Does the mode of delivery in Cardiac Rehabilitation determine the extent of psychosocial health outcomes?
Does the mode of delivery in Cardiac Rehabilitation determine the extent of psychosocial health outcomes?
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DOI：
10.1016/j.ijcard.2017.11.056
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发表时间：
2018-03-15
影响因子：
3.5
通讯作者：
Doherty P
中科院分区：
文献类型：
--
作者：
Harrison AS;Doherty P
心脏康复（CR）是一种多组分量身定制的干预措施，旨在减少生活方式风险因素，促进心血管疾病后患者的健康。CR可以通过监督或自我促进的方式进行交付，但很少有证据评估交付方式与结果之间的关系。这项观察性研究使用了2012年4月至2016年3月期间心脏康复国家审计常规收集的数据。该分析比较了接受监督和便利自我交付模式的人群在基线人口统计学、CR前后的四项社会心理健康测量以及干预后焦虑、抑郁和生活质量的变化方面的差异。该分析还模拟了模式和结果之间的关系，考虑了协变量，如年龄、性别、持续时间和人员配备。该研究纳入120,927例患者（65岁，26.5例女性），其中82.2%在监督下分娩，17.8%自行分娩。分析显示，在自行分娩组中，女性、就业者和老年患者的比例更高。CR后，两组患者均表现出相当大小的积极变化。当考虑协变量时，回归模型显示分娩方式与所有四种社会心理结局之间无显著关联（p值> 0.0.5）。参加两种CR模式的患者显示出改善的心理社会健康结果，与基线相比改变了3-76%。在英国，超过一半的CR项目不提供自我交付的CR，但这种模式已知适用于老年患者、女性和受雇患者。在临床团队的监督下，应作为一种真正的选择，提供和支持便利的自我交付的CR。自产人口年龄较大，女性比例较大。无论是在监督下还是自行接生，都对患者有心理社会方面的好处。英国国家审计得出有代表性的例行人口自我交付结论。受监督的康复患者和自我交付的康复患者具有相似的心理社会健康结果。
Cardiac Rehabilitation (CR) is a multicomponent tailored intervention aiming to reduce lifestyle risk factors and promote health in patients post cardiovascular disease. CR is delivered either as supervised or facilitated self-delivered yet little evidence exists evaluating the association between mode of delivery and outcomes. This observational study used data routinely collected from the National Audit of Cardiac Rehabilitation from April 2012–March 2016. The analysis compared the populations receiving supervised and facilitated self-delivered modes for differences in baseline demographics, four psychosocial health measures pre and post CR and changes in anxiety, depression and quality of life following the intervention. The analysis also modelled the relationship between mode and outcomes, accounting for covariates such as age, gender, duration and staffing. The study contained 120,927 patients (age 65, 26.5 female) with 82.2% supervised and 17.8% self-delivered. The analysis showed greater proportion of females, employed and older patients in the self-delivered group. Following CR, patients in both groups demonstrated positive changes which were of comparable size. The regression model showed no significant association between mode of delivery and outcome in all four psychosocial outcomes when accounting for covariates (p-value > 0.0.5). Patients benefited from attending both modes of CR showing improved psychosocial health outcomes with 3–76% change from baseline. Over half of CR programmes in the UK do not provide self-delivered CR yet this mode is known to reach older patients, female and employed patients. Facilitated self-delivered CR should be offered and supported as a genuine option, alongside supervised CR, by clinical teams. Self-delivered population is older and greater proportion female. Patients have psychosocial benefit from attending either supervised or self-delivered. UK National audit concludes in representative routine population self-delivered. Supervised and self-delivered rehabilitation patients have similar psychosocial health outcomes.
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DOI：
10.1136/bmj.h5000
发表时间：
2015-09-29
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Dalal HM;Doherty P;Taylor RS
通讯作者：
Taylor RS
影响因子：
2.7
作者：
Sagar VA;Davies EJ;Briscoe S;Coats AJ;Dalal HM;Lough F;Rees K;Singh S;Taylor RS
通讯作者：
Taylor RS
影响因子：
2.7
作者：
Doherty, Patrick;Harrison, Alexander S.;Dale, Veronica
通讯作者：
Dale, Veronica
影响因子：
3.5
作者：
Harrison, Alex S.;Sumner, Jennifer;Doherty, Patrick
通讯作者：
Doherty, Patrick
影响因子：
168.9
作者：
LEWIN, B;ROBERTSON, IH;CAMPBELL, M
通讯作者：
CAMPBELL, M