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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
The effect of problem-based learning after coronary heart disease - a randomised study in primary health care
Anita Kärner Köhler1, Tiny Jaarsma2, Pia Tingström2
1Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden. anita.karner@liu.se.
Insights
Problem-based learning (PBL) in cardiac rehabilitation did not improve patient empowerment or self-efficacy compared to standard information. However, PBL positively impacted weight, BMI, and HDL cholesterol, suggesting benefits for managing CHD risk factors.
Area of Science:
- Cardiology
- Medical Education
- Public Health
Background:
- Cardiac rehabilitation (CR) is crucial for coronary heart disease (CHD) patients, yet residual risk factors and fear of recurrence persist.
- Problem-based learning (PBL) offers a self-directed, group-based approach for managing CHD risk factors and enhancing self-care.
- This study evaluated PBL's effectiveness against standard patient information in improving long-term patient empowerment and self-care post-CHD.
Purpose of the Study:
- To compare the effectiveness of one year of problem-based learning (PBL) versus standardized home-sent patient information in improving patient empowerment and self-efficacy for self-care in CHD patients.
- To assess the long-term impact of PBL on CHD risk factors, including body mass index (BMI), body weight, and HDL cholesterol levels.
Main Methods:
- A randomized controlled trial involving 157 CHD patients (post-PCI or CABG) in Sweden (2011-2015).
- Participants were assigned to either a PBL group (n=79) receiving nurse-tutored group education over one year or a control group (n=78) receiving home-sent information.
- Outcomes, including patient empowerment, self-efficacy, BMI, body weight, and HDL cholesterol, were assessed at one-year follow-up.
Main Results:
- No significant differences were found in patient empowerment or self-efficacy between the PBL and control groups at one-year follow-up.
- The PBL group showed significant improvements in reducing body mass index (BMI) and body weight compared to the control group.
- The PBL group also demonstrated a significant increase in HDL cholesterol levels compared to controls.
Conclusions:
- While PBL did not significantly enhance patient empowerment or self-efficacy over standard information, it positively influenced key CHD risk factors.
- PBL interventions demonstrated a beneficial effect on weight management (BMI, body weight) and lipid profiles (HDL cholesterol).
- These findings suggest PBL may be a valuable adjunct to standard care for improving metabolic risk factors in patients recovering from coronary heart disease.
Background:
Cardiac rehabilitation is effective after coronary heart disease (CHD). However, risk factors remain, and patients report fear for recurrence during recovery. Problem-based learning is a pedagogical method, where patients work self-directed in small groups with problem solving of real-life situations to manage CHD risk factors and self-care. We aimed to demonstrate the better effectiveness of problem-based learning over home-sent patient information for evaluating long-term effects of patient empowerment and self-care in patients with CHD. Hypothesis tested: One year of problem-based learning improves patients' empowerment- and self-efficacy, to change self-care compared to 1 year of standardised home-sent patient information after CHD.
Methods:
Patients (N = 157) from rural and urban areas in Sweden between 2011 and 2015 (78% male; age. 68 ± 8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) were randomly assigned to problem-based learning (experimental group; n = 79) or home-sent patient information (controls; n = 78). The problem-based learning intervention consisted of patient education in primary care by nurses tutoring groups of 6-9 patients on 13 occasions over 1 year. Controls received home-sent patient information on 11 occasions during the study year.
Results:
At one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [- 0.17 (SD 1.5) vs. 0.50 (SD 1.6), P = 0.033], body weight [- 0.83 (SD) 4.45 vs. 1.14 kg (SD 4.85), P = 0.026] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P = 0.038] favouring the experimental group compared to controls.
Conclusions:
The problem-based learning- and the home-sent patient information interventions had similar results regarding patient empowerment, self-efficacy, and well-being. However, problem-based learning exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that this intervention positively affected risk factors compared to the home-sent patient information.
Trial Registration:
NCT01462799 (February 2020).
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