Troy A. Klinger

Quality of life and self-efficacy: gender and diagnoses considerations for management during cardiac rehabilitation.

PURPOSE Outcome measurement research has extended beyond traditional clinical and physiologic parameters to include psychosocial aspects. Accordingly, the purpose of this study was to investigate quality-of-life (QOL) and self-efficacy disparities for gender and diagnoses during participation in cardiac rehabilitation. METHODS For this study, 472 patients (114 women and 358 men) were stratified by gender and then again by diagnosis to include surgical revascularization, myocardial infarction, and percutaneous coronary intervention. Measures obtained at baseline and at the end of the study assessed quality of life (QOL-o = total score), including emotional (QOL-e) and limitation (QOL-l) domains; self-efficacy (SE-o = total score), including ambulatory (SE-a) and muscular (SE-m) domains; and caloric expenditure. RESULTS Both self-efficacy and QOL were greater at the end of the study across genders (P <.05). The men had greater self-efficacy values for all domains (P <.05). There was a significant gender-time interaction for QOL-e (P <.05) among the women, and for QOL-o, QOL-l, and all self-efficacy domains (P <.05) among the surgical revascularization patients. Percutaneous coronary intervention patients had higher self-efficacy scores throughout. Caloric expenditure was a consistent positive predictor of self-efficacy and QOL-e (P <.05). CONCLUSIONS Quality of life and self-efficacy improve during cardiac rehabilitation across gender and diagnoses. Female and revascularized patients present with low QOL and self-efficacy scores initially, but improvements in scores similar to or greater than the men can be expected. Because the self-efficacy scores of percutaneous coronary intervention patients are higher and their physical limitations are less prohibitive, these patients can be progressed more aggressively. Improvements in self-efficacy scores parallel caloric expenditure increases.

Religiosity and Spirituality: Influence on Quality of Life and Perceived Patient Self-Efficacy among Cardiac Patients and Their Spouses

The purpose of this study was to determine the influence of spirituality, religiosity, and religious coping on quality of life and self-efficacy among couples following a first time cardiac event. There was no significant association between measures for spirituality and religiosity and couples’ ratings for quality of life and self-efficacy. Negative forms of religious coping were associated with lower levels of quality of life and decreased confidence in the patient’s ability to perform physical tasks. Spouses’ measures for quality of life, self-efficacy, spirituality, religiosity, and religious coping were associated with patients’ measures for the same study variables.

Cardiac Rehabilitation Without Exercise Tests for Post-Myocardial Infarction and Post-Bypass Surgery Patients

PURPOSE To compare the progress of patients who were exercise tested before or during cardiac rehabilitation versus those patients who were not tested. METHODS Eighty-eight (88) post-myocardial infarction patients and 141 post-bypass surgery patients had a symptom-limited exercise test before or during 12 weeks of cardiac rehabilitation. Another 125 post-myocardial infarction and 146 post-surgery patients were not tested. RESULTS Caloric expenditure during class increased for the entire group (P < 0.001) from week 1 to week 12. Body weight decreased for the entire group as a result of cardiac rehabilitation (P < 0.001). Tricep skinfolds decreased for the entire group (P < 0.001) while subscapular skinfolds did not change (P = 0.28). The percent change from week 1 to week 12 for both groups was similar for all variables. No problems occurred during cardiac rehabilitation that required emergency medical management. CONCLUSIONS Patients completing a 12-week cardiac rehabilitation program can be safely progressed in terms of their exercise capacity without an entry exercise test. This is desirable in a managed-care setting for reducing costs while maintaining effective patient care. Such factors as staff training and experience, institutional philosophy, patient referral patterns, and facility location must be considered before adopting a no-test policy.

Demographic Differences in Religious Coping After a First-Time Cardiac Event

PURPOSE: The purpose of this project was to describe demographic characteristics of patients who may use religion as a coping response to a first-time cardiac event. METHODS: Patients (N = 105), who were enrolled in cardiac rehabilitation after a first-time myocardial infarction or coronary artery revascularization bypass surgery, completed the Religious Coping Activities Scale. Independent variables included age, gender, religious affiliation, diagnosis, marital status, and education level. The 6 types of religious coping activities were compared for each level of the independent variables. RESULTS: Significant differences emerged for gender, religious affiliation, marital status, and level of education. Women scored higher than men on spiritually based activities (T = 1550, P = .03), good deeds (T = 1504, P = .08), and religious avoidance coping (T = 1505, P = .08). Participants who claimed no religious affiliation scored lowest on good deeds (H[2] = 9.7, P = .008) and interpersonal religious support coping (H[2] = 13.4, P = .001) and higher on discontent coping (H[2] = 5.4, P = .07). Single participants scored higher on spiritually based coping than did married participants (T = 1251, P = .04) and lower on discontent coping (H[1] = 4.3, P = .04). Plead coping was an inverse function of education (H[3] = 6.8, P = .08). CONCLUSIONS: Patients beginning cardiac rehabilitation, particularly those with the demographic characteristics discussed in this study, may benefit from assessment of their desire for pastoral intervention.