Associations between socio-demographic factors, encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study.
The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure.
This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses.
For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating.
Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.
A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce. Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals. Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.
Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology.
The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring.
A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology.
The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (P
Cites: Conf Proc IEEE Eng Med Biol Soc. 2009;2009:6584-719964700
Little is known about sick leave and the ability to return to work (RTW) for people with heart failure (HF). Previous research findings raise questions about the significance of encounters with social insurance officers (SIOs) and sociodemographics in people sick-listed due to HF.
To investigate how people on sick leave due to HF experience encounters with SIOs and associations between sociodemographic factors, experiences of positive/negative encounters with SIOs, and self-estimated ability to RTW.
This was a population-based study with a cross-sectional design. The sample consisted of 590 sick-listed people with HF in Sweden. A register-based investigation supplemented with a postal survey questionnaire was conducted. Bivariate correlations and logistic regression analysis was used to test associations between sociodemographic factors, positive and negative encounters, and self-estimated ability to RTW.
People with low income were more likely to receive sickness compensation. A majority of the responders experienced encounters with SIOs as positive. Being married was significantly associated with positive encounters. Having a low income was related to negative encounters. More than a third of the responders agreed that positive encounters with SIOs facilitated self-estimated ability to RTW. High income was strongly associated with the impact of positive encounters on self-estimated ability to RTW.
Encounters between SIOs and people on sick leave due to HF need to be characterized by a person-centred approach including confidence and trust. People with low income need special attention.
Describe rates of, and examine factors affecting, referral to cardiac rehabilitation (CR) following revascularization in Ontario.
CR reduces mortality following cardiac revascularization, but is largely underutilized, partly due to poor referral rates.
In this retrospective study, the sample consisted of all CR-indicated patients who underwent revascularization at the Cardiac Care Network of Ontario hospitals between October 2011 through March 2012. Referral rates were described, and multivariate analyses performed to identify disparities.
Of the 3739 patients included, 51.8% were referred to CR. Patients aged =85 or requiring a translator, and patients with hyperlipidemia, heart failure, or comorbid pulmonary, renal or peripheral vascular disease, were significantly less likely to be referred. Patients with a history of smoking or myocardial infarction, or who underwent coronary artery bypass graft surgery, were significantly more likely.
A national policy statement recommends 85% referral of indicated patients to CR, a target currently missed by almost 35%.
The use of the Internet to administer questionnaires has many potential advantages over the use of pen-and-paper administration. Yet it is important to validate Internet administration, as most questionnaires were initially developed and validated for pen-and-paper delivery. While some have been validated for use over the Internet, these questionnaires have predominately been used amongst the healthy general population. To date, information is lacking on the validity of questionnaires administered over the Internet in patients with chronic diseases such as heart failure.
To determine the validity of three heart failure questionnaires administered over the Internet compared to pen-and-paper administration in patients with heart failure.
We conducted a prospective randomized study using test-retest design comparing administration via the Internet to pen-and-paper administration for three heart failure questionnaires provided to patients recruited from a heart failure clinic in Toronto, Ontario, Canada: the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Self-Care Heart Failure Index (SCHFI).
Of the 58 subjects enrolled, 34 completed all three questionnaires. The mean difference and confidence intervals for the summary scores of the KCCQ, MLHFQ, and SCHFI were 1.2 (CI -1.5 to 4.0, scale from 0 to 100), 4.0 (CI -1.98 to 10.04, scale from 0 to 105), and 10.1 (CI 1.18 to 19.07, scale from 66.7 to 300), respectively.
Internet administration of the KCCQ appears to be equivalent to pen-and-paper administration. For the MLHFQ and SCHFI, we were unable to demonstrate equivalence. Further research is necessary to determine if the administration methods are equivalent for these instruments.
Cites: Stat Med. 2004 Jun 30;23(12):1921-8615195324
Cites: J Med Internet Res. 2004 May 14;6(2):e1215249261
Cites: J Card Fail. 2004 Aug;10(4):350-6015309704
Cites: J Med Internet Res. 2004 Sep 15;6(3):e2915471755
Cites: Am J Cardiol. 1993 May 1;71(12):1069-738475871
Cites: J Am Coll Cardiol. 1993 Oct;22(4 Suppl A):6A-13A8376698
Cites: Stat Med. 1996 Aug 30;15(16):1729-388870155
Cites: Ann Thorac Surg. 1999 Mar;67(3):723-3010215217
Cites: J Public Health (Oxf). 2005 Sep;27(3):281-9115870099
Cites: Am Heart J. 2005 Oct;150(4):707-1516209970
Cites: J Am Coll Cardiol. 2006 Feb 21;47(4):752-616487840
Cites: Telemed J E Health. 2006 Aug;12(4):439-4716942416
To live with heart failure means that life is delimited. Still, people with heart failure can have a desire to stay active in working life as long as possible. Although a number of factors affect sick leave and rehabilitation processes, little is known about sick leave and vocational rehabilitation concerning people with heart failure. This study aimed to identify emotions and encounters with healthcare professionals as possible predictors for the self-estimated ability to return to work in people on sick leave due to heart failure.
A population-based cross-sectional study design was used.
The study was conducted in Sweden. Data were collected in 2012 from 3 different sources: 2 official registries and 1 postal questionnaire.
A total of 590 individuals were included.
Descriptive statistics, correlation analysis and linear multiple regression analysis were used.
3 variables, feeling strengthened in the situation (ß=-0.21, p=0.02), feeling happy (ß=-0.24, p=0.02) and receiving encouragement about work (ß=-0.32, p=0.001), were identified as possible predictive factors for the self-estimated ability to return to work.
To feel strengthened, happy and to receive encouragement about work can affect the return to work process for people on sick leave due to heart failure. In order to develop and implement rehabilitation programmes to meet these needs, more research is needed.
Cites: Scand J Public Health. 2007;35(6):577-8417852974
Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL).
The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care.
An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12months.
Exercise significantly improved muscle endurance in the intervention group (n=29, mean age 76.2years) compared to the control group (n=31, mean age 74.4years) at all follow-ups except for shoulder flexion right at 12months (shoulder abduction p=0.006, p=0.048, p=0.029; shoulder flexion right p=0.002, p=0.032, p=0.585; shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3months (p=0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12months (p=0.016 and p=0.034) and SF-36, general health (p=0.048) and physical component scale (p=0.026) significantly improved at 3months compared to the control group.
This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population.
Due to improved treatments and ageing population, many countries now report increasing prevalence in rates of ischemic heart disease and heart failure. Cardiac rehabilitation has potential to reduce morbidity and mortality, but not all patients complete. In light of favourable effects of cardiac rehabilitation it is important to develop patient education methods which can enhance adherence to this effective program. The LC-REHAB study aims to compare the effect of a new patient education strategy in cardiac rehabilitation called 'learning and coping' to that of standard care. Further, this paper aims to describe the theoretical basis and details of this intervention.
Open parallel randomised controlled trial conducted in three hospital units in Denmark among patients recently discharged with ischemic heart disease or heart failure. Patients are allocated to either the intervention group with learning and coping strategies incorporated into standard care in cardiac rehabilitation or the control group who receive the usual cardiac rehabilitation program. Learning and coping consists of two individual clarifying interviews, participation of experienced patients as educators together with health professionals and theory based, situated and inductive teaching. Usual care in cardiac rehabilitation is characterised by a structured deductive teaching style with use of identical pre-written slides in all hospital units. In both groups, cardiac rehabilitation consists of training three times a week and education once a week over eight weeks. The primary outcomes are adherence to cardiac rehabilitation, morbidity and mortality, while secondary outcomes are quality of life (SF-12, Health education impact questionnaire and Major Depression Inventory) and lifestyle and risk factors (Body Mass Index, waist circumference, blood pressure, exercise work capacity, lipid profile and DXA-scan). Data collection occurs four times; at baseline, at immediate completion of cardiac rehabilitation, and at three months and three years after the finished program.
It is expected that learning and coping incorporated in cardiac rehabilitation will improve adherence in cardiac rehabilitation and may decrease morbidity and mortality. By describing learning and coping strategies the study aims to provide knowledge that can contribute to an increased transparency in patient education in cardiac rehabilitation.
Learning and coping education strategies (LC) was implemented to enhance patient attendance in the cardiac rehabilitation programme. This study assessed the cost-utility of LC compared to standard education (standard) as part of a rehabilitation programme for patients with ischemic heart disease and heart failure.
The study was conducted alongside a randomised controlled trial with 825 patients who were allocated to LC or standard rehabilitation and followed for 5 months. The LC approach was identical to the standard approach in terms of physical training and education, but with the addition of individual interviews and weekly team evaluations by professionals. A societal cost perspective including the cost of intervention, health care, informal time and productivity loss was applied. Cost was based on a micro-costing approach for the intervention and national administrative registries for other cost categories. Quality adjusted life years (QALY) were based on SF-6D measurements at baseline, after intervention and follow-up using British preference weights. Multiple imputation was used to handle non-response on the SF-6D. Conventional cost effectiveness methodology was employed to estimate the net benefit of the LC and to illustrate cost effectiveness acceptability curves. The statistical analysis was based on means and bootstrapped standard errors.
An additional cost of DKK 6,043 (95% CI -5,697; 17,783) and a QALY gain of 0.005 (95% CI -0.001; 0.012) was estimated for LC. However, better utility scores in both arms were due to higher utility while receiving the intervention than better health after the intervention. The probability that LC would be cost-effective did not exceed 29% for any threshold values of willingness to pay per QALY. The alternative scenario analysis was restricted to a health care perspective and showed that the probability of cost-effectiveness increased to 62% over the threshold values.
The LC was unlikely to be cost-effective within 5 months of follow-up from a societal perspective, but longer-term follow-up should be evaluated before a definite conclusion is drawn.
Future research should assess the LC strategies' long-term efficacy and cost-utility.
Cites: J Health Econ. 2002 Mar;21(2):271-9211939242
The aim of this article is to describe the development and testing of a prototype application ("The Heart Game") using gamification principles to assist heart patients in their telerehabilitation process in the Teledialog project.
A prototype game was developed via user-driven innovation and tested on 10 patients 48-89 years of age and their relatives for a period of 2 weeks. The application consisted of a series of daily challenges given to the patients and relatives and was based on several gamification principles. A triangulation of data collection techniques (interviews, participant observations, focus group interviews, and workshop) was used. Interviews with three healthcare professionals and 10 patients were carried out over a period of 2 weeks in order to evaluate the use of the prototype.
The heart patients reported the application to be a useful tool as a part of their telerehabilitation process in everyday life. Gamification and gameful design principles such as leaderboards, relationships, and achievements engaged the patients and relatives. The inclusion of a close relative in the game motivated the patients to perform rehabilitation activities.
"The Heart Game" concept presents a new way to motivate heart patients by using technology as a social and active approach to telerehabilitation. The findings show the potential of using gamification for heart patients as part of a telerehabilitation program. The evaluation indicated that the inclusion of the patient's spouse in the rehabilitation activities could be an effective strategy. A major challenge in using gamification for heart patients is avoiding a sense of defeat while still adjusting the level of difficulty to the individual patient.
Cites: Int J Nurs Pract. 2008 Jun;14(3):237-4218460065