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The Couples' Experiences of Patients' Physical Limitation in Daily Life Activities and Effects of Physical Exercise in Primary Care when having Chronic Heart Failure
Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore and describe couples’ experiences of patients’ physical limitation in activities of daily life and evaluate the effects of an exercise programme in primary care when having chronic heart failure (CHF). In Study I, a comparison between patients with CHF and their spouses was made regarding health-related quality of life and depression. Inthe thesis a comparison was also made between patients, spouses and specific age and gender matched norms. There were statistically significant differences in health-related quality of life between patients and spouses as well as between patients and their norms as in SF-36 scores. The deteriorated health-related quality of life in patients was most present in the physical component but also in social function in the mental component. There were no differences between patients and spouses in depression symptoms. In Study II, patients with CHF described their conceptions of physical limitation in daily life activities. A phenomenographic approach made it possible to identify variations of the conceptions and the referential aspects that emerged were: need of finding practical solutions in daily life, having realistic expectations about the future, not believing in one’s own ability and losing one’s social role in daily life. In Study III, spouses’ conceptions about the physical limitation in daily life activities in a loved one with CHF andthe impact these limitations had on their daily life were examined. The phenomenographic approach resulted in different referential aspects. These were: losing self-containment, missing communality, accommodating to the situation and finding satisfaction in life. Study IV aimed at determining effects of an exercise programme in primary care in elderly patients with CHF. The intervention period was 12 months with continuous exercise in the primary care centre and in the patients’ homes. Tests of physical capacity showed significant consistent improvement in the exercise group in arms and shoulders during the intervention and in the 6 minute walk test at 3 months compared to the control group. The physical dimension of Minnesota living with heart failure was significantly improved at 3 months and Euroqol5DVAS was significantly improved at 3 and 12 months in the exercise group compared to the control group. The thesis shows that patients and spouses conceive a variety of issues of physical limitation in daily life and the physical component of health-related quality of life is the most affected. The physical capacity in patients is possible to affect with an exercise programme in primary care and patient homes. The exercise programme is beneficial interms of physical capacity in the upper body and walked distance in 6 minutes.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2010. , p. 122
Series
Dissertation Series. School of Health Sciences, ISSN 1654-3602 ; 12
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-16235ISBN: 978-91-85835-11-9 OAI: oai:DiVA.org:hh-16235DiVA, id: diva2:441096
Public defence
2010-10-22, R4312, Halmstad Högskola, Halmstad, 11:51 (Swedish)
Opponent
Supervisors
Available from: 2011-09-14 Created: 2011-09-14 Last updated: 2018-03-22Bibliographically approved
List of papers
1. Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study
Open this publication in new window or tab >>Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: a comparative study
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2005 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 7, no 4, p. 583-589Article in journal (Refereed) Published
Abstract [en]

Background:

Little is known about the factors that influence the health outcome of elderly patients suffering from heart failure or the health of their spouses. The aim of this comparative study was to determine if older patients suffering from heart failure and their spouses experience similar levels of health-related quality of life (HRQOL) and depression. The aim was also to identify those factors that contribute to HRQOL and depression in patient-spouse pairs.

Methods:

Data were collected from 47 couples, using the Short Form 36 (SF-36) and Zung Self-rating Depression Scale (SDS) questionnaires.

Results:

Patients suffering from heart failure and their spouses differed significantly in their experience of the physical, but not the mental, health-related quality of life, with patients experiencing significantly worse physical functioning. Physical symptoms of heart failure seemed to dominate the experience of the patient and was positively related to mental health and inversely related to the New York Heart Association classification (NYHA class) and patients' depression. Depressive symptoms as reflected in SDS showed no significant difference between patients and spouses. Patients' depression was positively related to high NYHA class, while spouse depression was positively related with higher age of the patient.

Conclusion:

Physical symptoms seem to dominate the experience of heart failure.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2005
Keyword
Depression, Heart failure, Health-related quality of life, Patient-spouse pairs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-3490 (URN)10.1016/j.ejheart.2004.07.016 (DOI)000229723900022 ()15921798 (PubMedID)2-s2.0-19544391782 (Scopus ID)
Available from: 2010-01-29 Created: 2009-12-01 Last updated: 2018-03-23Bibliographically approved
2. Patients' experiences of physical limitations in daily life activities when suffering from chronic heart failure: A phenomenographic analysis
Open this publication in new window or tab >>Patients' experiences of physical limitations in daily life activities when suffering from chronic heart failure: A phenomenographic analysis
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 1, p. 3-11Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe how patients suffering from chronic heart failure conceived their physical limitations in daily life activities. An explorative and qualitative design with a phenomenographic approach was chosen, a total of 15 patients were interviewed. The findings indicate that participants perceived a variety of structural aspects pertaining to physical limitations in activities of daily life which resulted in four referential aspects. Need of finding practical solutions in daily life focused on how life had to be changed and other ways of performing activities of daily life had to be invented. Having realistic expectations about the future was characterised by belief that the future itself would be marked by change in physical functioning, but an incentive to maintain functions and activities ensured good quality of or even increased capacity in daily life. Not believing in one's own ability included the perception of having no opportunity to improve ability to perform activities of daily life. There were perceptions of undesired passivity, undefined fear of straining themselves or performing activities that could endanger their health in addition to uncertainty about the future. In Losing one's social role in daily life, participants described losing their social network and their position in society and family because of limited physical capacity. A lack of important issues, mental and physical, occurred when physical capacity was lost. In conclusion, patients suffering from chronic heart failure found new solutions to manage activities in daily life, including willingness to change focus and identify other ways of doing important things. Patients had an incentive to maintain functions and activities to ensure a good quality of and strengthen their physical capacity in daily life. Inability to trust in their physical capacity in combination with experienced limitations in daily life prevented patients from attempting to increase activities.

Place, publisher, year, edition, pages
Oxford: Wiley-Blackwell, 2011
Keyword
activities of daily life, chronic heart failure, elderly, nursing care, phenomenography, physical limitations
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-16231 (URN)10.1111/j.1471-6712.2010.00780.x (DOI)000288571500002 ()20630034 (PubMedID)2-s2.0-79951529030 (Scopus ID)
Note

Ingår i avhandling: Pihl, Emma. The Couples' Experiences of Patients' Physical Limitation in Daily Life Activities and Effects of Physical Exercise in Primary Care when having Chronic Heart Failure. 2010.

Available from: 2011-09-14 Created: 2011-09-14 Last updated: 2018-03-22Bibliographically approved
3. Spouses' experiences of impact on daily life regarding physical limitations in the loved one with heart failure: A phenomenographic analysis
Open this publication in new window or tab >>Spouses' experiences of impact on daily life regarding physical limitations in the loved one with heart failure: A phenomenographic analysis
2010 (English)In: Canadian Journal of Cardiovascular Nursing, ISSN 0843-6096, Vol. 20, no 3, p. 9-17Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Physical limitation is a great burden for patients with heart failure, but little is known about how that affects spouses. Beneficial effects of support on the prognosis for the patient with chronic heart failure may come at a psychological and physical cost to the person providing the support. PURPOSE: The aim of this study was to explore and describe how spouses conceive the physical limitations in patients with heart failure and the impact these limitations have on the daily life of the spouse. DESIGN: A qualitative design with a phenomenographic approach was chosen for the study. FINDINGS: The informants were 15 spouses of heart failure patients. The spouses perceived a variety of aspects pertaining to how they conceive the physical limitations in the loved one with heart failure and the implication this had on their daily life. The referential aspects were: Losing self-containment, Missing communality, Accommodating to the situation and Finding satisfaction in life. IMPLICATIONS AND CONCLUSIONS: Awareness must be raised among health care professionals about the profound impact heart failure in loved ones has on the spouses and explore how the spouses' needs can be appropriately met. Since spouses have an important role to play in the management of heart failure, it is of great importance that nurses identify and support spouses to manage daily life activities. Taking care of the good days in order to have a rich life and to help spouses see possibilities is necessary since it is difficult to predict the future.

Place, publisher, year, edition, pages
Ottawa: Canadian Council of Cardiovascular Nurses, 2010
Keyword
adaptive behavior, aged, article, attitude to health, chronic disease, cost of illness, daily life activity, female, heart failure, home care, human, male, needs assessment, nurse attitude, nursing assessment, nursing methodology research, psychological aspect, qualitative research, quality of life, questionnaire, satisfaction, social support, spouse, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-16232 (URN)20718235 (PubMedID)2-s2.0-77956629429 (Scopus ID)
Projects
Ingår i avhandling: Pihl, Emma. The Couples' Experiences of Patients' Physical Limitation in Daily Life Activities and Effects of Physical Exercise in Primary Care when having Chronic Heart Failure. 2010.
Available from: 2011-09-14 Created: 2011-09-14 Last updated: 2018-03-22Bibliographically approved
4. Exercise in elderly patients with chronic heart failure in primary care: Effects on physical capacity and health-related quality of life
Open this publication in new window or tab >>Exercise in elderly patients with chronic heart failure in primary care: Effects on physical capacity and health-related quality of life
Show others...
2011 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 3, p. 150-158Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: 

Chronic heart failure (CHF) limits exercise capacity which influences physical fitness and health-related quality of life (HRQoL). 

AIM: 

The aim was to determine the effects on physical capacity and HRQoL of an exercise programme in elderly patients with CHF in primary care.

METHODS: 

An exercise intervention was conducted as a prospective, longitudinal and controlled clinical study in primary care in elderly patients with CHF. Endurance exercise and resistance training were conducted as group-training at the primary care centre and as home training. Follow-up on physical capacity and HRQoL was done at 3, 6 and 12 months.

RESULTS: 

Exercise significantly improved muscle endurance in the intervention group (n=29, mean age 76.2years) compared to the control group (n=31, mean age 74.4years) at all follow-ups except for shoulder flexion right at 12months (shoulder abduction p=0.006, p=0.048, p=0.029; shoulder flexion right p=0.002, p=0.032, p=0.585; shoulder flexion left p=0.000, p=0.046, p=0.004). Six minute walk test improved in the intervention group at 3months (p=0.013) compared to the control group. HRQoL measured by EQ5D-VAS significantly improved in the intervention group at 3 and 12months (p=0.016 and p=0.034) and SF-36, general health (p=0.048) and physical component scale (p=0.026) significantly improved at 3months compared to the control group. 

CONCLUSION: 

This study shows that exercise conducted in groups in primary care and in the patients' homes could be used in elderly patients with CHF. The combination of endurance exercise and resistance training has positive effects on physical capacity. However, the minor effects in HRQoL need further verification in a study with a larger study population. ©Sage Publications

Place, publisher, year, edition, pages
London: Sage Publications, 2011
Keyword
Chronic heart failure, Elderly, Exercise, Health-related quality of life, Physical fitness, Primary care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-16233 (URN)10.1016/j.ejcnurse.2011.03.002 (DOI)000294037100004 ()21470913 (PubMedID)2-s2.0-79960316103 (Scopus ID)
Projects
Ingår i avhandling: The Couples' Experiences of Patients' Physical Limitation in Daily Life Activities and Effects of Physical Exercise in Primary Care when having Chronic Heart Failure
Available from: 2011-09-14 Created: 2011-09-14 Last updated: 2018-03-22Bibliographically approved

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  • nn-NO
  • nn-NB
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Output format
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