Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
BMJ Open. 2023 Feb 24;13(2):e065230. doi: 10.1136/bmjopen-2022-065230.
To investigate long-term effects of a 1-year problem-based learning (PBL) on self-management and cardiac risk factors in patients with coronary heart disease (CHD).
A prospective, randomised, parallel single centre trial.
Primary care settings in Sweden.
157 patients with stable CHD completed the study. Subjects with reading and writing impairments, mental illness or expected survival less than 1 year were excluded.
Participants were randomised and assigned to receive either PBL (intervention) or home-sent patient information (control group). In this study, participants were followed up at baseline, 1, 3 and 5 years.
Primary outcome was patient empowerment (Swedish Coronary Empowerment Scale, SWE-CES) and secondary outcomes General Self-Efficacy Scale (GSES), self-rated health status (EQ-VAS), high-density lipoprotein cholesterol (HDL-C), body mass index (BMI), weight and smoking. Outcomes were adjusted for sociodemographic factors.
The PBL intervention group resulted in a significant improved change in SWE-CES over the 5-year period (mean (M), 39.39; 95% CI 37.88 to 40.89) compared with the baseline (M 36.54; 95% CI 35.40 to 37.66). PBL intervention group increased HDL-C level (M 1.39; 95% CI 1.28 to 1.50) compared with baseline (M 1.24; 95% CI 1.15 to 1.33) and for EQ-VAS (M 77.33; 95% CI 73.21 to 81.45) compared with baseline (M 68.13; 95% CI 63.66 to 72.59) while these outcomes remained unchanged in the control group. There were no significant differences in BMI, weight or scores on GSES, neither between nor within groups over time. The overall proportion of smokers was significantly higher in the control group than in the experimental group.
One-year PBL intervention had positive effect on patient empowerment, health status and HDL-C at a 5-year follow-up compared with the control group. PBL education aiming to improve patient empowerment in cardiac rehabilitation should account for sociodemographic factors.
NCT01462799.
探讨为期 1 年的以问题为基础的学习（PBL）对冠心病患者自我管理和心脏危险因素的长期影响。
前瞻性、随机、平行的单中心试验。
瑞典的初级保健机构。
157 例稳定型冠心病患者完成了本研究。排除有阅读和书写障碍、精神疾病或预计生存时间少于 1 年的患者。
参与者被随机分配接受 PBL（干预组）或家庭邮寄的患者信息（对照组）。在这项研究中，参与者在基线、1、3 和 5 年时进行随访。
主要结局为患者授权（瑞典冠心病授权量表，SWE-CES），次要结局为一般自我效能感量表（GSES）、自我评定健康状况（EQ-VAS）、高密度脂蛋白胆固醇（HDL-C）、体重指数（BMI）、体重和吸烟情况。结局根据社会人口因素进行了调整。
与基线相比，PBL 干预组在 5 年期间 SWE-CES 的变化具有显著改善（平均（M）39.39；95%CI 37.88 至 40.89）。与基线相比，PBL 干预组的 HDL-C 水平（M 1.39；95%CI 1.28 至 1.50）升高，EQ-VAS（M 77.33；95%CI 73.21 至 81.45）升高，而对照组的这些结局则保持不变。BMI、体重或 GSES 评分在组间或组内均无随时间变化的显著差异。对照组的吸烟者比例明显高于实验组。
与对照组相比，为期 1 年的 PBL 干预对冠心病患者的患者授权、健康状况和 HDL-C 具有积极影响，随访 5 年。旨在提高心脏康复中患者授权的 PBL 教育应考虑社会人口因素。
NCT01462799。
