LC-REHAB: randomised trial assessing the effect of a new patient education method - learning and coping strategies – in cardiac rehabilitation

BMC Cardiovascular Disorders

Inge Wittrup⁴  Claus Vinther Nielsen³  Alison Beauchamp¹  Ole May²  Vibeke Lynggaard² 

[1] Deakin University, Public Health Innovation, Melbourne, Australia;Regional Hospital West Jutland, Cardiovascular Research Unit, Herning, Denmark;Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark;CFK - Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark

关键词: Coping;    Learning;    Patient education;    Rehabilitation;    Cardiovascular disease;   

Others  :  1088407
DOI  :  10.1186/1471-2261-14-186

 received in 2014-12-02, accepted in 2014-12-08,  发布年份 2014

【 摘 要 】

Background

Due to improved treatments and ageing population, many countries now report increasing prevalence in rates of ischemic heart disease and heart failure. Cardiac rehabilitation has potential to reduce morbidity and mortality, but not all patients complete. In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program. The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called ‘learning and coping’ to that of standard care. Further, this paper aims to describe the theoretical basis and details of this intervention.

Methods/design

Open parallel randomised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure. Patients are allocated to either the intervention group with learning and coping strategies incorporated into standard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program. Learning and coping consists of two individual clarifying interviews, participation of experienced patients as educators together with health professionals and theory based, situated and inductive teaching. Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units. In both groups, cardiac rehabilitation consists of training three times a week and education once a week over eight weeks. The primary outcomes are adherence to cardiac rehabilitation, morbidity and mortality, while secondary outcomes are quality of life (SF-12, Health education impact questionnaire and Major Depression Inventory) and lifestyle and risk factors (Body Mass Index, waist circumference, blood pressure, exercise work capacity, lipid profile and DXA-scan). Data collection occurs four times; at baseline, at immediate completion of cardiac rehabilitation, and at three months and three years after the finished program.

Discussion

It is expected that learning and coping incorporated in cardiac rehabilitation will improve adherence in cardiac rehabilitation and may decrease morbidity and mortality. By describing learning and coping strategies the study aims to provide knowledge that can contribute to an increased transparency in patient education in cardiac rehabilitation.

Trial registration

Identifier NCT01668394.

【 授权许可】

   
2014 Lynggaard et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Videbæk J, Andersen LV, Bentzen J: Danish Heart Statistics 2010. Copenhagen: The Danish Heart Foundation, National Institute of Public Health; 2011.
• [2]Scholte op Reimer W, Gitt A, Boersma E, Simoons M: Cardiovascular Diseases in Europe. Euro Heart Survey. European Society of Cardiology; 2006. http://www.escardio.org webcite
• [3]Bui AL, Horwich TB, Fonarow GC: Epidemiology and risk profile of heart failure. Nat Rev Cardiol 2011, 8(1):30-41.
• [4]Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N: Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004, 116(10):682-692.
• [5]Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, Lough F, Taylor RS: Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail 2010, 12(7):706-715.
• [6]Clark AM, Hartling L, Vandermeer B, McAlister FA: Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005, 143(9):659-672.
• [7]McAlister FA, Lawson FM, Teo KK, Armstrong PW: Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. BMJ 2001, 323(7319):957-962.
• [8]Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S: Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2001, 1:CD001800.
• [9]World Health Organization Expert Committee: Rehabilitation after cardiovascular diseases, with special emphasis on developing countries. Geneva: World Health Organization; 1993. [Technical report series no. 831]
• [10]World Health Organization: World Report on Disability. Geneva: World Health Organization and The World Bank; 2011.
• [11]Grace SL, Abbey SE, Shnek ZM, Irvine J, Franche RL, Stewart DE: Cardiac rehabilitation I: review of psychosocial factors. Gen Hosp Psychiatry 2002, 24(3):121-126.
• [12]Goulding L, Furze G, Birks Y: Randomized controlled trials of interventions to change maladaptive illness beliefs in people with coronary heart disease: systematic review. J Adv Nurs 2010, 66(5):946-961.
• [13]Danish Health and Medicines Authority: Patient education - a health technology assessment. Copenhagen: Danish Health and Medicines Authority; 2009.
• [14]Karmali KN, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S: Promoting patient uptake and adherence in cardiac rehabilitation. Cochrane Database Syst Rev 2014, 6:CD007131.
• [15]Beswick AD, Rees K, West RR, Taylor FC, Burke M, Griebsch I, Taylor RS, Victory J, Brown J, Ebrahim S: Improving uptake and adherence in cardiac rehabilitation: literature review. J Adv Nurs 2005, 49(5):538-555.
• [16]Steihaug S, Hatling T: Evaluation of ‘Learning and Coping’ activity in Health North. SINTEF Helse. 2007.
• [17]Wittrup I: Learning and Coping. Patient Education on the Patients' Premisses. Central Denmark Region: Public Health and Quality Improvement; 2011. http://www.cfk.rm.dk webcite
• [18]Central Denmark Region: Disease Management Program for Cardiovascular Diseases, Focus on Cardiac Rehabilitation after Myocardial Infarction and Severe Angina. Viborg: Central Denmark Region; 2008. http://www.rm.dk webcite
• [19]Kleinman A: The meaning of Symptoms and Disorders. The illness narratives - Suffering, healing and the human condition. 1st edition. New York: Basic Books, Inc., Publishers; 1988:3-30.
• [20]Bury M: Chronic illness as biographical disruption. Sociol Health Illn 1982, 4(2):167-182.
• [21]Charmaz K: Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn 1983, 5(2):168-195.
• [22]Williams G: The genesis of chronic illness; Narrative reconstruction. In The sociology of Health and Illness. 1st edition. Edited by Bury M, Gabe J. London: Routledge; 2004:247-255.
• [23]Garro L: Cultural knowledge as Ressource in Illness Narratives; Remembering through Accounts of Illness. In Narrative and the Cultural Construction of Illness and Healing. 1st edition. Edited by Mattingly C, Garro LC. Berkeley and Los Angeles, California: University of California Press; 2000:70-87.
• [24]Mattingly C: Emergent narratives. In Narrative and the Cultural Construction of illness and healing. 1st edition. Edited by Mattingly C, Garro LC. Berkeley and Los Angeles, California: University of California Press; 2000:181-211.
• [25]Mattingly C: Reading Minds and Telling Tales in a Cultural Borderland. Ethos 2008, 36(1):136-154.
• [26]Mattingly C: The mimetic question. Healing dramas and clinical plots. 1st edition. Cambridge: Cambridge University Press; 1998:25-47.
• [27]Mattingly C: Therapeutic plots. Healing dramas an clinical plots. 1st edition. Cambridge: Cambridge University Press; 1998:72-103.
• [28]Bruner J: Actual Minds, Possible Worlds. 1st edition. Cambridge, Massachusett and London, England: Harvard University Press; 1986.
• [29]Rollnick S, Miller W, Butler C: Motivational Interviewing in Health Care. Helping Patients Change Behavior. 1st ed. New York: The Guilford Press; 2008.
• [30]Illeris K: Learning, Learning Processes and Learning Dimensions. The Three Dimensions of Learning. 1st edition. Frederiksberg: Roskilde University Press; 2002:13-25.
• [31]Srivastva S, Cooperrider D: Appriciative Inquiry in Organizational Life. Research in Organizational Change and Developement. Appriciative Management and Leadership. Revised edition. Euclid, Ohio: Williams Custom Publishing; 1999:129-169.
• [32]Watkins J, Mohr J, Kelly R: Appriciative Inquiry - Change at the Speed of Imagination. 2nd edition. Hoboken, New Jersey: John Wiley and Sons Ltd; 2011.
• [33]Rubak S, Sandbaek A, Lauritzen T, Christensen B: Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005, 55(513):305-312.
• [34]Everett B, Davidson PM, Sheerin N, Salamonson Y, DiGiacomo M: Pragmatic insights into a nurse-delivered motivational interviewing intervention in the outpatient cardiac rehabilitation setting. J Cardpulm Rehabil 2008, 28(1):61-64.
• [35]Tomm K: Interventive interviewing: Part III. Intending to ask lineal, circular, strategic, or reflexive questions? Fam Process 1988, 27(1):1-15.
• [36]Mattingly C, Gron L, Meinert L: Chronic homework in emerging borderlands of healthcare. Cult Med Psychiatry 2011, 35(3):347-375.
• [37]Prochaska JO, DiClemente CC: Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol 1983, 51(3):390-395.
• [38]Prochaska JO, DiClemente CC, Norcross JC: In search of how people change. Applications to addictive behaviors. Am Psychol 1992, 47(9):1102-1114.
• [39]Bandura A: Athletic Functioning. Self-Efficacy - The exercise of control. 1st edition. New York: W.H. Freeman and Company; 1997:369-421.
• [40]Bandura A: The Nature and Structure of Self-Efficacy. Self-Efficacy - The exercise of control. 1st edition. New York: W.H. Freeman and Company; 1997:36-78.
• [41]Lazarus RS: Coping and the Process of Secondary Appraisal: Degree of Threat and FActors in the Stimulus Configuration. Psychological Stress and the Coping Process. 1st edition. New York: McGraw-Hill Book Company; 1966:150-209.
• [42]Hinrichsen EK: Manual: Learning and Coping Education. Central Denmark Region: Public Health and Quality Improvement; 2012. http://www.cfk.rm.dk webcite
• [43]Ware JE, Kosinski M, Turner-Bowker DM, Gandeck MS: User’s manual for the SF-12v2 Health Survey (with a supplement Documenting SF-12 Health Survey). 1st edition. Lincoln, Rhode Island: QualityMetric Incorporated; 2007.
• [44]Brazier JE, Roberts J: The estimation of a preference-based measure of health from the SF-12. Med Care 2004, 42(9):851-859.
• [45]Nolte S, Elsworth GR, Sinclair AJ, Osborne RH: The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey. Patient Educ Couns 2007, 65(3):351-360.
• [46]Osborne RH, Elsworth GR, Whitfield K: The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 2007, 66(2):192-201.
• [47]Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W: The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord 2001, 66(2–3):159-164.
• [48]Hind K, Oldroyd B, Truscott JG: In vivo precision of the GE Lunar iDXA densitometer for the measurement of total body composition and fat distribution in adults. Eur J Clin Nutr 2011, 65(1):140-142.
• [49]Stata Statistical Software: Release 13 [computer program]. TX: StataCorp LP; 2013.