scholarly journals Effect of reinforced, targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire in patients with atrial fibrillation: A randomized controlled trial

2018 ◽  
Vol 18 (3) ◽  
pp. 194-203 ◽  
Author(s):  
Lien Desteghe ◽  
Lara Engelhard ◽  
Johan Vijgen ◽  
Pieter Koopman ◽  
Dagmara Dilling-Boer ◽  
...  

Background: The knowledge level of atrial fibrillation patients about their arrhythmia, its consequences and treatment is poor. The best strategy to provide education is unknown. Aim: To investigate the effect of reinforced targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ). Methods: Sixty-seven atrial fibrillation patients were randomized to standard care (including brochures) or targeted education. Follow-up visits were scheduled after one, three, six and 12 months. Targeted education during each visit focused on the knowledge gaps revealed by the JAKQ. Patients completed two questionnaires to assess their quality of life and symptom profile. Adherence to non-vitamin K antagonist oral anticoagulants was measured using electronic monitoring. Results: Sixty-two patients (31 education; 31 standard care) completed follow-up. Median baseline score on the JAKQ was similar in education (62.5%) and standard care group (56.3%; p=0.815). The intervention group scored significantly better over time (one month: 75.0%, 12 months: 87.5%; p<0.001) whereas there was no significant improvement in the control group (one month: 62.5%, 12 months: 62.5%; p=0.085). Providing targeted education after completion of the JAKQ required on average 6.9±4.6 min. Some improvements in quality of life, symptom burden and adherence were shown, without significant differences between the two groups ( p-values between 0.282 and 0.677). Conclusion: The JAKQ is an effective tool for providing individualized education. A first targeted educational session significantly improved patients’ knowledge level. Additional educational sessions maintained and strengthened this effect. A larger scale study is warranted to evaluate the impact on adherence and outcome measures.

2019 ◽  
Author(s):  
Anna María Pálsdóttir ◽  
Kjerstin Stigmar ◽  
Bo Norrving ◽  
Patrik Grahn ◽  
Ingemar F Petersson ◽  
...  

Abstract Fatigue is common after stroke and contributes to disability and impaired quality of life. Currently, there is insufficient evidence on the efficacy of any intervention for post-stroke fatigue. The aim of the study was to examine whether 10 weeks Nature-based rehabilitation (NRB) as add-on to standard care may improve post-stroke fatigue, perceived value of everyday occupations, function, activity and participation compared to standard care only (Clinical Trial.gov Identifier: NCT02435043, 2012/352, 05-06-2015). The study was carried out as a single blinded two-armed randomised controlled trial. Stroke survivors identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke > 1 year earlier) were randomised to Standard care + NBR or Standard care only. Blinded evaluations were conducted at follow-up 8 and 14 months after randomisation. The primary outcomes were post-stroke fatigue (Mental Fatigue Scale, total score) and perceived value of everyday occupations (Oval-pd) 8 months after randomisation. About a quarter of the screened patients were eligible; half accepted to participate and 101 were randomised, mean age 67 years, 60% female. The patients with sub-acute stroke were highly compliant with the intervention. Fatigue decreased to a value below the suggested cut-off for mental fatigue (<10.5) in the intervention group but not in the control group; no statistically significant differences were found though between the groups. Conclusion: NASTRU is the first randomised study on NBR for patients with post stroke fatigue. NBR was feasible and well tolerated. The study was underpowered due to difficulties in recruiting participants. No significant differences were detected between intervention and control group. A larger RCT is warranted. Keywords: clinical trial, enriched environment, everyday occupations, horticulture therapy, quality of life.


2020 ◽  
Author(s):  
Ricard Carrillo Muñoz ◽  
Jose Luis Ballve Moreno ◽  
Ivan Villar Balboa ◽  
Yolanda Rando Matos ◽  
Oriol Cunillera Puertolas ◽  
...  

Abstract Background: Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment of choice is the Epley manoeuvre (EM). The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Method: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to an intervention (EM) group or a control (sham manoeuvre) group. The main study covariables were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory-screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men ( P <0.001) and 16 [IQR, 10.0-24.0] vs 12 [IQR, 8.0–18.0] for patients without nystagmus vs those with nystagmus ( P =0.033).Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusion: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale, Trial registration : ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513


2019 ◽  
Author(s):  
Emily Guhl ◽  
Andrew D Althouse ◽  
Alexandra M Pusateri ◽  
Everlyne Kimani ◽  
Michael K Paasche-Orlow ◽  
...  

BACKGROUND Atrial fibrillation (AF) is a common arrhythmia that adversely affects health-related quality of life (HRQoL). We conducted a pilot trial of individuals with AF using a smartphone to provide a relational agent as well as rhythm monitoring. We employed our pilot to measure acceptability and adherence and to assess its effectiveness in improving HRQoL and adherence. OBJECTIVE This study aims to measure acceptability and adherence and to assess its effectiveness to improve HRQoL and adherence. METHODS Participants were recruited from ambulatory clinics and randomized to a 30-day intervention or usual care. We collected baseline characteristics and conducted baseline and 30-day assessments of HRQoL using the Atrial Fibrillation Effect on Quality of Life (AFEQT) measure and self-reported adherence to anticoagulation. The intervention consisted of a smartphone-based relational agent, which simulates face-to-face counseling and delivered content on AF education, adherence, and symptom monitoring with prompted rhythm monitoring. We compared differences in AFEQT and adherence at 30 days, adjusted for baseline values. We quantified participants’ use and acceptability of the intervention. RESULTS A total of 120 participants were recruited and randomized (59 to control and 61 to intervention) to the pilot trial (mean age 72.1 years, SD 9.10; 62/120, 51.7% women). The control group had a 95% follow-up, and the intervention group had a 93% follow-up. The intervention group demonstrated significantly higher improvement in total AFEQT scores (adjusted mean difference 4.5; 95% CI 0.6-8.3; <i>P</i>=.03) and in daily activity (adjusted mean difference 7.1; 95% CI 1.8-12.4; <i>P</i>=.009) compared with the control between baseline and 30 days. The intervention group showed significantly improved self-reported adherence to anticoagulation therapy at 30 days (intervention 3.5%; control 23.2%; adjusted difference 16.6%; 95% CI 2.8%-30.4%; <i>P</i>&lt;.001). Qualitative assessments of acceptability identified that participants found the relational agent useful, informative, and trustworthy. CONCLUSIONS Individuals randomized to a 30-day smartphone intervention with a relational agent and rhythm monitoring showed significant improvement in HRQoL and adherence. Participants had favorable acceptability of the intervention with both objective use and qualitative assessments of acceptability.


Author(s):  
DaJuanicia N Simon ◽  
Laine E Thomas ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
Bernard J Gersh ◽  
...  

Background: The Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) survey has recently been validated to measure the impact of atrial fibrillation on patients’ quality of life, but a clinically important difference (CID) in AFEQT score has not been defined. Knowing the CID is needed to interpret the meaningfulness of differences between treatments in clinical trials; or patient populations for quality assessment. Objectives: To calculate CID values in AFEQT in the ORBIT registry. Methods: ORBIT-AF is a US-based outpatient AF registry that measured disease-specific QoL with the AFEQT tool (score range= 0 (worst) to 100) at baseline and at 1 year follow-up. Two anchor-based methods were used to relate changes in AFEQT to clinically important differences in the more established European Heart Rhythm Association (EHRA) measure of functional status. Ranging from 1 (no symptoms) to 4 (disabling), a change of 1 EHRA class was defined as an important change in the anchor. Both the mean change and receiver operating characteristics (ROC) methods were then used to identify CIDs in AFEQT at 1 year follow-up. This was done for both improvement and worsening on the anchor. The mean change method defines a CID as the mean change in AFEQT score among patients with a 1 EHRA class change. The ROC method identifies a CID as the point on the ROC curve that best discriminates patients who experienced an important change in the anchor (≥ 1 EHRA class change) from those who experienced no change. Results: AFEQT was assessed in 2008 AF patients at baseline and 1347 patients at 1 year from 99 US sites participating in ORBIT-AF. CIDs and 95% confidence intervals (CI) corresponding to an improvement in EHRA for the mean change method were 5.4 (3.6, 7.2) AFEQT points and 1.9 (0.4, 9.3) AFEQT points for the ROC method. CIDs corresponding to worsening in EHRA for the mean change method were -4.2 (-6.9,-1.5) AFEQT points and -7.4 (-13.9,-4.6) AFEQT points for the ROC method. Conclusions: Changes in AFEQT as small as 2 points may be clinically relevant, although CIDs vary depending on the method of calculation. The variability suggests identifying a single universal CID to assess improvement in quality of life in AF patients may not be ideal and improvement may relate to the nature of a patient’s symptoms and their baseline level of activity.


2020 ◽  
pp. 90-95

Background and Objectives: Irritable bowel syndrome is the most common diagnosis among patients with gastrointestinal diseases and can adversely affect their quality of life. In this regard, the present study aimed to evaluate the effectiveness of self-efficacy-based training on depression, self-care behaviors, and the quality of life of patients with irritable bowel syndrome. Materials and Methods: This applied quasi-intervention study was conducted based on a pretest-posttest design with a control group and follow-up. The statistical population included all patients with irritable bowel syndrome who referred to Khorshid Hospital in Isfahan, Iran from September to November 2019. The samples were selected using the convenience sampling method. In total, 30 patients with irritable bowel syndrome were included in the study and randomly divided into two groups of intervention and control. The data were collected using Beck depression inventory, self-care questionnaire, and quality of life questionnaire. The intervention group received four sessions of self-efficacy training (one session per week for 90 min), while the control group did not receive any training. Two months later, the follow-up period was completed. The collected data were analyzed using repeated measures of analysis of variance in SPSS software (version 22). Results: The results showed that self-efficacy training was effective in decreasing depression (P<0.0001, F=35.39) and increasing quality of life (P<0.0001, F=120.30) and self-care behaviors (P<0.0001, F=70.50) in patients with irritable bowel syndrome. Conclusion: It can be concluded that training based on self-efficacy theory can effectively reduce depression and increase self-care behaviors and quality of life in patients with irritable bowel syndrome.


2021 ◽  
Vol 8 (8) ◽  
pp. 166
Author(s):  
Veronica Marchetti ◽  
Eleonora Gori ◽  
Valeria Mariotti ◽  
Angelo Gazzano ◽  
Chiara Mariti

This research was aimed at evaluating the impact of canine chronic enteropathies on dogs’ quality of life (QoL), their behavior, and owner–dog relationship. Forty-four dogs suffering from primary chronic enteropathies were assessed on the first visit with a veterinary gastroenterologist and on the first follow-up visit using a 1–10 visual scale to evaluate five features of QoL, the Canine Chronic Enteropathy Clinical Activity Index, the Lexington Attachment to Pet Scale, and the Canine Behavioral Assessment and Research Questionnaire. They were compared to a control group of 49 healthy dogs and to a group of 50 dogs suffering from cancer. QoL and severity of enteropathy were negatively associated; enteropathic dogs on the first visit had a lower QoL than healthy dogs for all features and a lower general QoL than cancer patients; enteropathic dogs on the follow-up visit improved significantly for general QoL, health QoL, and interaction QoL. Higher levels of attachment between the owner and the dog were obtained for dogs affected by chronic enteropathies. Finally, dogs showed higher scores for separation-related behaviors and contact/attention behaviors on the first visit than on the subsequent follow-up. As in human medicine, chronic enteropathies have a strong negative impact on dogs.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Lambrinou ◽  
A Protopapas ◽  
V Barberis ◽  
L Paikousis ◽  
M Kyriakou ◽  
...  

Abstract Background In order to improve health-related quality of life (HR-QoL) of heart failure (HF) patients, different disease management programs have been developed at the discharged and follow-up phase. Aim To determine the effectiveness of a three-month telephone follow-up, a telephone follow-up with education before discharge, or education only before discharge (all performed by nurse specialists) on HR-QoL in HF patients. The results of the randomized clinical trial (RCT) MEETinCY are presented. Method This is a multicenter RCT with 3 different intervention groups (IGs) and one control group (CG) The first IG included only patients' education before discharge (E). The second IG included patients' education and telephone follow-up after discharge for three months (ET). The third IG included only telephone follow-up for three months (T). The Greek version of the MLHFQ was used. The statistical analysis of the impact of the intervention was done using ANCOVA. The magnitude of the effect of the intervention was studied with the Cohen's d coefficient for repeated measurements. The exploration of clinical and demographic factors in the relationship of HR-QoL was done by using linear coefficients of regression. The investigation of the robustness of the results and the intention to treat was carried out by sensitivity analysis. The management of missing value of the MLHFQ was done by using multiple imputation. Results The study included 334 patients. The analysis demonstrated that the study groups differentiates the level of HR-QoL post-intervention measurement in terms of the Overall QoL (F=2.8, 47, p=0.04). The mean level of Overall HR-QoL adjusted for the pre-intervention measurement, in the T: 40.3 (SE=2.2) and ET: 42 (2.2) groups was higher than that of the E group: 39 (2.2) and the CG: 47 (2). Study group differences were also detected statistically in the Social dimension (F=3.4, p=0.02) but not in in the Physical dimension (F=1.9, p=0.11) or the Emotional dimension (F=0.99, p=0.40). However, in the ET and T groups, higher adjusted average levels of the Physical and Social dimension are observed compared to the E and Control group. Overall, IGs exhibited low to moderate effect size improvements (drm = 0.4) while the CG had negligible improvement (drm = 0.02). Women exhibit lower overall HR-QoL scores compared to men by 13.9 points in the MLHFQ scale (b=13.9, p<0.015). NYHA IV (38.5, p<0.001), NYHA III (29.5, p<0.001) and NYHA II (9.15, p<0.001) patients exhibit worse overall HR-QoL compared to NYHA I patients. Conclusion Patients' education before discharge was not found to have an important role over the three- months telephone follow-up after discharge. On the other hand, improvement was found in patients who had the telephone intervention and the possibility to call researchers (nurses) whenever they needed. Patients seem to need continuing communication and support and to feel the availability of contacting and seeking help when needed. Acknowledgement/Funding Cyprus University of Technology's state funded budget [Startup Fund EX2007 (04)]


JMIR Cardio ◽  
10.2196/17162 ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. e17162
Author(s):  
Emily Guhl ◽  
Andrew D Althouse ◽  
Alexandra M Pusateri ◽  
Everlyne Kimani ◽  
Michael K Paasche-Orlow ◽  
...  

Background Atrial fibrillation (AF) is a common arrhythmia that adversely affects health-related quality of life (HRQoL). We conducted a pilot trial of individuals with AF using a smartphone to provide a relational agent as well as rhythm monitoring. We employed our pilot to measure acceptability and adherence and to assess its effectiveness in improving HRQoL and adherence. Objective This study aims to measure acceptability and adherence and to assess its effectiveness to improve HRQoL and adherence. Methods Participants were recruited from ambulatory clinics and randomized to a 30-day intervention or usual care. We collected baseline characteristics and conducted baseline and 30-day assessments of HRQoL using the Atrial Fibrillation Effect on Quality of Life (AFEQT) measure and self-reported adherence to anticoagulation. The intervention consisted of a smartphone-based relational agent, which simulates face-to-face counseling and delivered content on AF education, adherence, and symptom monitoring with prompted rhythm monitoring. We compared differences in AFEQT and adherence at 30 days, adjusted for baseline values. We quantified participants’ use and acceptability of the intervention. Results A total of 120 participants were recruited and randomized (59 to control and 61 to intervention) to the pilot trial (mean age 72.1 years, SD 9.10; 62/120, 51.7% women). The control group had a 95% follow-up, and the intervention group had a 93% follow-up. The intervention group demonstrated significantly higher improvement in total AFEQT scores (adjusted mean difference 4.5; 95% CI 0.6-8.3; P=.03) and in daily activity (adjusted mean difference 7.1; 95% CI 1.8-12.4; P=.009) compared with the control between baseline and 30 days. The intervention group showed significantly improved self-reported adherence to anticoagulation therapy at 30 days (intervention 3.5%; control 23.2%; adjusted difference 16.6%; 95% CI 2.8%-30.4%; P<.001). Qualitative assessments of acceptability identified that participants found the relational agent useful, informative, and trustworthy. Conclusions Individuals randomized to a 30-day smartphone intervention with a relational agent and rhythm monitoring showed significant improvement in HRQoL and adherence. Participants had favorable acceptability of the intervention with both objective use and qualitative assessments of acceptability.


2014 ◽  
Vol 10 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Mauro Giovanni Carta ◽  
Federica Maggiani ◽  
Laura Pilutzu ◽  
Maria Francesca Moro ◽  
Gioia Mura ◽  
...  

The aim of this study was to evaluate the impact of a sailing rehabilitation program on the quality of life (QoL) in a sample of patients with severe mental disorders. The study adopted a randomized, crossover, waiting-list controlled design. The participants enrolled in the study were outpatients diagnosed with severe chronic mental disorders. The participants (N=40) exposed to rehabilitation with sailing took part in a series of supervised cruises near the gulf of Cagliari, South Sardinia, and showed a statistically significant improvement of their quality of life compared to the control group. This improvement was comparable to the improvement in psychopathologic status and social functioning as shown in a previous report of the same research project. The improvement was maintained at follow-up only during the trial and for a few months later: after 12 months, patients returned to their baseline values and their quality of life showed a worsening trend. This is the first study to show that rehabilitation with sailing may improve the quality of life of people with severe chronic mental disorders. In all likelihood, a program grounded on learning how to manage a sailing vessel - during which patients perform cruises that emphasize the exploration of the marine environment by sailing - might be interesting enough and capture the attention of the patients so as to favour greater effectiveness of standard rehabilitation protocols, but this should be specifically tested.


2019 ◽  
Vol 101-B (3) ◽  
pp. 272-280 ◽  
Author(s):  
F. G. M. Verspoor ◽  
M. J. L. Mastboom ◽  
G. Hannink ◽  
W. T. A. van der Graaf ◽  
M. A. J. van de Sande ◽  
...  

Aims The aim of this study was to evaluate health-related quality of life (HRQoL) and joint function in tenosynovial giant cell tumour (TGCT) patients before and after surgical treatment. Patients and Methods This prospective cohort study run in two Dutch referral centres assessed patient-reported outcome measures (PROMs; 36-Item Short-Form Health Survey (SF-36), visual analogue scale (VAS) for pain, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) in 359 consecutive patients with localized- and diffuse-type TGCT of large joints. Patients with recurrent disease (n = 121) and a wait-and-see policy (n = 32) were excluded. Collected data were analyzed at specified time intervals preoperatively (baseline) and/or postoperatively up to five years. Results A total of 206 TGCT patients, 108 localized- and 98 diffuse-type, were analyzed. Median age at diagnosis of localized- and diffuse-type was 41 years (interquartile range (IQR) 29 to 49) and 37 years (IQR 27 to 47), respectively. SF-36 analyses showed statistically significant and clinically relevant deteriorated preoperative and immediate postoperative scores compared with general Dutch population means, depending on subscale and TGCT subtype. After three to six months of follow-up, these scores improved to general population means and continued to be fairly stable over the following years. VAS scores, for both subtypes, showed no statistically significant or clinically relevant differences pre- or postoperatively. In diffuse-type patients, the improvement in median WOMAC score was statistically significant and clinically relevant preoperatively versus six to 24 months postoperatively, and remained up to five years’ follow-up. Conclusion Patients with TGCT report a better HRQoL and joint function after surgery. Pain scores, which vary hugely between patients and in patients over time, did not improve. A disease-specific PROM would help to decipher the impact of TGCT on patients’ daily life and functioning in more detail. Cite this article: Bone Joint J 2019;101-B:272–280.


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