Elsevier

Heart & Lung

Volume 36, Issue 6, November–December 2007, Pages 418-430
Heart & Lung

Issues in cardiovascular nursing
Impact of an early recovery management intervention on functioning in postoperative coronary artery bypass patients with diabetes

https://doi.org/10.1016/j.hrtlng.2007.02.011Get rights and content

Background

Approximately 30% of patients undergoing coronary artery bypass graft (CABG) procedures have diabetes and, as such, are at increased risk for postoperative complications and a lengthy recovery.

Objective

To test the feasibility of an in-home early recovery management intervention to improve physical and psychosocial functioning in the diabetic CABG population.

Methods

This pilot study was a 2-group, randomized, experimental study. The 6-week in-home early recovery intervention was delivered by way of a device called the Health Buddy (Health Hero Network, Redwood City, CA). Subjects were 49 diabetic patients who had undergone a first-time CABG procedure.

Results

Although no statistical differences between groups were found, descriptively, the intervention group’s baseline means on Medical Outcomes Study Short Form-36 subscales measuring physical functioning were lower but improved to levels comparable with that of the control group. Improvements in psychosocial functioning were comparable between the 2 groups.

Conclusion

This in-home telehealth intervention may have promise for improving functioning outcomes in high-risk CABG patients with diabetes. However, weaknesses of the intervention and the need for a more focused, directive intervention were identified.

Section snippets

Physical functioning

Recovery from CABG surgery in the early postoperative period can be accurately gauged by improvements in physical functioning. Although there is little literature describing the recovery patterns of CABG patients with diabetes, physical functioning in the general CABG population is known to improve significantly between hospital discharge and 6 months after surgery5, 14, 15, 16; most improvement occurs in the first 3 months after CABG procedures.5 Patients with lower preoperative physical or

Methods

A 2-group, repeated measures experimental design was used in this pilot study. Patients who were eligible to participate were randomly assigned to either the intervention group (received early recovery management intervention and routine care) or the routine care group (received routine care only) using a previously generated randomization schedule. Routine care for all post-CABG patients at the study institutions consisted of in-hospital teaching related to discharge orders, such as activity,

Discussion

Given that this was a pilot study, and significant differences were not expected, consideration must be given to possible reasons for these preliminary results. Several of the outcome variables had large SDs, indicating a great deal of within-group variability. However, both groups improved with time, with significant improvement on variables such as physical, role physical, and social functioning (as measured by the MOS SF-36 subscales) and levels of anxiety and depression (as measured by the

Implications and Recommendations

As more CABG procedures are performed on higher risk patients, such as those with diabetes, it is imperative that interventions enhancing the improvement of physical and psychosocial outcomes in this population in the early recovery period are tested. However, much more work must be done to develop interventions that are more specific to this patient population. Intervention mapping should be used before redesign of the intervention to ensure that the intervention promotes action rather than

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    This research study was supported by funds from the Clinical Research Fund at the University of Nebraska Medical Center.

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