RISK REDUCTION OF SEDENTARY BEHAVIOR POST CABG SURGERY

降低冠状动脉搭桥手术后久坐行为的风险

• 批准号: 2036207
• 负责人: NALINI N JAIRATH
• 金额: $ 5.48万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-08-01 至 1998-08-04
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2036207
• 关键词: clinical research; coronary bypass; exercise; health services research tag; human subject; nursing models; patient care management; postoperative complications

DESCRIPTION (Adapted from the Investigator's Abstract): Sedentary behavior is a major risk factor for coronary artery disease (CAD) progression in coronary artery bypass graft (CABG) patients post-discharge. However, existing interventions primarily target patients ready to increase habitual exercise, fail to assist remaining patients progress to the point of physical and psychological readiness, and may have limited accessibility, and high attrition rates. Therefore, a multidimensional, community based, nurse directed intervention model to increase habitual exercise and reduce sedentary behavior is necessary. The specific aims of this pilot study are to (a) determine whether a trend exists supporting the Sedentary Behavior Intervention Model's (SBIM) effectiveness in decreasing sedentary behavior by promoting habitual exercise by CABG patients and (b) identify the magnitude of subjects attrition, reasons for, and distribution of, attrition among study groups (SBIM-experimental, standard care-control), gender and minorities. Should pilot data support the SBIM s effectiveness, a larger sample clinical trial will be conducted to confirm the SBIM's effectiveness. Data about subject attrition will be used to develop mechanisms to reduce attrition and modify the sampling scheme, as necessary, in the projected clinical trial. The SBIM is adapted from Prochaska and DiClemente's Trans-Theoretical Model which conceptualizes the process of behavioral change. In the SBIM, each patient receives a multi-dimensional set of interventions specifically adapted to his/her readiness to change sedentary behavior and increase habitual exercise. Readiness, expressed as a "stage of change," is determined by the patient s current behavior and intended behavior within the next 6 months. SBIM interventions focus upon (a) modifying patient perceptions of the relative benefits to drawbacks of increasing habitual exercise, (b) maximizing the effectiveness of strategies identified by the patient as helping promote exercise, and (c)minimizing barriers and maximizing factors facilitating habitual exercise. The 100 subjects will be stratified with respect to prestudy left ventricular function, gender, and minority status, and their "stage of change" determined. They will then be randomly assigned to receive either the SBIM (i.e. experimental) or the standard care (i.e. control) intervention for a 9 month period. Interventions will be delivered by a trained team of experienced cardiac nurses in our master's or doctoral nursing programs. A repeated measures experimental design will be used. Outcome variables include energy expenditure, functional capacity, cardiac exercise self-efficacy, and stage of change. Hypotheses/research questions are (a) experimental subject will exhibit significantly greater pre- to post-intervention increases in outcome variables than control subjects and (b) a significant amount of the variance in outcome variables will be accounted for the variables of group, cardiac rehabilitation program participation and prestudy left ventricular function, and (c) how is attrition distributed in the total sample and with respect to group, gender, and minority status.

描述（改编自研究者摘要）：久坐行为 是冠状动脉疾病（CAD）进展的主要危险因素 冠状动脉搭桥术（CABG）患者出院后。 然而， 现有的干预措施主要针对准备好增加习惯的患者 锻炼，未能帮助其余患者进展到 身体和心理上的准备，并且可及性可能有限， 和高流失率。 因此，一个多维的、基于社区的、 护士指导的干预模型，以增加习惯性运动并减少 久坐的行为是必要的。 这项试点研究的具体目标是 (a) 确定是否存在支持久坐行为的趋势 干预模型 (SBIM) 在减少久坐行为方面的有效性 通过促进 CABG 患者进行习惯性锻炼，以及 (b) 确定 受试者流失的程度、流失的原因和分布 研究组之间（SBIM-实验、标准护理-控制）、性别和 少数民族。 如果试点数据支持 SBIM 的有效性，则需要更大的 将进行样本临床试验以确认SBIM的有效性。 有关受试者流失的数据将用于制定减少受试者流失的机制 并根据需要在预计的时间内修改抽样方案 临床试验。 SBIM 改编自 Prochaska 和 DiClemente 的 概念化行为过程的跨理论模型 改变。 在 SBIM 中，每个患者都会收到一组多维信息 专门针对他/她改变久坐习惯的意愿进行的干预措施 行为并增加习惯性锻炼。 准备状态，表示为“阶段” 的变化”由患者当前的行为和预期的行为决定 未来 6 个月内的行为。 SBIM 干预措施的重点是 (a) 改变患者对相对益处和缺点的看法 增加习惯性锻炼，(b) 最大限度地提高策略的有效性 患者认为有助于促进锻炼，以及 (c) 最大限度地减少 障碍和最大化促进习惯性锻炼的因素。 100 名 受试者将根据研究前的左心室情况进行分层 职能、性别和少数群体地位及其“变革阶段” 决定。 然后，他们将被随机分配接收 SBIM （即实验）或标准护理（即对照）干预 9 月期间。 干预措施将由训练有素的团队提供 我们的硕士或博士护理课程中有经验丰富的心脏护士。 一个 将使用重复测量实验设计。 结果变量 包括能量消耗、功能能力、心脏锻炼 自我效能感和变革阶段。 假设/研究问题是 (a) 实验对象将表现出明显更强的预 干预后结果变量比对照组有所增加 (b) 结果变量中的大量方差将 考虑组、心脏康复计划的变量 参与和预研究左心室功能，以及 (c) 情况如何 流失分布在总样本中，并按群体、性别、 和少数民族地位。