| BackgroundSince Andreas Gruentzig made the coronary angioplasty as a non-surgical method of coronary revascularization for the first time in1977, percutaneous coronary intervention (PCI) is one of the most common methods of clinical treatment for coronary heart disease(CHD)currently.It significantly reduces or eliminates the subjective and objective performance of myocardial ischemia. But the successful of the operation does not mean the end of the treatment.Patients must take anticoagulants for a long term.They also need to control the complications due to the anticoagulants and adapt to changes in lifestyle.Therefore,Self-management of patients in the diet, therapy, physical activity and social psychology is very important.Zhang wenting et al had shown that only25%of patients after percutaneous coronary intervention got a good level of self-management, while63.89%of patients in the general level and11.11%of patients with poor self-management. Self-management in treatment and diet performed better than in physical activities and psychosocial. A number of studies at home and abroad showed that the strongest demand for patients who have had PCI on managing health is medical knowledge of the disease,such as knowledge of anticoagulant drugs and lipid-lowering drugs,self-monitoring,time of periodic review and other methods.Because most patients return to the society,continuous disease self-management can help patients identify early harbinger of declining health,to accept the intervention as early as possible to reduce readmission rates and the financial burden on patients,to improve the quality of life of patients.Cardiac rehabilitation after PCI is a comprehensive long-term plan to help patients recover from percutaneous coronary interventions,such as stenting and angioplasty. Cardiac rehabilitation programs usually provide education and counseling services to help patients to enhance physical fitness, reduce symptoms and improve overall health and reduce cardiovascular risk in future. It includes medical evaluation, exercise prescription,cardiovascular risk factors moditication, education, counseling and behavioral intervention.A large number of evidence-based medicine researchs had proved that cardiac rehabilitation after myocardial infarction can reduce all-cause mortality and cardiovascular mortality. Rehabilitation of coronary heart disease can be divided into three stages:hospital rehabilitation, outpatient early rehabilitation and long-term rehabilitation.According to the guidance,patients with coronary heart disease who are in the stage Ⅰ and Ⅱ,excise and daily activities need to be done under the guidance and monitor in the professional rehabilitation center. For the Ⅲ stage, which also called community (family) rehabilitation,will enable the rehabilitation of patients in the community or at home.According to the patient’s condition,cooperative attitude,social status and environmental conditions,cardiac rehabilitation therapists should make a plan which patient is willing to accept, and adapt to their desire and living habits.What’s more,we need to obtain the family support to make the medical rehabilitation,vocational rehabilitation and social rehabilitation together to help patients return to society. The Six-Minute Walk Test(6MWT) test was developed by Butland in1982which was based on the15-minute Walk Test developed by Balke to evaluate functional capacity.The6MWT is a simple test that measures the distance walked during a defined period. The test is easy to perform,interpret and particularly useful in conditions such as chronic heart failure (CHF),that are characterised by diminished functional capacity.The test requires the patient walking as fast as possible in a30m flat,straight hallway, and then measure the distance in6min.During the test,we allow patients to rest in a half way because of discomfort or use crutches.Currently, the6-minute walk test is mainly used in the following four areas:①Pretreatment and posttreatment comparisons:cardiopulmonary functional reserve and drug treatment evaluation on COPD,chronic respiratory failure, chronic heart failure patients;②Predictor of morbidity and mortality:a number of studies abroad have confirmed that6-minute walk test can be a predictor of morbidity and mortality in patients with chronic heart failure.An eight-year follow-up study abroad showed that the6-minute walk test can better predict patients with stable coronary artery disease risk for cardiovascular events;③rehabilitation exercises:Liu found that since6-minute walk test is mainly daily activities and can be very simple, safe,economical,it is more likely to be accepted and mastered by elderly patients.They can feel a sense of accomplishment and increase rehabilitation initiative.Taking the6-minute walk test as rehabilitation exercises,can not only improve the patient’s tolerance,but also can significantly relieve symptoms of coronary heart disease;④self-assessment tool:Du HY developed the Home-Heart-Walk (HHW)which is based on the principle of self-efficacy and the mechanistic elements of the6MWT as a self-assessment tool. A randomised controlled trial is being conducted in patients with chronic heart failure. A self-monitoring intervention that can improve individual’s exercise self-efficacy, self-management capacity could have potential significance in improving the management of people with chronic heart failure in community settings.Overall,Outside the hospital’s long-term rehabilitation after PCI can be managed at home, but patients had a poor self-management skills.Use a simple,easy self-assessment tool to assessment cardiac function by themselves can improve patient compliance, affecting their diet,exercise and other aspects of self-management skills.The simplicity and reliability of the6MWT in patients after PCI can be use as a potential self-assessment tool.To make it easier for using at home,pre-experiment of this study indicated that there was a high Pearson correlation between the6MWD on10m and30m courses(r=0.876).6-minute walk test taking in5m course can react the result of standard6-minute walk test in30m course. The length of5m needs smaller space for the patient, and can be better grasped on their own at home.This study is designed to apply home-based6MWT on5m courses in patients after PCI to explore the influence on the physical activity and self-management.Objectives1.Explore the effects of home-based6-minute walk test on physical activity in patients after percutaneous coronary intervention.2.Explore the effects of home-based6-minute walk test on self-management in patients after percutaneous coronary intervention. Method1. subjectsA convenience sample of84patients based on inclusion and exclusion criteria who admitted for a PCI in the past five years in a cardiovascular medicine center in some hospital in Haizhu District,Guangzhou and living in the three major communities beside were obtained for the study.The medical treatment for all patients accord to the evidence-based standard medication for secondary prevention of coronary heart disease.According to the’Chinese expert consensus rehabilitation and secondary prevention of coronary heart disease in2013’and’ATS statement:guidelines for the six-minute walk test’:Inclusion criterias:①selective operation patients who passed through the radial artery for percutaneous coronary intervention after six months or more and had single vessel disease;the number of stent is less than2;②New York Heart Association (NYHA) heart function Ⅰ～Ⅲ class; Killip Ⅰ～Ⅲ class;③LVEF:40%～49%;④smooth gait,clear consciousness;⑤home environment is suitable for carrying out this research;⑥agreed to participate in the study and signed an informed consent form.Exclusion criterias:①patients with left main disease;②patients with triple vessel disease;③unstable angina;④myocardial infarction within the past month;⑤malignant arrhythmia;⑥patients with speech,cognitive disorders;⑦patients in end stage with important organs such as the brain,liver,lung and kidney disease;⑧patients unable to climb a flight of stairs;⑨resting heart rate≥120beats/min;blood pressure≥180/100mmHg before testing.2. Procedures①Contact with the three major communities and select the appropriate community medical staffs involved in the study.Explain the content of the study and train them.②Get baseline information from hospital patients after PCI in nearly five years who live in the vicinity of the three major communities. Research nurses explain the study in detail to individuals who are interested in the study and agree to be contacted by the research nurse. Once consented, participants will undergo a screening phase, which includes review of their medical records, resting blood pressure and heart rate for assessment of eligibility.③Collect baseline data of patients together with the community hospital staff.Complete the first assessment of the ability of self-management and distribute’ education manual for patients after percutaneous coronary intervention’.④Use SPSS17.0software generates random numbers conducted on84cases completely and then randomize to2groups. Analysis and adjust the baseline data for each patient until the baseline data for each indicator is balance.⑤Determine the community persons who implement a six-month intervention together with researchers. The intervention group have the home-based6-minute walk test and monthly telephone follow-up while the control group are followed up by telephone and keep daily activities.⑥Six months after the intervention,assess again the observed indicators and analyze the effect of interventions on various indicators before and after the intervention.3. Intervention methods3.1The control groupSubjects in the control group after the general and clinical data collection,patients will accept a10-15min monthly telephone follow-up at an acceptable period of time.Content on telephone follow-up includes:①postoperative recovery;②have readmission or other unexpected events;③emphasize the importance of adherence to medication,diet, exercise changes.Keep the daily activities.3.2The intervention groupIntervention group take the home-based6-minute walk test.Patients in the intervention group require to undergo a pre-training for one week of home-based6-minute walk test before the study start, which include①Day1,researchers demonstrate the way of the home-based5m6-minute walk test,and tell them that in the process of the walk we allow the break because of feeling comfortable or using means of transport, when to stop the test and so on.②Day2,Teach them how to calculate the6-minute walk distance at home.The study release a measurement tool pouch,which contains:5m Scale (a mak every lm),hand-held counter, timer, and a record book.③Combined with measurement tools, Patients take the home6-minute walk test at least three times by themselves.Patients and researchers both record values to calibrate the accuracy of patient records.④On day3～6,walk test was conducted by themselves at home every day at a fixed time,and records the6-minute walk distance on the record book.⑤On day7, patients discuss the problems during the test,ask questions together with researchers.After participating in the pre-training,the subjects start home-based6-minute walk test at a fixed time every day for six months.They need to insist the exercises at least three times a week. In the first month, researchers make an appointment at the phone and visit patients weekly for data collection,guiding practice.From the second month on,the researchers visit patients every two weeks.4. Evaluation①clinical datas:blood pressure,height,weight,waist circumference,BMI,6-minute walk distance;②’Chronic Disease Self-Management Program Questionnaire’.5. Statistical Methods①General demographic datas on gender, marital status, education, medical expenses, years of coronary heart disease and complications et al use frequency and percentage (%).Comparison between the two groups of each index use the chi-square test.②Age,weight,height,waist circumference,BMI,blood pressure,6-minute walk distance are all measurement data.Measurement data use the mean±standard deviation (x±s).Comparison between the two groups with various index use the two independent samples t test. Changes before and after the intervention are compared using two levels of each index two-factor repeated measures analysis of variance, with MauChly method to test the spherical nature.If it does not satisfy the spherical assumption,use Greenhouse-Geisser correction factor to correct for freedom.③Use analysis of covariance for each index value changes on self-management before and after the intervention.④All data are statistically processed using SPSS17.0statistical software for analysis,and select the test level α=0.05, sided P<0.05as a statistically significant result.Results1.With a premise that demographic and clinical baseline data were balanced in both groups,six months later,the main effect of time,the main effect of group,time and group crossover effect of systolic blood pressure and6-minute walk distance were statistically significant(P<0.05).2.The main effect of time on diastolic blood pressure,body weight,BMI were statistically significant(P<0.05),but the main effect of group,time and group crossover effect were not statistically significant(P>0.05).All the effect were not statistically significant on waist circumference.3.After six months intervention,6-minute walk distance in the intervention group increased52.73m. The difference before and after in male or age<70years old patients were statistically significant (P<0.05).4.After six months,Analysis of covariance based on’Chronic Disease Self-Management Program Questionnaire1was used to compare six-month changes of14outcome variables. The results showed that:①The intervention group compared with controls were demonstrated significant improvement in overall health self-assessment, fatigue and chest pain(P values were both less than0.05). the intervention group and the control group were increased on physical activity time,where time of aerobic exercise compared to the control group had a significant difference(P=0.041).③The increase of self-efficacy in the intervention group after6months was the average of0.71points higher than the control group,and the two groups had significant difference (P=0.001).④The times of hospitalization in intervention group after6months got a0.52times less on average than the control group (P=0.039).Six months later, times of physician visits,emergency dept visits,hospital days although had a decline in intervention group, but there is no significant difference compared to the control group.Conclusions1.The research showed that since the home-based6-minute walk test is barely restricted by space and time and easy to master, it can be a simple self-assessment tool used at home or community for patients after PCI to enhance self-efficacy and improve the self-management ability.2.The home-based6-minute walk test in patients after PCI can increase the physical activity time.Thereby it reduces the systolic blood pressure, increases the6-minute walking distance, reduces fatigue and chest pain discomfort, improves the overall health status. Male, age under70years are more sensitive to the home-based6minute walk test.3.The home-based6-minute walk test can reduce the times of hospitalizations for outpatients,but reducing the times of physician visits,emergency dept visits and hospital stay days need further more follow-up study. |
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