Efeito da entrevista motivacional no autocuidado de pessoas com insuficiência cardíaca: ensaio clínico randomizado

Abstract

RESUMO Objetivo: Analisar o efeito da entrevista motivacional no autocuidado de pessoas com insuficiência cardíaca crônica. Método: Ensaio clínico randomizado, multicêntrico, dividindo as pessoas em grupo intervenção (n=59) e grupo controle (n=59), acompanhadas por 60 dias nos centros do Brasil e Uruguai. O grupo intervenção recebeu três consultas por entrevista motivacional, com intervalo de 30 dias, e o grupo controle manteve o acompanhamento convencional nas clínicas especializadas. Os dados foram avaliados através do Self-Care of Heart Failure Index 6.2, antes e após a intervenção, em cada um dos centros e analisados através de média, mediana, teste-t, análise de correlação pelo coeficiente de Spearman e efeito da intervenção pelo d de Cohen. Resultados: 118 pessoas concluíram o estudo. Diante da avaliação do efeito da entrevista motivacional no autocuidado, comparando-se ao acompanhamento convencional, foi identificado efeito médio na manutenção e manejo (Cohen-d=0,6723; 0,5086) e alto na confiança do autocuidado (Cohen-d=0,9877). Conclusão: A entrevista motivacional foi efetiva na melhora do autocuidado dos pacientes com insuficiência cardíaca, sendo uma estratégia factível a ser implementada em clínicas especializadas. Registro Brasileiro de Ensaios Clínicos: RBR-6fp5qt.

The Impact of Motivational Interviewing on Self-care and Health-Related Quality of Life in Patients With Chronic Heart Failure

“…17,20,21,23,24 Several studies, including ours, confirmed that the same healthcare professionals implemented the MI program and the conventional educational programs 19,20,22,25 ; this information was not reported, however, in a number of other studies. 17,21,23,24 In terms of duration, our intervention took place for a longer period than in other studies, whose interventions lasted less than 1 month 21,22 or between 1 and 3 months. 17,19,20,[23][24][25] Several studies did not report interview duration, 17,[19][20][21] which in our case was 45 minutes (baseline visit) or 30 minutes (other visits).…”

“…17,19,20,[23][24][25] Several studies did not report interview duration, 17,[19][20][21] which in our case was 45 minutes (baseline visit) or 30 minutes (other visits). Regarding the delivery format, several studies, including ours, held face-to-face sessions, 21,23,24 whereas others combined face-to-face and telephone sessions. 17,19,20,22,25 The essential element in ensuring intervention reliability is monitoring, which in our case, was carried out in situ by a psychologist, an expert in MI, who coded nursing interventions using the MITI 38 during visits with patients.…”

“…17,21,23,24 In terms of duration, our intervention took place for a longer period than in other studies, whose interventions lasted less than 1 month 21,22 or between 1 and 3 months. 17,19,20,[23][24][25] Several studies did not report interview duration, 17,[19][20][21] which in our case was 45 minutes (baseline visit) or 30 minutes (other visits). Regarding the delivery format, several studies, including ours, held face-to-face sessions, 21,23,24 whereas others combined face-to-face and telephone sessions.…”

“…Although MI interventions were superior to conventional approaches in the self-care maintenance domain in most studies, 17,20,21,25 benefits have only been confirmed in a handful of studies for self-care management 21,25 and for self-care confidence. [21][22][23] The divergence in results may be due to study design differences in sample size, level of follow-up, and population. Our results are partially in line with those reported for the global Self-Care of Heart Failure Index 40 and also for the Self-Care of Heart Failure Index self-management domain, which shares some items with the EHFScB "consulting behavior" domain.…”

“…14,15 On the basis of a set of techniques aimed at facilitating the development and maintenance of certain behaviors, MI is delivered in the form of semistructured patient-centered visits during which patients examine and resolve attitudes of possible ambivalence and resistance to change. 11,15,16 Relatively few study authors have evaluated the effectiveness of MI in patients with HF, measured in terms of physical exercise, [16][17][18] hospital readmissions, 19 self-care, 11,17,[20][21][22][23] and HRQoL. 20,24 Furthermore, those studies have reported mixed results, partially explained by design limitations such as small samples and short follow-ups (<6 months).…”