The impact of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation

Therapeutic Patient Education as Part of the Physiotherapy Management of Adults with Headache: A Scoping Review

PURPOSE OF REVIEW

Physiotherapy interventions for headache mostly include exercise and manual therapy. Yet, the complex nature of headache, sometimes characterized by symptoms of facilitated central pain mechanisms, demands an individualized approach in which therapeutic patient education could be supportive. This scoping review aimed to summarize the position of therapeutic patient education within the physiotherapy management of adults with headache. PubMed, EMBASE, Web of Science, and Scopus were searched. The search-query comprised terminology relating to "headache", "education", and "physiotherapy". Eligibility criteria were: adults with headache, interventions including education within the domain of physiotherapy, reviews, clinical trials, cohort, case report, case-control studies.

RECENT FINDINGS

Eleven publications were included from the 281 retrieved publications. These publications were clinical trials (n = 4), reviews (n = 4), case-reports (n = 2), and a guideline (n = 1). Type of headaches studied were migraine (n = 3), post-traumatic headache (n = 2), tension-type headache (n = 2), cervicogenic headache (n = 1), primary headaches (n = 1), chronic daily headache (n = 1), and mixed migraine-cervicogenic headache (n = 1). Education seems an umbrella-term for postural education, lifestyle advice, and pain education. Three themes emerged across the publications: handling headache triggers (migraine, post-traumatic headache), promoting active lifestyle (post-traumatic headache, chronic daily headache, migraine), evaluating posture (post-traumatic headache, chronic daily headache, tension-type headache, cervicogenic headache). All publications recommended education in the management of headache. Only one (of the 11 included) publication described the educational program and determined its efficacy. Based on this scoping review, therapeutic patient education seems supported within physiotherapy management of headache. However, it is unclear how such education is tailored to the specific needs of the individual, the headache subtype, or when it should be added to physiotherapy management of headache.

Care models for patients with heart failure at home: A systematic review

AIMS

The aim of this study is to evaluate the relative merits of various heart failure models of care with regard to a variety of outcomes.

DESIGN

Systematic review.

DATA SOURCES

Five databases including PubMed, Web of Science, Medline, Embase and Science Direct were searched from the inception date of databases to August 20, 2022.

REVIEW METHODS

This review used the Cochrane Collaboration's 'Risk of Bias' tool to assess quality. Only randomised controlled trails were included in this review that assessed all care models in the management of adults with heart failure. A categorical summary of the pattern of the papers was found, followed by extraction of outcome indicators.

RESULTS

Twenty articles (19 studies) were included. Seven examined nurse-led care, two examined multidisciplinary specialist care, nine (10 articles) examined patient self-management, and one examined nurse and physiotherapist co-led care. Regarding outcomes, this review examined how well the four models performed with regard to quality of life, health services use, HF self-care, and anxiety and depression for heart failure patients. The model of patient self-management showed more beneficial results than nurse-led care, multidisciplinary specialist care, and nurse and physiotherapist co-led care in reducing hospital days, improving symptoms, promoting self-care behaviours of HF patients, enhancing the quality of life, and strengthening self-care ability.

CONCLUSIONS

This systematic review synthesises the different care models and their relative effectiveness. Four different models of care were summarised. Of these models, the self-management model demonstrated better outcomes.

IMPACT

The self-management model is more effective in increasing self-management behaviours and self-management abilities, lowering the risk of hospitalisation and death, improving quality of life, and relieving anxiety and depression than other models.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no funding to remunerate a patient/member of the public for this review.

Use of qualitative methods to optimize collaborative practices by highlighting differences in perceptions between professionals: an example of patient education

Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.

Heart failure self-management: a scoping review of interventions implemented by allied health professionals

BACKGROUND

Heart failure (HF) is typically managed using both medical and patient self-management interventions. Individuals with HF often have frequent readmissions to hospital for medical management. Effective self-management can help to reduce the exacerbation of HF symptoms and the frequency of readmissions.

METHODS

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines was conducted to identify literature on the interventions used by allied health professionals to promote HF self-management. A search strategy was implemented, and articles were reviewed by two independent reviewers.

RESULTS

Twenty articles met the inclusion criteria. Articles included interventions from physical therapy, nutrition, social work, and occupational therapy, as well as other health professions in team-based programs. The most common interventions were verbal education, textual information, monitoring resources, and skills practice. Interventions addressed diet/fluid control, exercise and activity, symptom monitoring, medication management, cardiovascular disease knowledge, and mental health. Many interventions were theory informed.

CONCLUSION

There is nascent evidence that interventions promoting HF self-management positively impact health and quality of life outcomes. HF self-management is multi-faceted and requires interprofessional collaboration. Further work is warranted exploring the impact of theory-informed interventions, and the effectiveness of interventions on self-management competence and desired health outcomes.

Patient Satisfaction and Perspectives on Self-Management Education Programs: A Qualitative Study

Purpose

According to the Centre for Disease Control and Prevention, "Self-management education (SME) refers to programs that help people who have ongoing health conditions learn how to live life to the fullest". Most studies to date have focused on SME outcomes, such as the acquisition of predefined knowledge or skills or quality of life. However, no study has yet investigated patients' satisfaction with SMEs. The aim of the present study was therefore to explore participants' subjective appreciation of SME programs using qualitative methods and formulate propositions based on patients' preferences to improve ultimately clinical outcomes.

Patients and Methods

Twenty-five participants from five French SME programs to conduct focus groups were recruited. An inductive approach using grounded theory as an overall methodology orientation for the thematic analysis process has been followed. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria (COREQ).

Results

Patients expressed great satisfaction concerning the effective delivery of SME sessions. They appreciated the considerations for their concerns and needs, the adaptation of sessions' content to their interests and questions, and learning to take care of themselves. Moreover, patients had a positive opinion on the quality of their relationship with health care providers. However, the major point of improvement of SMEs was the opportunity to repeat the program if needed, as this opportunity was not offered. This consideration was particularly salient when patients did not consider themselves autonomous for disease management at the end of the program, ie, when they had low levels of perceived self-efficacy.

Conclusion

While patients expressed great satisfaction regarding SME programs, our results suggest that some changes might be needed to make the endpoint of SME interventions coincide with the patient's perception of self-efficacy in disease self-management and ultimately improve clinical outcomes.

Effects of a health psychology-based intervention for patients with asplenia on psychological determinants of preventive behaviour: A propensity score analysis

OBJECTIVE

Patients with asplenia have an increased lifelong risk of severe infections especially post splenectomy sepsis with hospital mortality rates of 30-50%. Adherence to existing guidelines for preventive measures is low. Objective of the study is the evaluation of a novel intervention to increase health psychological outcomes in patients with asplenia resulting in better adherence to preventive measures.

METHODS

The intervention was evaluated by conducting a prospective, two-armed historical control group design via propensity score analysis. Focus are health-psychological outcomes: self-efficacy, intention, risk perception, behaviour planning, self-management, health literacy, patient involvement and disease-knowledge.

RESULTS

Patients in the intervention group (N = 110) showed a higher increase in almost all outcomes compared to a historical control group (N = 115). The strongest increase was observed in "asplenia-specific self-management" (average treatment effect: ATE 1.14 [95% CI 0.91-1.36] p < .001) and "asplenia-specific health-literacy" (ATE 1.42 [95% CI 1.18-1.65] p < .001). Significant intervention effects were also found in behaviour planning, perceived involvement and disease-knowledge.

CONCLUSION

The patient-focused intervention is effective in improving health-psychological outcomes in patients with asplenia.

PRACTICE IMPLICATIONS

The implementation of the intervention can make an important contribution to care and lead to an improvement of health-psychological outcomes that may result in a higher adherence to prevention measures.

The effectiveness of self-care management in treating heart failure: A scoping review

Introduction: Heart failure is a common chronic disease associated with increased mortality and rehospitalization rates. Self-care management provided in various ways is one approach to avoiding the need for rehospitalization by lowering recurrence rates. Therefore, this study aims to determine the most effective self-care management interventions for heart failure patients. Design and Methods: The databases Science Direct, Google Scholar, and PubMed were used to conduct literature reviews over ten years. In September 2021, a full-text article search was conducted using the keywords "Self-Care," "Self-Management," "Intervention," "Heart Failure Patients," and "Randomized Control Trial" in PubMed ScienceDirect and Google Scholar databases. The inclusion and exclusion criteria were determined using the PICOS technique. After the screening, 39 articles met the criteria. Results: Self-care management is provided through education programs, training programs, and the utilization of apps and websites to improve its self-care abilities. Conclusions: Therefore, one way to provide self-care management during the COVID-19 pandemic was through the program's website, which is viewed "remotely" and used to track patient progress.  

Tailored patient therapeutic educational interventions: A patient-centred communication model

Background

Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions.

Objectives

We used a data‐driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization.

Design

Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria.

Results

Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions.

Conclusion

From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions.

Short Informative

Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient‐centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient‐centred communication model for tailoring patient education intervention.

"I Can't Go Far": Perceptions and Experiences of Heart Failure Patients Regarding Physical Activity: A Qualitative Study Using Semistructured Face-to-Face Interviews

BACKGROUND

Participation in regular physical activity (RPA) is beneficial to the quality of life and life expectancy of patients with chronic heart failure (CHF). However, it is inadequate in many patients.

AIMS

To determine the factors that influence the practice of RPA in patients with CHF managed in general practice.

METHOD

This was a qualitative study using semistructured, individual face-to-face interviews. Patients with CHF (New York Heart Association Stages 1-3) capable of participating in RPA were enrolled by their general practitioner. A longitudinal and transversal inductive thematic analysis was performed by two researchers.

RESULTS

Five themes emerged from the 19 interviews that were conducted. Poor knowledge of the disease and the benefits of participating in RPA, as well as the lack of motivation or enjoyment, in particular due to the absence of previous participation, were considered significant obstacles. Fear associated with CHF or other comorbidities was also an obstacle. Attendance at a rehabilitation center, family and social circles, and having a pet all appeared to be beneficial. Family and friends were important for motivating the patient to participate in an activity but could also be an obstacle when they were overprotective.

CONCLUSION

This study helps highlight the difficulties for patients with CHF associated with participation in RPA. Despite the obstacles, there are enabling factors on which the general practitioner may rely to motivate their patients.

Effectiveness of health education in the self-care and adherence of patients with heart failure: a meta-analysis

OBJECTIVE

to evaluate in the literature the effectiveness of the health education interventions in self-care and adherence to treatment of patients with Chronic Heart Failure.

METHOD

a systematic review with meta-analysis. Studies were selected that compared health education interventions with the usual care to assess the outcomes of adherence and self-care. The quality of the methodological evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation system.

RESULTS

the educational interventions were more effective in relation to the usual care in the outcome of adherence (fixed effect=0-3841; p-value <0.001). There was no statistical difference in the outcome of self-care (fixed effect=0.0063; p-value=0.898).

CONCLUSION

the educational interventions improved the outcome of adherence, though not self-care in the patient with Heart Failure.

Secondary prevention of coronary heart disease: The effect of a nursing intervention using Cox's interaction model of client health behaviour

AIMS

Secondary prevention of coronary heart disease is of utmost importance to facilitate people to achieve health outcomes and behaviours. This study was to investigate the effect of a nursing intervention based on Cox's interaction model of client health behaviour to improve health outcomes and behaviours of secondary prevention of coronary heart disease.

DESIGN

This study is a cluster randomised controlled trial.

METHODS

Participants were recruited between August and November 2019 in two community settings in Hengyang city, Hunan province, China. Participants in the intervention group received a nursing intervention based on Cox's interaction model of client health behaviour and routine health education, while those in the control group received routine health education only. The outcome variables included selfߚmanagement, physical activity, medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, blood pressure, body mass index (BMI), and lowߚdensity lipoprotein cholesterol (LDLߚC). The influential statistical tests applied to analyse the data included χ² tests and t tests.

RESULTS

Seventyߚseven participants completed this study. Compared with the control group (n = 40), the intervention group (n = 37) showed statistically significant better health outcomes and behaviours regarding selfߚmanagement, physical activity (except for high energy consumption), medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, systolic blood pressure, BMI, and LDLߚC. However, there was no statistically significant difference in diastolic blood pressure and high energy consumption for physical activity.

CONCLUSION

A wellߚdeveloped nursing intervention based on Cox's interaction model of client health behaviour could successfully improve health outcomes and behaviours of secondary prevention of coronary heart disease. Such an intervention may be incorporated into community healthcare practice by nurses to improve patient care.

IMPACT

This study provides a valuable insight to facilitate further development of effective nursing interventions to improve secondary prevention of coronary heart disease in community settings.

Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis

Objectives

This meta-analysis aims to (1) evaluate the efficacy of physical activity interventions in heart failure and (2) to identify intervention characteristics significantly associated with the interventions’ efficacy.

Methods

Randomised controlled trials reporting intervention effects on physical activity in heart failure were combined in a meta-analysis using a random-effect model. Exploratory meta-analysis was performed by specifying the general approach (eg, cardiac rehabilitation), strategies used (eg, action planning), setting (eg, centre based), mode of delivery (eg, face to face or online), facilitator (eg, nurse), contact time and behavioural change theory use as predictors in the random-effect model.

Results

Interventions (n=21) had a significant overall effect (SMD=0.54, 95% CI (0.13 to 0.95), p<0.0005). Combining an exercise programme with behavioural change intervention was found efficacious (SMD=1.26, 95% CI (0.26 to 2.26), p<0.05). Centre-based (SMD=0.98, 95% CI (0.35 to 1.62), and group-based (SMD=0.89, 95% CI (0.29 to 1.50),) delivery by a physiotherapist (SMD=0.84, 95% CI (0.03 to 1.65),) were significantly associated with efficacy. The following strategies were identified efficacious: prompts/cues (SMD=3.29, 95% CI (1.97 to 4.62)), credible source (standardised mean difference, SMD=2.08, 95% CI (0.95;3.22)), adding objects to the environment (SMD=1.47, 95% CI (0.41 to 2.53)), generalisation of the target behaviour SMD=1.32, 95% CI (0.22 to 2.41)), monitoring of behaviour by others without feedback (SMD=1.02, 95% CI (0.05 to 1.98)), self-monitoring of outcome(s) of behaviour (SMD=0.79, 95% CI (0.06 to 1.52), graded tasks (SMD=0.73, 95% CI (0.22 to 1.24)), behavioural practice/rehearsal (SMD=0.72, 95% CI (0.26 to 1.18)), action planning (SMD=0.62, 95% CI (0.03 to 1.21)) and goal setting (behaviour) (SMD=0.56, 95% CI (0.03 to 1.08)).

Conclusion

The meta-analysis suggests intervention characteristics that may be suitable for promoting physical activity in heart failure. There is moderate evidence in support of an exercise programme combined with a behavioural change intervention delivered by a physiotherapist in a group-based and centre-based settings.

PROSPERO registeration

CRD42015015280.

How is the education component of pulmonary rehabilitation delivered in practice--Is it patient-centred?

OBJECTIVES

Pulmonary rehabilitation (PR) involves a significant component of education, but little has been published on what educational content is covered or how it is delivered. This survey study set out to investigate how PR education is delivered in practice.

METHODS

A survey was designed to investigate the current educational delivery and which topics respondents reported should be included in a PR programme. The survey was sent to 11 Scottish PR Action group regional leads.

RESULTS

Nine completed the questionnaire (81.8%). Education was reported to be predominately group-based and face-to-face (n = 9, 100%) consisting of between 6 and 12 sessions. Most educational topics lasted 15 min or less, some topic areas were not consistently covered. The educational content was variable and not personalised to individual needs. Three health areas undertook informal literacy assessment at baseline assessment and when tailoring COPD plans. Often attendance at educational sessions was not needed to 'complete' PR.

CONCLUSIONS

Content and delivery of educational topics were varied, and no consistent outcome measure to assess the effectiveness of education was used.

PRACTICE IMPLICATIONS

Education needs to be delivered in a patient-centred way tailoring for literacy skills using a range of different teaching approaches and aids.

Effects of self-management interventions on heart failure: Systematic review and meta-analysis of randomized controlled trials - Reprint

BACKGROUND

Self-management intervention is an important component of disease management in patients with heart failure. It can improve heart failure knowledge, quality of life, and heart failure-related hospitalizations of heart failure patients. However, studies on the effect of two self-management interventions tasks have reported conflicting results.

OBJECTIVE

This study conducted an up-to-date systematic review of the literature to evaluate the effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalizations in patients with heart failure.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

We searched PubMed, Embase, Web of Science, Cochrane Library, and the references of articles in 14th December 2019.

METHODS

The study characteristics included: authors, year, country, sample size, mean age of patients with heart failure, duration of intervention, recruitment and intervention delivery, interventions based on self-efficacy theory, cognitive behavioral therapy, disease management, self-care education. The risk of bias for each study was assessed independently by two investigators based on the Cochrane Handbook. This study used Revman to analyze different research outcomes. The fixed-effect model was used in the absence of significant heterogeneity or low heterogeneity, and if the heterogeneity was high, the random effect model was used.

RESULTS

A total of 4977 publications were retrieved in this study. After eliminating duplicates and screening for titles and abstracts, 209 articles were retrieved for full-text evaluation. Finally, a total sample size analyzed across 15 randomized controlled trials was 2630 participants. This study showed that self-management interventions significantly improved heart failure knowledge (0.61, 95% confidence interval (CI) 0.27-0.95, p = 0.0004), quality of life (0.20, 95% CI 0.02-0.38, p = 0.03), and heart failure-related hospitalization (OR 0.40, 95% CI 0.29 to 0.55, p<0.00001) in patients with heart failure.

CONCLUSIONS

This study reveals the beneficial effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalization in patients with heart failure. Therefore, high quality randomized controlled designs are needed to explore the optimal self-management interventions for patients with heart failure. Tweetable abstract: This study reveals self-management interventions can improve heart failure knowledge, quality of life, and reduced heart failure-related hospitalization.

Healthcare experiences of patients with chronic heart failure in Germany: a scoping review

OBJECTIVES

To review systematically the past 10 years of research activity into the healthcare experiences (HCX) of patients with chronic heart failure (CHF) in Germany, in order to identify research foci and gaps and make recommendations for future research.

DESIGN

In this scoping review, six databases and grey literature sources were systematically searched for articles reporting HCX of patients with CHF in Germany that were published between 2008 and 2018. Extracted results were summarised using quantitative and qualitative descriptive analysis.

RESULTS

Of the 18 studies (100%) that met the inclusion criteria, most were observational studies (60%) that evaluated findings quantitatively (60%). HCX were often concerned with patient information, global satisfaction as well as relationships and communication between patients and providers and generally covered ambulatory care, hospital care and rehabilitation services. Overall, the considerable heterogeneity of the included studies' outcomes only permitted relatively trivial levels of synthesis.

CONCLUSION

In Germany, research on HCX of patients with CHF is characterised by missing, inadequate and insufficient information. Future research would benefit from qualitative analyses, evidence syntheses, longitudinal analyses that investigate HCX throughout the disease trajectory, and better reporting of sociodemographic data. Furthermore, research should include studies that are based on digital data, reports of experiences gained in under-investigated yet patient-relevant healthcare settings and include more female subjects.

Effect of pragmatic versus explanatory interventions on medication adherence in people with cardiometabolic conditions: a systematic review and meta-analysis

OBJECTIVE

To synthesise findings from randomised controlled trials (RCTs) of interventions aimed at increasing medication adherence in individuals with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD). And, in a novel approach, to compare the intervention effect of studies which were categorised as being more pragmatic or more explanatory using the Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) tool, to identify whether study design affects outcomes. As explanatory trials are typically held under controlled conditions, findings from such trials may not be relatable to real-world clinical practice. In comparison, pragmatic trials are designed to replicate real-world conditions and therefore findings are more likely to represent those found if the intervention were to be implemented in routine care.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Ovid Medline, Ovid Embase, Web of Science and CINAHL from 1 January 2013 to 31 December 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

RCTs lasting ≥3 months (90 days), involving ≥200 patients in the analysis, with either established CVD and/or T2DM and which measured medication adherence. From 4403 citations, 103 proceeded to full text review. Studies published in any language other than English and conference abstracts were excluded.

MAIN OUTCOME MEASURE

Change in medication adherence.

RESULTS

Of 4403 records identified, 34 studies were considered eligible, of which 28, including 30 861 participants, contained comparable outcome data for inclusion in the meta-analysis. Overall interventions were associated with an increase in medication adherence (OR 1.57 (95% CI: 1.33 to 1.84), p<0.001; standardised mean difference 0.24 (95% CI: -0.10 to 0.59) p=0.101). The effectiveness of interventions did not differ significantly between studies considered pragmatic versus explanatory (p=0.598), but did differ by intervention type, with studies that included a multifaceted rather than a single-faceted intervention having a more significant effect (p=0.010). The analysis used random effect models and used the revised Cochrane Risk of Bias Tool to assess study quality.

CONCLUSIONS

In this meta-analysis, interventions were associated with a significant increase in medication adherence. Overall multifaceted interventions which included an element of education alongside regular patient contact or follow-up showed the most promise. Effectiveness of interventions between pragmatic and explanatory trials was comparable, suggesting that findings can be transferred from idealised to real-word conditions.

PROSPERO REGISTRATION NUMBER

CRD42017059460.

Effects of self-management interventions on heart failure: Systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Self-management intervention is an important component of disease management in patients with heart failure. It can improve heart failure knowledge, quality of life, and heart failure-related hospitalizations of heart failure patients. However, studies on the effect of two self-management interventions tasks have reported conflicting results.

OBJECTIVE

This study conducted an up-to-date systematic review of the literature to evaluate the effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalizations in patients with heart failure.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

We searched PubMed, Embase, Web of Science, Cochrane Library, and the references of articles in 14th December 2019.

METHODS

The study characteristics included: authors, year, country, sample size, mean age of patients with heart failure, duration of intervention, recruitment and intervention delivery, interventions based on self-efficacy theory, cognitive behavioral therapy, disease management, self-care education. The risk of bias for each study was assessed independently by two investigators based on the Cochrane Handbook. This study used Revman to analyze different research outcomes. The fixed-effect model was used in the absence of significant heterogeneity or low heterogeneity, and if the heterogeneity was high, the random effect model was used.

RESULTS

A total of 4977 publications were retrieved in this study. After eliminating duplicates and screening for titles and abstracts, 209 articles were retrieved for full-text evaluation. Finally, a total sample size analyzed across 15 randomized controlled trials was 2630 participants. This study showed that self-management interventions significantly improved heart failure knowledge (0.61, 95% confidence interval (CI) 0.27-0.95, p = 0.0004), quality of life (0.20, 95% CI 0.02-0.38, p = 0.03), and heart failure-related hospitalization (OR 0.40, 95% CI 0.29 to 0.55, p<0.00001) in patients with heart failure.

CONCLUSIONS

This study reveals the beneficial effects of self-management interventions on heart failure knowledge, quality of life, and heart failure-related hospitalization in patients with heart failure. Therefore, high quality randomized controlled designs are needed to explore the optimal self-management interventions for patients with heart failure. Tweetable abstract: This study reveals self-management interventions can improve heart failure knowledge, quality of life, and reduced heart failure-related hospitalization.

Does a Train-the-Trainer Approach for Enhancing Healthcare Professionals' Skills in Patient Education during Inpatient Medical Rehabilitation Improve Patient Outcomes?

This study is aimed at identifying the impact of a team-based train-the-trainer program (TTT-P) to enhance healthcare professional (HCP) skills in patient education during medical rehabilitation. Focusing on patient-reported outcomes, a prospective, sequential two-cohort study was conducted in the fields of psychosomatic and oncological rehabilitation. Two hundred fifteen patients were evaluated before (Cohort 1) and 196 post implementation of TTT-P (Cohort 2). Patients of both cohorts completed validated questionnaires on self-management (heiQ®), general self-efficacy (GSE scale), and quality of life (WHOQOL-Bref) at the beginning, at the end, and at the 6-month follow-up to analyze short- and intermediate-term effects. Analyses were conducted separately for the psychosomatic and oncological setting. Results showed that TTT-P had no impact on patient outcomes in both rehabilitation settings. Patients did report positive outcomes as a result of the whole inpatient rehabilitation programs, though effects at follow-up were mostly small to medium size. Concerning self-management competencies, cancer patients gained less benefit during rehabilitation than psychosomatic patients. In conclusion, TTT-P did not result in measurable improvements at the patient level, likely because of the limited nature of the intervention. However, these populations of rehabilitants took benefit from participating in a multimodal rehabilitation program, of which patient education is one part.

Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial

OBJECTIVE

To examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities.

METHODS

A randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12).

RESULTS

Over the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU.

CONCLUSIONS

The NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities.

PRACTICE IMPLICATIONS

This study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities.

Prevention of post-splenectomy sepsis in patients with asplenia - a study protocol of a controlled trial

Background

Patients with asplenia have a significantly increased lifelong risk of severe invasive infections, particular post-splenectomy sepsis (PSS). Clear preventive measures have been described in the literature, but previous studies found poor implementation of prevention recommendations. Aim of the study is to improve the adherence to guideline-based preventive measures and thereby reduce the incidence of PSS by a novel telephone-delivered intervention that involves both patients and their physicians.

Methods

A prospective controlled, two-armed historical control group design is used to evaluate the new intervention compared to usual care. The intervention for patients includes both educational aspects and, building on the Health Action Process Approach (HAPA), intervention components that promote motivation and planning of preventive measures. For physicians the intervention is primarily information-based. The primary outcome, the adherence to preventative measures, is indicated by a study-specific ‘Preventing PSS-score’ (PrePSS-score), which is assessed at baseline and at 6-months follow-up. Secondary outcomes include, amongst others, patient self-efficacy and action-planning, asplenia-specific health literacy, general self-management and asplenia-specific self-management. In a process-evaluating part of the study interview-data on patients’ and physicians’ evaluation of the intervention will be gathered.

Discussion

This trial will provide evidence about the effectiveness of the novel prevention intervention for asplenic patients. If demonstrated beneficial, the intervention manual will be made publicly available to enable implementation in practice. The experience gained within this trial may also be valuable for prevention strategies in patients with other diseases.

Trial registration

German Clinical Trials Register (DRKS): DRKS00015238; Trial registration date 07. December 2018.

Symptom perception in heart failure - Interventions and outcomes: A scoping review

BACKGROUND

Symptom perception in heart failure has recently been described as essential in the self-care process bridging self-care maintenance and self-care management. Accordingly, symptom perception appears to be critical for improving patient outcomes such as decreased hospital readmission and increased survival.

OBJECTIVES

To explore what interventions have been reported on heart failure symptom perception and to describe outcomes responsive to symptom perception.

DESIGN

We conducted a scoping review using PRISMA Extension for Scoping Reviews.

DATA SOURCES

Structured searches of Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, Joanna Briggs Institute and Grey literature databases.

REVIEW METHODS

Two authors independently screened references for eligibility. Eligible articles were written in English, French, German, Swedish, Italian or Spanish and concerned symptom perception in adults with heart failure. Data were extracted and charted in tables by three reviewers. Results were narratively summarized.

RESULTS

We identified 99 eligible studies from 3055 references. Seven interventional studies targeted symptom perception as the single intervention component. Mixed results have been found: while some reported decreased symptom frequency, intensity and distress, enhanced health-related quality of life, improved heart failure self-care maintenance and management as well as a greater ability to mention heart failure symptoms, others found more contacts with healthcare providers or no impact on anxiety, heart failure self-care nor a number of diary reported symptoms. Additional interventional studies included symptom perception as one component of a multi-faceted intervention. Outcomes responsive to symptom perception were improved general and physical health, decreased mortality, heart failure decompensation, as hospital/emergency visits, shorter delays in seeking care, more consistent weight monitoring, improved symptom recognition as well as self-care management, decreased hospital length of stay and decreased costs.

CONCLUSIONS

While many studies allowed to map a comprehensive overview of interventions supporting symptom perception in heart failure as well as responsiveness to outcomes, only a few single component intervention studies targeting symptom perception have been reported and study designs preclude assessing intervention effectiveness. With regard to multiple component interventions, the specific impact of symptom perception interventions on outcomes remains uncertain to date. Well-designed studies are needed to test the effectiveness of symptom perception interventions and to elucidate relationships with outcomes.

Improvement in oral health related quality of life among the elderly: a randomized controlled trial

Background

The present study was conducted to determine the impact of educational intervention based on adult learning theory on oral health related quality of life of the elderly.

Materials and methods

This study (IRCT20120910010804N13) was performed with 92 elderly patients referred to the dental clinic of Ahvaz Jundishapur University of medical sciences. Participants were randomly divided into experimental and control groups. The data were gathered by a questionnaire with demographic variables, variables of oral health related quality of the elderly, and variables for assessing the effectiveness of adult learning theory. Following pre-test, educational programs were conducted for the interventional group. After 1 month, the questionnaire was again administered to both groups. Next, the results of pre-test and post-test were analyzed using SPSS-23 at a significance level of 0.05.

Results

Educational intervention was significant in terms of overall oral health related quality of life and the overall effectiveness score of adult learning theory (P < 0.001). There was a significant difference between the two groups in terms of the mean change score of three physical, psychosocial, and pain dimensions following the educational intervention (P < 0.001).

Conclusion

Education based on adult learning theory is recommended for improving oral health related quality of life among the elderly.

Trial registration

Iranian Registry of Clinical Trials, IRCT20120910010804N13. Registered on 2018-12-16.

https://www.irct.ir/trial/35239

Development and Psychometric Evaluation of the Cardiac Rehabilitation Adherence Tool (CRAT)

Patients with cardiac diseases can achieve the greatest benefit from cardiac rehabilitation through modification of their unhealthy behaviors. This study aimed to develop and examine the psychometric properties of the Cardiac Rehabilitation Adherence Tool (CRAT), which was designed to assess patients' adherence to cardiac rehabilitation. In this instrument development study, the items of the CRAT were extracted through a comprehensive literature review. The CRAT was assessed in terms of validity and reliability. Exploratory factor analysis was conducted to assess its construct validity, which led to the development of a tool containing 57 items and five dimensions including "acceptance of the rehabilitation center", "being interested in health", "feeling a need", "personal control over the situation", and "encouragement and advice." These five factors accounted for 45.23% of the observed variance. The Cronbach's alpha was 0.935. The test-retest method supported the stability of the instrument (r = 0.95). Health care professionals can use the CRAT to examine factors influencing the patient's decision to leave cardiac rehabilitation and design strategies for improving their adherence to the rehabilitation program.

Specializing Nurses as An Indirect Education Program for Stoma Patients

Education programs are beneficial for patients with different chronic conditions. Prior studies have examined direct education, where information is transferred directly to patients. In contrast, in this program, information is transferred directly to nurses who become specialists and transfer education individually to patients. Hence, this paper evaluates the impact of having specialist nurses for stoma patients at hospitals, as those nurses provide healthcare to patients but also inform and educate patients about their condition and needs. The analysis uses an observational study with ostomized patients in Spain at hospitals with and without specialist nurses, and measures health service utilization and health-related quality of life (HRQL), besides performing a cost analysis and a cost-effectiveness analysis at both types of hospitals. The results show that patients with access to specialist nurses self-manage better, present lower adverse events and a better evolution of HRQL, and significantly demand more consultations with specialist nurses and less to A&E, primary care or specialists, resulting in important savings for the health system. Consequently, specializing or hiring nurses to provide indirect education to stoma patients is cost-effective and highly beneficial for patients. This type of indirect education strategy might be considered for specific conditions with low incidence or difficulties in identifying target patients or delivering information directly to them.

Additional effects of psychological interventions on subjective and objective outcomes compared with exercise-based cardiac rehabilitation alone in patients with cardiovascular disease: A systematic review and meta-analysis

Background

Exercise-based cardiac rehabilitation (ebCR) often includes various psychological interventions for lifestyle change or distress management. However, the additional benefit of specific psychological interventions on depression, anxiety, quality of life, cardiac morbidity and cardiovascular or total mortality is not well investigated.

Design

Systematic review and meta-analysis.

Methods

Randomized controlled trials and controlled cohort trials published between January 1995 and October 2017 comparing ebCR with or without pre-specified psychosocial interventions were selected and evaluated on the basis of predefined inclusion and outcome criteria.

Results

Out of 15,373 records, 20 studies were identified, including 4450 patients with coronary artery disease (88.5%) or congestive heart failure (11.5%), respectively. Studies were of low to moderate quality and methodological heterogeneity was high. As compared with ebCR alone, additional psychological interventions for lifestyle change or distress management showed a trend to reduce depressive symptoms (standardized mean difference –0.13, 95% confidence interval (CI) –0.30; 0.05). Furthermore, during a follow-up of five years, distress management was associated with a trend to reduce cardiac morbidity (risk ratio 0.74, 95% CI 0.51; 1.07). There was no evidence for an additional impact of either psychological lifestyle change interventions or distress management on anxiety, quality of life, cardiovascular or total mortality.

Conclusions

Specific psychological interventions offered during ebCR may contribute to a reduction of depressive symptoms and cardiac morbidity, but there remains considerable uncertainty under which conditions these interventions exert their optimal effects. (CRD42015025920).

Interventions to promote patient utilisation of cardiac rehabilitation

BACKGROUND

International clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes for comprehensive secondary prevention. However, data show that only a small proportion of these patients utilise rehabilitation.

OBJECTIVES

First, to assess interventions provided to increase patient enrolment in, adherence to, and completion of cardiac rehabilitation. Second, to assess intervention costs and associated harms, as well as interventions intended to promote equitable CR utilisation in vulnerable patient subpopulations.

SEARCH METHODS

Review authors performed a search on 10 July 2018, to identify studies published since publication of the previous systematic review. We searched the Cochrane Central Register of Controlled Trials (CENTRAL); the National Health Service (NHS) Centre for Reviews and Dissemination (CRD) databases (Health Technology Assessment (HTA) and Database of Abstracts of Reviews of Effects (DARE)), in the Cochrane Library (Wiley); MEDLINE (Ovid); Embase (Elsevier); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); and Conference Proceedings Citation Index - Science (CPCI-S) on Web of Science (Clarivate Analytics). We checked the reference lists of relevant systematic reviews for additional studies and also searched two clinical trial registers. We applied no language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) in adults with myocardial infarction, with angina, undergoing coronary artery bypass graft surgery or percutaneous coronary intervention, or with heart failure who were eligible for cardiac rehabilitation. Interventions had to aim to increase utilisation of comprehensive phase II cardiac rehabilitation. We included only studies that measured one or more of our primary outcomes. Secondary outcomes were harms and costs, and we focused on equity.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the titles and abstracts of all identified references for eligibility, and we obtained full papers of potentially relevant trials. Two review authors independently considered these trials for inclusion, assessed included studies for risk of bias, and extracted trial data independently. We resolved disagreements through consultation with a third review author. We performed random-effects meta-regression for each outcome and explored prespecified study characteristics.

MAIN RESULTS

Overall, we included 26 studies with 5299 participants (29 comparisons). Participants were primarily male (64.2%). Ten (38.5%) studies included patients with heart failure. We assessed most studies as having low or unclear risk of bias. Sixteen studies (3164 participants) reported interventions to improve enrolment in cardiac rehabilitation, 11 studies (2319 participants) reported interventions to improve adherence to cardiac rehabilitation, and seven studies (1567 participants) reported interventions to increase programme completion. Researchers tested a variety of interventions to increase utilisation of cardiac rehabilitation. In many studies, this consisted of contacts made by a healthcare provider during or shortly after an acute care hospitalisation.Low-quality evidence shows an effect of interventions on increasing programme enrolment (19 comparisons; risk ratio (RR) 1.27, 95% confidence interval (CI) 1.13 to 1.42). Meta-regression revealed that the intervention deliverer (nurse or allied healthcare provider; P = 0.02) and the delivery format (face-to-face; P = 0.01) were influential in increasing enrolment. Low-quality evidence shows interventions to increase adherence were effective (nine comparisons; standardised mean difference (SMD) 0.38, 95% CI 0.20 to 0.55), particularly when they were delivered remotely, such as in home-based programs (SMD 0.56, 95% CI 0.37 to 0.76). Moderate-quality evidence shows interventions to increase programme completion were also effective (eight comparisons; RR 1.13, 95% CI 1.02 to 1.25), but those applied in multi-centre studies were less effective than those given in single-centre studies, leading to questions regarding generalisability. A moderate level of statistical heterogeneity across intervention studies reflects heterogeneity in intervention approaches. There was no evidence of small-study bias for enrolment (insufficient studies to test for this in the other outcomes).With regard to secondary outcomes, no studies reported on harms associated with the interventions. Only two studies reported costs. In terms of equity, trialists tested interventions designed to improve utilisation among women and older patients. Evidence is insufficient for quantitative assessment of whether women-tailored programmes were associated with increased utilisation, and studies that assess motivating women are needed. For older participants, again while quantitative assessment could not be undertaken, peer navigation may improve enrolment.

AUTHORS' CONCLUSIONS

Interventions may increase cardiac rehabilitation enrolment, adherence and completion; however the quality of evidence was low to moderate due to heterogeneity of the interventions used, among other factors. Effects on enrolment were larger in studies targeting healthcare providers, training nurses, or allied healthcare providers to intervene face-to-face; effects on adherence were larger in studies that tested remote interventions. More research is needed, particularly to discover the best ways to increase programme completion.

Effects of the self-management education program using the multi-method approach and multimedia on the quality of life of patients with chronic heart failure: A non-randomized controlled clinical trial

BACKGROUND

Self-management behaviors help patients deal issues related to the treatment process and lead to appropriate health outcomes.

OBJECTIVE

To compare the effects of the self-management education program using the multi-method approach and multimedia on the quality of life among patients with chronic heart failure.

METHODS

This non-randomized controlled clinical trial was conducted on 111 patients suffering from chronic heart failure. They were assigned into the multi-method approach (n = 36), multimedia (n = 37), and control (n = 38) groups. The Iranian heart failure quality of life questionnaire was used for data collection before and three months after the education program. Data was analyzed using descriptive and inferential statistics via the SPSS software.

RESULTS

Statistically significant differences were reported between the multi-method approach and multimedia groups in terms of the quality of life after the intervention compared with the control group (p < 0.001 and p = 0.002, respectively). Also, statistically significant differences were found between the two intervention groups in terms of the dimension of self-efficacy and knowledge (p = 0.047). No statistically significant differences were seen between the intervention groups in other domains of the quality of life.

CONCLUSION

The education program improved the quality of life in patients with chronic heart failure. However, the multi-method approach was more effective compared to other methods in patients with chronic heart failure. Healthcare providers especially nurses should consider different educational approaches for patient education. Also, they need to consider patient's preferences during education to improve their quality of life.

Effectiveness of a PRECEDE-based education intervention on quality of life in elderly patients with chronic heart failure

Background

One of the most important challenges in public health is to improve the quality of life in patients with chronic heart failure (CHF). Depression, self-care capacity, and quality of life interact each other in these patients. It’s difficult to treat with general education programs and conventional therapy. PRECEDE model is a comprehensive and exclusive theory-based education programs. Its effectiveness for reducing depression and increasing quality of life has been demonstrated in patients with coronary artery bypass grafting, type 2 diabetes, and the elderly. It has not been used in elderly patients with CHF. Thus, this study aims to investigate the effects of this model on self-care behaviors, depression, and quality of life in these patients.

Methods

Patients who met the inclusion criteria were randomly assigned to the intervention or control group. All the patients received conventional medical care. The patients in the intervention group also received 9 sessions of education intervention based on the PRECEDE model and then followed up for 3 months after the intervention. Data were collected before and 3 months after the intervention using 4 questionnaires, namely a PRECEDE-based questionnaire to evaluate predisposing, reinforcing, and enabling factors; the 9-item European Heart Failure Self-care Behavior Scale (EHFScBS-9); the 9-item Personal Health Questionnaire (PHQ-9); and the Minnesota Living with Heart Failure Questionnaire (MLHFQ).

Results

No significant differences were found in the mean scores for the predisposing, enabling, and reinforcing factors, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ before the intervention between the intervention and control groups. After the intervention, the scores for the predisposing, reinforcing, and enabling factors increased significantly, and the mean total scores in EHFScBS-9, PHQ-9, and MLHFQ decreased significantly in the intervention group. In addition, these scores significantly differed from those of the control group. Furthermore, the MLHFQ score significantly correlated with the EHFScBS-9 and PHQ-9 scores.

Conclusion

This study demonstrates a trend that PRECEDE model of health education promotion is effective in relieving depression symptoms, enhancing self-monitoring, and improving the quality of life of elderly patients with CHF.

Trial registration

Trial registration number: ChiCTR-IOR-17012779; Trial registry: Chinese Clinical Trial Registry; Date registered: 22 Sep 2017; Retrospectively registered.

Gesundheitskompetenz durch Patientenschulungen – ein Überblick

Chronisch Kranke benötigen Kompetenzen, die sie dazu befähigen, möglichst selbstbestimmt mit ihrer Erkrankung umzugehen (Selbstmanagement). Solche Kompetenzen können durch Patientenschulungen vermittelt werden (Empowerment). Kontrollierte Studien konnten Effekte innovativer, interaktiver Schulungsprogramme auf Gesundheitskompetenz und Selbstmanagement-Outcomes nachweisen. Außerdem zeigte sich, dass Verbesserungen der Gesundheitskompetenz Verbesserungen der Lebensqualität mit sich bringen.

Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education

Background

Heart failure (HF) patient education aims to foster patients’ self-management skills. These are assumed to bring about, in turn, improvements in distal outcomes such as quality of life. The purpose of this study was to test the hypothesis that change in self-reported self-management skills observed after participation in self-management education predicts changes in physical and mental quality of life and depressive symptoms up to one year thereafter.

Methods

The sample comprised 342 patients with chronic heart failure, treated in inpatient rehabilitation clinics, who received a heart failure self-management education program. Latent change modelling was used to analyze relationships between both short-term (during inpatient rehabilitation) and intermediate-term (after six months) changes in self-reported self-management skills and both intermediate-term and long-term (after twelve months) changes in physical and mental quality of life and depressive symptoms.

Results

Short-term changes in self-reported self-management skills predicted intermediate-term changes in mental quality of life and long-term changes in physical quality of life. Intermediate-term changes in self-reported self-management skills predicted long-term changes in all outcomes.

Conclusions

These findings support the assumption that improvements in self-management skills may foster improvements in distal outcomes.

Protocol for a Randomized Controlled Trial of Proactive Web-Based Versus Telephone-Based Information and Support: Can Electronic Platforms Deliver Effective Care for Lung Cancer Patients?

Background

Community-based services such as telephone support lines can provide valuable informational, emotional, and practical support for cancer patients via telephone- or Web-based (live chat or email) platforms. However, very little rigorous research has examined the efficacy of such services in improving patient outcomes.

Objective

This study will determine whether: proactive telephone or Web-delivered support produces outcomes superior to printed information; and Web-delivered support produces outcomes comparable to telephone support.

Methods

A consecutive sample of 501 lung cancer outpatients will be recruited from 50 Australian health services to participate in a patient-randomized controlled trial (RCT). Eligible individuals must: be 18 years or older; have received a lung cancer diagnosis (including mesothelioma) within the previous 4 months; have an approximate life expectancy of at least 6 months; and have Internet access. Participants will be randomly allocated to receive: (1) an information booklet, (2) proactive telephone support, or (3) proactive Web support, chat, and/or email. The primary patient outcomes will be measured by the General Health Questionnaire (GHQ-12) and Health Education and Impact Questionnaire (heiQ) at 3 and 6 months post recruitment. The acceptability of proactive recruitment strategies will also be assessed.

Results

It is hypothesized that participants receiving telephone or Web support will report reduced distress (GHQ-12 scores that are 0.3 standard deviations (SD) lower) and greater self-efficacy (heiQ scores that are 0.3 SDs higher) than participants receiving booklets. Individuals receiving Web support will report heiQ scores within 0.29 SDs of individuals receiving telephone support.

Conclusions

If proven effective, electronic approaches such as live-chat and email have the potential to increase the accessibility and continuity of supportive care delivered by community-based services. This evidence may also inform the redesigning of helpline-style services to be effective and responsive to patient needs.