exercise-based cardiac rehabilitation and control in 18 of 21 HRQoL domains reported, or between high and moderate intensity exercise in any of the 10 HRQoL domains reported. One adverse event was reported by one study.Exercise-based cardiac rehabilitation improves exercise capacity, but exercise was found to have no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients whose health is stable.There was no evidence of statistical heterogeneity across trials for exercise capacity and no evidence of small study bias. The overall risk of bias in included studies was judged as low or unclear; more than 50% of included studies were assessed at unclear risk of bias with respect to allocation concealment, blinding of outcome assessors and declaration of conflicts of interest. Evidence quality was assessed as moderate according to GRADE criteria. AUTHORS' CONCLUSIONS We found moderate quality evidence suggesting that exercise-based cardiac rehabilitation improves exercise capacity, and that exercise has no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients. Cardiac rehabilitation appears to be safe in this population, but long-term follow-up data are incomplete and further good quality and adequately-powered trials are needed to demonstrate the longer-term benefits of exercise on safety and impact on both clinical and patient-related outcomes, such as health-related quality of life, and healthcare costs.
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Affiliation(s)
- Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
| | - Tricia T Nguyen
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
| | - Christian H Dall
- Bispebjerg Hospital, University of CopenhagenDept. of Cardiology, Dept. of Physical Therapy and IOC Sports Institute CopenhagenBispebjerg Bakke 23CopenhagenDenmark
| | - Laura Burgess
- Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation TrustCardiac RehabilitationManchesterUK
| | - Charlene Bridges
- University College LondonFarr Institute of Health Informatics Research222 Euston RoadLondonUKNW1 2DA
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
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He X, Li J, Wang B, Yao Q, Li L, Song R, Shi X, Zhang JA. Diabetes self-management education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55:712-731. [PMID: 27837440 DOI: 10.1007/s12020-016-1168-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diabetes self-management education is an essential part of diabetes care, but its impact on all-cause mortality risk of type 2 diabetes patients is unclear. A systematic review and meta-analysis aiming to elucidate the impact of diabetes self-management education on all-cause mortality risk of type 2 diabetes patients was performed. METHODS Randomised controlled trials were identified though literature search in Medline, Embase, CENTRAL, conference abstracts, and reference lists. Only randomised controlled trials comparing diabetes self-management education with usual care in type 2 diabetes patients and reporting outcomes after a follow-up of at least 12 months were considered eligible. Risk ratios with 95 %CIs were pooled. This study was registered at PROSPERO with the number of CRD42016043911. RESULTS 42 randomised controlled trials containing 13,017 participants were included. The mean time of follow-up was 1.5 years. There was no heterogeneity among those included studies (I 2 = 0 %). Mortality occurred in 159 participants (2.3 %) in the diabetes self-management education group and in 187 (3.1 %) in the usual care group, and diabetes self-management education significantly reduced risk of all-cause mortality in type 2 diabetes patients (pooled risk ratios : 0.74, 95 %CI 0.60-0.90, P = 0.003; absolute risk difference: -0.8 %, 95 %CI -1.4 to -0.3). Both multidisciplinary team education and nurse-led education could significantly reduce mortality risk in type 2 diabetes patients, and the pooled risk ratios were 0.66 (95 %CI 0.46-0.96, P = 0.02; I 2 = 0 %) and 0.64 (95 % CI 0.47- 0.88, P = 0.005; I 2 = 0 %), respectively. Subgroup analyses of studies with longer duration of follow-up (≥1.5 years) or larger sample size (≥300) also found a significant effect of diabetes self-management education in reducing mortality risk among type 2 diabetes. Significant effect of diabetes self-management education in reducing mortality risk was also found in those patients receiving diabetes self-management education with contact hours more than 10 h (pooled risk ratio: 0.60, 95 %CI 0.44-0.82, P = 0.001; I 2 = 0 %), those receiving repeated diabetes self-management education (pooled RR: 0.71, P = 0.001; I 2 = 0 %), those receiving diabetes self-management education using structured curriculum (pooled risk ratio: 0.72, P = 0.01; I 2 = 0 %) and those receiving diabetes self-management education using in-person communication (pooled risk ratio: 0.75, P = 0.02; I 2 = 0 %). The quality of evidence for the effect of diabetes self-management education in reducing all-cause mortality risk among type 2 diabetes patients was rated as moderate according to the Grading of Recommendations Assessment, Development, and Evaluation method, and the absolute risk reduction of all-cause mortality of type 2 diabetic patients by diabetes self-management education was estimated to be 4 fewer per 1000 person-years (from 1 fewer to 6 fewer). CONCLUSIONS The available evidence suggests that diabetes self-management education can reduce all-cause mortality risk in type 2 diabetes patients. Further clinical trials with longer time of follow-up are needed to validate the finding above.
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Affiliation(s)
- Xiaoqin He
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
- Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jie Li
- Department of Nephrology, Xi'an Central Hospital, Xi'an, 710003, China
| | - Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Ling Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Ronghua Song
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Xiaohong Shi
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Jin-An Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, 201508, China.
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Lynggaard V, Nielsen CV, Zwisler AD, Taylor RS, May O. The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial. Int J Cardiol 2017; 236:65-70. [PMID: 28259552 DOI: 10.1016/j.ijcard.2017.02.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education 'Learning and Coping Strategies' (LC) on patient adherence to an eight-week CR program. METHODS 825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression. RESULTS More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P=0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P=0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income. CONCLUSIONS Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention. TRIAL REGISTRATION www.clinicaltrials.gov identifier NCT01668394.
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Affiliation(s)
- Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark.
| | - Rod S Taylor
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark; Institute of Health Research, University of Exeter Medical School, Exeter, England, UK.
| | - Ole May
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark.
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Clinical effectiveness of individual patient education in heart surgery patients: A systematic review and meta-analysis. Int J Nurs Stud 2017; 65:44-53. [DOI: 10.1016/j.ijnurstu.2016.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/01/2016] [Accepted: 11/04/2016] [Indexed: 11/19/2022]
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Bhagwat MM, Woods JA, Dronavalli M, Hamilton SJ, Thompson SC. Evidence-based interventions in primary care following acute coronary syndrome in Australia and New Zealand: a systematic scoping review. BMC Cardiovasc Disord 2016; 16:214. [PMID: 27829379 PMCID: PMC5103388 DOI: 10.1186/s12872-016-0388-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary artery disease has a significant disease burden, but there are many known barriers to management of acute coronary syndrome (ACS). General practitioners (GPs) bear considerable responsibility for post-discharge management of ACS in Australia and New Zealand (NZ), but knowledge about the extent and efficacy of such management is limited. This systematic review summarises published evidence from Australia and New Zealand regarding management in primary care after discharge following ACS. METHODS A search of PubMed, Scopus, CINAHL-Plus and PSYCINFO databases in August 2015 was supplemented by citation screening and hand-searching. Literature was selected based on specified criteria, and assessed for quality using the Mixed Methods Appraisal Tool (MMAT). Extracted data was related to evidence-based interventions specified by published guidelines. RESULTS The search yielded 19 publications, most of which reported on quantitative and observational studies from Australia. The majority of studies scored at least 75 % on the MMAT. Diverse aspects of management by GPs are presented according to categories of evidence-based guidelines. Data suggests that GPs are more likely to prescribe ACS medications than to assist in lifestyle or psychological management. GP referral to cardiac rehabilitation varied, and one study showed an improvement in the number of ACS patients with documented ACS management plans. Few studies described successful interventions to improve GP management, though some quality improvement efforts through education and integration of care with hospitals were beneficial. Limited data was published about interventions effective in rural, minority, and Indigenous populations. CONCLUSIONS Research reflects room for improvement in GP post-discharge ACS management, but little is known about effective methods for improvement. Additional research, both observational and interventional, would assist GPs in improving the quality of post-discharge ACS care.
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Affiliation(s)
- Manavi M. Bhagwat
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia 6009 Australia
- Georgetown University, Washington, DC USA
| | - John A. Woods
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Mithilesh Dronavalli
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Sandra J. Hamilton
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia 6009 Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia (M706), 35 Stirling Highway, Crawley, Western Australia 6009 Australia
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Greaves CJ, Wingham J, Deighan C, Doherty P, Elliott J, Armitage W, Clark M, Austin J, Abraham C, Frost J, Singh S, Jolly K, Paul K, Taylor L, Buckingham S, Davis R, Dalal H, Taylor RS. Optimising self-care support for people with heart failure and their caregivers: development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping. Pilot Feasibility Stud 2016; 2:37. [PMID: 27965855 PMCID: PMC5153822 DOI: 10.1186/s40814-016-0075-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life. METHODS We used intervention mapping to guide the development of our intervention. We identified "targets for change" by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We then used behaviour change theory, expert opinion and a taxonomy of behaviour change techniques, to identify barriers to and facilitators of change and to match intervention strategies to each target. A patient and public involvement group helped to identify patient and caregiver needs, refine the intervention objectives and strategies and deliver training to the intervention facilitators. A feasibility study (ISRCTN25032672) involving 23 patients, 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention. RESULTS The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention is a comprehensive self-care support programme comprising the "Heart Failure Manual", a choice of two exercise programmes for patients, a "Family and Friends Resource" for caregivers, a "Progress Tracker" tool and a facilitator training course. The main targets for change are engaging in exercise training, monitoring for symptom deterioration, managing stress and anxiety, managing medications and understanding heart failure. Secondary targets include managing low mood and smoking cessation. The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks, via home and telephone contacts. The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators, patients and caregivers. Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas, especially in terms of addressing caregivers' needs. The REACH-HF materials were revised accordingly. CONCLUSIONS We have developed a comprehensive, evidence-informed, theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers. A randomised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers.
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Affiliation(s)
- Colin J Greaves
- Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Jennifer Wingham
- Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK ; Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK
| | - Carolyn Deighan
- Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, York, YO10 5DD UK
| | - Jennifer Elliott
- Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK
| | - Wendy Armitage
- Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK ; Chest Heart & Stroke Scotland, 3rd floor, Rosebery House, 9 Haymarket Terrace, Edinburgh, EH12 5EZ UK
| | - Michelle Clark
- Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK
| | - Jackie Austin
- Heart Failure and Cardiac Rehabilitation Services, Aneurin Bevan Health Board, Ty-Meddyg, Nevill Hall Hospital, Abergavenny, Gwent NP7 7EG UK
| | - Charles Abraham
- Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Julia Frost
- Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK
| | - Sally Singh
- University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Kevin Paul
- REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, BIU, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK
| | - Louise Taylor
- Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK
| | - Sarah Buckingham
- Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK
| | - Russell Davis
- Sandwell & West Birmingham Hospitals NHS Trust, Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ UK
| | - Hasnain Dalal
- University of Exeter Medical School (Primary Care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD UK
| | - Rod S Taylor
- Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK
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Vordos Z, Kouidi E, Mavrovouniotis F, Metaxas T, Dimitros E, Kaltsatou A, Deligiannis A. Impact of traditional Greek dancing on jumping ability, muscular strength and lower limb endurance in cardiac rehabilitation programmes. Eur J Cardiovasc Nurs 2016; 16:150-156. [PMID: 27081164 DOI: 10.1177/1474515116636980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The objective of this study was to evaluate the effect of a training programme based on traditional Greek dance on the jumping ability, muscle strength and lower limb endurance in patients with chronic heart failure (CHF). PATIENTS AND METHODS Forty Greek patients with CHF graded as NYHA ⩽ II and aged 73.2±4.7 years were randomly divided into two groups. Group A ( n=20) participated in a three-month physical rehabilitation programme based on Greek traditional dances, whereas group B ( n=20) remained untrained and served as the control group. All patients were studied before and after the 12-week exercise training programme. At baseline and follow-up the exercise capacity of the patients was evaluated by the six-minute walking test, their lower extremity muscle strength was evaluated by an isokinetic dynamometer and their jumping ability by the Myotest-Pro test, which includes three types of jumps (plyometric, countermovement and squat jumps). RESULTS No significant difference was observed between the two groups at the baseline evaluation. At follow-up, group A showed significant improvements in walking distance calculated from the six-minute walking test (10.0% improvement; p<0.05), in lower limb strength (10.32% improvement; p<0.05), and in countermovement jump speed (6.9%; p<0.05) and squat jump speed (5.8%; p<0.05). Group A also increased their jump plyometry height by 13.86% ( p<0.05), their counter jump height by 10.68% ( p<0.05) and their squat jump height by 10.45% ( p<0.05). Group A had a 6.85% ( p<0.05) increased force of counter jump compared with group B. CONCLUSION The design and implementation of cardiac rehabilitation programmes using Greek traditional dances in patients with CHF are both safe and effective in improving lower limb function.
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Affiliation(s)
| | | | | | - Thomas Metaxas
- 2 Laboratory of Ergophysiology - Ergometry, Department of Physical Education and Sports Science, Aristotle University, Greece
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Unverzagt S, Meyer G, Mittmann S, Samos FA, Unverzagt M, Prondzinsky R. Improving Treatment Adherence in Heart Failure. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:423-30. [PMID: 27397013 PMCID: PMC4941608 DOI: 10.3238/arztebl.2016.0423] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite improved treatment options, heart failure remains the third most common cause of death in Germany and the most common reason for hospitalization. The treatment recommendations contained in the relevant guidelines have been incompletely applied in practice. The goal of this systematic review is to study the efficacy of adherence-promoting interventions for patients with heart failure with respect to the taking of medications, the implementation of recommended lifestyle changes, and the improvement in clinical endpoints. METHODS We performed a meta-analysis of pertinent publications retrieved by a systematic literature search. RESULTS 55 randomized controlled trials were identified, in which a wide variety of interventions were carried out on heterogeneous patient groups with varying definitions of adherence. These trials included a total of 15 016 patients with heart failure who were cared for as either inpatients or outpatients. The efficacy of interventions to promote adherence to drug treatment was studied in 24 trials; these trials documented improved adherence in 10% of the patients overall (95% confidence interval [CI]: [5; 15]). The efficacy of interventions to promote adherence to lifestyle recommendations was studied in 42 trials; improved adherence was found in 31 trials. Improved adherence to at least one recommendation yielded a long-term absolute reduction in mortality of 2% (95% CI: [0; 4]) and a 10% reduction in the likelihood of hospitalization within 12 months of the start of the intervention (95% CI: [3; 17]). CONCLUSION Many effective interventions are available that can lead to sustained improvement in patient adherence and in clinical endpoints. Longterm success depends on patients' assuming responsibility for their own health and can be achieved with the aid of coordinated measures such as patient education and regular follow-up contacts.
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Affiliation(s)
- Susanne Unverzagt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale):
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle (Saale)
| | - Susanne Mittmann
- Institute for Medical Epidemiology, Biostatistics and Informatics, Section for General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale):
| | - Franziska-Antonia Samos
- Institute for Medical Epidemiology, Biostatistics and Informatics, Section for General Practice, Martin-Luther-University Halle-Wittenberg, Halle (Saale):
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Aspry K, Wu WC, Salmoirago-Blotcher E. Cardiac Rehabilitation in Patients with Established Atherosclerotic Vascular Disease: New Directions in the Era of Value-Based Healthcare. Curr Atheroscler Rep 2016; 18:10. [PMID: 26803511 DOI: 10.1007/s11883-016-0561-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Exercise-based cardiac rehabilitation (CR) is associated with significant improvements in coronary disease outcomes, but has been underutilized. However, new developments within the field, some spurred by healthcare reform and the transition to more accountable and coordinated care, offer hope for closing the large CR treatment gap. This review presents new CR-related research, policy, and analyses, and discusses how evolving eligibility criteria, referral processes, performance measures, care models, and delivery and payment options could increase CR utilization over the next decade and enable this life-saving secondary prevention intervention to thrive in the era of value-based health care.
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Affiliation(s)
- Karen Aspry
- Alpert Medical School of Brown University, Providence, RI, USA. .,Lifespan Cardiovascular Institute, Providence, RI, USA. .,Center for Cardiac Fitness, Miriam Hospital, Providence, RI, USA. .,Lifespan Cardiovascular Institute, 1454 South County Trail-Suite 200, East Greenwich, RI, 02818, USA.
| | - Wen-Chih Wu
- Alpert Medical School of Brown University, Providence, RI, USA.,Lifespan Cardiovascular Institute, Providence, RI, USA.,Center for Cardiac Fitness, Miriam Hospital, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - Elena Salmoirago-Blotcher
- Alpert Medical School of Brown University, Providence, RI, USA.,Center for Preventive and Behavioral Medicine, Miriam Hospital, Providence, RI, USA
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Fålun N, Fridlund B, Schaufel MA, Schei E, Norekvål TM. Patients' goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction. Eur J Cardiovasc Nurs 2015; 15:495-503. [PMID: 26507076 DOI: 10.1177/1474515115614712] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/26/2015] [Accepted: 10/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients' ability to effect lifestyle changes at the time of discharge is limited. AIM The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients. METHODS We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis. FINDINGS Three themes suggested that, at the time of discharge, patients' views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going. CONCLUSIONS AND IMPLICATIONS There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge.
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Affiliation(s)
- Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Norway.,School of Health and Welfare, Jönköping University, Sweden
| | | | - Edvin Schei
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Norway.,Department of Clinical Science, University of Bergen, Norway
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Affiliation(s)
- Hasnain M Dalal
- University of Exeter Medical School (primary care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro TR1 3HD, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Rod S Taylor
- Institute of Health Research, University of Exeter Medical School, Exeter EX1 2LU, UK
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Dehbarez NT, Lynggaard V, May O, Søgaard R. Learning and coping strategies versus standard education in cardiac rehabilitation: a cost-utility analysis alongside a randomised controlled trial. BMC Health Serv Res 2015; 15:422. [PMID: 26412226 PMCID: PMC4586001 DOI: 10.1186/s12913-015-1072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/18/2015] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure. METHODS The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors. RESULTS An additional cost of DKK 6,043 (95% CI -5,697; 17,783) and a QALY gain of 0.005 (95% CI -0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29% for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62% over the threshold values. DISCUSSION The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn. CONCLUSION Future research should assess the LC strategies' long-term efficacy and cost-utility. TRIAL REGISTRATION NCT01668394.
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Affiliation(s)
- Nasrin Tayyari Dehbarez
- Health Economics, Public Health and Quality Improvement, Olof Palmes Alle 15, 8200, Aarhus N, Denmark. .,Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark.
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Ole May
- Cardiovascular Research Unit, Regional Hospital West Jutland, 7400, Herning, Denmark.
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark. .,Department of Clinical Medicine, Aarhus University, Bartholins Allé 2, Buldg. 1260, 8000, Aarhus C, Denmark.
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Melamed RJ, Tillmann A, Kufleitner HE, Thürmer U, Dürsch M. Evaluating the efficacy of an education and treatment program for patients with coronary heart disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:802-8. [PMID: 25487763 DOI: 10.3238/arztebl.2014.0802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Until now, there has not been any evaluated, disease-specific education and treatment program for patients with coronary heart disease (CHD) in Germany. It is thought that education can improve these patients' physical activity and quality of life and teach them how to lessen their risk factors, what to do in case of an emergency, and how to assess their own medical treatment. METHODS A randomized controlled open intervention trial was carried out from February 2010 to September 2011. 196 patients were assigned to receive the intervention (patient education), while 199 were assigned to a control group. In an intention-to-treat analysis, baseline and follow-up data were compared after a mean interval of 220 days. The evaluative instruments included the Freiburg Questionnaire of Physical Activity, the MacNew Heart Disease Quality of Life Questionnaire, questionnaires regarding knowledge about CHD, ergometric performance ability, and the body-mass index. RESULTS The patients in the intervention group reported having increased their physical activity by a mean of 9.3 MET/week (MET=metabolic equivalent of task), compared to 2.5 MET/week in the control group; the difference of 6.8 MET/week was statistically significant (p = 0.015). The patients in the intervention group also rated their quality of life higher than those in the control group (0.2 ± 0.56 vs. 0.09 ± 0.53 [mean ± standard deviation], p = 0.056). They were significantly better informed than patients in the control group about risk factors and about what to do in an emergency. CONCLUSION Persistently unhealthy lifestyle is a common problem of CHD patients; the education and treatment program presented here may be a suitable means of improving patients' lifestyle for secondary prevention. Further studies will be needed to document long-term efficacy and to determine whether occasional refresher courses will be needed as well.
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Affiliation(s)
- Richard J Melamed
- Tillmann have equally contributed to the article, Department of Medicine, Goethe University Frankfurt/Main, Studiumdigitale-E-Learning Center, Goethe University Frankfurt/Main, Bürgerhospital, Frankfurt am Main, Praxis Thürmer/Endruleit, Frankfurt am Main, Cardiology Frankfurt-Sachsenhausen, Frankfurt am Main
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Clark AM, Thirsk LM, Wiens KS, Ski CF, Thompson DR. How to research the mechanisms of non-pharmacological cardiac interventions. Int J Cardiol 2015; 201:457-61. [PMID: 26313866 DOI: 10.1016/j.ijcard.2015.08.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/17/2015] [Accepted: 08/09/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To discuss research into the mechanisms of non-pharmacological interventions for cardiac populations. METHODS Overview of past research and theory. RESULTS Non-pharmacological interventions for cardiac patients (including: cardiac rehabilitation, heart failure disease management programs and psychosocial interventions) have never been so common or diverse, but also have never been subject to so much scrutiny and skepticism. Better understanding of outcomes of these interventions is an urgent global priority. Mechanisms are the "underlying entities, processes, or structures which operate in particular contexts to generate outcomes of interest." PRACTICE Research into the mechanisms of non-pharmacological interventions offers useful and robust knowledge of how and why cardiac interventions work that can be vital to explaining outcomes from interventions and inconsistencies in results. CONCLUSIONS Research into intervention mechanisms can inform the design and optimization of interventions. IMPLICATIONS We recommend that future research into the mechanisms of non-pharmacological interventions for cardiac population 1) view effectiveness as 'somewhat' patterned, 2) conceptualize mechanisms adequately, 3) assume they are hidden, 4) examine how context affects mechanisms, and 6) address what works for whom, when, and why.
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Affiliation(s)
- A M Clark
- Faculty of Nursing, Level 5 Edmonton Clinic Health Academy, 11405-87 Avenue, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - L M Thirsk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - K S Wiens
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - C F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
| | - D R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
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Boyde M, Grenfell K, Brown R, Bannear S, Lollback N, Witt J, Jiggins L, Aitken L. What have our patients learnt after being hospitalised for an acute myocardial infarction? Aust Crit Care 2015; 28:134-9. [DOI: 10.1016/j.aucc.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/16/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022] Open
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Perk J, Hambraeus K, Burell G, Carlsson R, Johansson P, Lisspers J. Study of Patient Information after percutaneous Coronary Intervention (SPICI): should prevention programmes become more effective? EUROINTERVENTION 2015; 10:e1-7. [DOI: 10.4244/eijv10i11a223] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Schaepe C, Bergjan M. Educational interventions in peritoneal dialysis: a narrative review of the literature. Int J Nurs Stud 2015; 52:882-98. [PMID: 25616708 DOI: 10.1016/j.ijnurstu.2014.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 12/19/2014] [Accepted: 12/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To review the current literature on educational interventions used in peritoneal dialysis (PD). Educational interventions have become increasingly relevant because they play a key role in helping individuals to actively participate in their therapy and to manage their chronic condition. The paper will focus on two areas: (a) educational interventions for individuals living with PD and (b) educational interventions for PD nurses. DESIGN A narrative review of primary research. DATA SOURCES Electronic searches of the MEDLINE, CINAHL, EMBASE, ERIC and Cochrane Library (2006-2013) databases were undertaken using terms such as peritoneal dialysis, insertive training, curriculum, nursing education, train the trainer, coach the coach, tutor the tutor, and patient education were used. All studies were reviewed by two researchers. REVIEW METHODS Titles and abstracts of 555 studies were screened and read. Full text articles retrieved were further screened against the inclusion and exclusion criteria. Relevant data on the educational interventions for people receiving PD and nurse training programs were extracted and synthesized narratively. RESULTS Eighteen articles met the inclusion criteria. Most of them focused on educational intervention programs for people undergoing PD. Findings on the link between the PD trainer's background and peritonitis rates among individuals undergoing PD are inconsistent. PD learners should be taught self-management skills as well as technical skills. They might also benefit from receiving decision-making aids. Older people, people with co-morbidities and people with low educational status need more time to acquire self-care skills and are more likely to develop peritonitis. Home visits have the potential to improve learning outcomes. Re-training needs should be assessed and fulfilled as appropriate. Case and disease management programs have been shown to have positive outcomes for individuals receiving PD. CONCLUSIONS Educational interventions for PD remain an under-researched area, despite the potential they have to make this type of therapy more successful. Further research on education and training for people receiving PD and for PD nurses is needed. In the meantime, educational interventions used for other chronic conditions could provide guidance.
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Affiliation(s)
- Christiane Schaepe
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Manuela Bergjan
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2014; 2014:CD011273. [PMID: 25503364 PMCID: PMC7087435 DOI: 10.1002/14651858.cd011273.pub2] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Overviews are a new approach to summarising evidence and synthesising results from related systematic reviews. OBJECTIVES To conduct an overview of Cochrane systematic reviews to provide a contemporary review of the evidence for delivery of cardiac rehabilitation, to identify opportunities for merging or splitting existing Cochrane reviews, and to identify current evidence gaps to inform new cardiac rehabilitation systematic review titles. METHODS We searched The Cochrane Database of Systematic Reviews (2014, Issue 10) to identify systematic reviews that addressed the objectives of this overview. We assessed the quality of included reviews using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) measurement tool and the quality of the evidence for reported outcomes using the GRADE framework. The focus of the data presentation was descriptive with detailed tabular presentations of review level and trial level characteristics and results. MAIN RESULTS We found six Cochrane systematic reviews and judged them to be of high methodological quality. They included 148 randomised controlled trials (RCTs) in 98,093 participants. Compared with usual care alone, the addition of exercise-based cardiac rehabilitation in low-risk people after myocardial infarction or percutaneous coronary intervention or with heart failure appeared to have no impact on mortality, but did reduce hospital admissions and improved health-related quality of life. Psychological- and education-based interventions alone appeared to have little or no impact on mortality or morbidity but may have improved health-related quality of life. Home- and centre-based programmes were equally effective in improving quality of life outcomes at similar healthcare costs. Selected interventions can increase the uptake of cardiac rehabilitation programmes whilst there is currently only weak evidence to support interventions that improve adherence to cardiac rehabilitation programmes. The quality of the primary RCTs in the included systematic reviews was variable, and limitations in the methodological quality of the RCTs led to downgrading of the quality of the evidence, which varied widely by review and by outcome. AUTHORS' CONCLUSIONS Exercise-based cardiac rehabilitation is an effective and safe therapy to be used in the management of clinically stable people following myocardial infarction or percutaneous coronary intervention or who have heart failure. Future RCTs of cardiac rehabilitation need to improve their reporting methods and reflect the real world practice better including the recruitment of higher risk people and consideration of contemporary models of cardiac rehabilitation delivery, and identify effective interventions for enhancing adherence to rehabilitation.
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Affiliation(s)
- Lindsey Anderson
- Institute of Health Research, University of Exeter edical School, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG, UK.
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Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, Small N, Bower P. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundA critical part of future service delivery will involve improving the degree to which people become engaged in ‘self-management’. Providing better support for self-management has the potential to make a significant contribution to NHS efficiency, as well as providing benefits in patient health and quality of care.ObjectiveTo determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.Data sourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, EconLit (the American Economic Association’s electronic bibliography), EMBASE, Health Economics Evaluations Database, MEDLINE (the US National Library of Medicine’s database), MEDLINE In-Process & Other Non-Indexed Citations, NHS Economic Evaluation Database (NHS EED) and PsycINFO (the behavioural science and mental health database), as well as the reference lists of published reviews of self-management support.MethodsWe included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. Main outcome measures were quantitative measures of service utilisation (including hospital use) and quality of life (QoL). We presented the results for each condition group using a permutation plot, plotting the effect of interventions on utilisation and outcomes simultaneously and placing them in quadrants of the cost-effectiveness plane depending on the pattern of outcomes. We also conducted conventional meta-analyses of outcomes.ResultsWe found 184 studies that met the inclusion criteria and provided data for analysis. The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management. Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as we found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.LimitationsSelf-management support is a complex area in which to undertake literature searches. Our analyses were limited by poor reporting of outcomes in the included studies, especially concerning health-care utilisation and costs.ConclusionsVery few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.Study registrationThis study is registered as PROSPERO CRD42012002694.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Anderson L, Taylor R. Cardiac rehabilitation for people with heart disease: An overview of Cochrane systematic reviews. Int J Cardiol 2014; 177:348-61. [DOI: 10.1016/j.ijcard.2014.10.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/03/2014] [Accepted: 10/04/2014] [Indexed: 01/08/2023]
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Gelot P, Avenel-Audran M, Balica S, Bensefa L, Crépy MN, Debons M, Ammari H, Milpied B, Raison N, Vigan M, Weibel N, Stalder JF, Bernier C. Éducation thérapeutique du patient dans l’eczéma chronique des mains. Ann Dermatol Venereol 2014; 141 Suppl 1:S127-42. [DOI: 10.1016/s0151-9638(14)70150-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ryan R, Santesso N, Lowe D, Hill S, Grimshaw J, Prictor M, Kaufman C, Cowie G, Taylor M. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews. Cochrane Database Syst Rev 2014; 2014:CD007768. [PMID: 24777444 PMCID: PMC6491214 DOI: 10.1002/14651858.cd007768.pub3] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Many systematic reviews exist on interventions to improve safe and effective medicines use by consumers, but research is distributed across diseases, populations and settings. The scope and focus of such reviews also vary widely, creating challenges for decision-makers seeking to inform decisions by using the evidence on consumers' medicines use.This is an update of a 2011 overview of systematic reviews, which synthesises the evidence, irrespective of disease, medicine type, population or setting, on the effectiveness of interventions to improve consumers' medicines use. OBJECTIVES To assess the effects of interventions which target healthcare consumers to promote safe and effective medicines use, by synthesising review-level evidence. SEARCH METHODS We included systematic reviews published on the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. We identified relevant reviews by handsearching databases from their start dates to March 2012. SELECTION CRITERIA We screened and ranked reviews based on relevance to consumers' medicines use, using criteria developed for this overview. DATA COLLECTION AND ANALYSIS We used standardised forms to extract data, and assessed reviews for methodological quality using the AMSTAR tool. We used standardised language to summarise results within and across reviews; and gave bottom-line statements about intervention effectiveness. Two review authors screened and selected reviews, and extracted and analysed data. We used a taxonomy of interventions to categorise reviews and guide syntheses. MAIN RESULTS We included 75 systematic reviews of varied methodological quality. Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation and skills acquisition. No reviews aimed to promote systems-level consumer participation in medicines-related activities. Medicines adherence was the most frequently-reported outcome, but others such as knowledge, clinical and service-use outcomes were also reported. Adverse events were less commonly identified, while those associated with the interventions themselves, or costs, were rarely reported.Looking across reviews, for most outcomes, medicines self-monitoring and self-management programmes appear generally effective to improve medicines use, adherence, adverse events and clinical outcomes; and to reduce mortality in people self-managing antithrombotic therapy. However, some participants were unable to complete these interventions, suggesting they may not be suitable for everyone.Other promising interventions to improve adherence and other key medicines-use outcomes, which require further investigation to be more certain of their effects, include:· simplified dosing regimens: with positive effects on adherence;· interventions involving pharmacists in medicines management, such as medicines reviews (with positive effects on adherence and use, medicines problems and clinical outcomes) and pharmaceutical care services (consultation between pharmacist and patient to resolve medicines problems, develop a care plan and provide follow-up; with positive effects on adherence and knowledge).Several other strategies showed some positive effects, particularly relating to adherence, and other outcomes, but their effects were less consistent overall and so need further study. These included:· delayed antibiotic prescriptions: effective to decrease antibiotic use but with mixed effects on clinical outcomes, adverse effects and satisfaction;· practical strategies like reminders, cues and/or organisers, reminder packaging and material incentives: with positive, although somewhat mixed effects on adherence;· education delivered with self-management skills training, counselling, support, training or enhanced follow-up; information and counselling delivered together; or education/information as part of pharmacist-delivered packages of care: with positive effects on adherence, medicines use, clinical outcomes and knowledge, but with mixed effects in some studies;· financial incentives: with positive, but mixed, effects on adherence.Several strategies also showed promise in promoting immunisation uptake, but require further study to be more certain of their effects. These included organisational interventions; reminders and recall; financial incentives; home visits; free vaccination; lay health worker interventions; and facilitators working with physicians to promote immunisation uptake. Education and/or information strategies also showed some positive but even less consistent effects on immunisation uptake, and need further assessment of effectiveness and investigation of heterogeneity.There are many different potential pathways through which consumers' use of medicines could be targeted to improve outcomes, and simple interventions may be as effective as complex strategies. However, no single intervention assessed was effective to improve all medicines-use outcomes across all diseases, medicines, populations or settings.Even where interventions showed promise, the assembled evidence often only provided part of the picture: for example, simplified dosing regimens seem effective for improving adherence, but there is not yet sufficient information to identify an optimal regimen.In some instances interventions appear ineffective: for example, the evidence suggests that directly observed therapy may be generally ineffective for improving treatment completion, adherence or clinical outcomes.In other cases, interventions may have variable effects across outcomes. As an example, strategies providing information or education as single interventions appear ineffective to improve medicines adherence or clinical outcomes, but may be effective to improve knowledge; an important outcome for promoting consumers' informed medicines choices.Despite a doubling in the number of reviews included in this updated overview, uncertainty still exists about the effectiveness of many interventions, and the evidence on what works remains sparse for several populations, including children and young people, carers, and people with multimorbidity. AUTHORS' CONCLUSIONS This overview presents evidence from 75 reviews that have synthesised trials and other studies evaluating the effects of interventions to improve consumers' medicines use.Systematically assembling the evidence across reviews allows identification of effective or promising interventions to improve consumers' medicines use, as well as those for which the evidence indicates ineffectiveness or uncertainty.Decision makers faced with implementing interventions to improve consumers' medicines use can use this overview to inform decisions about which interventions may be most promising to improve particular outcomes. The intervention taxonomy may also assist people to consider the strategies available in relation to specific purposes, for example, gaining skills or being involved in decision making. Researchers and funders can use this overview to identify where more research is needed and assess its priority. The limitations of the available literature due to the lack of evidence for important outcomes and important populations, such as people with multimorbidity, should also be considered in practice and policy decisions.
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Affiliation(s)
- Rebecca Ryan
- Centre for Health Communication and Participation, School of Public Health and Human Biosciences, La Trobe University, Bundoora, VIC, Australia, 3086
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