Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: A randomized controlled trial
Ida Elisabeth Højskov , Philips Moons, Ingrid Egerod, Peter Skov Olsen, Lau Caspar Thygesen , Niels Viggo Hansen, Søren La Cour, Krisitna Hindhede Bech, Britt Borregaard, Christian Gluud, Per Winkel, Jane Lindschou, Selina Kikkenborg Berg
Department of Cardiothoracic Surgery/Department of Nursing, Faculty of Health and Technology, Rigshospitalet, University of Copenhagen/ Metropolitan University College, 2100 Copenhagen, Denmark. E-mail: firstname.lastname@example.org
Objectives: Rehabilitation of patients following coronary artery bypass grafting (CABG) has been widely studied; however, research into early rehabilitation after CABG is sparse. The aim of this trial was to assess the impact of early rehabilitation, compared with usual care in patients following CABG.
Design: Randomized controlled trial.
Patients: A total of 326 patients treated with CABG.
Methods: Patients treated with CABG were randomized 1:1 to 4 weeks of comprehensive early rehabilitation or usual care. The primary outcome was the Six Minute Walk Test (6MWT). Secondary outcomes were mental health and physical activity (Medical Outcome Study Short Form; SF-12); anxiety and depression (Hospital Anxiety and Depression Scale; HADS); physical and emotional scores; sleep (Pittsburgh Sleep Quality Index; PSQI); pain (Örebro Musculoskeletal Screening Questionnaire; ÖMSQ) and muscle endurance (Sit-To-Stand test).
Results: Sixteen patients dropped out. No significant differences between groups in the primary outcome (6MWT) were found after 4 weeks (p = 0.27). For secondary outcomes the odds ratio of HADS-D ≥ 8 decreased in favour of the experimental intervention (p = 0.04). There was non-adherence to parts of the intervention. Per-protocol analysis showed differences between groups for the 6MWT (p = 0.02) and the Sit-To-Stand test (p = 0.046).
Conclusion: In general, the intervention had no effect on the 6MWT, or secondary outcomes, except for depressive symptoms. However, in adherent participants, the intervention had a positive effect for the primary and several secondary outcomes.
This trial investigated the effects of an early rehabilitation programme in addition to usual care for patients undergoing heart bypass surgery. The programme consisted of exercise training and 4 planned nurse consultations in the period from admission to 4 weeks after surgery. The programme was tested by 163 patients undergoing heart bypass surgery, compared with a similar number of patients who followed usual care alone. The trial did not show any effect of the programme on physical function, but there was a positive effect in reducing depressive symptoms in the rehabilitation group. Although the rehabilitation programme was scheduled, adherence was low. The reason for lack of efficacy could be poor adherence to the programme, as patients who followed the programme significantly improved in terms of physical functioning 4 weeks after surgery. The results provide important information for health professionals for refining early rehabilitation programmes after heart bypass surgery.
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