Acute Myocardial Infarction: Rehabilitation Phase
Conditions
Keywords
Family-Centered Empowerment Model, Quality of life, Perceived stress, Anxiety, Myocardial infarction, Clinical trial, Iran
Brief summary
The objective of this study was to evaluate the effectiveness of a FCEM-focused hybrid CR program for survivors of myocardial infarction (MI). The study sought to compare the long-term impact of FCEM-based intervention with a standard CR program in terms of mortality rates and different aspects of health related quality of life (HRQoL), which includes soft outcomes such as levels of stress, anxiety, psychological distress, quality of life (QoL), and hard outcomes such as the percentage of ejection fraction (EF), independent functioning, and functional exercise capacity status.
Detailed description
The investigators conducted a triple-blind randomized controlled clinical trial study in patients admitted for MI to the CCU of an academic teaching hospital from June 2012 to January 2023. The study was approved by the institutional investigative review board at Tarbiat Modares University and Baqiyatallah University of Medical Sciences. Patients were block randomized to receive either standard home cardiac rehabilitation (CR) or CR using the Family-centered Empowerment Model (FCEM) strategy. Patients had not previously gone through CR programs. The difference between the two groups was not disclosed at any point. Patients consented knowing that they would receive cardiac rehabilitation, but without knowing the details. Patients and their designated family/friend were enrolled as a 'unit'. Patient empowerment was measured with FCEM questionnaires pre-intervention and post-intervention for a total of 9 assessments. Quality-of-life, perceived stress, state and trait anxiety, psychological distress, independent functioning, and functional exercise capacity status were assessed using the 36-Item Short Form Health Survey (SF-36), the 14-item Perceived Stress, the 20-item State and 20-item Trait Anxiety questionnaires, Kessler Psychological Distress Scale,Barthel Index (BI) activities of daily living index, six-minute walk test (6MWT), and free walking index (FWI), respectively. In addition, echocardiography was used to measure ejection fraction.
Interventions
OTHERFamily-centered empowerment model
FCEM and Control groups had similar inpatient care. Patients in the intervention group received care employing the FCEM in four stages. Stage 1: Awareness and cognition. During 3-5 group sessions they were evaluated for their insight into their perceived illness severity and perceived sensitivity, or the degree to which they felt threatened by their illness. Stage 2: Expectations. 3-5 sessions. Stage 3: Acceptance. Assessed using an educational participation method in group discussion. Stage 4: Formative summative evaluations. The formative evaluation encourages patients to internalize their locus of control by seeing his/her self-empowerment (increasing self-responsibility about their health). Summative evaluations were performed to evaluate the influence of the intervention on HRQoL dimensions, perceived stress and anxiety -- assessed at baseline and at 3 months post-intervention. Empowerment was measured at baseline and at 10 days post-intervention by deploying FCEM questionnaires.
OTHERControl
FCEM and Control groups had similar inpatient care. Upon discharge the Control group underwent routine care and follow-up.
Sponsors
Tarbiat Modarres University
Baqiyatallah Medical Sciences University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Intervention model description
All patients had similar inpatient rehabilitation programs. Both groups exercised for 0-2h/day. Walking distance was measured using a Fitbit (Fitbit, San Francisco, USA). Routine care included education on smoking cessation and education on food selection. FCEM: Daily exercise occurred between 8-10 AM and was supervised by designated family members. Investigators randomly attended sessions in an unannounced fashion. Physical therapy consultation was available on investigator request. Exercise data were independently collected from the patient and their designated family member on a weekly basis (κ statistic=0.9). Control: Patients exercised daily, at any time. Sessions were supervised by family members. Investigators did not attend sessions. Exercise data were independently collected from the patient and their designated family member on a weekly basis (κ statistic=0.4).
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Being within the age-range of 45 to 85 years old * having the minimum literacy for reading and writing * being hospitalized due to MI for the first time * verification of MI by clinical symptoms * enzyme-serum tests and cardiograph changes * lack of participation in the any related educational course simultaneously with the execution of intervention * patients' willingness toward participating in the research * having no psychological problems * ability to fill out the questionnaire and participating in the empowerment program.
Exclusion criteria
* any offending items from mentioned criteria.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mortality rate | 10-year | 5-year, 7-year, and 10-year mortality rates of MI survivors who received a FCEM-focused hybrid CR program as intervention group compared with those who received a standard CR program as control group |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anxiety | 48 months | Beck 20-Item state and 20-Item trait anxiety Questionnaires |
| Patient Stress | 48 months | 14-item Perceived Stress Questionnaire (PSQ-14) |
| Level of quality of life | 48 months | the 36-Item Short Form Health Survey (SF-36) |
| psychological distress | 48 months | Psychological Distress Scale (K10) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Ejection Fraction | 48 months | Measured by trans-thoracic echocardiography |
| Independent functioning | 48 months | Barthel Index (BI) activities of daily living index |
| Functional exercise capacity status | 48 months | six-minute walk test (6MWT), and free walking index (FWI) |
Outcome results
None listed