A motivational interview program for cardiac rehabilitation after acute myocardial infarction: study protocol of a randomized controlled trial in primary healthcare

Rocío Rodríguez-Romero, Carles Falces, Belchin Kostov, Noemí García-Planas, Esther Blat-Guimerà, María C Alvira-Balada, Mireia López-Poyato, María L Benito-Serrano, Ingrid Vidiella-Piñol, Juan J Zamora-Sánchez, Marta Benet, Manuel V Garnacho-Castaño, Susana Santos-Ruiz, Rosalia Santesmases-Masana, Silvia Roura-Rovira, Jaume Benavent-Areu, Antoni Sisó-Almirall, Luis González-de Paz, Rocío Rodríguez-Romero, Carles Falces, Belchin Kostov, Noemí García-Planas, Esther Blat-Guimerà, María C Alvira-Balada, Mireia López-Poyato, María L Benito-Serrano, Ingrid Vidiella-Piñol, Juan J Zamora-Sánchez, Marta Benet, Manuel V Garnacho-Castaño, Susana Santos-Ruiz, Rosalia Santesmases-Masana, Silvia Roura-Rovira, Jaume Benavent-Areu, Antoni Sisó-Almirall, Luis González-de Paz

Abstract

Background: Cardiac rehabilitation after acute myocardial infarction permits recovery of the heart function and enables secondary prevention programs in which changes in lifestyle habits are crucial. Cardiac rehabilitation often takes place in hospitals without coordination with primary healthcare and is not focused on individual patient preferences and goals, which is the core of the motivational interview. The objective of this study was to evaluate the efficacy of a cardiac rehabilitation program with a motivational interview in patients discharged from hospital after acute myocardial infarction.

Methods/design: A randomized, non-pharmacological clinical trial in six primary healthcare centers in Barcelona (Spain) will assess whether a tailored cardiac rehabilitation program consisting of four motivational interviews and visits with family physicians, primary healthcare nurses and a cardiologist, coordinated with the reference hospital, results in better cardiac rehabilitation than standard care. A minimum sample of 284 participants requiring cardiac rehabilitation after acute myocardial infarction will be randomized to a cardiac rehabilitation group with a motivational interview program or to standard primary healthcare. The main outcome will be physical function measured by the six-minute walk test, and the secondary outcome will be the effectiveness of secondary prevention: a composite outcome comprising control of blood pressure, cholesterol, diabetes mellitus, smoking and body weight. Results will be evaluated at 1,3 and 6 months.

Discussion: This is the first clinical trial to study the impact of a new primary healthcare cardiac rehabilitation program with motivational interviews for patients discharged from hospital after myocardial infarction. Changes in lifestyles and habits after myocardial infarction are a core element of secondary prevention and require patient-centered care strategies such as motivational interviews. Therefore, this study could clarify the impact of this approach on health indicators, such as functional capacity.

Trial registration: ClinicalTriasl.gov NCT05285969 registered on March 18, 2022.

Keywords: Cardiac rehabilitation; Motivational interview; Myocardial infarction; Primary healthcare.

Conflict of interest statement

The authors declare they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Partial map of Barcelona (1:30,000). Area of influence of the six PHC (blue), and the Hospital Clinic of Barcelona. The map was modified from the Cartographic and Geological Institute of Catalonia, which gave permission to reuse their data and content [36]
Fig. 2
Fig. 2
Study flowchart

References

    1. Bjarnason-Wehrensa B, McGeeb H, Zwislerc A-D, Piepolid M, Benzere W, Jean-Paul Schmidf PD, et al. Cardiac rehabilitation in Europe: results from the European Cardiac Rehabilitation Inventory Survey. Eur J Cardiovasc Prev Rehabil. 2010;17:410–418. doi: 10.1097/HJR.0b013e328334f42d.
    1. Abreu A, Pesah E, Supervia M, Turk-Adawi K, Bjarnason-Wehrens B, Lopez-Jimenez F, et al. Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?: Endorsed by the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2019;26(11):1131–1146. doi: 10.1177/2047487319827453.
    1. Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. 2018;104:1403–1410. doi: 10.1136/heartjnl-2017-312809.
    1. Piepoli M, Corrà U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol. 2014;21(6):664–681. doi: 10.1177/2047487312449597.
    1. Martín R. Efectividad de la rehabilitación cardíaca en un grupo de pacientes de alto riesgo. Rev Enferm Cardiol. 2018;25(75):34–39.
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology.(ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Hear J. 2016;18(8):891–975. doi: 10.1002/ejhf.592.
    1. Kotseva K, Wood D, De BD, De BG, Rydén L, Jennings C, et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardio. 2016;23(6):636–648. doi: 10.1177/2047487315569401.
    1. Haykowsky M, Scott J, Esch B, Schopflocher D, Myers J, Paterson I, et al. A Meta-analysis of the effects of Exercise Training on Left Ventricular Remodeling Following Myocardial Infarction: Start early and go longer for greatest exercise benefits on remodeling. Trials. 2011;12(1):92. doi: 10.1186/1745-6215-12-92.
    1. Bohplian S, Bronas UG. Motivational Strategies and Concepts to Increase Participation and Adherence in Cardiac Rehabilitation: AN INTEGRATIVE REVIEW. J Cardiopulm Rehabil Prev. 2022;42(2):75–83.
    1. Gené-Badia J, Ascaso C, Escaramis-Babiano G, Sampietro-Colom L, Catalán-Ramos A, Sans-Corrales M, et al. Personalised care, access, quality and team coordination are the main dimensions of family medicine output. Fam Pract. 2007;24:41–47. doi: 10.1093/fampra/cml056.
    1. Palomo L, Gené-Badia J, Rodríguez-Sendín JJ. The reform of primary care, between the last refuge of adventure and innovation. SESPAS report Gac Sanit. 2012;26(Suppl 1):14–19. doi: 10.1016/j.gaceta.2011.06.010.
    1. Santesmases-Masana R, González-de Paz L, Hernández-Martínez-Esparza E, Kostov B, Navarro-Rubio MD. Self-Care Practices of Primary Health Care Patients Diagnosed with Chronic Heart Failure: A Cross-Sectional Survey. Int J Environ Res Public Heal. 2019;16(1625):1–16.
    1. Buckingham SA, Taylor RS, Jolly K, Zawada A, Dean SG, Cowie A, et al. Home-based versus centre-based cardiac rehabilitation: Abridged Cochrane systematic review and meta-analysis. Open Hear. 2016;3(2):e000463. doi: 10.1136/openhrt-2016-000463.
    1. Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. Vol. 351, BMJ. 2015. p. h5000.
    1. Arena R, Williams M, Forman DE, Cahalin LP, Coke L, Myers J, et al. Increasing referral and participation rates to outpatient cardiac rehabilitation: The valuable role of healthcare professionals in the inpatient and home health settings: A science advisory from the american heart association. Circulation. 2012;125(10):1321–1329. doi: 10.1161/CIR.0b013e318246b1e5.
    1. Fariba Jokar, Hojatllah Yousefi, Alireza Yousefy MS. Begin Again and Continue With Life: A Qualitative Study on the Experiences of Cardiac Rehabilitation Patients. J Nurs Res. 2017;25(5):344–52.
    1. Rollnick S, Miller W. What is Motivational Interviewing? Behav Cogn Psychother. 1995;23(4):325–334. doi: 10.1017/S135246580001643X.
    1. Masterson Creber R, Patey M, Lee CS, et al. Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial. Patient Educ Couns. 2016;99:256–264. doi: 10.1016/j.pec.2015.08.031.
    1. Hardcastle SJ, Taylor AH, Bailey MP, Harley RA, Hagger MS. Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: A randomised controlled trial with a 12-month post-intervention follow-up. Int J Behav Nutr Phys Act. 2013;10:1–16. doi: 10.1186/1479-5868-10-40.
    1. Paradis V, Cossette S, Frasure-Smith N, Heppell S, Guertin MC. The efficacy of a motivational nursing intervention based on the stages of change on self-care in heart failure patients. J Cardiovasc Nurs. 2010;25(2):130–141. doi: 10.1097/JCN.0b013e3181c52497.
    1. Chew HSJ, Cheng HY, Chair SY. The suitability of motivational interviewing versus cognitive behavioural interventions on improving self-care in patients with heart failure: A literature review and discussion paper. Appl Nurs Res. 2019;45:17–22. doi: 10.1016/j.apnr.2018.11.006.
    1. Tamara Sokalski, K Alix Hayden, Shelley Raffin Bouchal, Pavneet Singh KK-S. Motivational Interviewing and Self-care Practices in Adult Patients With Heart Failure: A Systematic Review and Narrative Synthesis. J Cardiovasc Nurs. 2020;32(2):107–115.
    1. Generalitat de Catalunya. Població de referència del Servei Català de la Salut per a l’any 2020. Dades per ABS i UP assignada. Available in ; 2020. p. 1–29.
    1. Hospital Clínic de Barcelona. Available from:
    1. Miller WR (William R, Rollnick S. Motivational interviewing: helping people change. Guilford Press; 2013. 482 p.
    1. Rehabilitation. BC. Home Exercise Program Guidelines. BRONSON. 2016.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, SPIRIT, , et al. statement: Defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166(1):111–7.
    1. Badia X, Gutiérrez F, Wiklund I, Alonso J. Validity and reliability of the Spanish version of the Psychological General Well-Being Index. Qual Life Res. 1996;5(1):101–108. doi: 10.1007/BF00435974.
    1. Schmidt S, Vilagut G, Garin O, Cunillera O, Tresserras R, Brugulat P, et al. Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population. Med Clin (Barc) 2012;139(14):613–625. doi: 10.1016/j.medcli.2011.10.024.
    1. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017;23(2):377–381. doi: 10.1111/jep.12629.
    1. Fulk GD, He Y. Minimal clinically important difference of the 6-minute walk test in people with stroke. J Neurol Phys Ther. 2018;42(4):235–240. doi: 10.1097/NPT.0000000000000236.
    1. The American College of Sports Medicine (ACSM). ACSM’s guidelines for exercise testing and prescription. 11th ed. Lippincott Williams & Wilkins. Wolters Kluwer; 2021.
    1. R Core Team. R Foundation for Statistical Computing. R: A Language and Environment for Statistical Computing. Vienna, Austria; 2021. Available from:
    1. Cowie A, Buckley J, Doherty P, Furze G, Hayward J, Hinton S, et al. Standards and core components for cardiovascular disease prevention and rehabilitation. Heart. 2019;105(7):510–515. doi: 10.1136/heartjnl-2018-314206.
    1. Generalitat de Catalunya. Institut Cartogràfic i Geològic de Catalunya [Internet]. 2022. Available from:
    1. Morisky D, Green L, Levine D. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74. doi: 10.1097/00005650-198601000-00007.
    1. Rodríguez Chamorro MÁ, García-Jiménez E, Amariles P, Rodríguez Chamorro A, et al. Review of the test used for measuring therapeutic compliance in clinical practice. Aten Primaria. 2008;40(8):413–417. doi: 10.1157/13125407.
    1. Gual A, Contel M, Segura L, Ribas A, Colom J. The ISCA (Systematic Interview of Alcohol Consumption), a new instrument to detect risky drinking. Med Clin (Barc) 2001;117(18):685–689. doi: 10.1016/S0025-7753(01)72224-5.
    1. Huynh T, Kouz S, Yan A, Danchin N, Loughlin JO, Schampaert E, et al. Canada acute coronary syndrome risk score: A new risk score for early prognostication in acute coronary syndromes. Am Heart J. 2013;166(1):58–63. doi: 10.1016/j.ahj.2013.03.023.
    1. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–1251. doi: 10.1016/0895-4356(94)90129-5.
    1. Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity. Med Care. 1996;34(3):220–233. doi: 10.1097/00005650-199603000-00003.
    1. Broadhead WE, Gehlbach SH, de Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Med Care. 1988;26(7):709–23. doi: 10.1097/00005650-198807000-00006.
    1. Bellón Saameño JA, Delgado Sánchez A, Luna del Castillo JD, Lardelli Claret P. Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11. Aten Primaria. 1996;18(4):153–6, 158–63..
    1. Nasreddine Z, Phillips N, Bëdirian V. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–699. doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Ojeda N, Del Pino R, Ibarretxe-Bilbao N, Schretlen D, Peña J. Test de evaluación cognitiva de Montreal: normalización y estandarización de la prueba en población española. Rev Neurol. 2016;63:488–496.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: A New Depression Diagnostic and Severity Measure. J Gen Intern Med. 2001;16(9):606–613.
    1. Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Terol M, López-roig S, Rodríguez-Marín J, Martín-aragón M, Pastor M, Reig M. Propiedades psicométricas de la escala Hospitalaria de ansiedad y estrés (HaD) en población española. Ansiedad y Estrés. 2007;13:163–176.
    1. Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, et al. A collection of Physical Activity Questionnaires for health-related research. Med Sci Sport Exerc. 1997;29(6 Suppl):S1–205.
    1. Roman B, Ribas L, Ngo J, Serra L. Validación en población catalana del cuestionario internacional de actividad física. Gac Sanit. 2013;27(3):254–257. doi: 10.1016/j.gaceta.2012.05.013.
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–1026. doi: 10.1111/j.1475-6773.2004.00269.x.
    1. Moreno-Chico C, González-de Paz L, Monforte-Royo C, Arrighi E, Navarro-Rubio MD, Fernández-Puebla AG. Adaptation to European Spanish and psychometric properties of the Patient Activation Measure 13 in patients with chronic diseases. Fam Pract. 2017;34(5).

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner