Factors associated with change in health‐related quality of life among individuals treated with long‐term mechanical ventilation,a 6‐year follow‐up study

Aims

To examine changes and explanatory variables for changes in health‐related quality of life in patients treated with long‐term mechanical ventilation over a 6‐year period.

Background

Long‐term mechanical ventilation is a treatment for individuals with chronic hypercapnic respiratory failure, primarily caused by neuromuscular diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and restrictive thoracic diseases. Studies on long‐term outcome on health‐related quality of life and factors influencing it are lacking.

Design

Prospective cohort study.

Methods

Data were collected from the Norwegian Long‐Term‐Mechanical‐Ventilation Registry and from patient‐reported questionnaire in 2008 and 2014. Health‐related quality of life was measured by the Severe Respiratory Insufficiency questionnaire, containing 49 items and seven subdomains. Linear mixed effects models were used to measure changes and identify factors for changes.

Results

After 6 years, 60 patients were still participating, out of 127 at baseline. Health‐related quality of life improved significantly in the total score and in four subdomains of the questionnaire. Satisfaction with training in long‐term mechanical ventilation was an explanatory variable for improved ‘psychological well‐being’ and follow‐up for improvement of ‘anxiety’. Side effects of the treatment like facial soreness were associated with the total score. High age and high forced vital capacity were related to lower ‘physical function’ and improved ‘social functioning’, respectively.

Conclusion

Long‐term mechanical ventilation over 6 years improved health‐related quality of life in most patients. Patient training, follow‐up and reduction of side effects, largely delivered by trained nurses, contribute to achieve the main goal of the treatment—improved health‐related quality of life.     

Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2‐year follow‐up

Rational, aims and objectives Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability. Method A computer‐based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4‐week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE‐AIM framework was applied to assess and compare outcome according to strategy. Results A more positive outcome regarding reach, effectiveness, adoption and implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible. Conclusion After 24 months, the most positive outcomes regarding all RE‐AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.     

The effect of reminiscence therapy on quality of life,attitudes to ageing,and depressive symptoms in institutionalized elderly adults with cognitive impairment: A quasi‐experimental study

The aim of this study was to analyse the effect of group narrative reminiscence therapy on cognition, quality of life, attitudes towards ageing, and depressive symptoms in a group of older adults with cognitive impairment in institutional care. A quasi‐experimental pretest/post‐test control group design was employed. Interventions involving reminiscence therapy with a narrative approach were included in the care plan and implemented in groups of between five and ten respondents once a week for 8 weeks (total 59 participants). The members of the control group (n = 57) received standard care. A study questionnaire was designed to measure demographic characteristics, quality of life (WOHQOL‐BREF, WHOQOL‐OLD), depressive symptoms (GDS), cognition (MMSE), and attitudes towards ageing (AAQ). Reminiscence therapy positively affected older adults’ quality of life (mostly the areas of mental health and social participation), and also their attitudes to ageing and old age. It reduced symptoms of depression, but had no discernible effect on cognitive function. Reminiscence therapy can positively affect selected aspects of quality of life, attitudes towards old age, and symptoms of depression in the elderly in long‐term healthcare facilities. Group reminiscence therapy can be used as a nursing intervention.     

Improving self‐care efficacy and quality of life with a self‐management program among patients with chronic obstructive pulmonary disease: A quasi‐experimental study

Self‐management helps patients understand their illnesses and learn about disease‐related skills so they can better manage their situation. However, published studies on the effectiveness of self‐management for chronic obstructive pulmonary disease (COPD) are heterogeneous. Quasi‐experimental design was used to investigate the effectiveness of a self‐management program in self‐care efficacy and quality of life in patients with COPD. Sixty participants who had experienced COPD were assigned to control group (usual care) or experimental group (self‐care program) (1:1 ratio) according to a purposeful sampling at a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale, the Clinical COPD Questionnaire were used to analyze data. The Medical Research Council dyspnea scale was more significant improvement in the 2 months after discharge in the experimental group than in the control group. The COPD Self‐Efficacy Scale and Clinical COPD Questionnaire scores in the experimental group within 3 months after discharge were significantly improved compared with the control group. These findings demonstrate the application and initial effect of this self‐management program.     

Development of a family-based pulmonary rehabilitation programme: an exploratory study

Abstract

Purpose: This study explored the expectations of patients with chronic obstructive pulmonary disease (COPD) and family members about a family-based pulmonary rehabilitation (PR) programme; developed and implemented a family-based PR programme and explored the impacts of the intervention on patients and family members. Method: Patients with COPD and family members were interviewed. A family-based PR programme was designed. Patients' breathlessness, muscle strength, exercise tolerance, functional balance and health-related quality of life were collected pre/post-programme. Family coping and adjustment to illness were measured in patients and family members. Focus groups were conducted after the programme. Results: Patients (n?=?35; 69?±?10 years; FEV₁ 62?±?15% predicted) and family members (n?=?35; 57?±?12 years) had similar expectations/needs about a PR programme. Nine dyads participated. Patients' quadriceps strength, exercise tolerance and functional balance improved significantly (all p values?<?0.023). Patients and family members seem to use more positive coping behaviours (p?=?0.026; p?=?0.011). Patients (n?=?7; 78%) and family members (n?=?8; 89%) considered having more knowledge about COPD and its management. Patients felt more functional (n?=?9; 100%) and reported their family members to be more active (n?=?3; 38%). In family members' perspective, their relationship with the care receiver was enhanced (n?=?2; 22%). Conclusions: PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

• Implications for Rehabilitation

• Patients with chronic obstructive pulmonary disease (COPD) and their family members have similar expectations and needs about a family-based pulmonary rehabilitation (PR) programme.

• A family-based PR programme is feasible to implement within primary care.

• PR programmes, if inclusive of family members, may enhance the skills of the whole family to manage COPD.

     

Cost‐effectiveness of a nurse‐led education and psychosocial programme for patients with chronic heart failure and their partners

Aims and objectives.  This randomised controlled trial was conducted to estimate the cost‐effectiveness of a nurse‐led education and psychosocial support programme for patients with heart failure (HF) and their partners. Background.  There are few studies evaluating cost‐effectiveness of interventions among HF patient–partner dyads. Methods.  Dyads randomised to the experimental group received nurse‐led counselling, computer‐based education and written materials aimed at developing problem‐solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost‐effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality‐adjusted life‐year (QALY) weights for patients and partners were estimated by SF‐6D. Results.  A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners. Conclusion.  The intervention was not proven cost‐effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost‐effectiveness ratio was achieved. Relevance to clinical practice.  The study shows trends of a cost‐effective education and psychosocial care of HF patient–partner dyads.     

Effect of an emotion management programme for patients with schizophrenia: A quasi‐experimental design

One of the goals of psychiatric social rehabilitation treatment is to improve patients’ emotion recognition, emotional expression, and empathetic abilities. In this study, we used a quasi‐experimental, nonrandomized design to examine the effect of an emotion management programme on the emotion recognition (emotion attention and emotion clarity), emotional expression (positive expressivity, negative expressivity, and impulse strength), and quality of life (QoL) of a sample of patients with schizophrenia in South Korea. Over eight sessions, we collected data from 56 patients with schizophrenia registered in community mental rehabilitation facilities. After attending the emotion management programme, the emotion recognition, emotional expression, and QoL scores of the experimental group were found to have significantly increased, whereas those of the control group had significantly decreased. Therefore, our findings show that emotion management programmes can be used as nursing interventions to improve the QoL of people with schizophrenia.     

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.