Ghizzardi Greta, Arrigoni Cristina, Dellafiore Federica, Vellone Ercole, Caruso Rosario
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy.
Heart Fail Rev. 2022 Jul;27(4):1029-1041. doi: 10.1007/s10741-021-10110-z. Epub 2021 Apr 17.
Although motivational interviewing (MI) seems to be promising for enhancing self-care behaviors (i.e., daily disease management and responses to symptoms) in patients with heart failure (HF), no quantitative pooling of effect sizes has been described to summarize and test its efficacy on self-care. Given that self-care behaviors of patients with HF are essential to enhance pharmacological adherence and disease management and optimize clinical outcomes, we sought to perform a systematic review of randomized control trials (RCTs) regarding MI's efficacy on enhancing self-care behaviors among patients with HF, synthesizing MI effects on self-care through meta-analyses. Nine randomized controlled trials were included. MI showed moderate effects on enhancing self-care confidence (Hedge's g = 0.768; 95%CI = 0.326-1.210; P = 0.001) and self-care management (i.e., responses to symptoms) (Hedge's g = 0.744; 95%CI = 0.256-1.232; P = 0.003) and large effects on improving self-care maintenance (i.e., adherence to treatment and symptom monitoring) (Hedge's g = 0.873; 95%CI = 0.430-1.317; P < 0.001). No significant effects were found for enhancing the self-reported physical functioning (Hedge's g = -0.385; 95%CI = -1.063-0.294; P = 0.267) or the directly assessed physical functioning using the 6-min walking test (Hedge's g = -0.131; 95%CI = -0.981-0.720; P = 0.072). Although future research is still required to identify situation-specific indications regarding how MI should be implemented in relation to specific clinical conditions, this study showed that MI is an effective strategy to improve self-care in patients with HF.
尽管动机性访谈（MI）似乎有望增强心力衰竭（HF）患者的自我护理行为（即日常疾病管理和对症状的应对），但尚未有对效应量进行定量汇总的描述，以总结和检验其对自我护理的疗效。鉴于HF患者的自我护理行为对于提高药物依从性和疾病管理以及优化临床结局至关重要，我们试图对关于MI对增强HF患者自我护理行为疗效的随机对照试验（RCT）进行系统评价，通过荟萃分析综合MI对自我护理的影响。纳入了9项随机对照试验。MI对增强自我护理信心（Hedge's g = 0.768；95%CI = 0.326 - 1.210；P = 0.001）和自我护理管理（即对症状的应对）（Hedge's g = 0.744；95%CI = 0.256 - 1.232；P = 0.003）显示出中等效应，对改善自我护理维持（即坚持治疗和症状监测）（Hedge's g = 0.873；95%CI = 0.430 - 1.317；P < 0.001）显示出较大效应。在增强自我报告的身体功能（Hedge's g = -0.385；95%CI = -1.063 - 0.294；P = 0.267）或使用6分钟步行试验直接评估的身体功能方面（Hedge's g = -0.131；95%CI = -0.981 - 0.720；P = 0.072）未发现显著效应。尽管未来仍需要研究确定关于如何根据特定临床情况实施MI的具体适用情况，但本研究表明MI是改善HF患者自我护理的有效策略。
