Issues in cardiovascular nursingInfluence of an early recovery telehealth intervention on physical activity and functioning after coronary artery bypass surgery among older adults with high disease burden
Section snippets
Related Literature
Functioning improvements after cardiac revascularization appear to improve linearly over time.1, 3, 28, 29, 30 However, recent studies indicate that pre-procedural comorbidities,9, 10, 31 illness severity,2, 32 daily functioning abilities,33 and functional status34, 35 can predict HRQoL and recovery of functioning after cardiac revascularization. These findings corroborate the conclusion that there are patients with cardiac disease who do not experience improved health status or HRQoL and may
Conceptual Framework
The early recovery telehealth intervention in this study focused on using symptom management strategies to improve physical activity and functioning outcomes after CABS. The conceptual framework used for this study and the development of the intervention were based on the health outcomes research47 and symptom management48 conceptual models. In the symptom management model, it is assumed that the person, environment, and health and illness domains are affected by specific knowledge, skills,
Design
In the parent study, a randomized, 2-group (N = 280), repeated-measures design was used, with one group receiving the early recovery telehealth intervention plus usual care and the comparison group receiving only usual care. Data measurements were obtained before discharge (baseline measures), 3 and 6 weeks, and 3 and 6 months postoperatively among older adults (aged ≥ 65 years) who had undergone CABS. The 6-week symptom management telehealth intervention, developed by the investigators,49 was
Physical activity
In this study, physical activity was measured at baseline using the Modified 7-day Activity Interview, which provided baseline data (before having CABS) on the subject's average kilocalories/kilogram/day expended, average number of minutes spent exercising/week, and average minutes/day spent in moderate or greater activity. At 3 and 6 weeks and 3 and 6 months, physical activity and exercise were measured by the RT3 accelerometer providing average kilocalories/kilogram/day expended, which is an
Discussion
Physical well-being is important for patients with chronic conditions such as heart disease, because declines in physical ability and functioning are associated with higher health care use, morbidity, and mortality.9, 67 Cardiac revascularization compared with medical management can reduce overall mortality among older adults,68 although the beneficial outcomes realized from revascularization may be impeded by persistent physical inactivity and lack of exercise. In this study, those patients
Limitations
Findings from this study are limited given this is a subanalysis of a larger randomized clinical trial. In addition, the early recovery intervention examined in this study was not specifically designed for patients after CABS with a higher disease burden; therefore, the effect of the intervention may not have had as much of an impact as a more tailored intervention for this population. Another study limitation is the use of self-report measure of functioning with the MOS SF-36 tool, although
Conclusions and Recommendations
Despite preexisting impairments and higher risk for poor outcomes, older adults with heart disease can derive significant cardiovascular benefits and improved HRQoL from physical activity and exercise.13, 74, 75 Researchers have previously found a major determinant of the level of physical activity achieved and whether patients will maintain exercise are based on their level of activity and exercise before their cardiac event.19 Thus, patients with higher disease burden, who have lower levels
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