Krannich J-H, Weyers P, Lueger S, Faller H, Schimmer C, Deeg P, Elert O, Leyh R
Klinik und Poliklinik für Herz- und Thoraxchirurgie, Universitätsklinikum Würzburg, Zentrum Operative Medizin, Würzburg.
Rehabilitation (Stuttg). 2008 Aug;47(4):219-25. doi: 10.1055/s-2007-1004598.
An important rehabilitation aim following coronary artery bypass graft (CABG) surgery is to modify cardiovascular risk factors positively. Among the most potent possibilities for improvement of these factors is a lifestyle change in terms of increasing sports exercise, changing diet patterns, stress reduction, etc. An indispensable condition for these changes is the motivation to implement the necessary changes. In our working group a patient education programme was developed aimed at enhancing the motivation for lifestyle change, which was already applied in a cardiac surgery hospital. In evaluating the programme, we could observe that various cognitive factors of motivation for lifestyle change had dropped in untreated patients and risen in patients participating in the programme. Based on these preliminary findings we examined the motivation for lifestyle change one year after CABG surgery.
Each patient was evaluated for his/her value in motivation for lifestyle change using a 30-item questionnaire which measures the six factors Vulnerability, Intention, Social Expectations, Outcome Expectation, Self-Efficacy Expectation, and Perceived Severity two days before CABG surgery as well as ten days and one year after CABG surgery. Between January and May 2002 patients in usual care were investigated as control group (n=70). From January to May 2003, n=70 patients had the opportunity to take part in a comprehensive patient education programme that was provided by a specifically trained psychologist. Data from 108 patients could be evaluated one year after CABG surgery (response rate=77.1%). The programme had comprised individualized units, as well as a group lecture. If partners were available they were included in the process.
One year after CABG surgery no significant differences between the control group and the intervention group could be found.
The positive effects of the patient education programme measured ten days after surgery were found to have vanished one year after the operation. A possible reason is the short duration of the programme. Long-term, structured aftercare programmes should help stabilize the positive effects obtained in the short term.
冠状动脉旁路移植术（CABG）后一项重要的康复目标是积极改善心血管危险因素。改善这些因素最有效的方法之一是改变生活方式，如增加体育锻炼、改变饮食模式、减轻压力等。实现这些改变的一个不可或缺的条件是实施必要改变的动力。在我们的工作组中，开发了一个患者教育项目，旨在增强改变生活方式的动力，该项目已在一家心脏外科医院应用。在评估该项目时，我们观察到，未经治疗的患者中，改变生活方式的各种动机认知因素有所下降，而参与该项目的患者中这些因素有所上升。基于这些初步发现，我们在冠状动脉旁路移植术后一年对改变生活方式的动机进行了研究。
在冠状动脉旁路移植术（CABG）手术前两天以及手术后十天和一年，使用一份30项问卷对每位患者改变生活方式的动机价值进行评估，该问卷测量六个因素：易感性、意图、社会期望、结果期望、自我效能期望和感知严重性。2002年1月至5月，对常规护理的患者作为对照组进行调查（n = 70）。2003年1月至5月，n = 70名患者有机会参加由一名经过专门培训的心理学家提供的全面患者教育项目。冠状动脉旁路移植术后一年，对108名患者的数据进行了评估（回复率 = 77.1%）。该项目包括个性化单元以及小组讲座。如果有伴侣，他们也会参与其中。
冠状动脉旁路移植术后一年，对照组和干预组之间未发现显著差异。
术后十天所测量的患者教育项目的积极效果在术后一年消失。一个可能的原因是该项目持续时间较短。长期、结构化的术后护理项目应有助于稳定短期内获得的积极效果。
