ABSTRACT
Cardiac surgery patients with a prolonged ICU length of stay (prICULOS) have lower rates of functional survival following their procedure, however detailed information on their health related quality of life (HRQoL) is lacking. We sought to investigate the potential need for intervention in these high-risk patients through comprehensive HRQoL assessments in the months to year following their surgery. A prospective, observational pilot study was undertaken and cardiac surgery patients with a prICULOS (ICU length of stay ofâ¯≥5 days) were recruited. A control group was obtained through recruitment of cardiac surgery patients with an ICU length of stay ofâ¯<5 days. In-person clinical or telephone survey HRQoL assessments were completed at 3-6 months and 1-year time points after their procedure. The standardized mean difference (SMD) was calculated for all study variable comparisons to quantify the standardized effect size observed between non-prICULOS and prICULOS patients. 789 cardiac procedures were performed during the study period and 89 patients experienced a prICULOS (10.7%). Of these 89 patients, 35 prICULOS patients were recruited along with 35 controls. 29 out of 35 prICULOS patients completed the study (83%). At the 3-6 month follow up the prICULOS patients had higher levels of weight loss, fear of falling, and driving deficits. At 1-year, prICULOS patients had persistent difficulties with activities of daily living and required more family and external support. This study demonstrates the need for closer follow up and intervention for cardiac surgery patients with a prICULOS who were found to have poorer mid and long-term HRQoL.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Coronary Care Units , Length of Stay , Quality of Life , Activities of Daily Living , Aged , Case-Control Studies , Female , Health Status , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Recovery of Function , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
A self-instructed relaxation program was compared with therapist-instructed relaxation and waiting list controls. Self-report anxiety measures ( IPAT and STAI ) and a psychophysiological stress profile (frontal EMG, GSR, heart rate, finger temperature monitored under relaxation and stressor conditions) were utilized pre- and posttreatment to determine efficacy. Self-monitored heart rate, respiration rate, and finger temperature were used to monitor home practice sessions. Subjects reported increased ability to relax and control stress; however, frontal EMG measured under stressor conditions was the only dependent measure to confirm this perception. No between-group differences on any other dependent measures were observed. Reliable changes on all self-monitored home practice measures were observed, suggesting that this procedure is a useful gauge of home practice.
Subject(s)
Arousal , Programmed Instructions as Topic/methods , Relaxation Therapy , Stress, Psychological/therapy , Adolescent , Adult , Anxiety/therapy , Electromyography , Female , Galvanic Skin Response , Heart Rate , Humans , Male , Middle Aged , Skin TemperatureABSTRACT
Four cohorts of 40 subjects each were randomly assigned to 1 of 10 treatment conditions utilizing EMG feedback, cognitive monitoring training, systematic desensitization, high expectancy discussion group, or waiting list controls either in isolation or in various combinations. A three-way ANOVA for repeated measures indicated that significant anxiety reductions were experienced in all noncontrol treatment conditions. Treatment groups employing EMG feedback demonstrated significantly greater anxiety decrements on Cattell's IPAT Self-Analysis Form, and baseline frontalis EMG. Adding desensitization or cognitive monitoring to EMG feedback did not produce a more powerful effect than using EMG feedback alone. Sex and age differences were also observed. Some implications are discussed.
