@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(1):73-78

Background
… [1-6]. In many cases, coronary artery bypass is the only way to treat and increase the patient's life span. One of the most important measures for the effectiveness of cardiac surgery and its complications are cardiac rehabilitation [7].
Previous Studies
The cardiovascular rehabilitation program includes activities such as comprehensive medical assessment, sports, risk modification, training, observation and changer of patient behavior. Rehabilitation, the learning process of life, is associated with chronic illness or disabling conditions, and the purpose of rehabilitation is to return the patient to the highest possible degree of physical, mental, social, and occupational ability [8]. …Cardiac rehabilitation programs are considered as effective step in the continuation of treatment as an effective preventive measure of incidence of cardiac disease in most of the developed world [9]. … [10].
Aim(s)
No research has been found that follow up patients' rehabilitation with a follow-up pattern of patients with ischemic heart disease and its impact on empowerment of patients. Therefore, the aim of this study was to investigate the effectiveness of continuous cardiac rehabilitation training on empowerment and cardiovascular parameters in patients with ischemic heart diseases.
Research type
This is a randomized, controlled clinical trial.
Research society, place and time
The population included patients with ischemic heart disease (those diagnosed with myocardial infarction or unstable angina by a myocardial infraction specialist) who had been admitted to the cardiac unit of Vasei Hospital in Sabzevar City during the summer of 2017.
Sampling method and number
The sample of the study was 70 patients who were followed up with the case file. Inclusion criteria were ischemic heart disease, admission in the age group of 30-60 years, lack of history of heart surgery, no history of known mental illness, no motor problem, ability to speak and understand Persian language, having reading and writing skills, and history of uncomplicated myocardial infarction (lack of uncontrolled heart failure, arrhythmias, severe and persistent angina). Exclusion criteria were the lack of willingness to continue to engage in research, cardiac surgery, absence in training sessions for 2 sessions, and any medical condition that disturbed the follow-up. At first, the samples were selected from among the qualified individuals and then assigned into one of the two control and intervention groups randomly. Due to the similarity of the type of intervention and the nature of the disease and the lack of similar research done on the cardiac patients, the sample size was determined as 35 using the formula for comparing the mean systolic blood pressure after 3 months of follow-up care intervention in diabetic patients in two groups of intervention and control groups in the study conducted by Ghavami et al. [11]. Eligible patients were selected from among patients with ischemic heart disease who had referred to the cardiac unit of Sabzevar City in a 3-month period. After explaining the study and obtaining written consent from them, the researcher divided the patients into two groups of intervention and control.
Used devices&materials
The data collection tool was a questionnaire containing the following sections: 1- Demographic and individual characteristics (such as age, sex, level of education, occupational status, marital status, and ischemic disease) 2- Record sheets for hemodynamic variables including systolic and diastolic blood pressure, and pulse rate recorded before and after the follow-up care-based rehabilitation program by the researcher assistant. Also, the level of cholesterol and glucose were measured before and after the intervention. 3- Empowerment questionnaire which has been developed in Iran by Alhani et al. in three dimensions for patients with ischemic heart disease … [12]. After selecting the samples, the patients in the intervention group, participated in two sessions of the rehabilitation program: once at the time of discharge and once again after 2 to 3 weeks after discharge. The rehabilitation program included a continuous care model by Ahmadi et al. [13] which has been designed and evaluated for coronary chronic patients. The model consists of four stages of briefing, sensitization, control and evaluation. In the briefing phase, a 15-minute session was held with the patient and his family to persuade the patient, clarify expectations from one another, and recommendation on the need for continuity of care-therapy between the two sides until the end of the prescribed time. The sensitization stage was conducted to involve the patient and family in the implementation of continuous care approach. On average, 4 to 6 one-hour sessions were held four each group of patients with the presence of the patient and their family members. These two steps took 3 weeks. In the control phase, the patients' care needs, attention to new problems and complications were monitored weekly for 2 months by means of telephone calls. In order to ensure that the materials had been learnt and more review of the material, an educational booklet was prepared based on educational needs and was given to the patients with the approval of the cardiologist. In the evaluation phase, the researcher attempted to monitor the effect of provided training, resolve the problems or incidence of new problems to monitor and control of the patient's behavior, either by telephone follow up or through face-to-face interviews, and finally, this phases was ended by completing the questionnaire at the end of the month and after intervention. The number of samples in sessions varied between 7 and 10 based on the number of available samples. Hemodynamic status was recorded at the time of discharge and 3 months after discharge. Interpretation of hemodynamic status was performed by an internal cardiologist who did not know the patient group. Patients in the control group only received routine care and did not participate in the rehabilitation program, and in order to solve the ethical problems, after completion of the research, the pamphlets were given to the group. This plan was approved by the Ethics Committee of the Gonabad University of Medical Sciences with ethical code IR.Gmu.REC.1395 and was registered at the Iranian Center for Clinical Trial (2017022632779N1 IRCT).
Findings by Text
The assumption of the normal distribution of data was investigated using Kolmogorov-Smirnov test. To compare the demographic variables in the two groups, changes in each group before and after 3 months of intervention, and changes between the two groups before and after the intervention, independent t-test and chi-square test were used. Statistical analysis was performed using SPSS 22 software. The mean age in the control and experimental groups was 52.40±4.89 and 53.57±5.12 years respectively. Also, the mean of body mass index in the control and experimental groups was 24.71±3.68 and 25.35±3.42 kilogram per square meter respectively. There was no significant difference between the demographic variables in the two control and intervention groups and the groups were homogenous in terms of this variable (p>0.05; Table 1).There was no significant difference between the total empowerment mean score in the two control and experimental groups before the intervention (p<0.05), but there was a significant difference between the two groups after the intervention (p=0.03; Table 2). The mean systolic blood pressure, diastolic blood pressure, cholesterol and blood glucose levels was not significantly different in the control and intervention groups (p>0.05), while all of these variables had a significant difference after the intervention in the two groups (p<0.05; Table 3).
Main comparison to the similar studies
Nakoa et al. showed that physical activity parameters, daily routine activities and exercise ability should be investigated in self-care programs based on rehabilitation program. They showed that patients who followed the mentioned self-care program, had better muscular strength, ability to walk, balance and mass, and control compared with those who were dependent on others [14]. … [15-17]. In a study by Mandegar et al., doing cardiac rehabilitation program significantly reduced systolic and diastolic blood pressure [18]. … [19-21].
Suggestions
It is recommended that nurses receive training on how to develop a cardiac rehabilitation program based on continuous care model that can be effective in empowering patients so that they can help their patients with these techniques. Also, community health nurses can use cardiac rehabilitation program based on continuous follow-up model.
Limitations
One of the limitations of this study was the probability of the control group being influenced by the intervention group, which tried to minimize the probability of contact between the two groups.
Conclusions
The cardiac rehabilitation program based on a continuous care model is effective on empowerment and cardiovascular parameters in patients with ischemic heart disease.
Acknowledgments
The cardiac rehabilitation program based on continuous care model is effective on empowerment and cardiovascular parameters in patients with ischemic heart disease.
Conflict of interest
Non-declared
Ethical Permissions
This research was approved on July 25, 2016 at the Ethics Committee of the Gonabad University of Medical Sciences with ethical code IR.Gmu.REC.1395 and it was registered at the Iran Center for Clinical Trials (IRCT 2017022632779N1).
Funding Sources
This research is a part of the e master's thesis, and has received financial support from the respectful Deputy of Research of Gonabad University of Medical Sciences.

TABLES and CHARTS

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