Functional Recovery and Exercise Behavior in Men and Women 5 to 6 Years Following Coronary Artery Bypass Graft (CABG) Surgery

The Effectiveness of Interventions to Maintain Exercise and Physical Activity in Post-Cardiac Rehabilitation Populations: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

PURPOSE

Cardiac rehabilitation is a medically supervised program addressing health behavior changes and promoting self-management among individuals with heart disease. This includes initiation of regular physical activity. However, long-term physical activity after cardiac rehabilitation among this population remains a challenge.

METHODS

This study was a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials were identified by searching multiple databases and were selected if they evaluated an intervention with a physical activity or exercise component among individuals who completed cardiac rehabilitation. A descriptive synthesis was performed for all studies and means and standard deviations were used for meta-analysis when possible. Risk of bias, heterogeneity, and publication bias were assessed.

RESULTS

Twenty-five studies met the inclusion criteria and 19 were included in the meta-analysis. The mean age of participants across studies was 60 yr and 80% were male. Descriptive synthesis of the studies combined with meta-analysis results provided evidence of increased physical activity among intervention groups compared with control groups at follow-up.

CONCLUSION

There is evidence to support the effectiveness of interventions aimed at maintaining physical activity and exercise among adults who have completed cardiac rehabilitation.

Addressing Physical Health Needs of Individuals With Schizophrenia Using Orem's Theory

People with schizophrenia have increased morbidity and mortality rates associated with poor physical health that requires a holistic and comprehensive nursing approach. Dorothy Orem's self-care deficit nursing theory (SCDNT) has made a substantive contribution to nursing by focusing on people as whole entities who engage with their environment to sustain health. We offer an expanded view of the SCDNT by showing how it is a useful framework for nurses to integrate interpretive, empirical, and critical theoretical perspectives for addressing both the physical and mental health needs for people with schizophrenia. Understanding patient needs through different theoretical lenses will help nurses integrate high-quality, evidence-based care with patients' realities, needs, and values while considering the influence of the broader sociopolitical context. We demonstrate how the SCDNT allows nurses incorporate a critical perspective for critiquing the influence of societal barriers on individual's health and advocate for initiatives to address the complex sociopolitical, economic, and contextual factors that affect the physical well-being of individuals with schizophrenia.

Diet and exercise interventions following coronary artery bypass graft surgery: a review and call to action

Coronary artery bypass graft (CABG) surgery has been used for the treatment of coronary artery disease (CAD) for approximately 50 years, and has been performed on millions of people globally. However, little is known about the impact of diet and exercise on long-term outcomes of patients who have undergone CABG surgery. Although clinical practice guidelines on the management of this patient population have been available for approximately 2 decades, evidence regarding secondary prevention behavioral interventions, lifestyle modifications and self-management to slow the progressive decline of CAD, reduce cardiac hospitalizations, and prevent reoperation remains virtually absent from the literature. Diet and exercise are modifiable factors that affect secondary CAD risk. This article reviews the relevant current literature on long-term diet and exercise outcomes in patients who underwent CABG. The limited available literature shows the positive impacts of exercise on psychosocial well-being and physical fitness. Current evidence indicates diet and exercise interventions are effective in the short-term, but effects fade over time. Potential age and sex differences were found across the reviewed studies; however, further research is needed with more rigorous designs to replicate and confirm findings, and to define optimal management regimens and cost-effective prevention strategies.

Sex differences in presentation and outcome among patients with type 2 diabetes and coronary artery disease treated with contemporary medical therapy with or without prompt revascularization: a report from the BARI 2D Trial (Bypass Angioplasty Revascularization Investigation 2 Diabetes)

OBJECTIVES

This study evaluated differences in outcome among women and men enrolled in the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.

BACKGROUND

Women and men with coronary artery disease have different clinical presentations and outcomes that might be due to differences in management.

METHODS

We compared baseline variables, study interventions, and outcomes between women and men enrolled in the BARI 2D trial and randomized to aggressive medical therapy alone or aggressive medical therapy with prompt revascularization.

RESULTS

At enrollment, women were more likely than men to have angina (67% vs. 58%, p < 0.01) despite less disease on angiography (Myocardial Jeopardy Index 41 ± 24 vs. 46 ± 24, p < 0.01; number of significant lesions 2.3 ± 1.7 vs. 2.8 ± 1.8, p < 0.01). Over 5 years, no sex differences were observed in BARI 2D study outcomes after adjustment for difference in baseline variables (death/myocardial infarction/cerebrovascular accident: hazard ratio: 1.11, 99% confidence interval [CI]: 0.85 to 1.44). However, women reported more angina than men (adjusted odds ratio: 1.51, 99% CI: 1.21 to 1.89, p < 0.0001) and had lower scores for the Duke Activity Status Index (adjusted beta coefficient: -1.58, 99% CI: -2.84 to -0.32, p < 0.01).

CONCLUSIONS

There were no sex differences in death, myocardial infarction, or cerebrovascular accident among patients enrolled in the BARI 2D trial. However, compared with men, women had more symptoms and less anatomic disease at baseline, with persistence of higher angina rates and lower DASI scores after 5 years of medical therapy with or without prompt revascularization. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes [BARI 2D]; NCT00006305).

Determinants of social activity and work status after coronary bypass surgery

Despite the occurrence of adverse events after coronary artery bypass, the degree of social integration can be increased following this operation. This study addresses the predictive power of risk factors as well as clinical status in determining long-term social functioning and rate of return to work following isolated bypass surgery. A prospective cohort study was conducted in 178 patients who underwent isolated bypass surgery between 2004 and 2007. Information on work status and social relationships was obtained 1-2 days before surgery and during a mean follow-up of 29.4 ± 1.1 months. The proportion of patients who engaged in social activities at 2, 3, and 4 years of follow-up was 0.3, 0.6, and just over 0.8, respectively, and the proportion who had returned to work at these time points was 0.2, 0.45, and 0.63, respectively. Social activity after surgery was less in patients with left ventricular dysfunction, cerebrovascular disease, and higher New York Heart Association functional class. The rate of return to work was lower for men and for patients with left ventricular dysfunction, diabetes, cerebrovascular disease, and those who were hospitalized for more than 14 days.

Influence of a symptom management telehealth intervention on older adults' early recovery outcomes after coronary artery bypass surgery

OBJECTIVE

The study objective was to examine the effect of a symptom management (SM) telehealth intervention on physical activity and functioning and to describe the health care use of older adult patients (aged > 65 years) after coronary artery bypass surgery (CABS) by group (SM intervention group and usual care group).

METHODS

A randomized clinical trial design was used. The study was conducted in 4 Midwestern tertiary hospitals. The 6-week SM telehealth intervention was delivered by the Health Buddy (Health Hero Network, Palo Alto, CA). Measures included Modified 7-Day Activity Interview, RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA), physical activity and exercise diary, Medical Outcomes Study Short-Form 36, and subjects' self-report and provider records of health care use. Follow-up times were 3 and 6 weeks and 3 and 6 months after CABS.

RESULTS

Subjects (N = 232) had a mean age of 71.2 (+4.7) years. There were no significant interactions using repeated-measures analyses of covariance. There was a significant group effect for average kilocalories/kilogram/day of estimated energy expenditure as measured by the RT3 accelerometer, with the usual care group having a higher estimated energy expenditure. Both groups had significant improvements over time for role-physical, vitality, and mental functioning. Both groups had similar health care use.

CONCLUSION

Subjects were able to return to preoperative levels of functioning between 3 and 6 months after CABS and to increase their physical activity over reported preoperative levels of activity. Further study of those patients undergoing CABS who could derive the most benefit from the SM intervention is warranted.

Exercise, quality of life, and symptoms in men and women five to six years after coronary artery bypass graft surgery

BACKGROUND

Coronary artery bypass graft (CABG) surgery is commonly performed to treat symptoms of heart disease and improve function and quality of life (QL). Health-related behavior including exercise after surgery may promote optimal recovery; however, relationships among exercise behavior, functional status, symptoms, and QL 5 to 6 years after CABG have not been examined in a representative patient sample.

METHODS

Telephone interviews and postal surveys were used to examine long-term (5-6 year) recovery after CABG of 163 men and women of the Minnesota participants enrolled in the Post-CABG Biobehavioral Study.

RESULTS

Regular exercise and better functional status were related to reports of less shortness of breath and fatigue and better subjective health perception, satisfaction, and QL.

RECOMMENDATIONS

Positive relationships between regular exercise and more favorable QL and symptom relief 5 to 6 years after CABG in this observational cohort study warrant prospective study trials to determine the potential long-term benefits of regular exercise after CABG.

Quality of life after coronary artery bypass surgery

This study assessed the quality of life (QoL) of 124 people with coronary artery disease who had coronary artery bypass surgery in a hospital in Brazil, by using the Modified Flanagan's QoL instrument as the outcome measure. In addition, we studied the association between QoL and demographic, clinical, and perceived health status (using SF-36 Health Survey) measures. The mean for the Modified Flanagan's QoL was high (M = 84.8, SD = 13.6) when compared to similar studies in the United States. In a linear regression analysis, the SF-36 subscales of vitality, and general and mental health were statistically significant (p < .01 for all), after adjusting for other demographic and clinical variables. Increasing values of those SF-36 subscales corresponded to increasing Modified Flanagan's QoL. Despite the limitations of the study, this result suggests that future clinical interventions aimed to improve QoL in this population could focus on the patient's psychological conditions after the surgery.

Understanding paradigms used for nursing research

AIMS

The aims of this paper are to add clarity to the discussion about paradigms for nursing research and to consider integrative strategies for the development of nursing knowledge.

BACKGROUND

Paradigms are sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines. The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Researchers may consider these differences so vast that one paradigm is incommensurable with another. Alternatively, researchers may ignore these differences and either unknowingly combine paradigms inappropriately or neglect to conduct needed research. To accomplish the task of developing nursing knowledge for use in practice, there is a need for a critical, integrated understanding of the paradigms used for nursing inquiry.

METHODS

We describe the evolution and influence of positivist, postpositivist, interpretive and critical theory research paradigms. Using integrative review, we compare and contrast the paradigms in terms of their philosophical underpinnings and scientific contribution.

FINDINGS

A pragmatic approach to theory development through synthesis of cumulative knowledge relevant to nursing practice is suggested. This requires that inquiry start with assessment of existing knowledge from disparate studies to identify key substantive content and gaps. Knowledge development in under-researched areas could be accomplished through integrative strategies that preserve theoretical integrity and strengthen research approaches associated with various philosophical perspectives. These strategies may include parallel studies within the same substantive domain using different paradigms; theoretical triangulation to combine findings from paradigmatically diverse studies; integrative reviews; and mixed method studies.

CONCLUSION

Nurse scholars are urged to consider the benefits and limitations of inquiry within each paradigm, and the theoretical needs of the discipline.