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Scherer LD, Lin GA, Kini V. Impact of a patient-centered tool to reduce misconceptions about coronary artery disease and its treatment: The CAD roadmap. PEC INNOVATION 2024; 4:100303. [PMID: 38911020 PMCID: PMC11193033 DOI: 10.1016/j.pecinn.2024.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
Objective Health misinformation is common and can lead to harmful behaviors such as medication non-adherence. We assessed the impact of a novel patient educational tool focused on overcoming misconceptions among patients with coronary artery disease (CAD). Methods We developed the CAD Roadmap, an educational tool aimed at explaining the disease trajectory and overcoming common disease misconceptions (such as that statin medications are not beneficial). We designed a pilot survey to assess patients' 1) CAD-related knowledge, 2) medication-taking behavior, and 3) acceptability of the Roadmap. Survey participants were recruited online. CAD knowledge scores were compared with repeated measures t-tests. Results Among 114 patients with CAD (mean age 67 years, 63% male), average CAD-related knowledge was 79.0% pre-test and 89.7% after review of the CAD Roadmap (p < .001). After review of the Roadmap, 24% indicated they planned to take their medications more regularly, 93% agreed it was helpful in understanding medication benefits, and 77% felt more empowered to participate in medical decisions. Conclusion The CAD Roadmap was evaluated positively, improved disease-related knowledge, and has the potential to improve adherence to treatments. Innovation Unlike many other interventions, the CAD Roadmap is specifically designed to overcome common misconceptions to improve health behaviors.
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Affiliation(s)
- Laura D. Scherer
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Grace A. Lin
- University of California San Francisco, Department of Medicine, San Francisco, CA, USA
| | - Vinay Kini
- Weill Cornell Medical College, Department of Medicine, New York, NY, USA
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2
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Yang J, Pu Y, Jiang X, Yao Q, Luo J, Wang T, Zhang X, Yang Z. Association between quality of discharge teaching and self-management in patients after percutaneous coronary intervention: A chain mediation model. J Clin Nurs 2024. [PMID: 38764246 DOI: 10.1111/jocn.17204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/21/2024]
Abstract
AIMS To examine chain mediating effect of discharge readiness and self-efficacy between quality of discharge teaching and self-management in patients after percutaneous coronary intervention (PCI). BACKGROUND Although self-management after PCI has significant benefits in controlling risk factors and delaying disease progression, the status of self-management remains unoptimistic. A large number of studies have explored the close relationship between the quality of discharge teaching and patients self-management, but little is known about the underlying mechanisms. METHODS The cross-sectional samples was collected from a tertiary hospital in China. Self-reported questionnaires were used to assess quality of discharge teaching, discharge readiness, self-efficacy and self-management. Pearson correlation analysis and mediation effect analysis were used for statistical analysis. REPORTING METHOD The study used the STROBE checklist for reporting. RESULTS A total of 198 patients with a mean age of 64.99 ± 11.32 (34-85) were included. The mean score of self-management was 88.41 ± 11.82. Quality of discharge teaching, discharge readiness, self-efficacy and self-management were all positively correlated. Mediation effect analysis showed that the mediating effects of discharge readiness, self-efficacy, discharge readiness and self-efficacy between quality of discharge teaching and self-management were 0.157, 0.177 and 0.049, respectively, accounting for 21.96%, 24.76% and 6.85% of the total effect. CONCLUSION The quality of discharge teaching for patients after PCI not only directly affects self-management, but also can indirectly affect self-management through discharge readiness and self-efficacy. RELEVANCE TO CLINICAL PRACTICE To improve the life quality of patients after PCI, medical staff should pay attention to the influence of self-management of quality of discharge teaching, and develop intervention strategies based on the path of discharge readiness and self-efficacy. PATIENT OR PUBLIC CONTRIBUTION Questionnaires filled out by patients were used to understand the association between quality of discharge teaching, discharge readiness, self-efficacy and self-management.
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Affiliation(s)
- Jin Yang
- Chengdu Medical College, Chengdu, China
- Department of Cardiology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - You Pu
- Department of Oncology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Xia Jiang
- Department of Cardiology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Qian Yao
- Chengdu Medical College, Chengdu, China
| | - Jian Luo
- Chengdu Medical College, Chengdu, China
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3
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Shang S, Zheng X, Xu Z, Sun S, Huang T. Mediation effect of hope on the relationship between inner strength and self-management in patients after percutaneous coronary intervention. Front Psychol 2024; 15:1268598. [PMID: 38328383 PMCID: PMC10847588 DOI: 10.3389/fpsyg.2024.1268598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Effective self-management can enhance a patient's quality of life and delay disease progression. However, motivating patients to adhere to self-management behavior following percutaneous coronary intervention (PCI) remains a challenge. With the robust development of positive psychology and interdisciplinary research, the role of psychology factors in patients' health behavior has increasingly garnered attention. This study, focusing on positive psychological qualities, aims to investigate the relationship between inner strength, hope, and self-management in patients post-PCI, and to analyze the mediating role of hope between inner strength and self-management. Methods A cross-sectional survey was conducted among 216 PCI patients from a tertiary hospital in Nanjing. Research instruments included a self-designed general information questionnaire, the Inner Strength Scale (ISS), the Herth Hope Index (HHI), and the Coronary Self-Management Scale (CSMS). T-test, analysis of variance, Pearson's correlation analysis, and mediating effect test were utilized for statistical analysis. Results The average scores of the ISS, HHI, and CSMS were 81.46 ± 12.00, 35.94 ± 5.38, and 86.79 ± 14.84, respectively. Inner strength was positively correlated with hope and self-management (r = 0.867, r = 0.630, respectively; all P < 0.05), and hope was positively correlated with self-management (r = 0.671, P < 0.05). Moreover, hope had a complete mediating effect between inner strength and self-management (β = 0.630, P < 0.01). Conclusion The inner strength, hope, and self-management of patients with PCI are at a moderate level. Inner strength primarily influences patients' self-management behavior through hope, suggesting that medical staff can target hope to help patients build confidence in life after illness, form and accumulate inner strength, thereby promoting their self-management and improving prognosis.
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Affiliation(s)
- Shuhua Shang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xuemei Zheng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhongmei Xu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Si Sun
- Department of Nursing, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tianyi Huang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Verma SJ, Gulati P, Injety RJ, Arora D, Dhasan A, Singhania A, Khatter H, Sharma M, Sylaja PN, Pandian JD. Secondary prevention by structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA): Findings from the process evaluation of a randomized controlled trial. Eur Stroke J 2023; 8:1053-1063. [PMID: 37585729 PMCID: PMC10683732 DOI: 10.1177/23969873231192291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA Trial delivered secondary stroke awareness intervention to sub-acute stroke patients in form of workbook, videos and SMS across 31 centres in 12 languages. Trial was stopped for futility due to fewer vascular outcomes than anticipated. Trial results indicated that trial intervention, did not lead to reduction in vascular events. We carried out process evaluation, to evaluate trial implementation and participant's perspectives, to comprehend the trial's futile outcomes. MATERIALS AND METHODS Using mixed methods approach, qualitative interviews and quantitative data from case report forms, workbooks and questionnaires were analysed to measure intervention fidelity and contamination. Using purposive sampling, 115 interviews of patient-caregiver dyads and health professionals at 11 centres and 2 focus group discussions were held. RESULTS AND DISCUSSION Iterative thematic analysis of qualitative data was done with RE-AIM and realist models. There was good fidelity to intervention and adherence to protocol; however, there was dilution of inclusion criteria by randomly enrolling uneducated and caregiver-dependent patients. Centre coordinators provided counselling to both arms, not specified by protocol, causing bias. Coordinators found it difficult to keep patients motivated to view intervention which was corroborated by fidelity questionnaire showing decreased viewing of intervention for a year. Cardiovascular protection improved in routine care by virtue of participating in trial. No contamination of intervention was reported. CONCLUSION The intervention was acceptable by patients and caregivers, which could be made a community-based programme. Reasons identified for decreased viewing were repetitive content and non-availability of personal cellular device.
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Affiliation(s)
- Shweta Jain Verma
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Puja Gulati
- School of Pharmacy, Desh Bhagat University, Mandi Gobindgarh, Punjab, India
| | - Ranjit J Injety
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Deepti Arora
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Aneesh Dhasan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Anusha Singhania
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Himani Khatter
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Meenakshi Sharma
- Non-Communicable Diseases Section, Indian Council of Medical Research, New Delhi, India
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Mares M, Salamonson Y, Maneze D, Elmir R, Everett B. Development and Validation of a Scale to Measure Self-efficacy and Self-management in People With Coronary Heart Disease. J Cardiovasc Nurs 2022; 37:E81-E88. [PMID: 37707975 DOI: 10.1097/jcn.0000000000000777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-management is important in reducing coronary risk factors and in preventing recurrent cardiac events. An enabling factor that promotes self-management among patients with coronary heart disease (CHD) is self-efficacy. However, there is no standardized measure that captures self-efficacy and self-management concurrently in this population. AIM The authors of this study report on the development and validation of a brief scale to measure self-efficacy and self-management in patients with CHD. METHODS Scale development and testing comprised (1) item generation, (2) content validity, and (3) pilot testing. The Heart Health Self-Efficacy and Self-Management (HH-SESM) scale includes 2 constructs: self-efficacy and self-management, measured concurrently. Components of the HH-SESM scale consisted of items related to behavioral and coronary risk factor modification. Survey data from 143 participants were used in exploratory factor analyses to test the factorial validity and internal consistency of the scale. RESULTS Twelve items with the same response format were included in the exploratory factor analysis. The factor analysis revealed a single-factor solution accounting for 36.7% and 36.5% of the variance in scores of the self-efficacy and self-management scales, respectively. The correlation ( r = 0.72, P < .001) between the self-efficacy and self-management constructs indicates moderate convergent validity. Cronbach α of self-efficacy (0.83) and self-management (0.81) constructs showed good internal consistency. CONCLUSION The HH-SESM is a brief, easy-to-administer, and reliable measure of self-efficacy and self-management in patients with CHD.
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Paalimäki-Paakki K, Virtanen M, Henner A, Nieminen MT, Kääriäinen M. Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review. J Med Internet Res 2022; 24:e30077. [PMID: 34989681 PMCID: PMC8778552 DOI: 10.2196/30077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/21/2021] [Indexed: 12/17/2022] Open
Abstract
Background Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling.
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Affiliation(s)
- Karoliina Paalimäki-Paakki
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Mari Virtanen
- School of Rehabilitation and Examination, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland
| | - Anja Henner
- Degree Programme of Radiography and Radiation Therapy, Oulu University of Applied Sciences, Oulu, Finland
| | - Miika T Nieminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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7
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Leutualy V, Trisyany Y, Nurlaeci N. Effectivity of Health Education with Telenursing on the Self-care Ability of Coronary Artery Disease Patients: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronary artery disease (CAD) develops chronically and progressively, causes recurrence and premature death, so a good knowledge of changes in self-care behavior by patients is needed. Telenursing can be a medium for health education to allow patients to receive information and for nurses to follow up on health conditions without being obstructed by distance, place, time, and carried out sustainably. So far, telenursing has not been reviewed as a recent intervention to deliver education to CAD patients.
AIM: This systematic review aimed to determine the effectiveness of health education interventions with telenursing on the self-care of CAD patients based on the implementation media.
METHODS: Systematic reviews were conducted based on items found in CINAHL EBSCO, PubMed, ScienceDirect, and Google Scholar from 2008 to 2019. The combination of keywords used Indonesian and English language. All articles were assessed using the Joanna Briggs Institute critical appraisal tool for randomized controlled trial (RCT) and quasi-experiment. After that, the study found was synthesized narratively.
RESULTS: A total of 11.319 titles were identified, and seven studies met inclusion criteria with 3313 participants. Six studies were RCT studies, and one was a quasi-experimental study. The results of the narrative synthesis conducted on seven articles showed that health education by telenursing was effective in improving self-care ability, such as maintaining blood pressure, body mass index, hemoglobin A1c levels, fasting blood glucose, and low-density lipoprotein within normal limits. In addition, there was also an increase in physical activity, dietary compliance (consumption of fruits, vegetables and fish), control of salt intake, smoking, and alcohol cessation. The media used were phone calls and text messages.
CONCLUSION: This review provides evidence that health education interventions effectively improve the self-care abilities of CAD patients with the media used are text messages and telephone calls.
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Campbell DJT, Saunders-Smith T, Manns BJ, Tonelli M, Ivers N, Hemmelgarn BR, Tsuyuki RT, Pannu R, King-Shier K. Exploring patient and pharmacist perspectives on complex interventions for cardiovascular prevention: A qualitative descriptive process evaluation. Health Expect 2020; 23:1485-1501. [PMID: 33047417 PMCID: PMC7752191 DOI: 10.1111/hex.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Assessing outcomes of enhanced Chronic disease Care through patient Education and a value-baSed formulary Study (ACCESS) is a randomized controlled trial evaluating two interventions targeting barriers to care among those at high risk of cardiovascular disease: copayment elimination for cardioprotective medications, and a tailored self-management support programme. We designed a process evaluation to better understand participant perspectives on the interventions. DESIGN We used a qualitative descriptive study design, collecting patient and pharmacist feedback via individual semi-structured telephone interviews and in-person focus groups. Data were analysed inductively using thematic analysis. RESULTS Fifty-three patients (39 interviews and 14 in two focus groups) and 20 pharmacists participated. Copayment elimination provided quality of life benefits: minimizing the need to 'cut-back', allowing 'peace of mind' and providing emotional support. Health-related benefits included: improving adherence to covered medications, and helping to afford non-covered goods. The only criticism was that not all medications and testing supplies were covered. Patients reported that the educational materials provided helpful information, acted as a reminder, improved confidence, improved adherence to medication, and helped initiate conversations with providers about indicated medication. Some participants felt that the educational materials were repetitive, overly medication-focused and not tailored enough. Pharmacists felt that their patients benefitted from both interventions, which improved patient adherence and communication with their patients. CONCLUSION The success of interventions intended to change behaviour is largely dependent upon participant's feelings that the intervention is helpful. This process evaluation provided insights into participants' perceptions on these interventions. Reception of both was largely positive with a few criticisms noted.
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Affiliation(s)
- David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Terry Saunders-Smith
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Noah Ivers
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Family & Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Pharmacology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raj Pannu
- Emergence Creative, New York, NY, USA
| | - Kathryn King-Shier
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Kate MP, Verma SJ, Arora D, Sylaja PN, Padma MV, Bhatia R, Khurana D, Sharma A, Ojha PK, Renjith V, Kulkarni GB, Sadiq M, Jabeen S, Borah NC, Ray BK, Sharma M, Pandian JD. Systematic Development of Structured Semi-interactive Stroke Prevention Package for Secondary Stroke Prevention. Ann Indian Acad Neurol 2020; 23:681-686. [PMID: 33623271 PMCID: PMC7887475 DOI: 10.4103/aian.aian_639_19] [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: 12/03/2020] [Revised: 12/10/2020] [Accepted: 01/26/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Lack of compliance to medication and uncontrolled risk factors are associated with increased risk of recurrent stroke and acute coronary syndrome in patients with recent stroke. Multimodal patient education may be a strategy to improve the compliance to medication and early adoption of nonpharmacological measures to reduce the vascular risk factor burden in patients with stroke. We thus aim to develop multilingual short messaging services (SMS), print, and audio-visual secondary stroke prevention patient education package. The efficacy of the package will be tested in a randomized control trial to prevent major cardiovascular and cerebrovascular events. Methods: In the formative stage, intervention materials (SMS, video, and workbook) were developed. In the acceptability stage, the package was independently assessed and modified by the stakeholders involved in the stroke patient care and local language experts. The modified stroke prevention package was tested for implementation issues (implementation stage). Results: Sixty-nine SMS, six videos, and workbook with 11 chapters with 15 activities were developed in English language with a mean ± SD SMOG index of 9.1 ± 0.4. A total of 355 stakeholders including patients (24.8%), caregivers (24.8%), doctors (10.4%), nurses (14.1%), local language experts (2.8%), physiotherapists (13.2%), and research coordinators (9.8%) participated in 10 acceptability stage meetings. The mean Patient Education Material Assessment Tool understandability score in all languages for SMS, video scripts, and workbook was 95.2 ± 2.6%, 95.2 ± 4.4%, and 95.3 ± 3.6%, respectively. The patients [n = 20, mean age of 70.3 ± 10.6 years and median interquartile range (IQR) baseline NIHSS 1 (0–3)] or the research coordinators (n = 2) noted no implementation issues at the end of 1 month. Conclusion: An implementable complex multilingual patient education material could be developed in a stepwise manner. The efficacy of the package to prevent major adverse cardiovascular events is being tested in the SPRINT INDIA study.
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Affiliation(s)
- Mahesh Pundlik Kate
- Department of Clinical Neurosciences, Alberta Health Services, Edmonton, Canada
| | - Shweta Jain Verma
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Deepti Arora
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - P N Sylaja
- Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - M V Padma
- Department of Neuroscience, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neuroscience, All India Institute of Medical Sciences, New Delhi, India
| | - Dheeraj Khurana
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Sharma
- Department of Neurology, Zydus Hospital, Ahmedabad, Gujarat, India
| | - Pawan Kumar Ojha
- Department of Neurology, Grant Government Medical College, Mumbai, Maharashtra, India
| | - Vishnu Renjith
- Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bangalore, Karnataka, India
| | - Mohammad Sadiq
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - N C Borah
- Department of Neurology, Guwahati Neurological Research Centre, Dispur, Assam, India
| | - Biman Kanti Ray
- Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Meenakshi Sharma
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Allegrante JP, Wells MT, Peterson JC. Interventions to Support Behavioral Self-Management of Chronic Diseases. Annu Rev Public Health 2019; 40:127-146. [PMID: 30601717 DOI: 10.1146/annurev-publhealth-040218-044008] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A majority of the US adult population has one or more chronic conditions that require medical intervention and long-term self-management. Such conditions are among the 10 leading causes of mortality; an estimated 86% of the nation's $2.7 trillion in annual health care expenditures goes toward their treatment and management. Patient self-management of chronic diseases is increasingly essential to improve health behaviors, health outcomes, and quality of life and, in some cases, has demonstrated effectiveness for reducing health care utilization and the societal cost burden of chronic conditions. This review synthesizes the current state of the science of chronic disease self-management interventions and the evidence for their effectiveness, especially when applied with a systematic application of theories or models that account for a wide range of influences on behavior. Our analysis of selected outcomes from randomized controlled trials of chronic disease self-management interventions contained in 10 Cochrane systematic reviews provides additional evidence to demonstrate that self-management can improve quality of life and reduce utilization across several conditions.
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Affiliation(s)
- John P Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; .,Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Martin T Wells
- Department of Statistical Science, Cornell University, Ithaca, New York 14853, USA;
| | - Janey C Peterson
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA;
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11
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Chen L, Chen Y, Chen X, Shen X, Wang Q, Sun C. Longitudinal Study of Effectiveness of a Patient-Centered Self-Management Empowerment Intervention During Predischarge Planning on Stroke Survivors. Worldviews Evid Based Nurs 2018; 15:197-205. [PMID: 29878691 DOI: 10.1111/wvn.12295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the effectiveness of a patient-centered self-management empowerment intervention (PCSMEI) on self-efficacy, activities of daily living (ADL), and rehospitalization of first-time stroke survivors. METHODS One hundred forty-four first-time stroke survivors were recruited from a comprehensive hospital in China. The intervention group (IG; n = 72) received a PCSMEI, whereas the control group (CG; n = 72) received routine care. The data on self-efficacy and ADL were collected at baseline (T0), on discharge (T1), 1-month postdischarge (T2), and 3 months postdischarge (T3) while the rehospitalization was collected at T2 and T3. The general estimation equations model was used to examine the effects of the PCSMEI program on the outcome variables. RESULTS One hundred twenty-six participants finished the study (IG: n = 64; CG: n = 62). Compared with the CG, patients in the IG showed significant higher level in self-efficacy on discharge (p = .014), 1-month postdischarge (p = .008), and 3 months postdischarge (p = .023), and higher level in ADL at 3 months postdischarge (p = .044). The rehospitalization rate of the IG was lower than that in the CG at 1-month postdischarge and 3 months postdischarge, which had clinical significance. LINKING EVIDENCE TO ACTION PCSMEI is of great value to stroke patients. This paper forms the basis for more widespread implementation of PCSMEI.
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Affiliation(s)
- Lu Chen
- Doctor of Nursing, Head nurse of Department of Neurosurgery, Nursing Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Yan Chen
- Bachelor of Nursing, Director of Nursing Department of Nanjing Drum Tower Hospital, Nursing Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Xiangyu Chen
- Bachelor of Nursing, Nursing Leader of Nanjing Drum Tower Hospital, Nursing Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Xiaofang Shen
- Bachelor of Nursing, Head nurse in Department of Neurology, Nursing Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Qing Wang
- Master of Nursing, Assistant to the Director of the Nursing Department, Nursing Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
| | - Chunyan Sun
- Master of Nursing, A Nurse in Department of Cardiology, Nursing Department, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu, China
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Williams NH, Roberts JL, Din NU, Charles JM, Totton N, Williams M, Mawdesley K, Hawkes CA, Morrison V, Lemmey A, Edwards RT, Hoare Z, Pritchard AW, Woods RT, Alexander S, Sackley C, Logan P, Wilkinson C, Rycroft-Malone J. Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR). Health Technol Assess 2018; 21:1-528. [PMID: 28836493 DOI: 10.3310/hta21440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Proximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking. OBJECTIVES To develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation. DESIGN Phase I - realist review, survey and focus groups to develop the rehabilitation package. Phase II - parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study. SETTING Recruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge. PARTICIPANTS Older adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area. INTERVENTIONS Participants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients' self-efficacy and increasing the amount and quality of patients' practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions. MAIN OUTCOME MEASURES The primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale - International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers. RESULTS Sixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control, n = 32; intervention, n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen's d = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen's d = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen's d = 0.31) and 1.3 (Cohen's d = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported. CONCLUSIONS Trial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure. TRIAL REGISTRATION Current Controlled Trials ISRCTN22464643. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.
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Affiliation(s)
- Nefyn H Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK.,Betsi Cadwaladr University Health Board, St Asaph, UK
| | | | - Nafees Ud Din
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Nicola Totton
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Kevin Mawdesley
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Claire A Hawkes
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sports, Health and Exercise Science, Bangor University, Bangor, UK
| | | | - Zoe Hoare
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Robert T Woods
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | | | - Catherine Sackley
- School of Health and Social Care Research, King's College London, London, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Wilkinson
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Mülhauser S, Bonhôte Börner M, Saner H, Zumstein-Shaha M. Auswirkung motivierender Gesprächsführung auf die Krankheitswahrnehmung bei stabiler koronarer Herzkrankheit. Eine randomisiert-kontrollierte Studie. Pflege 2018; 31:75-85. [DOI: 10.1024/1012-5302/a000595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung.Hintergrund: Koronare Herzkrankheit ist eine der häufigsten Todesursachen für Menschen > 60 Jahre. Vom Lebensstil abhängige Risikofaktoren sind wesentlich beteiligt. Kardiale Rehabilitation ist daher essenziell für eine optimale Behandlung. Leider verstehen die Betroffenen ihre Krankheit kaum. Motivierende Gesprächsführung kann die Krankheitswahrnehmung verbessern. Ziel / Methode: In einer randomisiert-kontrollierten Studie wurde die Wirksamkeit einer Intervention mit motivierender Gesprächsführung auf die Krankheitswahrnehmung untersucht. Personen mit stabiler koronarer Herzkrankheit wurden konsekutiv nach perkutaner transluminaler Koronarangioplastie (PTCA) in die Studie aufgenommen. Die Interventionsgruppe erhielt ein kurzes motivierendes Gespräch zur Erkrankung und den Risikofaktoren als Intervention. Die Kontrollgruppe erhielt die Standardbetreuung. Vor der Intervention und sechs Monate später wurden Daten zur Krankheitswahrnehmung (Illness Perception Questionnaire-Revised) erhoben. Ergebnisse: Total wurden 312 Personen (n = 148 Intervention, n = 164 Kontrollgruppe) in die Studie aufgenommen (Durchschnittsalter: 66,2 Jahre). Nach der Intervention zeigte sich eine signifikante Veränderung im Bereich der emotionalen Reaktionen auf die Erkrankung. Schlussfolgerung: Um die Krankheitswahrnehmung bei Personen mit stabiler koronarer Herzkrankheit zu verbessern, ist eine kurze Intervention mit motivierender Gesprächsführung möglicherweise wirksam. Ob eine Intensivierung der Intervention das Resultat weiter verbessert, muss noch untersucht werden.
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Affiliation(s)
- Sara Mülhauser
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern
| | | | - Hugo Saner
- Universitätsklinik für Kardiologie, Inselspital, Universitätsspital Bern
| | - Maya Zumstein-Shaha
- Abteilung angewandte Forschung und Entwicklung Pflege, Departement Gesundheit, Berner Fachhochschule
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The effectiveness of learning portfolios in learning participation and learners' perceptions of skills and confidence in the mother of preterm infant. Midwifery 2018; 62:86-91. [PMID: 29660574 DOI: 10.1016/j.midw.2018.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/24/2017] [Accepted: 03/15/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effectiveness of preterm infant learning portfolios in enabling mothers to develop infant care knowledge and skills, as well as confidence in their abilities. DESIGN This study used a quasi-experimental design. SETTING AND PARTICIPANTS The sample consisted of 52 mothers with preterm infants recruited at a neonatal intermediate unit of a medical centre in central Taiwan. Among those, 26 participants in the control group received regular health education and 26 participants in the experimental group received learning portfolios and regular care. INTERVENTION The Preterm Infant Care Learning Portfolio (PICLP) is a semi-structured learning portfolio which was provided by nurses. Intervention started with 15 min of instructions on how to use PICLP, including a list of learning task and methods of self-assessment. Follow-up sessions of 5-10 min were conducted after each learning task. The frequency of learning skills could be adjusted depending on participants' learning needs. MEASUREMENTS Self-administered questionnaires regarding knowledge of and skills in preterm infant care and maternal confidence were used to evaluate the effectiveness of the intervention; the questionnaires were conducted before the intervention, 1 day before discharge and 1 month after discharge. We also tracked the frequency with which participants attended instructional sessions before discharged. FINDINGS Mothers' preterm infant care knowledge and skills and confidence improved in both groups after the intervention. The experimental group showed greater improvement than the control group by post-test 2; there was no statistical difference between groups at 1 day before discharge and 1 month after discharge. However, participants in the experimental group came for instructional sessions on baby care for more frequently than the control group. The frequency of learning sessions attended was a predictor of improved scores of the skill assessment before discharge. CONCLUSIONS Both programmes led to improvements in preterm infant care knowledge and skills and maternal confidence. Giving mothers learning portfolios appears to stimulate significantly greater participation in hospital-based instructional programmes, which should in turn lead to greater long-term retention of learning. The learning portfolios may have an additional benefit in promoting acquisition of care abilities for mothers with preterm infant before hospital discharge and application of these abilities at home. IMPLICATION FOR PRACTICE At-home care for preterm infants requires specialized care skills and confidence. Learning portfolios can be used as an effective learner-centred strategy for teaching these health care abilities.
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15
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Shen Z, Jiang C, Chen L. Evaluation of a train-the-trainer program for stable coronary artery disease management in community settings: A pilot study. PATIENT EDUCATION AND COUNSELING 2018; 101:256-265. [PMID: 28774653 DOI: 10.1016/j.pec.2017.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/20/2017] [Accepted: 07/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the feasibility and effectiveness of conducting a train-the-trainer (TTT) program for stable coronary artery disease (SCAD) management in community settings. METHODS The study involved two steps: (1) tutors trained community nurses as trainers and (2) the community nurses trained patients. 51 community nurses attended a 2-day TTT program and completed questionnaires assessing knowledge, self-efficacy, and satisfaction. By a feasibility and non-randomized control study, 120 SCAD patients were assigned either to intervention group (which received interventions from trained nurses) or control group (which received routine management). Pre- and post-intervention, patients' self-management behaviors and satisfaction were assessed to determine the program's overall impact. RESULTS Community nurses' knowledge and self-efficacy improved (P<0.001), as did intervention group patients' self-management behaviors (P<0.001). The satisfaction of community nurses and patients was all very positive after training. CONCLUSION The TTT program for SCAD management in community settings in China was generally feasible and effective, but many obstacles remain including patients' noncompliance, nurses' busy work schedules, and lack of policy supports. PRACTICE IMPLICATIONS Finding ways to enhance the motivation of community nurses and patients with SCAD are important in implementing community-based TTT programs for SCAD management; further multicenter and randomized control trials are needed.
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Affiliation(s)
- Zhiyun Shen
- Fudan University, School of Nursing, Shanghai, China.
| | - Changying Jiang
- Fudan University, School of Nursing, Shanghai, China; South-dock Community Health Service Center, Shanghai, China.
| | - Liqun Chen
- Fudan University, School of Nursing, Shanghai, China.
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16
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Allegrante JP. Advancing the Science of Behavioral Self-Management of Chronic Disease: The Arc of a Research Trajectory. HEALTH EDUCATION & BEHAVIOR 2017; 45:6-13. [PMID: 29258348 DOI: 10.1177/1090198117749010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes advances in the behavioral self-management of chronic disease from the perspective of a 25-year trajectory of National Institute of Health-funded research in arthritis and cardiopulmonary diseases that has sought to develop a transdisciplinary understanding of how applied behavioral science can be used to improve health behaviors, functional status, and health outcomes. The article traces the arc of a novel research program-conducted in collaboration with physician-scientists at Columbia, Weill Cornell Medical College, and New York University School of Medicine-that runs through social cognitive theory, behavioral economics, and the emerging science of positive psychology in an effort to develop promising new approaches to fostering the adoption and maintenance of health-related behavioral change. The article concludes with what has been learned and what the implications of the work are for advancing behavioral self-management and patient education to improve patient outcomes and achieve the compression of morbidity.
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Affiliation(s)
- John P Allegrante
- 1 Teachers College and the Mailman School of Public Health, Columbia University, New York, NY, USA
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17
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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: 264] [Impact Index Per Article: 37.7] [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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18
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Peterson JC, Charlson ME, Wells MT, Altemus M. Depression, coronary artery disease, and physical activity: how much exercise is enough? Clin Ther 2014; 36:1518-30. [PMID: 25456561 PMCID: PMC4311731 DOI: 10.1016/j.clinthera.2014.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE The mechanisms by which depressive symptoms negatively affect clinical outcomes in patients with coronary artery disease (CAD) remain poorly understood. Previous interventions that have attempted to treat depressive symptoms in patients with CAD to improve their clinical outcomes have been disappointing. Our objectives were, among a cohort of CAD patients, to evaluate the impact of depressive symptoms over time, controlling for comorbidity, in determining both successful long-term lifestyle change (ie, increased physical activity), and cardiovascular morbidity and mortality outcomes. In addition, we examined the impact of physical activity changes over time on 2 known mediators of cardiovascular morbidity: parasympathetic tone and inflammation. METHODS Clinical data were previously collected (2004-2006) from 242 elective/urgent coronary angioplasty patients who participated in a prospective randomized controlled trial evaluating the efficacy of a behavioral intervention versus an educational control to motivate physical activity over 12 months. Exclusion criteria included: (1) inability to walk; (2) enrollment in other risk-reduction trials; (3) non-English speaking; and (4) lack of cardiologist's permission to increase physical activity. Participants were assessed every 2 months for interval clinical events and physical activity. In addition, biomarkers were collected at baseline and at 12 months in a subset of 54 participants; these biomarkers included low-frequency heart rate variability (lfHRV), high-frequency heart rate variability (hfHRV), serum C-reactive protein, interleukin-6, and salivary cortisol. FINDINGS The mean age of participants was 63 years and 30% were female. Overall, 37% had high depressive symptoms at baseline. Patients with high depressive symptoms who achieved an increase in physical activity of ≥336 kilocalories(kcal)/week by 12 months had significantly lower rates of cardiovascular morbidity/mortality (5.1% vs. 21.3%; odds ratio [OR], 0.20, [95% CI, 0.04-0.98]; P = 0.03). In a multivariate model examining cardiovascular morbidity/mortality in patients with high depressive symptoms, an increase in physical activity of ≥336 kcal/week reduced the risk of new cardiovascular morbidity/mortality (OR, 0.11 [95% CI, 0.02-0.81]; P < 0.03), and comorbidity increased the risk (OR, 1.58 [95% CI, 1.18-2.13]; P = 0.002). In a generalized structural equation model, increasing physical activity by ≥336 kcal/week decreased the risk of complications, and comorbidity increased the risk. Furthermore, increasing physical activity (≥336 kcal/week) predicted an increase in hfHRV, a marker of parasympathetic tone, and the increase in hfHRV predicted a reduction in the proinflammatory mediators interleukin-6 and C-reactive protein. IMPLICATIONS This study found a threshold in physical activity in CAD patients with depressive symptoms that is associated with a decrease in cardiovascular morbidity and mortality. Exercise maintenance at this level may improve clinical outcomes via enhanced parasympathetic tone and decreased inflammation. ClinicalTrials.gov identifier: NCT00248846.
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Affiliation(s)
- Janey C. Peterson
- The Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, New York, NY USA
| | - Mary E. Charlson
- The Division of Clinical Epidemiology and Evaluative Sciences Research, Center for Integrative Medicine, Weill Cornell Medical College, New York, NY USA,
| | - Martin T. Wells
- Departments of Statistical Science and Social Statistics, Cornell University, Ithaca, NY, USA,
| | - Margaret Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY USA,
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