Burgess A W, Lerner D J, D'Agostino R B, Vokonas P S, Hartman C R, Gaccione P
Soc Sci Med. 1987;24(4):359-70. doi: 10.1016/0277-9536(87)90154-7.
A randomized trial using controls tested whether psycho-social rehabilitation of acute myocardial infarction (MI) patients would improve significantly their return to work rate and assessed the importance of various psychological, social, occupational, socio-demographic, and medical factors in facilitating or impeding rapid return to work. Eighty-nine patients were assigned randomly to participate in an experimental cardiac rehabilitation program (rehab care), and 91 patients were controls who received conventional hospital rehabilitation (usual care). By the first follow-up interview at three months, patients assigned to experimental treatment were significantly less distressed psychologically and less dependent on family support than controls (P = 0.04 and P = 0.05, respectively). By the final follow-up interview at 13 months, there was a marginally significant difference in favor of the experimental group in the frequency of reported deterrents to work resumption (P = 0.07). However, the intervention did not result in a statistically significant difference in the return to work rate (P greater than 0.10). In each group, 88% were back at work by approximately the first year after infarction. In addition, the two groups were similar in the amount of time patients remained out of the workforce (median days rehab care = 75, usual care = 81; P greater than 0.10). A multi-stage data analysis procedure utilizing the Cox regression technique indicated that while several independent variables had significant univariate associations with the length of time patients convalesced, outcome was most influenced by the patient's initial cardiological status and clinical course, by the patterns of family support, and by the several variables measuring the presence of obstacles to resuming work. Our findings suggest that rehabilitation programs intervening on multiple levels (psychological, social, occupational, and physical) may best meet the needs of chronically ill cardiac patients. Results indicate that implementing measures addressing the patient's general psycho-social adjustment to MI may improve existing programs.
一项采用对照组的随机试验，检验了急性心肌梗死（MI）患者的心理社会康复是否会显著提高其重返工作岗位的比率，并评估了各种心理、社会、职业、社会人口统计学和医学因素在促进或阻碍快速重返工作岗位方面的重要性。89名患者被随机分配参加实验性心脏康复计划（康复护理），91名患者为接受传统医院康复（常规护理）的对照组。在三个月时的首次随访访谈中，被分配接受实验性治疗的患者在心理上的痛苦明显低于对照组，对家庭支持的依赖也更少（分别为P = 0.04和P = 0.05）。在13个月时的最终随访访谈中，在报告的阻碍恢复工作的频率方面，实验组有微弱的显著差异（P = 0.07）。然而，干预措施在重返工作岗位的比率上并没有产生统计学上的显著差异（P大于0.10）。在每组中，约88%的患者在心肌梗死后大约第一年就重返工作岗位。此外，两组患者离开劳动力队伍的时间量相似（康复护理组中位数天数 = 75天，常规护理组 = 81天；P大于0.10）。利用Cox回归技术的多阶段数据分析程序表明，虽然几个自变量与患者康复时间长度有显著的单变量关联，但结果受患者最初的心脏状况和临床病程、家庭支持模式以及几个衡量恢复工作障碍存在情况的变量影响最大。我们的研究结果表明，在多个层面（心理、社会、职业和身体）进行干预的康复计划可能最能满足慢性病心脏患者的需求。结果表明，实施针对患者对心肌梗死的总体心理社会适应的措施可能会改善现有计划。
