Reese C, Spieser A, Mittag O
Universitätsklinikum Freiburg, Abteilung Qualitätsmanagement und Sozialmedizin, Freiburg, Germany.
Rehabilitation (Stuttg). 2012 Dec;51(6):405-14. doi: 10.1055/s-0031-1295446. Epub 2012 Jun 6.
To summarize national and international evidence and recommendations for psychological interventions in the rehabilitation of patients with coronary heart disease. Background is a project for the development of evidence-based practice guidelines for psychological interventions in the rehabilitation of patients with coronary heart disease.
A systematic literature search in several databases and on the websites of professional associations was conducted in order to identify relevant reviews and guidelines. A handsearch was conducted in addition to the electronic search. Eligible publications were selected, and evidence for psychological interventions was extracted as well as recommendations relative to psychological diagnostics or interventions.
5 systematic reviews and 34 guidelines were included. Recommendations and (partially restricted) evidence from systematic reviews was found for the following psychological interventions: patient counselling and health education; screening and treatment of comorbid psychological disorders; occupational counselling; stress management; relaxation training; interventions for smoking cessation; interventions promoting appropriate nutrition and weight management; interventions enhancing sufficient, regular physical activity; interventions enhancing social support; specific interventions for women; involvement of family members or partners; discussion of sexual activity.
DISCUSSION/CONCLUSION: For several psychological interventions in the treatment of patients with coronary heart disease we found empirical evidence from systematic reviews. For other psychological interventions, no empirical evidence from systematic reviews was found. The summary of guidelines shows that both in Germany and abroad, a number of psychologically grounded interventions are an inherent part of cardiac rehabilitation. However, many recommendations which refer to psychological diagnostics and interventions are not precise enough to guide psychological care of individual patients. In particular, there are no statements in many guidelines on which (psychological) treatments should be considered for which problems. Moreover, hardly any evidence or recommendations were found for specific interventions referring to special groups of patients (e.g., women, patients with low socio-economic status or migration background). Further research is needed in these respects in order to answer questions concerning the indication and effectiveness of such tailored interventions.
总结国内外关于冠心病患者康复中心理干预的证据和建议。背景是一项制定冠心病患者康复心理干预循证实践指南的项目。
在多个数据库以及专业协会网站上进行系统文献检索，以识别相关综述和指南。除电子检索外还进行了手工检索。筛选出符合条件的出版物，提取心理干预的证据以及与心理诊断或干预相关的建议。
纳入了5篇系统综述和34篇指南。从系统综述中发现了以下心理干预的建议和（部分受限的）证据：患者咨询与健康教育；共病心理障碍的筛查与治疗；职业咨询；压力管理；放松训练；戒烟干预；促进适当营养和体重管理的干预；增加充足、规律体育活动的干预；增强社会支持的干预；针对女性的特定干预；家庭成员或伴侣的参与；性活动讨论。
讨论/结论：对于冠心病患者治疗中的几种心理干预，我们从系统综述中找到了实证证据。对于其他心理干预，未从系统综述中找到实证证据。指南总结表明，在德国和国外，许多基于心理学的干预都是心脏康复的固有组成部分。然而，许多涉及心理诊断和干预的建议不够精确，无法指导个体患者的心理护理。特别是，许多指南中没有关于针对哪些问题应考虑哪些（心理）治疗的说明。此外，几乎没有找到针对特定患者群体（如女性、社会经济地位低或有移民背景的患者）的特定干预的证据或建议。在这些方面需要进一步研究，以回答有关此类量身定制干预的适应症和有效性的问题。
