The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial.
The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial.
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DOI：
10.1371/journal.pone.0154678
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Conboy L
中科院分区：
文献类型：
--
作者：
Yeh GY;Chan CW;Wayne PM;Conboy L
在一项慢性心力衰竭（HF）患者的临床试验中，定性地探讨为期12周的太极（TC）干预和教育组与感知的身体和心理社会影响以及总体患者体验相关。我们将100例慢性收缩期心力衰竭（NYHA 1-3级，射血分数≤40%）患者随机分为12周TC组和教育对照组。在12周时，对随机抽取的一个子集（n = 32，实验组n = 17，对照组n = 15）进行半结构化访谈，录音并逐字转录。两名独立的审稿人使用基于理论的方法提取紧急主题的信息。我们探讨了各组之间主题/子主题的异同，并检查了从基线到干预后定量测量（例如，明尼苏达州生活与心衰，心脏运动自我效能和情绪状态概况）变化的定性关联。参与者的平均年龄（±SD）为68±9岁，基线射血分数为29±7%，中位纽约心脏协会分级为2级HF。我们确定了与患者疾病经历、自我认知和与他人关系相关的主题。描述了具体的心理和生理益处。两组的共同主题包括：与活动/锻炼和饮食有关的社会支持和自我效能。然而，太极拳组也表现出更多的全球授权和感知控制。TC的其他主题包括正念/自我意识，减少压力反应和重新定位社会角色。这些主题反映了先前报道的定量测量（生活质量、自我效能和情绪）与对照组相比的改善。TC患者还报告了身体上的益处（例如，疼痛减轻，能量，耐力和灵活性提高）。两组都出现了积极的主题，尽管两组之间在自我效能和感知控制的概念上存在质的差异。那些打太极的人不仅自我效能和社会支持，而且总体上获得了额外的收益，如内在控制点、自我意识和压力管理。未来对身心运动的研究可能会进一步检查知觉控制、自我效能和控制点作为潜在的效果中介。
To qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF). We randomized 100 patients with chronic systolic HF (NYHA Class 1–3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States). The mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient’s experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility). Positive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.