A community model of group rehabilitation for older patients with chronic heart failure: A pilot study

Purpose. The aim of this study was to develop and evaluate a community-based programme for heart failure patients, with emphasis on exercise and education.

Method. In a before-and-after trial, subjects with heart failure underwent a 12-week group programme comprising of exercise, education and mutual support. Outcome measures included subjects' compliance and views of the programme, knowledge related to disease management, physical parameters (symptoms, exercise tolerance, muscle strength) and psychosocial well-being (using generic and disease-specific tools). A focus group was held and participants' feedback noted.

Results. Overall patient compliance and satisfaction rate was high. Significant changes were observed in knowledge, physical performance and psychosocial parameters. Subjects' feedback following the programme was generally positive.

Conclusions. This pilot study shows that a group programme for heart failure patients is feasible, acceptable and improved physical status and quality of life. It can be a useful model in the management of chronic disease in the community.     

A community model of group therapy for the older patients with chronic obstructive pulmonary disease: a pilot study

OBJECTIVE: A community-based programme for chronic obstructive pulmonary disease (COPD) patients in group sessions is designed, and the feasibility, acceptability and physical and psychosocial outcomes evaluated. METHODS: Patients with COPD discharged from hospital, or those attending specialist outpatient clinic, with a history of hospital admission owing to COPD in the preceding 12 months were recruited. Those who had malignancy or were housebound were excluded. Group sessions were arranged once a week in a Community Centre, and consisted of two hourly sessions. The components of each session consist of education regarding the disease, breathing techniques, use of oxygen and other medication, smoking cessation, nutrition, dyspnoea management skills, relaxation and energy conservation techniques, introduction of social and community support, and strengthening as well as aerobic exercises. Assessments before and after intervention include lung function, 6 minutes walk test (6MWT), general Health Questionnaire (GHQ), the St. George's Respiratory Questionnaire (SGRQ), and a COPD knowledge Questionnaire. A programme evaluation was carried out using questionnaire and group discussions. RESULTS: Forty-four subjects were recruited, with 75% completing the programme, and 20% with drawing for unavoidable reasons. Statistically significant improvement was noted in all domains of the GHQ, SGRQ, and knowledge test, while the mean 6MWT improved, although statistical significance was not reached. Subjects were enthusiastic about the provision of this service in helping them cope with the disease through empowerment and mutual support. CONCLUSION: A group community intervention programme for COPD patients is feasible and acceptable, with positive psychosocial outcomes. Such a model could be further developed and cost-effectiveness evaluated as a model of chronic disease management in the community.     

A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure

Aims and objectives. To evaluate the effectiveness and cost‐effectiveness of a community nurse‐supported hospital discharge programme in preventing hospital re‐admissions, improving functional status and handicap of older patients with chronic heart failure. Design. Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re‐admission at six months. Secondary outcomes were number of unplanned re‐admissions, six‐minute walking distance, London Handicap Scale and public health care and personal care costs. Results. At sixth months, the re‐admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi‐square test). But the median number of re‐admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six‐minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion. Community nurse‐supported post‐discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re‐admissions. The cost benefits to public health care were not significant. Relevance to clinical practice. Older chronic heart failure patients are likely to benefit from post‐discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken.     

运动康复路径在老年慢性心力衰竭患者运动康复中的应用

目的探讨运动康复路径在老年慢性心力衰竭患者运动康复中的应用效果。方法采用随机数字表法,将100例老年慢性心力衰竭患者分为研究组和对照组,每组各50例,对照组实施常规护理,研究组采用运动康复路径对患者实施康复运动干预。观察患者各项心功能指标情况和再住院率。结果经过康复运动后,研究组患者左室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末容积(left ventricular volume index of diastolic end,LVEDV)、左心室收缩末容积(left ventricular endystolic volume,LVESV)均优于干预前和对照组;6min步行距离大于干预前和对照组;再住院率低于对照组(均P0.05)。结论实施运动康复路径可提高老年慢性心力衰竭患者康复运动的主动性和积极性,进而有效改善老年慢性心力衰竭患者的心功能,提高患者运动耐力,降低再住院率,促进患者康复。     

跨理论模型在住院慢性心力衰竭患者运动康复训练中的应用

摘要 目的：探讨基于跨理论模型的干预方法在住院慢性心力衰竭患者运动康复训练中的效果。 方法：抽取住院治疗4周的心衰患者120例为研究对象,并将其随机分为干预组（60例）和对照组（60例）。干预组在常规治疗、护理及康复训练教育的基础上,接受基于跨理论模型的干预措施,对照组给予常规治疗、护理及康复训练教育。运动康复训练4周后,比较两组患者运动康复训练的行为变化、生存质量得分、6MWT、慢性心力衰竭康复训练知识的掌握情况。 结果：干预前两组运动康复训练的行为变化阶段、生存质量得分、6MWT,差异无显著性意义（P>0.05）。运动康复训练4周后干预组运动康复训练的行为变化趋势（P<0.001）、生存质量得分（25.82±9.82）、6MWT（450.93±74.27m）,均优于对照组,两组比较差异有显著性意义（χ2=21.94,t=5.059,-4.626,P<0.01）;与各组干预前比较,差异有显著性意义（P<0.05）。干预后两组康复训练知识得分比较,差异有显著性意义（P<0.01）。 结论：基于跨理论模型的干预方法能促进住院慢性心力衰竭患者运动康复训练的行为变化、提高患者对康复训练知识的掌握程度、增加患者康复训练的6MWT并提高其生存质量。     

运动康复训练在慢性心衰患者中的康复效果

目的：探讨以有氧运动为主的运动康复在慢性心力衰竭患者中的应用效果。方法：选择2018年2月至11月诊治的120例慢性心力衰竭患者，随机分成康复训练组、体外反搏组与单纯药物治疗组，每组40例。单纯药物治疗组患者仅接受药物治疗；体外反搏组患者在药物治疗的基础上接受体外反搏治疗；康复训练组患者在药物治疗的基础上接受心脏康复训练。治疗3个月后，比较3组患者的左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)；检测3组血浆氨基末端脑钠肽前体(NT-proBNP)水平；评估3组患者的明尼苏达心力衰竭生活质量问卷；评估3组患者的疗效。结果：治疗后，康复训练组患者的LVEF高于其他2组患者(P<0.01)，LVEDD及LVESD均低于其他2组患者(P<0.01)。康复训练组患者的NT-proBNP水平及明尼苏达量表得分均低于其他2组患者(P<0.01)。康复训练组患者的总有效率(97.5%)高于体外反搏组(82.5%)及单纯药物治疗组(77.5%)患者(P<0.05)。结论：心脏康复训练治疗方案在慢性心力衰竭患者中应用效果较好，有助于恢复患者正常的心肌功能，减少患者的症状，提高生活质量，促进患者康复。     

家庭自我管理监测表在慢性心力衰竭患者家庭康复中的应用效果

目的探讨家庭自我管理监测表在慢性心力衰竭患者家庭康复中的应用效果。方法将150例慢性心力衰竭患者按随机数字表分为观察组75例和对照组75例,两组患者在院期间均接受早期心脏康复,对照组出院前进行常规健康教育,出院后通过电话、微信随访;观察组在对照组基础上,利用家庭自我管理监测表对患者的家庭康复进行干预。干预半年后,比较两组患者的6 min步行距离、家庭康复依从性与自我护理能力。结果出院时两组患者的自我护理能力比较,差异无统计学意义(P0.05);出院后半年,观察组患者的自我护理能力与家庭康复依从性高于对照组,6 min步行距离长于对照组,均P0.05,差异具有统计学意义。结论家庭自我管理监测表的使用有利于促进慢性心力衰竭居家患者的心脏康复。     

The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi‐experimental study

Patients with heart failure (HF) live with a serious disease, and need long‐term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the European Society of Cardiology and focuses on self‐care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi‐experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form‐36. One hundred sixty‐two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.     

Effect of home-based rehabilitation on activities of daily living and gait in older adults with heart failure at risk for falling: A retrospective cohort study

Purpose: The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure. Methods: A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C). Change in total ADL score was described and adjusted for significant baseline factors/covariates using a generalized linear model. Factors predictive of exceeding the ADL score Minimal Detectable Change (MDC) were identified with multiple variable logistic regression. Results: Mean change in total ADL score from admission to discharge was 1.6 ± 1.2, the mean change for gait speed was 0.17 ± 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by 57% of subjects. Improvement in mean ADL score was significantly predicted by age, baseline total ADL score, baseline gait speed score, cognitive-behavioral status, and living situation (R² = 42%). Conclusions: Patients with heart failure receiving home-based rehabilitation services make significant improvements in ADL function and gait performance. Greater ADL improvements are associated with younger age, faster gait speed at baseline, and greater impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite score are significantly related to making a change beyond measurement error in ADL change score.     

运动康复在慢性心力衰竭治疗中的病理生理机制

心力衰竭是多种心血管疾病终末期的共同结局,给个人、社会造成巨大负担。运动康复通过多种途径延缓疾病进展,减少心血管病危险因素,改善患者的生存质量。该文主要介绍运动康复在慢性心力衰竭患者治疗中的病理生理机制。     

自我管理小组在抑郁症患者社区康复护理中的应用效果评价

目的观察自我管理小组在抑郁症患者社区康复护理中的应用效果。方法将80例在社区门诊的缓解期抑郁症患者按建档时档案的单双号分为两组,每组40例。对照组患者实施常规康复护理,观察组患者实施以自我管理小组为基础的康复护理。干预2年后,采用汉密尔顿抑郁量表和患者抑郁症健康行为调查表及疗效比较干预效果。结果干预后,观察组和对照组汉密尔顿抑郁量表评分分别为(17.6±6.5)分和(25.5±3.7)分;干预后,观察组和对照组显效率分别为65.0%和37.5%(x~2=6.054,P=0.014);观察组患者干预后健康行为中遵医服药情况、体育锻炼情况、心情、膳食情况均优于对照组。结论应用自我管理小组模式的康复护理能改善抑郁症患者的症状,有效促进其健康行为的养成。     

社区慢性心力衰竭病人家庭照顾者心力衰竭知识水平现状调查

[目的]了解社区慢性心力衰竭病人家庭照顾者心力衰竭知识水平及其影响因素。[方法]采用一般资料调查表和亚特兰大心力衰竭知识问卷对155例社区慢性心力衰竭病人家庭照顾者进行调查。[结果]社区慢性心力衰竭病人家庭照顾者的心力衰竭知识得分为17.66分±3.98分;得分低水平者(答对率低于60%)占43.9%;照顾者答对率后5个条目为低盐饮食的标准、液体摄入量的控制方法、身体疼痛时非处方药的选择、接种流感、肺炎疫苗以及监测体重的频率;不同文化程度的照顾者其心力衰竭知识得分差异有统计学意义(P<0.05),文化程度越低者相关知识得分越低。[结论]社区慢性心力衰竭病人家庭照顾者的心力衰竭知识水平处于低水平,医护人员进行健康教育时,应注意评估教育对象的接受能力并采取个体化、持续性的健康教育,以提高其相关知识水平。     

心脏康复模式对慢性心力衰竭患者心肺储备功能、生活质量及NT-proBNP水平的影响

目的探讨应用心脏康复模式对慢性心力衰竭患者心肺储备功能、生活质量及血清标志物N末端脑钠肽前体(NTproBNP)水平的影响。方法选取2013年4月至2015年4月该院心内科诊治的98例慢性心力衰竭患者为研究对象,按随机数字表法将患者分为对照组和心脏康复组,每组各49例。对照组患者予以常规慢性心力衰竭治疗与护理,康复组则在此基础之上分别予以强化心脏康复模式的干预方案,比较两组患者心肺储备功能、生活质量和NT-proBNP水平的变化。结果干预后,康复组患者心力衰竭相关知识的掌握率、去除高危因素重要性的知晓率较干预前显著提高(P0.05),对照组与干预前比较差异无统计学意义(P0.05);且康复组患者心力衰竭发生次数和间隔时间均显著优于对照组(P0.05),但两组患者并发症的发生率比较,差异无统计学意义(P0.05);干预后两组患者的生活质量评分均显著升高,且康复组患者生活质量各项指标得分值的增加幅度显著优于对照组(P0.05);康复组心肺功能指标左心室收缩期末容量(LVESV)、左心室舒张期末容量(LVEDV)、左心室射血分数(LVEF)和最大通气量(MVV)均较干预前明显增加,且4项指标的改善水平均显著高于对照组(P0.05);而其他指标干预前后差异无统计学意义(P0.05);另外,干预后两组患者NT-proBNP水平均显著下降,且康复组的降低幅度较对照组更为明显(P0.05)。结论心脏康复模式可明显提高慢性心力衰竭患者对疾病相关知识的掌握,降低复发率,延长间隔时间,提高生活质量,改善患者的心肺储备功能和NT-proBNP水平。     

Pilot study of an exercise intervention suitable for older heart failure patients with left ventricular systolic dysfunction

Background

Most studies of exercise training for heart failure have been conducted on relatively young patients with little comorbidity. Such programmes are unsuitable for the majority of older frail heart failure patients.

Aims

To test the acceptability and tolerability of an outpatient exercise programme in older heart failure patients with comorbid disease.

Methods

17 patients aged 70 years and over with left ventricular systolic dysfunction attended twice weekly group exercise classes for 12 weeks, focussing on endurance exercise and everyday functional tasks. Outcome measures were proportion of sessions attended; adverse events and reasons for non-attendance; six-minute walk, accelerometry, hospital depression and anxiety score, Guyatt quality of life scale, carer strain and satisfaction scores.

Results

83% of sessions were attended; 80% of subjects attended at least 80% of allocated sessions. One adverse incident occurred in 324 person-sessions. Encouraging improvements were seen in six minute walk test (+ 19 m, p = 0.14) and in Functional Limitation Profile score (− 82 points, p = 0.02). 50% of informal carers attended at least one session. No increase in carer strain was noted.

Conclusions

Twice-weekly group exercise focussing on aerobic endurance and everyday functional tasks was acceptable and well-tolerated in this patient group.     

Effects of cardiac rehabilitation with motion assistance from a wearable cyborg hybrid assistive limb on patients with chronic heart failure: a randomized controlled trial with a one-year follow-up

[Purpose] We have recently reported that using a wearable cyborg hybrid assistive limb improved the isometric knee extensor muscle strength of patients with chronic heart failure. Here, we investigated the long-term effects of a lumbar-type hybrid assistive limb for patients with chronic heart failure. [Participants and Methods] A total of 28 hospitalized patients with chronic heart failure (mean age, 73.1 ± 13.8 years) were randomly assigned to two groups: the hybrid assistive limb group or the control group, in which they performed a sit-to-stand exercise with or without the hybrid assistive limb, respectively. The cardiac rehabilitation therapy included this intervention, which was performed as many times as possible for 5–30 minutes per day for 6–10 days. Clinical assessments like lower-limb muscle strength, walking ability, etc., were measured before and after the intervention. Cardiac events were followed up for up to a year after discharge. [Results] No adverse events occurred during the study period in either group. In terms of long-term effects, the incidence of cardiac events was 23% and 45% in the hybrid assistive limb and the control groups, respectively. [Conclusion] Hybrid assistive limb-assisted exercise therapy may be a safe and feasible cardiac rehabilitation tool in patients with chronic heart failure. The lumbar-type wearable cyborg hybrid assistive limb may have a positive effect on heart failure prognosis by adding long-term exercise therapy.     

全责护理模式在慢性心力衰竭患者康复训练中的应用效果

目的观察全责护理模式在慢性心力衰竭患者康复训练中的应用效果。方法采用随机数字表法将86例患者随机分为观察组（n=43）和对照组（n=43）;16名护士分为A、B两组,A组实行全责护理模式,B组实行责任制和功能制相结合的护理模式;观察组由A组护士负责康复训练4周,对照组由B组护士负责康复训练4周。比较两组患者人院时和出院时的射血分数（EF）、6rain步行试验的距离（6MWT）和出院时患者对康复训练知识的知晓率和满意度得分之间的差异。结果入院时两组EF、6MWT比较,差异无统计学意义（t值分别为1．598,1．523;P均〉0．05）。出院时观察组EF（54．13±9．12）、6MWF（402．63±74．81）,均高于对照组EF（43．26±8．57）、6MWT（336．16±75．82）,两组比较差异有统计学意义（t值分别为2．093,2．145;P均〈0．05）;各组EF、6MWT出院与入院时比较,差异有统计学意义（t值分别为2．681,2．010,2．791,2．185;P均．〈0．01）。出院时两组患者满意度得分比较,差异有统计学意义（t=2．145,P〈0．05）。结论全责护理模式用于慢性心力衰竭患者的康复训练中可取得显著效果。     

规范康复随访流程在出院慢性心力衰竭患者心脏康复随访中的应用效果研究

目的探讨规范康复随访流程在出院慢性心力衰竭患者心脏康复随访中的应用效果。方法将102例出院慢性心力衰竭患者分为对照组与干预组,对照组出院时接受常规康复指导和出院后随访,干预组采用依据临床护理路径管理模式制订的随访手册进行干预。两组患者分别于干预前、干预后第6周、第12周、第24周采用慢性病自我效能量表和心力衰竭生活质量量表进行调查。结果干预组的自我效能和生活质量得分均高于对照组(P0.01),且随着时间的延长均呈逐步升高趋势(P0.01)。结论应用规范康复随访流程对出院慢性心力衰竭患者进行心脏康复随访,可提升患者依从性,明显提高自我效能,改善生活质量。     

运动疗法对老年慢性充血性心力衰竭患者的治疗效果

目的　观察运动疗法对老年慢性充血性心力衰竭患者的治疗效果。方法慢性心衰患者106例,分为运动治疗组(54例)和对照组(52例),综合观察患者运动前后的有关指标,并评价运动能力和生存质量。结果　动疗法可促进临床表现的好转,增强患者的运动能力,明显提高患者的生存质量;检测血浆心钠素、内皮素可作为运动观察的可靠指标。结论　动疗法对老年慢性充血性心力衰竭患者安全有效。     

慢性心力衰竭患者吸气肌训练的研究进展

文章对吸气肌训练的应用机制、适应证和禁忌证进行了概述,综述了慢性心力衰竭患者吸气肌训练的实施要素、方法、频率、周期及强度,探讨了吸气肌训练及其联合其他训练对慢性心力衰竭患者的影响,并对未来该领域的研究和临床实践提出了建议。