A comparison of women's and men's symptoms during home recovery after coronary artery bypass surgery

Psychological interventions targeting mental health and stress among females with cardiac disease: a scoping review

Interventions that target mental health symptoms and stress among those with established cardiac disease have included predominately male samples despite female patients reporting greater severity of these symptoms. The aim of this scoping review was to synthesize the published literature on psychological interventions for females with cardiac disease. We conducted a systematic search of peer-reviewed randomized clinical trials (RCTs) published in the English language from 2003 to 2023, in three databases: Medline (Ovid), PsycInfo (Ovid), and CINAHL (EBSCO). Articles that included female samples, a control or comparison group, implemented psychological interventions, and measured depression, anxiety, or stress as an outcome were included in the review. Nine articles describing eight RCTs of psychological interventions, with a total of 1587 female patients with cardiac disease, were included. Interventions were most successful at reducing stress (75% of studies measuring stress reported efficacy), while symptoms of depression and anxiety were less responsive to intervention (∼30% of studies targeting these symptoms reported improvements) in comparison to a control condition. This scoping review highlights that further advancement in knowledge is required to better address the needs of females with cardiac disease and distress, particularly depression and anxiety.

Comparison of Two Techniques Performing the Supine-to-Sitting Postural Change in Patients with Sternotomy

Patients with sternotomy are advised to follow sternal precautions to avoid the risk of sternal complications. However, there are no standard recommendations, in particular to perform the supine-to-sitting postural change, where sternal asymmetrical force may be applied. The aim of this study was to compare the rotational movement and the use of a tied rope (individual device for supine-to-sitting, "IDSS") to perform the supine-to-sitting postural change. A total of 92 patients (26% female) admitted to a rehabilitative post-surgery ward with sternotomy were assessed for sternal instability. Levels of pain and perceived effort during the two modalities of postural change and at rest were assessed. Patients reported higher values of pain and perceived effort (both p < 0.0005) during rotational movement with respect to the use of the IDSS. Moreover, patients with sternal instability (14%) and female patients with macromastia (25%) reported higher pain than those stable or without macromastia (both p < 0.05). No other risk factors were associated with pain. Thus, the IDSS seems to reduce the levels of pain and perceived effort during the supine-to-sitting postural change. Future studies with quantitative assessments are required to suggest the adoption of this technique, mostly in patients with high levels of pain or with sternal instability.

Preparation and support for physical activity following hospital discharge after coronary artery bypass graft surgery: A survey of current practice in New Zealand

BACKGROUND AND PURPOSE

Engagement in physical activity following coronary artery bypass graft (CABG) surgery has many benefits and also many potential barriers, especially during the first few months. It is important to explore current clinical practice before investigating ways to optimally prepare and support people to progressively increase their physical activity post-hospital discharge and to navigate the challenges. The aim of the study was to explore current practice in New Zealand hospital services for preparing and supporting people who have had CABG surgery to engage in physical activity following hospital discharge.

METHODS

Locality authorisation to participate in the study was sought from all 11 hospitals providing cardiac surgery services in New Zealand. The most senior health professional responsible for preparing people to engage in physical activity following CABG surgery was invited to participate by completing a purpose designed questionnaire on behalf of their hospital service. Respondents were also requested to provide any patient information handouts regarding progressive physical activity engagement following CABG surgery.

RESULTS

Responses were received from all nine hospitals that granted locality authorisation. All nine hospitals prepared people to engage in aerobic exercise prior to discharge, predominantly through the provision of a walking schedule. In contrast, no hospitals provided information about engagement in resistance exercise. There was wide variability in both the advice provided regarding sternal precautions and time to return to activities of daily living. Additionally, the facilitation of some elements of self-management for physical activity, in particular problem solving and providing follow up support outside of the cardiac rehabilitation setting was provided infrequently.

DISCUSSION

The findings demonstrated variability in service delivery in a number of areas and highlighted potential areas for improvement in light of what is known from the literature. Provision of follow up support for those unable to access outpatient cardiac rehabilitation is a key need.

Perceptions and experiences of engaging in physical activity following coronary artery bypass graft surgery

BACKGROUND

Engagement in physical activity (PA) during the recovery period following coronary artery bypass graft (CABG) surgery improves physical and health-related quality-of-life outcomes.

OBJECTIVE

To explore people's perceptions and experiences of engaging in PA during the first three months following CABG surgery.

METHODS

A mixed methods study design was utilized. Quantitative data were collected via accelerometer activity capture and standardized questionnaires. Qualitative data were collected via semi-structured interviews at weeks 1, 3, 6 and 12 post-hospital discharge. Interviews were analyzed using inductive thematic analysis.

RESULTS

Two overarching themes described the overall experience of engaging in PA: 1) "Navigating a difficult and unfamiliar road to recovery" and 2) "Still cautious but becoming more confident and able." These themes described the impact over time that various physical (i.e., fatigue, pain, medical complications, and physical deconditioning), psychological (i.e., fear, confidence, uncertainty, and motivation), and environmental (support) factors had on PA engagement, as well as the relationships between these factors.

CONCLUSION

The findings provided insight into the physical, psychological, and environmental factors that impacted participants' PA engagement following CABG surgery. This knowledge may benefit health professionals to optimize preparation and support for adults to engage in PA post-hospital discharge following CABG surgery.

Factors influencing physical activity engagement following coronary artery bypass graft surgery: A mixed methods systematic review

BACKGROUND

Engagement in physical activity during the initial months following coronary artery bypass graft (CABG) surgery is important in order to improve health, quality of life and functional outcomes. There are, however, many potential barriers to physical activity engagement during the recovery period. No review studies have focused on barriers and facilitators to engagement in physical activity during the early stages of recovery following CABG surgery.

OBJECTIVE

To explore the factors that influence engagement in physical activity during the first three months following CABG surgery.

METHODS

Four electronic databases were searched. Extracted data from selected studies were synthesised using the Joanna Briggs Institute convergent integrated approach.

RESULTS

Nineteen studies met the inclusion criteria. Four main themes that influenced engagement were identified: sociodemographic variables; physical symptoms; psychosocial factors; and environmental factors. More barriers were identified than facilitating factors. Psychosocial factors were the most commonly reported barriers in the literature.

CONCLUSIONS

The findings of this review provide insights into factors that inhibit and facilitate engagement in physical activity following CABG surgery. Further research specifically exploring factors that influence engagement, especially facilitators, is required.

Patient-Reported Outcomes in Cardiovascular Trials

Patient-reported outcomes (PROs) are reports of a person's health status that provide a global perspective of patient well-being. PROs can be classified into 4 primary domains: global, mental, physical, and social health. In this descriptive review, we focus on how PROs can be used in cardiac clinical trials, with an emphasis on cardiac surgical trials for patients with coronary heart disease and heart failure. We also highlight ongoing challenges and provide specific suggestions and novel opportunities to advance cardiac clinical trials. Current challenges include the long-term measurement of PROs in clinical trials beyond 1 year, inconsistency in the choice of the outcome measures among studies, and the lack of measurement of PROs across multiple domains. Opportunities for advancement include measuring PROs using consumer health informatics tools, including returning information back to participants in formats that they can understand using visualization. Future opportunities include quantifying cohort-specific minimal clinically important differences for PROs.

Bras for Breast Support After Sternotomy: Patient Satisfaction and Wear Compliance

BACKGROUND

For women undergoing median sternotomy, especially those with a bra cup size C or larger, breast support can reduce pain, wound breakdown, and infection. This study addressed a gap in research, identifying the best bra after sternotomy in terms of patient satisfaction and wear compliance.

OBJECTIVES

To evaluate larger-breasted women's satisfaction and compliance with wearing 3 commercially available front-closure bras-with a hook-loop closure (the hospital's standard of care), a zipper closure, or a hook-eye closure-after cardiac surgery.

METHODS

This study used a posttest-only, 3-group randomized controlled design. A convenience sample of participants were sized and randomly assigned a product that was placed immediately postoperatively. Participants agreed to wear the bra at least 20 h/d until the provider cleared them for less wear. At inpatient day 5 or discharge, and at the follow-up outpatient visit, subjects completed investigator-developed surveys. Data were analyzed from 60 participants by using the χ2 test and Kruskal-Wallis analysis of variance; also, patterns were identified within written comments.

RESULTS

Participants were most satisfied with the hook-eye front-closure product before (P = .05) and after (P = .02) discharge. Participants recommended the hook-eye and zipper products over the hook-loop bra (H = 8.39, P = .02). Wear compliance was strongest in the group wearing the hook-eye bra.

CONCLUSIONS

The hook-eye closure product had the most satisfaction and greatest wear compliance, and it received the highest recommendation. A practice change was made to fit and place the hook-eye bra in the operating room immediately after surgery.

Fatigue in Chronic Heart Failure – Does Gender Make a Difference?

The primary aim of this study was to describe and compare the experience of fatigue in a group of elderly women and men with severe chronic heart failure. A sample of 158 patients (66 women and 92 men, with a mean age of 83 and 78 years, respectively) was invited to participate in a study on admission to a hospital outpatient heart failure clinic. A registered nurse interviewed patients using a modified version of the Fatigue Interview Schedule (FIS). Descriptions of the experiences of fatigue generally showed good agreement between men and women; however, some gender differences were found. Women expressed a clear role to fulfil because they were engaged in maintenance activities of their household. Although we still have only limited knowledge about the impact of gender on the experiences and coping strategies in disease and aging, it is important for care providers to consider gender differences when planning caring interventions.

Recovery Symptoms and Mood States in Thai CABG patients

Recovery symptoms and related mood states during early recovery after coronary artery bypass graft surgery (CABG) have never been assessed in Thailand. This cross-sectional descriptive correlational study was to identify the relationships between frequency of recovery symptoms and mood states of a convenience sample of 91 Thai CABG patients during 2 weeks after discharge. Standardized tools/procedures were used to measure the variables of interest. The most common recovery symptoms were chest and leg incision pain, having trouble sleeping, and neck and shoulder or back discomfort. The most common mood states were confusion, anxiety, and anger, respectively. In addition, Thai CABG patients who had more frequent recovery symptoms also had greater negative mood disturbance. These findings provide a beginning explanation about the phenomena of recovery symptoms and mood states in a specific culture, Thai CABG patients.

Preoperative sleep complaints are associated with poor physical recovery in the months following cardiac surgery

BACKGROUND

Sleep disturbance is associated with poorer outcomes in cardiac patients, but little is known about the independent role of sleep quality in coronary artery bypass graft (CABG) patients.

PURPOSE

This study aims to examine the relationship between preoperative sleep complaints and post-operative emotional and physical recovery in CABG surgery patients, independently of demographic, clinical and mood factors.

METHODS

Two hundred thirty CABG patients (aged 67.81 ± 9.07 years) completed measures of self-reported sleep complaints before surgery and health-related quality of life (HRQoL), physical symptoms and pain 2 months after surgery.

RESULTS

Greater sleep complaints prior to surgery were associated with greater physical symptoms, poorer physical HRQoL and greater sensory pain after surgery (p < 0.05), but not with affective pain or mental HRQoL. Preoperative mood was not able to explain these associations.

CONCLUSIONS

Sleep complaints may be implicated in physical recovery from CABG surgery but further work is needed to understand the role of causal pathways.

Perceptions of exercise and quality of life in older patients in the United States during the first year following coronary artery bypass surgery

BACKGROUND AND PURPOSE

It is important for patients recovering from coronary artery bypass (CAB) surgery to initiate and maintain recommended exercise guidelines. The purpose of this qualitative study was to describe factors that influence adherence to exercise, and perceptions of activity limitations and health-related quality of life (QoL) in older patients recovering from CAB surgery.

SUBJECTS

Participants were 28 people aged 65 and older, prospectively recruited from a U.S. hospital following CAB surgery.

PROCEDURES

A qualitative description methodology was used to identify factors that influenced participants' feelings about exercise and QoL. Data were collected using phone interviews 3, 6, and 12 months after surgery. Data were coded by identifying significant statements, grouping them into meaningful units or "themes", and generating descriptions of participants' experiences and understandings.

RESULTS

Across time points, participants' most commonly described motivators were that it feels good to exercise, and belief that it improves physical health. The most commonly cited barriers to exercise were other time commitments, inclement weather, and pain/injury/illness related or unrelated to CAB surgery.

DISCUSSION AND CONCLUSION

Motivating themes remained consistent across the time intervals but the number of responses regarding barriers to exercise increased over time. A better understanding of the patient experience may help to promote exercise initiation and adherence following CAB surgery.

Challenges associated with delivering education to patients after heart surgery

AIM

The aim of this report is to provide a detailed description of the challenges that arose throughout the implementation of an individualized patient education intervention delivered to patients during their home recovery following heart surgery.

METHODS

The intervention was delivered at two points in time by telephone to patients following heart bypass and/or valvular replacement.

RESULTS

The individualized patient education intervention was found to be effective in reducing the rate and number of complications developed during the first three months following hospital discharge. However, throughout the implementation of this intervention, specific challenges arose that included: onset of symptoms that interfered with intervention delivery, patient's request for information beyond the scope of the teaching interaction, and the need to provide continued support to the therapist.

CONCLUSION

These challenges were addressed throughout the course of the study and the strategies are currently being implemented into the planned knowledge translation activities associated with this intervention.

A Systematic Review of Web-Based Educational Interventions

A complement to in-hospital educational interventions is web-based patient education accessed during the home recovery period. While findings demonstrate the effectiveness of web-based patient education interventions on patient outcomes, they fall short of identifying the characteristics that are associated with desired outcomes. The purpose of this systematic review was to determine the characteristics of web-based patient education interventions that are associated with producing changes in self-care behaviors. A systematic review involving 19 studies was conducted to determine the most effective components of a web-based intervention. Findings suggest that the most effective form of web-based patient education is one that is interactive and allows patients to navigate the online system on their own. The findings from this systematic review allow for the design of a web-based educational intervention that will promote increased performance of self-care behaviors during the home recovery period.

Educational Intervention Reduces Complications and Rehospitalizations After Heart Surgery

The effectiveness of in-hospital self-care patient education, delivered to patients following heart surgery, is questionable, as evidence indicates individuals are not able to absorb and/or retain information at this time. In the absence of adequate instruction, individuals will not have the relevant information to engage in specific self-care behaviors, resulting in the onset of complications and/or hospital readmissions. The purpose of this pilot study was to collect preliminary evidence to demonstrate the impact of an individualized education intervention given above and beyond usual care, delivered, at two points in time, following hospital discharge. A randomized controlled trial was used in which 34 patients were randomly assigned to one of two groups. Chi-square analyses to examine differences between groups on complications and hospital readmission rates were conducted. Findings point to the impact of the intervention in reducing the number of hospital readmissions and complications at 3 months following hospital discharge.

Patient recovery and transitions after hospitalization for acute cardiac events: an integrative review

Despite increased attention to providing seamless transitions after hospitalization, patients often feel unprepared, lack knowledge, and may be confused by what to expect during recovery at home after a cardiac event. Care transition after hospital discharge could be improved by informing and counseling patients more specifically about expected recovery after a cardiac event. Therefore, an integrative review of research was conducted to evaluate cardiac patients' trajectory of recovery after hospitalization. A total of 61 studies were included in this review. Studies included were those of cardiac patients who had been hospitalized for significant cardiac events and those focused on acute coronary syndrome (n = 18), percutaneous coronary intervention (PCI) (n = 12), cardiac surgery (coronary artery bypass surgery and valve surgery; n = 25), and heart failure (n = 6). Studies included quantitative, mixed-methods, and qualitative designs, with sample sizes ranging from 4 to 2121 participants. Notwithstanding the limitations of this review, findings demonstrated that patients' perceptions of their cardiac event evolved over time from uncertainty, fears, anxiety, and depression, which were often associated with a lack of knowledge of their cardiac condition, to a phase of self-management of their cardiac condition. Furthermore, patterns of commonly occurring symptoms and changes in functioning abilities during recovery after hospitalization were apparent among the different cardiac groups. These findings may be useful to both patients and clinicians to inform them about the recovery trajectory after a cardiac event to improve preparation for the transition from hospital to home.

Predictors of fear and anxiety nine years after coronary artery bypass grafting

AIM

This paper is a report of a study to identify (i) associations between fear and anxiety with variables of demography, symptoms, treatment and perceived health, (ii) associations between fear, anxiety, depression and social support and (iii) predictors of fear and anxiety nine years after coronary artery bypass grafting.

BACKGROUND

Earlier research shows that anxiety and fear are common, but there is a lack of knowledge about the long-term (>five years) situation of people after coronary artery bypass grafting.

METHOD

A convenience sample (n = 170) was formed of patients who had undergone coronary artery bypass grafting (n = 723) in one university hospital in 2007, nine years after surgery, by postal questionnaire. The questionnaire was sent to 152 surviving patients, and 114 responded (75%).

RESULTS

Fear had a connection to female sex, age under 65 years, more chest pain, hospitalization and poor perceived health. Anxiety had a connection to age under 65 years, living alone, more chest pain and poor perceived health. Social support had a low negative correlation with anxiety. Age under 65 years and chest pain explained 28% of the variance in fear. Age under 65 years and depressive symptoms explained 51-57% of the variance in anxiety.

CONCLUSION

Anxiety in people with coronary heart disease can be alleviated by developing social support from peers and professionals. Those aged under 65 years should be recognized as at greater risk of a predictor of long-term fear and anxiety after coronary artery bypass grafting.

Symptom burden clusters and their impact on psychosocial functioning following coronary artery bypass surgery

Although there is extensive literature on symptoms experienced by patients after coronary artery bypass surgery (CABS), there is a paucity of data on symptom clusters and their impact on functional outcomes. The purpose of these descriptive, secondary analyses was to identify and describe cluster subgroups of 226 elderly CABS patients at discharge and to examine the cluster's impact on psychosocial functioning over time (baseline, 6 weeks, and 3 months) using the 36-item Medical Outcome Study Short Form subscales. Cluster analysis revealed a 3-cluster solution with low, low-moderate, and moderate symptom burden clusters. Significant differences were detected for Duke Activity Status Index (F(2,223) = 5.12, P = .007), Barnason Efficacy Expectation Scale (F(2,223) = 9.60, P < .0001), Hospital Anxiety and Depression Scale (F(2,219) = 15.14, P < .0001), and New York Heart Association classification (chi = 17.44, P = .008). Significant differences were noted on all variables between the low and moderate symptom burden clusters with differences between the low-moderate and moderate clusters for only the Barnason Efficacy Expectation Scale and the Hospital Anxiety and Depression Scale. Those in the moderate symptom burden cluster had more symptoms, anxiety, and depression along with lower self-efficacy and physiological functioning than those in the other 2 clusters. There was no interaction or simple main effects for the role-emotional or social subscales as measured by the 36-item Medical Outcome Study Short Form. There was no significant interaction for mental functioning by time and cluster (F(4,641) = .30, P = .88); however, there was a simple main effect for cluster (F(2,641) = 4.11, P = .02). Follow-up analysis indicated significant differences between the low and low-moderate clusters, indicating that those with low symptom burden had significantly better mental health functioning than those with moderate symptom burden. Findings provide a foundation of knowledge on symptom clusters in CABS populations and may be useful to clinicians to identify patients at risk for slowed or delayed recovery and for early intervention.

Medications and associated symptoms/problems after coronary artery bypass surgery

OBJECTIVE

The purpose of this secondary analysis was to describe medication use and examine the relationship between medications and postoperative symptoms/problems in the first 3 months after coronary artery bypass surgery (CABS).

METHODS

The sample consisted of older (≥65 years) men and women (n = 232) who had undergone CABS. Medication data were collected through self-report 3 and 6 weeks and 3 months after surgery.

RESULTS

Most patients reported taking aspirin (88.2%-85.7%), statins or cholesterol-lowering drugs (88.6%-87%), and beta-blockers (68%-55.6%). No significant differences were found between the proportion of patients taking and not taking beta-blockers, antiarrhythmics, cholesterol-lowering drugs, or angiotensin-converting enzyme inhibitor medications for common medication-specific symptoms/problems.

CONCLUSION

Patients experience symptoms after surgery, but these symptoms did not seem to be side effects from medications. Nursing assessments and interventions targeting postoperative symptoms, symptom management, and medication side effects can enhance recovery and reinforce medication adherence.

Predictors of health care needs in discharged patients who have undergone coronary artery bypass graft surgery

OBJECTIVE

The study objective was to explore the health care needs of patients who have undergone coronary artery bypass graft (CABG) and identify the influential factors related to those needs. CABG is a current medical treatment for patients with ischemic heart disease. Discharged patients who have undergone CABG often have physical and psychosocial discomfort that can be intolerable. Understanding and meeting the health care needs of patients who have undergone CABG will facilitate their recovery.

METHODS

Descriptive correlational research was performed. The participants were patients who underwent CABG and were discharged within the first month. A total of 103 subjects were recruited by purposive sampling from 1 medical center in the Taipei area of Taiwan. The structured questionnaires of the Symptom Distress Inventory and Health Care Needs Inventory of patients who underwent CABG were used for data collection. Data were analyzed by descriptive statistics, t test, 1-way analysis of variance, Pearson's correlation, and multiple regressions.

RESULTS

The frequent order of health care needs were physical, informational, and psychosocial. The stepwise multiple regressions showed that the most important predictors for overall health care needs were length of hospital stay after surgery, symptom distress, and gender.

CONCLUSION

Clinical nursing care should focus on patients who have longer postsurgery hospitalization, patients with more severe symptom distress, and female patients after discharge. The results of this study will provide a reference for developing nursing interventions for patients who are discharged after CABG. The optimal goal is to enhance the quality care of these patients.

An exploration of the relationship between coronary artery bypass graft patients' self-sought educational resources and outcomes

Postoperative coronary artery bypass graft (CABG) patients seek educational resources around discharge. There is limited research on the type and perceived effectiveness of self-sought educational resources. The purpose of this study was to describe the use of self-sought educational resources by patients around time of discharge and to explore relationships between use of self-sought educational resources and self-care knowledge, performance of self-care behavior, and symptom frequency. This study is a substudy of a randomized clinical trial that included a convenience sample of first-time CABG patients. Significant correlations were found between use of self-sought educational resources and greater frequency of patient's behavior (P <or= .05), and a decrease in symptom frequency (P <or= .05). This study represents a first step toward identifying the association between the use of self-sought educational resources after CABG and outcomes expected of education.

Development and content validity testing of the Cardiac Symptom Survey in patients after coronary artery bypass grafting

BACKGROUND

Patients who have undergone coronary artery bypass grafting often experience numerous symptoms after surgery. There is a need for a symptom tool for this population that is disease-specific, comprehensive, and responsive to change.

AIMS

The aims of this study were to describe the development and preliminary content validity testing of the Cardiac Symptom Survey (CSS), assess further content validity of the CSS through an expert panel, and assess responsiveness of the CSS to change.

METHODS

The original development of the CSS is described. An expert panel of four judges was used to rate the clarity of the items (content validity) and the relevance of the symptoms and items to the domain. Responsiveness to change of the CSS was assessed in a sample of 90 subjects who underwent coronary artery bypass grafting.

RESULTS

Percent agreement and content validity index coefficients ranged from .90 to 1.00. Repeated measures analyses of variance showed significant changes over time as hypothesized in some of the symptom evaluation and symptom response scores.

CONCLUSION

Support is documented for both content validity and responsiveness of the CSS.

Physical, psychological and social recovery patterns after coronary artery bypass graft surgery: A prospective repeated measures questionnaire survey

AIM

This study examined the physical, psychological and social recovery patterns of Hong Kong Chinese patients who have undergone CABG surgery over a period of six months.

BACKGROUND

Recovery from coronary artery bypass graft (CABG) surgery is a dynamic process and the associated physical, psychological and social effects could lead to failure to recuperate leading to hospital re-admission and morbidity.

DESIGN

A prospective repeated measures design was used for this research. Patients were interviewed in person 5 days before surgery and at 1 week after discharge, and by telephone at 3 and 6 months after discharge. Physical recovery dimension was assessed by three categories of the Sickness Impact Profile (ambulation, sleep-rest, body movement and care). Social recovery dimension was assessed by three categories of the Sickness Impact Profile (SIP) (home management, social interaction, and recreation and pastimes). Psychological recovery was assessed using the Centre for Epidemiologic Studies-Depression (CES-D).

RESULTS

Sixty-eight patients participated in this research. The mean physical SIP-dimension score and depression level at discharge was the highest then gradually decreased at 6 months after CABG. The SIP-physical and SIP-social and depression level differed significantly across the four-assessment time within-group. There were no gender differences in physical and social recovery and depression levels. Patients who had poorer physical and social recovery had more depression at one week and three months after CABG surgery.

CONCLUSION

Patients should be prepared for discharge after CABG surgery. Cultural factors may have influenced the similar recovery patterns between genders. These factors contributing to early recovery must be further examined.

RELEVANCE TO CLINICAL PRACTICE

Because of the large number of patients who undergo CABG worldwide, and because of healthcare cost related to this intervention, it is important for both patients and healthcare providers to have realistic expectations about the recovery process and to recognise deviations from the norm. The results provided some insights into the Hong Kong Chinese patients' recovery from CABG surgery that would guide the development of culturally appropriate pre-operative and discharge teaching for this group of patients.

Functional status of patients during subacute recovery from coronary artery bypass surgery

BACKGROUND

Patients recovering from coronary artery bypass (CAB) surgery are particularly vulnerable to impaired functional status because in addition to the direct effects of heart disease on cardiac performance, many surgical factors may contribute to loss of function.

OBJECTIVES

The purposes of this study were to describe functional status across multiple domains using performance-based and self-report assessments and to determine the relationship among different domains of functional status in patients recovering subacutely (<6 months) from CAB surgery.

METHODS

The participants in this study (n = 25) had undergone CAB surgery in the past 6 months. This cross-sectional descriptive study measured functional status in several domains using self-report and performance-based assessments.

RESULTS

The study results indicate that participants had deficits in health-related quality of life, activities of daily living performance, endurance/aerobic capacity, and cognitive/memory ability. Several correlations between the scores for outcome measures in different domains were found in this study.

CONCLUSIONS

Impaired functional status occurs in patients recovering subacutely from CAB surgery. Different aspects of functional status are related, and an understanding of these relationships may help to improve the medical management of patients after CAB surgery.

A randomized controlled trial of women's early use of a novel undergarment following sternotomy: the Women's Recovery from Sternotomy Trial (WREST)

BACKGROUND

Despite a lack of randomized trial evidence, clinicians often suggest that women use a brassiere to reduce poststernotomy pain and discomfort. We tested the effect of women's use of a special (compression) undergarment after sternotomy on pain, discomfort, and functional status.

METHODS

Women (n = 481) having first-time sternotomy in 1 of 10 Canadian centers were randomized to receive the intervention or usual care. Pain and discomfort data (using numeric rating scales) were collected in person while participants were hospitalized. Thereafter, pain, discomfort, and functional status data (using Health Assessment Questionnaire) were collected by standardized telephone interview until 12 postoperative weeks.

RESULTS

Overall, and until at least 6 weeks postoperatively, fewer women in the intervention than usual care group reported having incision and breast pain and discomfort. Breast pain scores were lower in the intervention than the usual care group at 2 weeks postoperatively (P = .04), and over time (OR 0.65 [95% CI 0.45-0.94], P = .02). For women discharged within 14 postoperative days, post hoc analyses revealed intervention group patients had a significantly reduced likelihood of breast pain (OR 0.46 [95% CI 0.32-0.66], P < .001) and breast discomfort (OR 0.62 [95% CI 0.44-0.86], P = .01) but not incision pain (OR 0.99 [95% CI 0.72-1.37], P = .95) or discomfort (OR 0.77 [95% CI 0.55-1.02], P = .06). There was no difference between groups in functional status. The effects were not influenced by age or brassiere size.

CONCLUSIONS

Using a supportive undergarment during the early postoperative reduces breast pain. This finding is amplified and extends to include a reduction in breast discomfort, when women are discharged within 14 postoperative days.

Impact of a telehealth intervention to augment home health care on functional and recovery outcomes of elderly patients undergoing coronary artery bypass grafting

OBJECTIVE

This pilot study examined the effect of a home communication intervention (HCI) to augment home health care (HHC) on functioning and recovery outcomes of elderly patients undergoing coronary artery bypass graft.

DESIGN

A randomized, experimental two-group (N = 50) repeated-measures design was used. Both HCI and control subjects received HHC, and the HCI group also received the 12-week HCI delivered by a telehealth device, the Health Buddy (Health Hero Network). The Medical Outcome Study Short Form-36 measured physiologic and psychosocial functioning at baseline, 6 weeks, and 3 months after surgery. Follow-up subject interviews ascertained self-report of postoperative problems and health care use.

SAMPLE

Subjects had an average age of 75.3 years and included males (56%) and females (44%).

RESULTS

By using repeated-measures analyses of covariance, covariating for the total number of HHC visits, HCI subjects, compared with the HHC group only, had a significantly higher adjusted mean general health functioning score (F = 8.41 [1, 36], P < .01). There were significant time effects on physical, role-physical, and mental health functioning, indicating that both groups improved over time. The groups reported similar postoperative problems; however, the control group had more emergency department visits than the HCI group.

CONCLUSIONS

Findings demonstrate the potential benefit of using an HCI to further augment outcomes of high-risk patients undergoing coronary artery bypass graft surgery referred to HHC after hospitalization.

Psychometric Evaluation of the Heart Surgery Symptom Inventory in Patients Recovering From Coronary Artery Bypass Surgery

PURPOSE

The purpose of this study was to evaluate the test-retest reliability, internal consistency, and concurrent validity of the Heart Surgery Symptom Inventory (HSSI) in patients following coronary artery bypass surgery.

METHODS

This study included 28 patients attending outpatient rehabilitation who had undergone coronary artery bypass surgery within the past 6 months. Patients completed self-report instruments including a medical history form, HSSI, and Medical Outcomes Study Short Form-36. Patients also completed a second HSSI at a later time on the same testing day. HSSI scores were summed to create a total score and 4 subcategory scores (general, cardiac, trunk, lower extremity). Correlations were calculated for scores obtained during 2 trials of the HSSI to evaluate test-retest reliability, between individual items, subcategory, and total scores to evaluate internal consistency, and between HSSI scores and Medical Outcomes Study Short Form-36 scores to evaluate concurrent validity.

RESULTS

Correlations for the 2 trials of the HSSI total and all subcategories were significant (P < .05) and ranged from 0.89 to 0.99. Subcategories to total correlations were all significant and ranged from 0.59 to 0.85. Subcategories to subcategory correlations were all significant except for lower extremity to cardiac and lower extremity to general comparisons. Individual item to total correlations ranged from 0.02 to 0.84. Individual item to subcategory correlations ranged from 0.01 to 0.85. The correlations between the HSSI total and all Medical Outcomes Study Short Form-36 scores were significant.

CONCLUSIONS

Results indicate that the HSSI has appropriate reliability and validity for clinical and research applications. The HSSI can be a useful clinical and research tool to evaluate quality of life in patients after coronary artery bypass surgery.

Coping, social support and quality of life over time after myocardial infarction

AIM

This paper describes gender differences in perceived coping, social support and quality of life 1, 4 and 12 months after myocardial infarction.

BACKGROUND

There is a shortage of studies with a longitudinal research design investigating coping, social support and quality of life in women and men after myocardial infarction.

METHODS

A longitudinal, descriptive and comparative design was used for the study, which included 74 women and 97 men. At 12 months, 60 women and 88 men remained. Data were collected using the Jalowiec Coping Scale, a social support questionnaire, the SF-36 Health Survey (health-related quality of life) and the Quality of Life Index-Cardiac version (quality of life). The data were collected during the period 1999-2001.

RESULTS

No statistically significant changes over time in coping assessments emerged in the study group, except for fatalistic coping, which diminished over time in men. Women used more evasive coping than men at 4 and 12 months. The perceived efficiency in coping with physical aspects of the heart disease increased. More women than men perceived available support from grandchildren and staff of the church. Health-related quality of life increased in women and men in physical functioning, role-physical, vitality, social functioning, and role-emotional scales. Moreover, an improvement in the mental health scale was evident in women and a reduction in pain in men. No statistically significant gender differences were found for quality of life at any point in time.

CONCLUSIONS

The findings can be used to inform caregivers that optimistic, self-reliant and confrontational coping were the most frequently used by both women and men over the first year after myocardial infarction, and that confrontational coping has been shown to have positive outcomes in the longer term. Nurses should tell women about the importance of seeking prompt treatment and discuss health problems with caregivers and significant others. Care planning should include family members and significant others so that they can support and encourage patients to cope with problems in daily life.

Gender differences in recovery after coronary artery bypass graft surgery

This study examined the effect of gender on symptom evaluation, symptom response, and physical functioning following coronary artery bypass graft surgery. Symptom evaluation and symptom response were measured at baseline and 2, 4, and 6 weeks and 3 months following surgery, and physical functioning was measured at baseline, 6 weeks, and 3 months. The sample included 46 men and 19 women randomly assigned to the routine care group of a larger study examining symptom management intervention influence on recovery outcomes in elderly coronary artery bypass graft patients. No significant differences were found in symptom evaluation, symptom response, or physical functioning by gender over time. Women reported consistently higher symptom evaluation scores for shortness of breath, fatigue, depression, sleep disturbance, swelling, and anxiety and lower mean physical and vitality subscale scores than men at every time point. Gender-specific symptom management strategies should be developed and tested to address the differences in the reporting of symptoms by men and women.

Perceived coping, social support, and quality of life 1 month after myocardial infarction: a comparison between Swedish women and men

OBJECTIVE

The study objective was to compare coping, social support, and quality of life in Swedish women and men 1 month after myocardial infarction.

DESIGN

The study design was cross-sectional and descriptive-comparative.

SETTING

The study took place in 1 hospital service area in the middle of Sweden.

SUBJECTS

The sample consisted of 74 women and 97 men.

INSTRUMENTS

The Jalowiec Coping Scale, the Social Network and Social Support Questionnaire, the Short Form-36 Health Survey, and the Quality of Life Index-Cardiac Version were used.

RESULTS

Compared with men, women used more evasive and supportive coping and rated psychologic aspects of the heart disease as more problematic to manage. More women perceived available support from friends and grandchildren, and more men perceived available support from their partner. Women rated lower levels in physical and psychologic dimensions of quality of life.

CONCLUSION

The first month after myocardial infarction is a susceptible period especially for women. They used more evasive and supportive coping and experienced a lower quality of life compared with men.

The Women's Recovery from Sternotomy (WREST) study: design of a randomized trial of a novel undergarment for early use after sternotomy

BACKGROUND

Clinicians who work with women poststernotomy often suggest that they wear a supportive brassiere to ameliorate pain, discomfort, and potential wound complications. There is no empirical evidence that supports this practice.

METHODS

Despite methodological challenges, a clinical trial is currently underway to investigate the efficacy of early use of a novel undergarment after sternotomy. Women (N = 430) having first time sternotomy in 9 Canadian centers will be randomized to receive either the usual care of the institution or early use of a novel undergarment. Follow-up is planned over 12 postoperative weeks. Coprimary outcomes are pain, discomfort, and return to function. Wound healing is a secondary outcome. An economic evaluation substudy is also underway.

CONCLUSIONS

The WREST Study is a unique ongoing trial examining the efficacy of a novel undergarment in reducing women's pain and enhancing their comfort and return to function. The findings of the trial and its economic substudy will enable health care providers to make rational evidence-based clinical decisions regarding women's early care after sternotomy.

Technology dependence and health-related quality of life: a model

AIM

This paper presents a new theoretical model to explain people's diverse responses to therapeutic health technology by characterizing the relationship between technology dependence and health-related quality of life (HRQL).

INTRODUCTION

Technology dependence has been defined as reliance on a variety of devices, drugs and procedures to alleviate or remedy acute or chronic health problems. Health professionals must ensure that these technologies result in positive outcomes for those who must rely on them, while minimizing the potential for unintended consequences. Little research exists to inform health professionals about how dependency on therapeutic technology may affect patient-reported outcomes such as HRQL. Organizing frameworks to focus such research are also limited.

MODEL

Generated from the synthesis of three theoretical frameworks and empirical research, the model proposes that attitudes towards technology dependence affect HRQL through a person's illness representations or commonsense beliefs about their illness. Symptom distress, illness history, age and gender also influence the technology dependence and HRQL relationship. Five concepts form the major components of the model: a) attitudes towards technology dependence, b) illness representation, c) symptom distress, d) HRQL and e) illness history.

CONCLUSION

The model is proposed as a guide for clinical nursing research into the impact of a wide variety of therapeutic health care interventions on HRQL. Empirical validation of the model is needed to test its generality.

Sleep, memory, and learning in off-pump coronary artery bypass patients

In this study, I examined sleep, memory, and learning in off-pump coronary artery bypass (OPCAB) patients. Sixty-six men and women aged >or=60 years wore actigraphs to record sleep and completed sleep diaries for two 24-hour periods following OPCAB surgery. Prior to discharge from the hospital, participants completed the Pittsburgh Sleep Quality Index (PSQI) and Rey Auditory Verbal Learning Test. No significant correlations were found between habitual sleep, sleep time, efficiency, number, and duration of awakenings, daytime napping, or memory and learning. Nighttime sleep was short with frequent disturbances, and daytime sleep accounted for half the daily sleep time. Participants scored low in learning and delayed recall. These findings suggest the need to assess sleep and cognition in patients recovering from OPCAB surgery.

Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery

Cardiovascular diseases cause more disability and economic loss in industrialized nations than any other group of diseases. In previous work [Nurs Res 49 (2000a) 1], most coronary artery bypass graft patients (CABG, N=225 ) reported unrelieved pain and received inadequate analgesics. This study proposed to evaluate a preadmission education intervention to reduce pain and related activity interference after CABG surgery. Patients (N=406) were randomly assigned to (a) standard care or (b) standard care+pain booklet group. Data were examined at the preadmission clinic and across days 1-5 after surgery. Outcomes were pain-related interference (BPI-I), pain (MPQ-SF), analgesics (chart), concerns about taking analgesics (BQ-SF), and satisfaction (American Pain Society-POQ). The impact of sex was explored related to primary and secondary outcomes. The intervention group did not have better overall pain management although they had some reduction in pain-related interference in activities ( t(355)=2.54, P<0.01) and fewer concerns about taking analgesics ( F(1,313)=2.7, P<0.05) on day 5. Despite moderate 24-h pain intensity across 5 days, patients in both groups received inadequate analgesics (i.e. 33% prescribed dose). Women reported more pain and pain-related interference in activities than men. The booklet was rated as helpful, particularly by women. In conclusion, the intervention did not result in a clinically significant improvement in pain management outcomes. In future, an intervention that considers sex-specific needs and also involves educating the health professionals caring for these patients may influence these results.

Myocardial infarction: gender differences in coping and social support

AIM

The aim of this review is to summarize current knowledge about gender differences in perceptions of coping and social support among patients who have experienced myocardial infarction.

RATIONALE

Women with coronary heart disease have physical, social and medical disadvantages compared with their male counterparts, which can influence their perception of recovery after cardiac events. No review has been found which focuses on gender differences in coping and social support in myocardial infarction patients.

METHOD

A computerized search was conducted using the keywords 'myocardial infarction', 'coping', 'gender differences' and 'social support'. Forty-one articles, published between 1990 and October 2002, were scrutinized.

FINDINGS

Two studies report that women used more coping strategies than men. Several qualitative studies found that women used a variety of coping strategies. Women minimized the impact of the disease, tended to delay in seeking treatment and did not want to bother others with their health problems. Household activities were important to them and aided their recovery. Men were more likely to involve their spouses in their recovery, and resuming work and keeping physically fit were important to them. Women tended to report that they had less social support up to 1 year after a myocardial infarction compared with men. They received less information about the disease and rehabilitation and experienced lack of belief in their heart problems from caregivers. Further, they received less assistance with household duties from informal caregivers. Men tended to report more support from their spouses than did women.

CONCLUSIONS

Traditional gender-role patterns may influence the recovery of patients who have experienced myocardial infarction. Caregivers may need to be more sensitive to gender-specific needs with regard to risk profiles, social roles, and the patient's own role identity. For many women, especially older ones, household duties and family responsibilities may be an opportunity and a base for cardiac rehabilitation.

Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery

OBJECTIVE

To evaluate gender-related differences in quality of life (QOL) and cognitive function 1 year after coronary artery bypass surgery (CABG) after adjusting for known baseline differences.

MATERIALS AND METHODS

Two hundred eighty patients (96 women and 184 men) underwent neurocognitive and QOL evaluation at baseline (preoperatively) and at 1 year after CABG. Multivariable linear regression was used to assess the relationship of gender to follow-up QOL and cognitive function. Measures used to evaluate QOL were IADL, DASI, work activities (SF-36), social activities, social support, general health perception (SF-36), CESD, STAI, and symptom limitations. Cognitive function was measured with a battery of performance-based neuropsychological tests, reduced to a four-cognitive domain scores with factor analysis, and a self-report measure of cognitive difficulties. Covariates in multiple regression models included age, years of education, marital status, Charlson Comorbidity Index, hypertension, diabetes, race, and baseline QOL/cognitive status.

RESULTS

Female patients showed significantly worse outcome than male patients at 1 year follow-up in several key areas of QOL. After adjusting for baseline differences, women are at greater risk for increased cognitive difficulties (p= 0.04) and anxiety (p= 0.03), as well as impaired DASI (p= 0.02), IADL (p= 0.03), and work activities (p= 0.02). Cognitive sequelae attributable to bypass surgery were similar between men and women.

CONCLUSIONS

Even after adjusting for known risk factors for compromised QOL and cognitive functioning, women do not show the same long-term quality benefits of CABG surgery that men do.

Predictors of women's attendance at cardiac rehabilitation programs

This descriptive study was conducted to identify the factors that influence womens attendance at cardiac rehabilitation programs and womens adherence to risk factor modification following a cardiac event. Women (N=196) admitted to hospital for a cardiac event were followed-up at 12 weeks postdischarge. Despite eligibility, only 64% (n=112) had been referred to cardiac rehabilitation programs. By 12 weeks postdischarge only 32% of the total sample (n=57) attended programs and 12% of the total sample (n=21) had dropped out before completion. The odds of a woman attending cardiac rehabilitation were decreased by myocardial infarction diagnosis, lack of employment, <55 years or >70 years, and experiencing a personal stressful event during follow-up. Women were likely to adhere to smoking, medication, and stress modification guidelines but unlikely to adhere to modification guidelines for diet and exercise.

Depression and anxiety in coronary artery bypass grafting patients

PURPOSE

Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients.

SUBJECT AND METHODS

After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory.

RESULTS

Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed.

CONCLUSIONS

High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.

Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning

OBJECTIVE

The purpose of this study is to determine the impact of a home communication intervention (HCI) for ischemic heart failure Coronary Artery Bypass Graft (CABG) patients >/= 65 years of age on self-efficacy, coronary artery disease risk factor modification and functioning posthospitalization.

DESIGN

A randomized clinical trial with repeated measures was used.

SAMPLE

A subsample of ischemic heart failure CABG surgery patients (n = 35) was drawn from the parent study of 180 CABG patients.

RESULTS

HCI participants (n = 18) had significantly higher adjusted mean self-efficacy scores [F(1, 29) = 6.40, P <.05] and adjusted mean levels of functioning (physical, general health, mental, and vitality functioning) compared with the routine care group (n = 17), using repeated measures analysis of covariance with baseline scores as covariates. There were also significant effects of time on bodily pain and role emotional functioning. Significantly higher exercise adherence (t = 3.09, P <.01) and lower reported stress (t = 3.77, P <.01) at 3 months after surgery was reported by HCI subjects.

CONCLUSIONS

Data from this pilot study can be used to strengthen the HCI intervention with more tailored strategies for vulnerable subgroups of CABG patients.

Effects of a telephone counseling intervention on psychosocial adjustment in women following a cardiac event

OBJECTIVE

The purpose of this study was to test the effect of a post-discharge telephone counseling intervention on women's psychosocial adjustment following a cardiac event.

DESIGN

The study was a prospective, randomized, controlled trial.

PATIENTS

Women (n = 196) were recruited from 4 hospitals in Sydney, Australia, who were hospitalized for coronary artery disease: myocardial infarction, coronary artery bypass grafts, coronary angioplasty, or stable angina. Women were randomized to usual care (n = 103) or telephone counseling (n = 93) and were 67 years of age (range 34-92). The majority had not completed high school (92%) and were not employed (84%).

OUTCOMES

Psychosocial adjustment was measured by the Psychosocial Adjustment to Illness Scale and the Hospital Anxiety and Depression Scale the day before hospital discharge and 12 weeks postdischarge.

INTERVENTION

Individualized information and support, was designed to promote self-managed recovery and psychosocial adjustment, and began with an evaluation during admission and was followed up by telephone counseling at 1, 2, 3, and 6 weeks after discharge.

RESULTS

The intervention had no effect on psychosocial adjustment (F[1,182] = 0.06, P =.8), anxiety (F[1,182] = 0.15, P =.69) or depression (F[1,182] = 0.11, P =.74) at 12 weeks after discharge. Women made significant improvements during the 12 weeks on mean scores for psychosocial adjustment (F[1,182] = 58.37, P =.00), anxiety (F [1,182] = 74.58, P =.00) and depression (F[1,182] = 14.11, P =.00). The predictors of poor psychosocial outcomes for women included being less than 55 years of age, being unemployed or retired, having poor psychosocial adjustment to illness at baseline, having readmission, or experiencing a stressful, personal event during follow-up.

CONCLUSIONS

Women at risk for poor outcomes following hospitalization for a cardiac event can be identified (ie, women less than 55 years of age, unemployed or retired, poorly adjusted to their cardiac illness, or readmitted to hospital within 12 weeks of a previous cardiac admission), but an effective intervention to enhance psychosocial outcomes remains to be established.

A longitudinal study of functional status and correlates following coronary artery bypass graft surgery in women

BACKGROUND

There is limited information available to help women gauge their functional status following coronary artery bypass graft surgery.

OBJECTIVE

This article describes changes in functional status and the influence of comorbidity, household composition, fatigue, and surgical pain on functional status in women during the first 6 weeks at home following coronary artery bypass surgery.

METHOD

A single-group longitudinal design was used for this research. Women were interviewed in person before hospital discharge and by telephone at 2, 4, and 6 weeks after discharge. Functional status was assessed by (a) the Inventory of Functional Status in the Elderly and subscales of the Sickness Impact Profile; (b) comorbid conditions by simple tally; and (c) fatigue and surgical pain by the Energy/Fatigue and Pain Severity subscales of the MOS Patient Assessment Questionnaire.

RESULTS

Women experienced significant gains in functional status over 6 weeks, particularly between 2 and 4 weeks. They engaged most frequently in personal care and low-level household activities during the study period, and most reported improvement in their overall functional status. None of the women were completely recovered or had regained baseline functional status by 6 weeks. The women experienced significant decreases in fatigue and surgical pain, but continued to experience both at 6 weeks. Fatigue and surgical pain were significantly correlated at all time periods.

DISCUSSION

Information about recovery following coronary artery bypass graft, and particularly the finding that recovery is incomplete by 6 weeks, should be incorporated into discharge planning and follow-up for this patient population.

Physical demands of vacuuming in women using different models of vacuum cleaners

PURPOSE

Women continue to have the primary responsibility for housekeeping, even after a cardiac event. Vacuuming is one housekeeping task that is often reported as difficult to perform due to angina symptoms. The aim of this study was to evaluate the energy expenditure and hemodynamic responses associated with vacuuming using five different models of vacuum cleaners.

METHODS

Thirty-six healthy women 50-59 yr of age (54.5 +/- 3.1 yr) participated in this study. Energy expenditure was measured by indirect calorimetry using an Aerosport KB1-C portable metabolic system. After collection of baseline HR, blood pressure (BP), and oxygen consumption ( VO2 ) data, subjects performed vacuuming and treadmill walking in one of six different sequences. Vacuuming consisted of using five different models of vacuum cleaners, three upright models (heavy-duty, self-propelled, and lightweight) and two canister models (standard and compact) for 6 min each. Treadmill walking was conducted at 2.0 mph (0% grade) for 6 min. VO2, HR, BP, and RPE were recorded during each task. The rate-pressure product (RPP) was calculated to estimate myocardial oxygen demand.

RESULTS

Vacuuming with the self-propelled upright model resulted in significantly lower VO2, RPE, HR, systolic BP, and RPP responses compared with some of the other models.(2)

CONCLUSION

Significant differences in oxygen consumption and myocardial oxygen demand are associated with vacuuming using different models of vacuum cleaners. When making recommendations to individuals regarding the least physiologically demanding models, the power assist features of the machine should be the greatest consideration. This important characteristic should be taken into account when making recommendations for patients with limited capacity, or those wanting to limit physiological stress due to a disease state.