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Problem-based learning in the rehabilitation of patients with coronary artery disease
Linköping University, Department of Medicine and Care, Internal Medicine. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: A well-informed patient is a prerequisite for adherence to lifestyle changes and drug treatments, which improve prognosis of CAD. Problem-based learning (PBL) is in line with principles of adult learning. The aim was to develop and evaluate a PBL rehabilitation programme for coronary artery disease (CAD) patients.

The PBL model: In the PBL programme, 6-9 patients and a tutor met ftrst at 9 (I), and after revision at 13 (III and IV) sessions during a one year period. Learning needs related to CAD, its treatment, psychosocial issues, and behavioural changes were focused upon.

Subjects and methods: To validate the PBL programme, six tutors were interviewed, seven PBL groups were videotaped, and 44 other patients answered a questionnaire (I). To evaluate the validity of the MTI/CSA activity monitor, as a means of measuring physical activity intensity, 34 patients walked on a treadmill at three different speeds. Indirect calorimetry was used to determine energy expenditure (EE) (11). In order to evaluate the effects of the PBL programme (III and IV), 207 patients (55% of all eligible), were randomised to the PBL programme (n=104) or to a control group (n=103). All patients received standard therapy. Physical activity was measured by interview and by the activity monitor, and quality of life by the Ladder of Life, Self-rated Health, Cardiac Health Profile, and SF-36. All measurements were performed before randomisation and at the end of the programme.

Results: The PBL-model could be incorporated into the clinical routine with a high participation rate. Initial problems with the tutor role and the structured problem-solving process in the group-work were revealed, which led to revision of the model. PBL stimulated participants to search actively for knowledge, while remaining to fmd demands adequate and being positive about the education. According to self-reports, lifestyle changes had been performed (I). The MTI/CSA activity monitor was a valid tool for quantifying both amount and intensity of physical activity during walking (II). The PBL programme did not affect physical activity. No increase in activity was found in any of the groups over the one year period Activity, as measured by the activity monitor, was lower than recommended in guidelines for secondary prevention (III). On the contrary, self-reports indicated higher and adequate physical activity. The PBL programme seemed to have positive effects on quality of life, as measured by global instruments. No effects were found on health-related or disease specific aspects of quality of life (IV).

Conclusion: The PBL programme was feasible to run in clinical practice. Education of tutors was crucial and required time. The programme stimulated participants to become active learners. The PBL model had no effects on physical activity, but some effects on global quality of life. Physical activity remained unchanged and low in both groups, as measured by the activity monitor, which was a useful and reliable tool, while self-reports seemed to overestimate performed physical activity. Quality of life improved in both groups over the year. More data are needed to evaluate the usefulness of the PBL-model.

Place, publisher, year, edition, pages
Linköping: Linköpin Universitet , 2005. , 65 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 890
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-31915Local ID: 17748ISBN: 91-7373-869-7 (print)OAI: oai:DiVA.org:liu-31915DiVA: diva2:252738
Public defence
2005-04-29, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Opponent
Note

2005

Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-02Bibliographically approved
List of papers
1. Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease
Open this publication in new window or tab >>Validation and feasibility of problem-based learning in rehabilitation of patients with coronary artery disease
2002 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 47, no 4, 337-345 p.Article in journal (Refereed) Published
Abstract [en]

A patient education programme applying problem-based learning (PBL) was developed for patients with coronary artery disease (CAD). Groups with 6–8 patients and a tutor from the rehabilitation team met nine times for 1.5 h each. The feasibility and validity of the model was evaluated using patient questionnaires, interviews with tutors and video observations of tutorials. The participants were active (69% of all input) and discussions of acquired knowledge and lifestyle changes took place in all groups. A total of 89% of the patients reported implementation of lifestyle changes and over 90% rated their learning and overall experience of the programme as acceptable or high and the demands as acceptable. Shortcomings were the limited use of some of the steps in the problem-solving process and tutors’ difficulties in adapting to their new role; their answering of questions was higher than planned (35% of their total input). The programme was feasible in clinical routine.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26807 (URN)10.1016/S0738-3991(02)00007-1 (DOI)11416 (Local ID)11416 (Archive number)11416 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking
Open this publication in new window or tab >>The validity of the Computer Science and Applications activity monitor for use in coronary artery disease patients during level walking
Show others...
2002 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 22, no 4, 248-253 p.Article in journal (Refereed) Published
Abstract [en]

The principal aim of the present study was to examine the validity of the Computer Science and Applications (CSA) activity monitor during level walking in coronary artery disease (CAD) patients. As a secondary aim, we evaluated the usefulness of two previously published energy expenditure (EE) prediction equations. Thirty-four subjects (29 men and five women), all with diagnosed CAD, volunteered to participate. Oxygen uptake (VO2) was measured by indirect calorimetry during walking on a motorized treadmill at three different speeds (3·2, 4·8 and 6·4 km h−1). Physical activity was measured simultaneously using the CSA activity monitor, secured directly to the skin on the lower back (i.e. lumbar vertebrae 4–5) with an elastic belt. The mean (±SD) activity counts were 1208 ± 429, 3258 ± 753 and 5351 ± 876 counts min−1, at the three speeds, respectively (P<0·001). Activity counts were significantly correlated to speed (r=0·92; P<0·001), VO2 (ml kg−1 min−1; r=0·87; P<0·001) and EE (kcal min−1; r=0·85, P<0·001). A stepwise linear regression analysis showed that activity counts and body weight together explained 75% of the variation in EE. Predicted EE from previously published equations differed significantly when used in this group of CAD patients. In conclusion, the CSA activity monitor is a valid instrument for assessing the intensity of physical activity during treadmill walking in CAD patients. Energy expenditure can be predicted from body weight and activity counts.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24803 (URN)10.1046/j.1475-097X.2002.00426.x (DOI)7070 (Local ID)7070 (Archive number)7070 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
3. Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease
Open this publication in new window or tab >>Effects of a problem-based learning rehabilitation program on physical activity in patients with coronary artery disease
2006 (English)In: Journal of Cardiopulmonary Rehabilitation (JCR), ISSN 0883-9212, E-ISSN 1539-0691, Vol. 26, no 1, 32-38 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the effects of a problem-based learning (PBL) rehabilitation program on physical activity.

METHODS: We randomized 207 consecutive patients younger than 70 years, with a recent event of coronary artery disease (CAD), to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in a 1-year program with 13 sessions in small groups, where learning needs and behavior change were focused upon. Physical activity was assessed by means of interviews with all patients and by an activity monitor in 69 patients at pretest and in 175 after 1 year.

RESULTS: Only small differences between groups were found at posttest. Interview data revealed significantly less activity at low-intensity level in the control group, whereas the activity monitor showed no significant differences. No changes were found in total physical activity during the year within the 2 groups. The self-reported physical activity indicating a level of brisk walking was markedly higher than that measured by the activity monitor, the latter indicating that only 35% of the patients achieved a 10-minute period of continued physical activity per day on an adequate level.

CONCLUSIONS: Our PBL program had no important impact on the physical activity pattern of patients with CAD. The activity monitor is a feasible way of measuring physical activity in these patients, indicating a lower level of physical activity than interview data.

Keyword
Cardiac rehabilitation, Coronary artery disease, Physical activity, Problem-based learning
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50323 (URN)10.1097/00008483-200601000-00007 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved
4. Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease
Open this publication in new window or tab >>Effects of a problem-based learning rehabilitation programme on quality of life in patients with coronary artery disease
2005 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, 324-330 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim of cardiac rehabilitation (CR) is not only physical improvement but also increased quality of life (QoL). A CR programme based upon problem based learning (PBL) philosophy was developed, to achieve and apply new knowledge related to coronary artery disease (CAD). The aim of this paper was to evaluate the impact of the PBL programme on QoL.

Methods: 207 consecutive patients < 70 years of age with a recent event of CAD were randomised to a PBL group (n = 104) or a control group (n = 103). In addition to standard treatment, the PBL patients participated in 13 group sessions during 1 year, where individual learning needs and behavioural changes were focused upon. QoL was measured by the Ladder of Life, Self-Rated Health (SRH), SF 36, and Cardiac Health Profile (CHP).

Results: Significant differences between the groups, favouring the PBL patients, were found by global instruments: more optimistic expectations of the future QoL and a better general condition. No differences were found by SRH, SF 36 or subscales of CHP, but QoL increased in both groups during the year.

Conclusions: The main outcome was that QoL improved in both groups with some effects favouring the PBL programme.

Keyword
Coronary artery disease, Cardiac rehabilitation, Problem-based learning, Quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-31058 (URN)10.1016/j.ejcnurse.2005.04.008 (DOI)16778 (Local ID)16778 (Archive number)16778 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved

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