ARTICLE INFO

Article Type

Original Research

Authors

Mahdavi Shahri   S.M. (*)
Abbasi   I. (1)
Mohammadi   M. (2)






(*) Emegency Department, 22 Bahman Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
(1) Medical Surgical Nursing Department, Nursing & Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
(2) “Center for Nursing Care Research” and “Critical Care Nursing Department, Nursing and Midwifery School”, Iran University of Medical Sciences, Tehran, Iran

Correspondence

Address: No. 13, Alley 2, Bahar 3 Street, Gonabad, Iran
Phone: +985157224706
Fax: +985157228821
s.moslemmahdavi@gmail.com

Article History

Received:  October  8, 2014
Accepted:  May 11, 2015
ePublished:  June 20, 2015

BRIEF TEXT


… [1-18] Most heart patients, particularly patients undergoing coronary artery bypass by graft surgery require rehabilitation interventions to increase the efficiency of the heart, preventing complications of reduced blood supply to the heart muscle and encouraging starting social activities [19-21]. Cardiac rehabilitation refers to a coordinated and multifaceted interventions designed to optimize the physical, mental and social performance of the patients with heart disease which in addition to stability, reduction or even reversing the progression of underlying atherosclerotic process, result in the reduction of morbidity and mortality [2]. … [22-28] Physical exercises often develop good sense, reduce the confusion and depression in patients and make a positive attitude for the patients [29]. … [30-36]

The implementation of rehabilitation programs can prevent the re-hospitalization of patients and reduce the health care costs [28].

This study aimed to determine the effect of cardiac rehabilitation on quality of life in patients after coronary artery bypass by graft surgery.

This study is a quasi-experimental research with two groups.

Shahidrajaee Heart Center patients in Tehran (Iran) who had undergone the coronary artery bypass by graft surgery were included in the study in 2012. The inclusion criteria were as follows: having coronary artery bypass by graft surgery for the first time; to require at least three vascular grafts; having the ability to understand, speak, read and write in Persian; and living in Tehran. Exclusion criteria included any problem that could destroy the cooperation of patients in the study.

70 patients were selected by convenience sampling method.

The subjects were divided into two equal groups of experimental and control. 68 patients (33 in the experimental group and 35 in the control group) completed the study. In the experimental group, a cardiac rehabilitation program was conducted in 12 sessions (3 days a week), and control group followed their usual programs. Data collection tools included demographic information forms and questionnaires of quality of life. To evaluate the quality of life of patients with cardiac disease, Ferrans & Powers Quality of Life Index was used. The content validity of this questionnaire has been evaluated and its reliability has been assessed by Cronbach`s alpha [37]. The importance section of the questionnaire is based on the Likert scale with the choices from very important (grade 6) to very insignificant (grade 1). In the section for evaluating satisfaction, the response items have been developed from very satisfied (score 6) to very unsatisfied (score 1). Standard of living, based on the obtained score has been divided to three groups of undesirable (zero to nine), quite desirable (10 to 19) and desirable (20 to 30). The patients participated in 12 sessions of a cardiac rehabilitation program for three days a week as every other day for 2 months after surgery. The duration of each rehabilitation session was 80 minutes. Physical training was consisted of 15 minutes of stretching exercises for warm-ups, 30 minutes of aerobic exercise and 15 minutes of stretching exercises for body rest. Exercises were started with moderate-intensity. At the end of each session, instructions on the modification of risk factors, correction of lifestyle, diet modification and medication were presented as 20-minute lectures, question and answer, group discussions and educational films. At the end of the rehabilitation program session, the quality of life questionnaire was again completed with the experimental group. In control group, the questionnaire was completed after 2 months. The results were analyzed by SPSS 16 software and Paired T-test, Independent T-test and Linear Regression.

Of 35 patients in the experimental group, 2 patients were participated less than 12 sessions in cardiac rehabilitation care program and, therefore, were excluded from the study. 63 persons (92.8%) were older than 50 years. 37 persons (55.8%) were male and 31persons (44.2%) were female. All participants were married, and 56 persons (82.3%) have reading and writing ability. 51 persons (75%) had moderate economic status. 22 persons (32.3 %) of the patients reported a history of chronic heart. All patients underwent both venous and arterial grafts and had at least 3 grant veins. 54 persons (79.4%) had more than 40% ejection fraction. Regarding the duration of using cardiopulmonary pump during surgery, 43 patients (63.2%) had less than 100 minutes duration. In the control group, all patients (100%), and in the experimental group 32 patients (97.1%) had moderate level of quality of life. The quality of life, before the implementation of the rehabilitation program in the control group was 14.20 ± 1.60 and it was 14.50 ± 1.20 in the experimental group. There was no significant difference between the mean scores of the quality of life of the patients in the experimental group and control group before the intervention. Before implementing cardiac rehabilitation program, two experimental and control groups had similar quality of life scores. The score of quality of life in patients after cardiac rehabilitation program was 18.49 ±1.48 in the control group and it was 19.99 ± 1.11 in the experimental group, which indicated an increase in the quality of life in both groups compared to the beginning of the study. However, a significant difference was observed between the scores of the quality of life in both groups. There was a statistically significant difference in the dimensions of health, operation and family relationship of the quality of life in the control and experimental groups, after 12 sessions of rehabilitation for patients in the experimental group (Table 1). According to the result of regression test, there was no significant correlation between any of the demographic characteristics and the effect of cardiac rehabilitation. None of the demographic characteristics affected the achieving benefits from implemented cardiac rehabilitation program.

Experimental and control groups were not significantly different in terms of demographic variables. No significant difference was observed between the dimensions of quality of life in two groups and in both groups, the level of quality of life were similar (relatively moderate). The findings of this study were consistent with published studies. The quality of life in these patients has been intermediate [38]. The score of quality of life in patients 6 weeks after surgical operation has been relatively good [13]. The scores of quality of life in patients have been good [17]. The quality of life in patients after cardiac rehabilitation program in both groups had been increased compared with their scores before the intervention, but there was no statistically significant difference between the quality of life in both groups. Therefore, the quality of life shows significant increase in experimental group compared with control group. After 12 sessions of rehabilitation, similar results have been obtained and comparison between the quality of life in the experimental and control groups using a quality of life questionnaire with 36 questions (SF-36) have shown that there is statistically significant difference approximately in all variables of quality of life in experimental group (4 weeks after discharge in control group) [4]. Better quality of life and more return to work after participating in a cardiac rehabilitation program have been shown [19]. Creating lifestyle changes and enhancing social interaction through cardiac rehabilitation to improve the quality of life in patients after coronary artery bypass surgery have been effective [26]. Quality of life in patients has been increased significantly 4 months after surgery and the progress has been observed with less degree up to a year [38]. These results are in agreement with the findings of this study. The quality of life has been improved after rehabilitation [31]. Effect of cardiac rehabilitation improves the quality of life in patients even up to one year after cardiac rehabilitation [9]. Between the control and experimental groups, before and after cardiac rehabilitation programs, there was no significant difference in health, operation and family relationships dimensions. In addition, no statistically significant difference was observed in two other dimensions of quality of life namely psycho-spiritual and socio-economic dimensions. Significant improvement has been observed in the physical indices of quality of life 3 months after cardiac rehabilitation program. Nevertheless, no statistically significant difference has been observed in two other dimensions of the quality of life namely mental health and social functioning [34]. This finding is in accordance with the current study. The implementation of cardiac rehabilitation program is only effective on health and psycho-spiritual dimensions quality of life and it has no effect on the socio-economic quality of life [21]. Quality of life in the psychological-spiritual dimension has had significant increase comparing to the control group 6 months after receiving cardiac rehabilitation program [26]. The quality of life in the social dimension has had a significant increase in the intervention group, while the patients in the control group had experienced a reduction in the quality of life in the social dimension and no significant difference was observed between the two groups [36]. The positive effect of cardiac rehabilitation program on health-operation dimension and quality of life has been confirmed in other studies and in this regard they are in line with this study, but concerning other effects of cardiac rehabilitation program on quality of life, no comment has been made conclusively.

More time and a greater sample size are needed to study the dimensions. Cardiac rehabilitation program should be used to enhance the patients’ quality of life.

Patients in control group might obtain rehabilitation program trainings from other sources and apply them after surgery. In this case, it might affect the results of both groups, and show a weak difference between them. Since the physiological responses in the recovery period are changing, it can affect the results of rehabilitation.

Cardiac rehabilitation program is effective on improving the quality of life in patients after coronary artery bypass by graft surgery. In addition, all patients regardless of individual and social characteristics similarly benefit from cardiac rehabilitation program.

All members of Iran and Tehran Nursing Faculties as well as staff of rehabilitation unit in Tehran Shahid Rajaee Heart Center are appreciated.

Non-declared

This study was approved by Ethics Committee of Tehran University of Medical Sciences.

The present study is from a graduate student thesis.

TABLES and CHARTS

Show attach file


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