Psychosocial outcomes after an MI: An evaluation of two approaches to rehabilitation

Abstract

A bstract T his study compared the relative ef® cacy of two different rehabilitation programm es (one with and one without the Edinburgh H eart M anual) on psychosoc ial outcom e following a ® rst m yocardial infarction (M I).A six-m onth longitudinal design was used to assess changes in the following variables: locus of control, signi® cant other sup port, illness perceptions, anxiety, depression and generalized self-ef® cacy. T hese variables were also used to predict general practitioner (G P) contact and hospital adm issions in the six m onths following the M I. Patients receiving the manual (N 5 45) reported stronger beliefs in their ability to control the illness (p , 0.05) and less depression (p , 0.01) at follow -up, compared w ith patients receiving a hosp ital-based exercise and education programme (N 5 25). There was no signi® cant difference between the two groups on GP contact and hospital admissions in the six months after the M I. Baseline anxiety predicted GP contact in the six m onths post-M I (p , 0.001). Introdu ctionSigni® cant advan ces in m edical and pharm acological interventions have resulted in im proved survival and fewer com plications for post-M I patients. Num erous studies have been concerned with survival after M I, but far less is know n abo ut m orbidity and illness-related behaviour in post-M I patients. It has long been observed that patients' recovery following M I has been less com plete than would have been expected based solely on their ph ysical condition (W H O , 1964). M ore recently, research has focused on psycho social factors as potential predictors of outcom e following illness.The beliefs and attribu tions that people hold can in¯uence their health, either directly, by in¯uencing a physio logical system such as the imm une system , or indirectly, by affecting their behaviour such as the food they eat or whether they seek m edical help when they feel ill. M any different beliefs and attribu tions have been considered as precursors to health-related behaviour but there is a lack of consensus on which ones are m ost importan t. Locus of control, with its origins in social learning theory, has been extensively studied and the m ere A ddress for correspondence: Dr A Â ine O' R ourke, H artlepool and East Durham Trust, M edical D irectorate, H oldforth R oad, H artlepool TS24 9AH, UK. Tel: 1 44 01429 522417; Fax: 1 44 01429 869852.

The effectiveness and experience of self-management following acute coronary syndrome: A review of the literature

“…(Table 1). Nine were carried out in the UK (Lewin et al, 2002;Barlow et al, 2009;Lacey et al, 2004;Furze et al, 2012;Dalal et al, 2007; A c c e p t e d M a n u s c r i p t 14 Taylor et al, 2007;O'Rourke and Hampson, 1999;Zetta et al, 2011;Linden 1995), four in Australia (Fernandes et al, 2009;Hawkes et al, 2013;O'Neil et al, 2014;Turkstra et al, 2013) and one in each of the following countries: USA (Holmes-Rovner et al, 2008), Canada (Aish and Isenberg, 1996), Spain (Muniz et al, 2010), New Zealand (Petri et al, 2002, Philippine (Ocampo-Balabagno, 1999) and China (Wang et al, 2012).…”

“…Fourteen papers were randomised controlled trials (RCT) including three papers reporting the same ProActive Heart trial (Hawkes et al, 2013;Turkstra et al, 2013;O'Neil et al, 2014) and two papers reporting the same Heart Manual trial Taylor et al, 2007), and only one trial (Barlow et al, 2009) reported a nested qualitative study. The remaining five papers included one pilot RCT (Fernandes et al, 2009), two nonrandomised controlled design (Lacey et al, 2004;O'Rourke and Hampson, 1999), one pre-and post-test design without a control group (Ocampo-Balabagno, 1999) and one with a descriptive comparative design (Linden, 1995).…”

“…Of these, five suggested that self-management interventions were effective in reducing anxiety (Wang et al, 2012;Lewin et al, 2002;Lacey et al, 2004;Furze et al, 2012;O'Neil et al, 2014), whereas five did not demonstrate difference in anxiety scores between the intervention and control groups (Barlow et al, 2009;Dalal et al, 2007;O'Rourke and Hampson, 1999;Zetta et al, 2011;Linden, 1995). Four papers found a positive effect of self-management interventions on symptoms of depression (Lewin et al, 2002;Lacey et al, 2004;Furze et al, 2012;O'Rourke and Hampson, 1999) and six did not (Wang et al, 2012;Barlow et al, 2009;Zetta et al, 2011;O'Neil et al, 2014;Linden, 1995).…”

“…Healthcare utilisation was measured in five papers (Turkstra et al, 2013;Furze et al, 2012;O'Rourke andHampson, 1999, Zetta et al, 2011;Linden 1995). Of these, three did not conduct cost minimisation analysis and found that the two groups did not differ in the frequency of GP contact or/and hospital admission (O'Rourke and Hampson 1999;Zetta et al, 2011;Linden, 1995).…”

“…The Heart Manual was the most frequently implemented home-based cardiac rehabilitation self-management programme in the UK context (Lacey et al, 2004Taylor et al, 2007;O'Rourke and Hampson, 1999;Linden, 1995). It not only consisted of a user-friendly manual giving rehabilitation and lifestyle information to be used over six consecutive weeks, but it also included relaxation exercises and advice for patients and partners using audiotape and an exercise plan to be followed according to individual ability.…”