Developing self-management education in coronary artery disease

Peterson, Janey C.; Link, Alissa R.; Jobe, Jared B.; Winston, Ginger; Klimasiewfski, E. Marina; Allegrante, John P.

doi:10.1016/j.hrtlng.2013.11.006

Cited by 32 publications

(31 citation statements)

References 48 publications

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“…At baseline, all participants received an educational workbook. 27 The Consort diagram of the participants has been previously reported. 26 Fifty-four participants agreed to enroll in the biological measures substudy which had no additional exclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

Depression, Coronary Artery Disease, and Physical Activity: How Much Exercise Is Enough?

Peterson

Charlson

Wells

et al. 2014

Clinical Therapeutics

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Purpose The mechanisms by which depressive symptoms negatively impacts clinical outcomes in patients with CAD remains poorly understood. Previous interventions that have attempted to treat depressive symptoms in CAD patients in order to improve clinical outcomes have been disappointing. Our objectives were to evaluate the impact of depressive symptoms over time, controlling for comorbidity, in determining both successful long-term lifestyle change (i.e., increased physical activity), and cardiovascular morbidity and mortality outcomes. In addition, we examined the impact of physical activity changes over time on two 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 vs. 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 12 months in a subset of 54 participants, including low and high frequency heart rate variability (lfHRV and hfHRV), serum C-reactive protein (CRP) and interleukin-6 (IL-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). Implications This study demonstrates a threshold in physical activity in depressed CAD patients 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.

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Section: Methodsmentioning

confidence: 99%

Depression, Coronary Artery Disease, and Physical Activity: How Much Exercise Is Enough?

Peterson

Charlson

Wells

et al. 2014

Clinical Therapeutics

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“…In the UK NHS there are too few clinicians available to enable a psychological intervention to be delivered for the rehabilitation of a physical illness. However, there are examples of workbooks designed to improve self-efficacy in coronary heart disease 375 and following stroke. 376 In addition, a trial protocol has been published describing an intervention for patients with Huntington's disease that consists of an activity workbook combined with six home visits to promote physical activity and exercise.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal 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.ObjectivesTo 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.DesignPhase 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.SettingRecruitment 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.ParticipantsOlder 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.InterventionsParticipants 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 measuresThe 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.ResultsSixty-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’sd = 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’sd = 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’sd = 0.31) and 1.3 (Cohen’sd = 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.ConclusionsTrial 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 registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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“…Self‐management interventions were originally designed for supporting patients with chronic illness to adjust and cope with the impact of their chronic conditions or symptoms. Literature has shown that self‐management programs for patients with chronic illness may be effective (Harris, Eng, Miller, & Dawson, ; Mancuso, Sayles, Robbins, & Allegrante, ; Peterson et al., ; Rodda & Lubman, ; Taylor, Stone, & Huijbregts, ). Meanwhile, studies demonstrate less unplanned hospital readmission and emergency attendance rate (Allen et al., ; Cadilhac et al., ).…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Study of Effectiveness of a Patient‐Centered Self‐Management Empowerment Intervention During Predischarge Planning on Stroke Survivors

Chen

et al. 2018

Worldviews Ev Based Nurs

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Developing self-management education in coronary artery disease

Cited by 32 publications

References 48 publications

Depression, Coronary Artery Disease, and Physical Activity: How Much Exercise Is Enough?

Depression, Coronary Artery Disease, and Physical Activity: How Much Exercise Is Enough?

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Longitudinal Study of Effectiveness of a Patient‐Centered Self‐Management Empowerment Intervention During Predischarge Planning on Stroke Survivors

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