University of Nebraska Medical Center, College of Nursing-Lincoln Division, Lincoln, Nebraska, USA.
Heart Lung. 2009 Nov-Dec;38(6):459-68. doi: 10.1016/j.hrtlng.2009.01.010. Epub 2009 Apr 2.
Older adults with poor functioning preoperatively are at risk for delayed recovery and more impaired outcomes after coronary artery bypass surgery (CABS). The study objective was to determine whether a 6-week early recovery telehealth intervention, designed to improve self-efficacy and management related to symptoms after CABS, was effective in improving outcomes (physical activity, physiologic, and psychologic functioning) for older adults (aged > 65 years) with higher disease burden.
A descriptive, repeated-measures experimental design was used. Follow-up data were collected at 3 and 6 weeks and 3 months after CABS. Subjects were drawn from a larger randomized clinical trial. Parent study subjects who had high disease burden preoperatively (physical component score of < 50 on the Medical Outcome Study Short Form-36 and RISKO score of > 6) were included (N = 55), with 23 subjects in the early recovery intervention group and 31 subjects in the usual care group (n = 31). Subjects ranged in age from 65 to 85 years (M = 71.6 + 5.1 years).
There was a significant main effect by group (F[1,209] = 4.66, P < .05). The intervention group had a least square means of 27.9 kcal/kg/d of energy expenditure compared with the usual care group of 26.6 kcal/kg/d per the RT3 accelerometer (Stayhealthy, Inc, Monrovia, CA). Both groups had significantly improved physical (F[2,171] = 3.26, P < .05) and role-physical (F[2,171] = 6.64, P < .005) functioning over time.
The subgroup of subjects undergoing CABS with high disease burden were responsive to an early recovery telehealth intervention. Improving patients' physical activity and functioning can reduce morbidity and mortality associated with poor functioning after cardiac events.
术前功能较差的老年患者在冠状动脉旁路移植手术后（CABS）恢复缓慢，结局受损的风险更高。本研究旨在确定一种为期 6 周的早期康复远程医疗干预措施是否有效，该措施旨在提高 CABS 后与症状相关的自我效能和管理，从而改善疾病负担较高的老年患者（>65 岁）的结局（身体活动、生理和心理功能）。
采用描述性、重复测量实验设计。在 CABS 后 3、6 周和 3 个月收集随访数据。研究对象来自更大的随机临床试验。包括术前疾病负担较高的主要研究对象（医疗结局研究简表-36 物理成分评分<50 和 RISKO 评分>6）（N=55），其中早期康复干预组 23 例，常规护理组 31 例（n=31）。研究对象年龄 65 岁至 85 岁（M=71.6+5.1 岁）。
组间存在显著的主效应（F[1,209]=4.66，P<.05）。与常规护理组相比，干预组的能量消耗（RT3 加速度计）的最小二乘均数为 27.9 kcal/kg/d，而常规护理组为 26.6 kcal/kg/d（Stayhealthy，Inc，Monrovia，CA）。两组的身体功能（F[2,171]=3.26，P<.05）和角色身体功能（F[2,171]=6.64，P<.005）均随时间显著改善。
高疾病负担的 CABS 患者对早期康复远程医疗干预有反应。提高患者的身体活动和功能可以降低与心脏事件后功能不良相关的发病率和死亡率。
