Clinical Effects and Implications of Cardiac Rehabilitation for Implantable Cardioverter Defibrillator Patients: A Mixed-Methods Approach Embedding Data From the Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator Randomized Clinical Trial With Qualitative Data

Selina Kikkenborg Berg, Philip Moons, Anne Vingaard Christensen, Ann-Dorthe Zwisler, Birthe D Pedersen, Preben Ulrich Pedersen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND:: The Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator trial was a randomized clinical trial that compared a complex rehabilitation intervention including exercise training and psychoeducational interventions with usual care. A significant difference between rehabilitation and usual care was found in physical capacity and general and mental health. However, the clinical effect sizes of these findings were not investigated, and the findings from the quantitative and qualitative analyses were not triangulated to address the issue of whether the qualitative results could help explain the quantitative results and bring forward additional information.

OBJECTIVES:: The objectives are to (a) determine the clinical effect sizes of the primary outcomes and (b) triangulate the quantitative and qualitative findings.

METHODS:: A total of 196 patients with first-time implantable cardioverter defibrillator implantation were randomized (1:1) to comprehensive cardiac rehabilitation (12 weeks of exercise training and 1 year of psychoeducational follow-up) versus treatment as usual. Two primary outcomes, perceived health (Short Form-36) and peak oxygen uptake, were used. Cohen d was calculated. Qualitative interviews were conducted with 10 patients representing the rehabilitation group. Triangulation was carried out by integrating the findings from the quantitative and qualitative results in light of each other.

RESULTS:: Clinically meaningful effects were found between groups in peak oxygen uptake, general health, and mental health in favor of the rehabilitation group. Within groups, we found medium/high effect sizes on the mental component score in the rehabilitation group over time and only a small effect in the usual care group. The mechanisms of these effects were further explained by the qualitative findings. Patients with better physical health learned how to interpret body signals and adjust exercise behavior and experienced increased physical capacity. Those with better mental health received support that assisted them to cope with the possibility of shock and death and regain trust in their bodies.

CONCLUSION:: The program has a clinical effect and is perceived as beneficial through supportive coping.

OriginalsprogEngelsk
TidsskriftJournal of Cardiovascular Nursing
Vol/bind30
Udgave nummer5
Sider (fra-til)420-427
ISSN0889-4655
DOI
StatusUdgivet - 2015

Fingeraftryk

Implantable Defibrillators
Outpatients
Randomized Controlled Trials
Mental Health
Exercise
Health
Oxygen
Cardiac Rehabilitation
Interviews

Citer dette

@article{aca0465d9f2d488097427f2335649157,
title = "Clinical Effects and Implications of Cardiac Rehabilitation for Implantable Cardioverter Defibrillator Patients: A Mixed-Methods Approach Embedding Data From the Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator Randomized Clinical Trial With Qualitative Data",
abstract = "BACKGROUND:: The Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator trial was a randomized clinical trial that compared a complex rehabilitation intervention including exercise training and psychoeducational interventions with usual care. A significant difference between rehabilitation and usual care was found in physical capacity and general and mental health. However, the clinical effect sizes of these findings were not investigated, and the findings from the quantitative and qualitative analyses were not triangulated to address the issue of whether the qualitative results could help explain the quantitative results and bring forward additional information.OBJECTIVES:: The objectives are to (a) determine the clinical effect sizes of the primary outcomes and (b) triangulate the quantitative and qualitative findings.METHODS:: A total of 196 patients with first-time implantable cardioverter defibrillator implantation were randomized (1:1) to comprehensive cardiac rehabilitation (12 weeks of exercise training and 1 year of psychoeducational follow-up) versus treatment as usual. Two primary outcomes, perceived health (Short Form-36) and peak oxygen uptake, were used. Cohen d was calculated. Qualitative interviews were conducted with 10 patients representing the rehabilitation group. Triangulation was carried out by integrating the findings from the quantitative and qualitative results in light of each other.RESULTS:: Clinically meaningful effects were found between groups in peak oxygen uptake, general health, and mental health in favor of the rehabilitation group. Within groups, we found medium/high effect sizes on the mental component score in the rehabilitation group over time and only a small effect in the usual care group. The mechanisms of these effects were further explained by the qualitative findings. Patients with better physical health learned how to interpret body signals and adjust exercise behavior and experienced increased physical capacity. Those with better mental health received support that assisted them to cope with the possibility of shock and death and regain trust in their bodies.CONCLUSION:: The program has a clinical effect and is perceived as beneficial through supportive coping.",
author = "{Kikkenborg Berg}, Selina and Philip Moons and Christensen, {Anne Vingaard} and Ann-Dorthe Zwisler and Pedersen, {Birthe D} and Pedersen, {Preben Ulrich}",
year = "2015",
doi = "10.1097/JCN.0000000000000179",
language = "English",
volume = "30",
pages = "420--427",
journal = "Journal of Cardiovascular Nursing",
issn = "0889-4655",
publisher = "Lippincott Williams & Wilkins",
number = "5",

}

TY - JOUR

T1 - Clinical Effects and Implications of Cardiac Rehabilitation for Implantable Cardioverter Defibrillator Patients

T2 - A Mixed-Methods Approach Embedding Data From the Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator Randomized Clinical Trial With Qualitative Data

AU - Kikkenborg Berg, Selina

AU - Moons, Philip

AU - Christensen, Anne Vingaard

AU - Zwisler, Ann-Dorthe

AU - Pedersen, Birthe D

AU - Pedersen, Preben Ulrich

PY - 2015

Y1 - 2015

N2 - BACKGROUND:: The Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator trial was a randomized clinical trial that compared a complex rehabilitation intervention including exercise training and psychoeducational interventions with usual care. A significant difference between rehabilitation and usual care was found in physical capacity and general and mental health. However, the clinical effect sizes of these findings were not investigated, and the findings from the quantitative and qualitative analyses were not triangulated to address the issue of whether the qualitative results could help explain the quantitative results and bring forward additional information.OBJECTIVES:: The objectives are to (a) determine the clinical effect sizes of the primary outcomes and (b) triangulate the quantitative and qualitative findings.METHODS:: A total of 196 patients with first-time implantable cardioverter defibrillator implantation were randomized (1:1) to comprehensive cardiac rehabilitation (12 weeks of exercise training and 1 year of psychoeducational follow-up) versus treatment as usual. Two primary outcomes, perceived health (Short Form-36) and peak oxygen uptake, were used. Cohen d was calculated. Qualitative interviews were conducted with 10 patients representing the rehabilitation group. Triangulation was carried out by integrating the findings from the quantitative and qualitative results in light of each other.RESULTS:: Clinically meaningful effects were found between groups in peak oxygen uptake, general health, and mental health in favor of the rehabilitation group. Within groups, we found medium/high effect sizes on the mental component score in the rehabilitation group over time and only a small effect in the usual care group. The mechanisms of these effects were further explained by the qualitative findings. Patients with better physical health learned how to interpret body signals and adjust exercise behavior and experienced increased physical capacity. Those with better mental health received support that assisted them to cope with the possibility of shock and death and regain trust in their bodies.CONCLUSION:: The program has a clinical effect and is perceived as beneficial through supportive coping.

AB - BACKGROUND:: The Copenhagen Outpatient ProgrammE-Implantable Cardioverter Defibrillator trial was a randomized clinical trial that compared a complex rehabilitation intervention including exercise training and psychoeducational interventions with usual care. A significant difference between rehabilitation and usual care was found in physical capacity and general and mental health. However, the clinical effect sizes of these findings were not investigated, and the findings from the quantitative and qualitative analyses were not triangulated to address the issue of whether the qualitative results could help explain the quantitative results and bring forward additional information.OBJECTIVES:: The objectives are to (a) determine the clinical effect sizes of the primary outcomes and (b) triangulate the quantitative and qualitative findings.METHODS:: A total of 196 patients with first-time implantable cardioverter defibrillator implantation were randomized (1:1) to comprehensive cardiac rehabilitation (12 weeks of exercise training and 1 year of psychoeducational follow-up) versus treatment as usual. Two primary outcomes, perceived health (Short Form-36) and peak oxygen uptake, were used. Cohen d was calculated. Qualitative interviews were conducted with 10 patients representing the rehabilitation group. Triangulation was carried out by integrating the findings from the quantitative and qualitative results in light of each other.RESULTS:: Clinically meaningful effects were found between groups in peak oxygen uptake, general health, and mental health in favor of the rehabilitation group. Within groups, we found medium/high effect sizes on the mental component score in the rehabilitation group over time and only a small effect in the usual care group. The mechanisms of these effects were further explained by the qualitative findings. Patients with better physical health learned how to interpret body signals and adjust exercise behavior and experienced increased physical capacity. Those with better mental health received support that assisted them to cope with the possibility of shock and death and regain trust in their bodies.CONCLUSION:: The program has a clinical effect and is perceived as beneficial through supportive coping.

U2 - 10.1097/JCN.0000000000000179

DO - 10.1097/JCN.0000000000000179

M3 - Journal article

C2 - 25055078

VL - 30

SP - 420

EP - 427

JO - Journal of Cardiovascular Nursing

JF - Journal of Cardiovascular Nursing

SN - 0889-4655

IS - 5

ER -