การส่งเสริมความยึดมั่นในการฟื้นฟูสภาพหัวใจด้วยการออกกำลังกายใน ผู้ป่วยโรคหัวใจ : การทบทวนวรรณกรรมอย่างเป็นระบบ Adherence Promotion of Exercise-Based Cardiac Rehabilitation among Patients with Cardiovascular Disease: A Systematic Review

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ศักดา เปรมไทยสงค์ อัศนี วันชัย วาสนา รวยสูงเนิน

Abstract

This systematic review study aims to examine, analyze, and conclude current research on adherence promotion of exercise-based cardiac rehabilitation among patients with cardiovascular disease. The review specifically aims at examining models and theories underpinning the program, program description, and program outcomes. Studies include in the review are randomized control trial and quasi-experimental with control group research that published in Thai or English during 2006-2016. The database for searching includes PubMed, ProQuest, Medical Library, Science Direct, Cochrane Library, ISI Web of Science. Consequently, a total of 26 fulltext studies meet inclusion criteria and are included in the review.


Findings on study characteristics show that 16 studies (61.5) use exercise only for rehabilitation whereas the rest of them (N = 10; 38.5) use comprehensive rehabilitation that combined exercise with other intervention. The majority of the studies have a sample size not larger than 30 (N = 11; 42.3) and the program duration at 3-6 months (N = 11; 42.3). Findings on models and theories underpinning the program demonstrates that 19 studies (73.1) apply theories/models for adherence promotion, in which 11 studies (42.3) apply single theory/model. There are 8 studies (30.8) that apply at least 2 theories/models for adherence promotion. However, 7 studies (26.9) do not apply or identify theory/model underpinning the program at all. It is found that 81.8 of the studies that apply single theory/model tend to significantly increase program adherence among participants. Additionally, the studies that apply at least 2 theories/models are found to increase program adherence to 100 among the participants. Additionally, findings on program description show that most of the studies is intervened by multidisciplinary team (N=12; 46.2). Majority of the studies use integrated activities for adherence promotion including teaching, counseling, providing support, and exercise training (N = 17; 63.6). However, the most of the studies do not identify the type, frequency, intensity and duration of exercise program. Primary outcomes of adherence promotion are evaluated by frequency of exercise in 14 studies (53.9), duration of exercise in 10 studies (38.7), and number of patients completed the program in 9 studies (34.6).


In conclusion, the researches to promote adherence to cardiac rehabilitation program generally have small sample size (not larger than 30) and short intervention period (3-6 months). The intervention to promote program adherence are diverse in terms of theory/model application, program description, and evaluation of rehabilitation adherence. However, the study finding supports importance of combined theory/model application and integration of various activities in rehabilitation program to promote adherence. 

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