Abstract
BackgroundCardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients’ empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.MethodsPatients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age.68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6–9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.ResultsAt one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [− 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [− 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls.ConclusionsThe problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.Trial registrationNCT01462799 (February 2020).
Highlights
Cardiac rehabilitation is effective after coronary heart disease (CHD)
Patients According to the COR-PRIM study, [19] the following inclusion criteria were used: (i) CHD verified by myocardial infarction and/or Percutaneous Coronary Intervention (PCI) and/or coronary artery by-pass surgery (CABG) within 12 months before planned start of the intervention irrespective of age; (ii) stable cardiac condition; (iii) optimised cardiac medication not substantially changed the previous month; and (iv) completed hospital heart school at one of the identified six primary health care centres
In the problem-based learning group, losses to one-year follow-up were due to missing the one-year visit (n = 32) and failure to submit questionnaires (n = 38)
Summary
Cardiac rehabilitation is effective after coronary heart disease (CHD). We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients’ empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD. The future risk of mortality and myocardial infarction could decrease if new approaches to cardiac rehabilitation programmes were nurse coordinated [8] based on European guidelines involving multidisciplinary teams of health care professionals [4] with an effective and sustained contact with cardiologists and general practitioners [7]. There is a need to strengthen cardiac rehabilitation interventions aiming to bridge the gap for patients between hospital- and primary care
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