Is phase 2 cardiac rehabilitation necessary for early recovery of patients with cardiac disease? A randomized, controlled study

Article Abstract:

One million Americans survive heart attacks each year, and a quarter million undergo coronary artery bypass surgery. Afterward, many of these patients are afraid to perform physical activity and require cardiac rehabilitation to restore their confidence (self-efficacy) and quality of life. The first phase of rehabilitation is conducted in the hospital, and provides guidelines for progressive activity levels. Phase 2 ideally provides up to three months of support on an outpatient basis, but insurance carriers are reluctant to pay for this service. Patients also drop out because of the cost, inconvenience, or lack of accessibility. Development of treatment options is a challenge. Self-efficacy, or the tendency to avoid situations and activities perceived as beyond one's abilities, and the ready undertaking of activities believed to be achievable, is a potent determinant of behavior change. Forty patients recovering from a heart attack, bypass surgery, or heart attack with angioplasty were divided into three groups, two with special training (one with and one without exercise training), and one with only routine care. Both treatment groups had higher self-efficacy scores for ''total activity'' than the control group, but by nine weeks after the heart attack or surgery, there was little difference in scores. There was no advantage shown for the exercise group over the treatment group without exercise. The inpatient cardiac rehabilitation program may have raised the scores for all three groups, thereby muting distinctions. The selection criteria discouraged less motivated and more seriously ill individuals from enrolling in the study, since subjects had to be willing to participate in exercise testing and training, therefore the results cannot be generalized to other types of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Rehabilitation nursing

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Programmed instruction booklet for cardiac rehabilitation teaching

Article Abstract:

The rehabilitation of patients following myocardial infarction requires education about the changes in behavior and lifestyle that are necessary to maintain proper health and prevent a relapse. Studies have shown that patient education programs following myocardial infarction are cost-effective, reducing both the length of hospitalization and the risk of relapse. Programmed instruction is a method of education that was developed roughly 30 years ago. This method accommodates patients of all learning abilities because it provides diagrams and questions combined in a format that allows the patient to learn at his own pace. A study was performed to determine if a programmed instruction teaching method can result in increased patient knowledge about cardiac rehabilitation concepts. Twenty-nine cardiac patients were given programmed instruction booklets that provided information on cardiac anatomy, risk factors, diet, exercise, and medications; and 30 cardiac patients participated in the hospital's regular cardiac rehabilitation program. Following the completion of the rehabilitation programs, each patient was given a written test that evaluated the knowledge gained from the programs. The test results indicated that patients in both groups gained significant knowledge during the rehabilitation programs. The scores of the patients in the experimental group were higher than those in the control group, but this difference was not statistically significant. These results indicate that programmed instruction booklets can be effective in teaching cardiac rehabilitation to patients following myocardial infarction. (Consumer Summary produced by Reliance Medical Information, Inc.)

Education

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Educational interventions to alter pediatric emergency department utilization patterns

Article Abstract:

A brief educational visit with a health professional does not seem to change the habits of parents who bring their children to pediatric emergency departments (PEDs) for minor illnesses. Researchers compared the percentage of 130 families who returned to the PED for minor illnesses after either a brief educational visit (study group) or after routine discharge instructions (control group). The educational visit came right before leaving the PED and consisted of reading a simple booklet, watching a videotape, and reviewing care for minor childhood illnesses with a health professional. A similar percentage of control group (30%) and study group parents (26%) returned to the PED with their children for minor illnesses six months later. Most parents in both groups had an identified primary care provider (PCP) for their children. Reasons given for not contacting their PCP before going to the PED were similar in both groups.

Care and treatment, Emergency medical services, Pediatric emergencies, Medical care utilization

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