| 1. |
- Ben Gal, Tuvia, et al.
(författare)
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Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale
- 2020
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Ingår i: Heart, Lung and Circulation. - : Elsevier. - 1443-9506 .- 1444-2892. ; :7, s. E121-E130
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.
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| 2. |
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| 3. |
- Delgado, Bruno, et al.
(författare)
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The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients : Results of a multicenter randomized controlled trial (ERIC-HF study)
- 2022
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Ingår i: Clinical Rehabilitation. - : Sage Publications. - 0269-2155 .- 1477-0873. ; 36:6, s. 813-821
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Tidskriftsartikel (refereegranskat)abstract
- Objective To analyze (1) the effect of an aerobic training program on functional exercise tolerance in decompensated heart failure (DHF) patients; (2) to assess the effects of an aerobic training program on functional independence; and (3) dyspnea during activities of daily living. Design A randomized controlled clinical trial with follow-up at discharge. Settings Eight hospitals. Recruitment took place between 9/ 2017 and 3/2019. Group Assignments Patients with DHF who were admitted to the hospital, were randomly assigned to usual rehabilitation care guideline recommended (control group) or aerobic training program (exercise group). Main outcome Functional exercise tolerance was measured with a 6-min walking test at discharge. Results In total 257 patients with DHF were included, with a mean age of 67 +/- 11 years, 84% (n = 205) had a reduced ejection fraction and the hospital stay was 16 +/- 10 days. At discharge, patients in the intervention group walked further compared to the control group (278 +/- 117m vs 219 +/- 115m, p < 0.01) and this difference stayed significant after correcting for confounders (p < 0.01). A significant difference was found favoring the exercise group in functional independence (96 +/- 7 vs 93 +/- 12, p = 0.02) and dyspnea associated to ADL (13 +/- 5 vs 17 +/- 7, p < 0.01) and these differences persisted after correcting for baseline values and confounders (functional independence p < 0.01; dyspnea associated with ADL p = 0.02). Conclusion The ERIC-HF program is safe, feasible, and effective in increasing functional exercise tolerance and functional independence in hospitalized patients admitted due to DHF.
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| 4. |
- Jaarsma, Tiny, et al.
(författare)
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Preference-based care and research
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:1
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
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| 5. |
- Klompstra, Leonie, 1982-
(författare)
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Physical activity in patients with heart failure : motivations, self-efficacy and the potential of exergaming
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Adherence to recommendations for physical activity is low in patients with heart failure (HF). It is essential to explore to what extent and why patients with HF are physically active. Self-efficacy and motivation for physical activity are important in becoming more physically active, but the role of self-efficacy in the relationship between motivation and physical activity in patients with HF is unknown. Alternative approaches to motivate and increase self-efficacy to exercise are needed. One of these alternatives might be using exergames (games to improve physical exercise). Therefore, it is important to obtain more knowledge on the potential of exergaming to increase physical activity.The overall aim was to describe the physical activity in patients with HF, with special focus on motivations and self-efficacy in physical activity, and to describe the potential of exergaming to improve exercise capacity.Methods: Study I (n = 154) and II (n = 101) in this thesis had a cross-sectional survey design. Study III (n = 32) was a 12-week pilot intervention study, including an exergame platform at home, with a pretest-posttest design. Study IV (n = 14) described the experiences of exergaming in patients who participated in the intervention group of a randomized controlled study in which they had access to an exergame platform at home.Results: In total, 34% of the patients with HF had a low level of physical activity, 46% had a moderate level, 23% reported a high level. Higher education, higher selfefficacy, and higher motivation were significantly associated with a higher amount of physical activity. Barriers to exercise were reported to be difficult to overcome and psychological motivations were the most important motivations to be physically active. Women had significantly higher total motivation to be physically active. Self-efficacy mediated the relationship between exercise motivation and physical activity; motivation leads to a higher self-efficacy towards physical activity.More than half of the patients significantly increased their exercise capacity after 12 weeks of using an exergame platform at home. Lower NYHA-class and shorter time since diagnosis were factors significantly related to the increase in exercise capacity. The mean time spent exergaming was 28 minutes per day. Having grandchildren and being male were related to more time spent exergaming.The analysis of the qualitative data resulted in three categories describing patients’ experience of exergaming: (i) making exergaming work, (ii) added value of exergaming, (iii) no appeal of exergaming.Conclusion: One-third of the patients with HF had a low level of physical activity in their daily life. Level of education, exercise self-efficacy, and motivation were important factors to take into account when advising patients with HF about physical activity. In addition to a high level of motivation to be physically active, it is important that patients with HF have a high degree of exercise self-efficacy.Exergaming has the potential to increase exercise capacity in patients with HF. The results also showed that this technology might be suitable for some patients while others may prefer other kinds of physical activity.
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| 6. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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What are patients with heart failure willing to pay for an exergame intervention?
- 2019
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Konferensbidrag (refereegranskat)abstract
- Background: Regular physical activity in patients with heart failure (HF) improves physical capacity and quality of life, and may reduce health care utilization. One low-cost effective physical activity intervention to increase exercise capacity is exergaming. Exploring patients’ willingness to pay (WTP) for treatments/interventions is a way to obtain a monetary value for the health consequences of an intervention. This can further be used in economic evaluations.Aim: The aim of this study was to describe patients´ WTP for an exergame intervention and to determine factors influencing the WTP.Methods: This is a substudy of the Swedish cohort of the HF-Wii study (evaluating the effect of exergaming on exercise capacity in patients with HF; clinicaltrial.gov NCT01785121) including 34 patients who finished the 1-year follow-up. Structured telephone interviews were conducted focusing on WTP for the exergame intervention they received during the study including an exergame platform, an introduction lesson, installation of the exergame computer, and telephone follow-ups, and with an estimated cost of ∼€440 per patient. The WTP methodology used was adjusted for this specific study.Patients were also asked to rate their level of satisfaction with the intervention on a Numeric Rating Scale (NRS) from 0-10. In addition, information on background variables and income was collected during the interview, while data on six minute walk test (6MWT) and quality of life was retrieved from previous data collection in the main study.Results: In total, 29 patients with HF participated in this substudy, mean age 68±9 years, 69% males, and with a mean household disposable income/month of ∼€2700 (±1360). Ten patients (34.5%) had a clinically significant effect of the exergaming and improved more than 30 meters on the 6MWT.The average WTP for the exergame intervention was ∼€160 (range €0-580). Most patients were satisfied with the exergame intervention and the median score was 8 on the NRS. The satisfaction level was significantly related to WTP (rs=0.468, p=0.012). Patients with higher satisfaction levels were willing to pay more (€210±165) for the exergame intervention than those with lower satisfaction levels (€60±70), p=0.015. Income, changes in 6MWT, and quality of life showed no significant relationship to WTP.Conclusions: The WTP for an exergame intervention varied largely in patients with HF despite high satisfaction level with the intervention. The satisfaction level was the only factor influencing patients´ WTP. On average, patients were willing to pay about one-third of the cost of the exergame intervention. Future studies should focus on the cost-effectiveness of this intervention.
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| 7. |
- Pettersson, Sara, 1976-
(författare)
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Supporting Self-care in Migrants with Type 2 Diabetes
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Diabetes Mellitus, specifically type 2 diabetes, represents a growing global health concern, with a prevalence predicted to reach 783 million by 2045. Type 2 diabetes leads to personal suffering, reduced productivity and significant health care cost. Selfcare is the most important cornerstone in the treatment of type 2 diabetes and patient education is a prerequsite for performing adequate self-care. Migrants show a risk of uncontrolled diabetes and the prevalence of type 2 diabetes in migrants, living in European countries, poses challenges as cultural and language barriers might affect health care outcomes Culturally appropriate diabetes education is important for improving glycaemic control and health outcomes in migrant populations. In the Swedish health care setting, diabetes care follows national guidelines and is predominantly provided in primary health care centers. However, criticism has arisen regarding the lack of tailored care for migrants, leading to less effective health care. This thesis explores patients’ competence and health providers’ cultural competence influencing patient’s self-care.Aim: The overall aim of this thesis was to gain knowledge that can contribute to optimising support of self-care in migrants with type 2 diabetes. The aim in study I was to compare foreign‐ and Swedish‐born persons, diagnosed with type 2 diabetes, to study whether there are dissimilarities in knowledge about diabetes mellitus and to study determinants of knowledge. The aim in study II was to describe the cultural competence of primary health care professionals that specialize in diabetes care and to examine related factors that affect cultural competence. In study III the aim was to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes and in study IV the aim was to evaluate the feasibility of a culturally appropriate website, supporting self-care in migrants with type 2 diabetes.Methods: This thesis includes four studies with two cross-sectional descriptive studies one co-design study, and one feasibility study. In study I where knowledge and glycaemic control were assessed, patients diagnosed with type 2 diabetes, receiving care at a primary health care center, participated. The data was collected with validated questionnaire and described by numbers and percentage, mean (SD) and median (range). Comparisons between groups were made by tests of statistical significance where p < 0.05 was considered statistically significant. For analytical statistics, to identify any independent associations between knowledge and socio‐demographic variables and diabetes related characteristics, multiple logistic regression analysis was performed. Data was collected between September 2014 and March 2016. Study II was also a cross-sectional study and aimed to measure perceived cultural competence in health care providers. Data was collected by a questionnaire from January to July 2020. Data was analysed by descriptive statistics and to analyse sociodemographic factors associated with the three domains, univariate analyses with bivariate correlations, independent Student t-tests, or one-way ANOVA were employed, as appropriate. Linear regression analyses were conducted, including sociodemographic factors. The third study used a co-design process, involving fourteen migrant patients, ten health care providers in diabetes care, and four researchers with data collection between February 2021 to December 2022. In the fourth study feasibility of the developed culturally appropriate website was evaluated through qualitative interviews with seven migrant patients and ten health care providers who had previously participated in study III. The interviews focused on four areas: Acceptability, Demand, Implementation, and Integration of the website. Data was analysed by directed content analysis.Result: The results show a significant gap in competence, including knowledge about diabetes and poor glycaemic control in migrants, particularly those born in the Middle East with type 2 diabetes. The thesis emphasizes the influence of cultural factors on selfcare, highlighting the need for cultural competence in health care providers working with diverse populations. A significant proportion of health care providers perceived themselves as open and aware regarding clients with other cultural backgrounds, but the health care providers perceived a lack of organizational support to improve cultural competence. In the third study, the need for a comprehensive tool providing culturally appropriate information was emphasized by both patients and health care providers. A prototype of a culturally appropriate website developed with the aim of improving the patients' competence and thereby supporting the self-care of migrants with type 2 diabetes. The website was then developed into a mobile-friendly website that patients and health care providers tested and evaluated. Both patients and health care providers experienced the website as culturally appropriate with information at a reasonably basic level, in patient's own language (Arabic) and with information provided in several different ways, such as written information, images, videos and thus accessible to those who cannot read. The participants expressed interest and demand for the website, and the planned strategy for implementation was considered reasonable. They also felt it was possible to integration the tool into existing primary health care infrastructure, as a complementary cultural appropriate tool.Conclusions: There are vulnerable groups in the society such as migrants born in the Middle East, with type 2 diabetes. This thesis highlights the importance of patient’s competence and health care providers‘ cultural competence and the influence of self-care. The development of a culturally appropriate tool, such as the website, is proposed as a practical solution to enhance patient’s competence and support health care providers in delivering culturally competent care.
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| 8. |
- Vellone, Ercole, et al.
(författare)
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Cognitive impairment in patients with heart failure : an international study
- 2020
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Ingår i: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 7:1, s. 47-54
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Cognitive impairment (CI) in heart failure (HF) patients has mostly been studied in single countries in specific health care settings. Sociodemographic and clinical predictors of the global CI and CI dimensions are still unclear. We described CI in a diverse HF population recruited in several countries and in different health care settings and investigated sociodemographic and clinical factors associated with the global and specific CI dimensions in HF patients.Methods and results: A secondary analysis from the baseline data of the Wii-HF trial. Patients (n = 605) were enrolled in Sweden, Italy, Israel, The Netherlands, Germany, and the United States. We used the Montreal Cognitive Assessment to evaluate CI and the 6 minute walk test (6MWT) to measure exercise capacity. Patients were on average 67 years old (SD, 12), and 86% were in New York Heart Association Class II and III. The mean Montreal Cognitive Assessment score was 24 (SD, 4), and 67% of patients had at least a mild CI. The item evaluating short-term memory had a considerable proportion of low scoring patients (28.1%). Worse CI was associated with patients' older age, lower education, and lower 6MWT scores (R2 = 0.27). CI dimension scores were differently associated with specific clinical and demographic variables, but the 6MWT scores were associated with five out of seven CI dimension scores.Conclusions: CI is an important problem in HF patients, with specific challenges in regard to memory. Exercise capacity is a modifiable factor that could be improved in HF patients with the potential to improve cognition and other outcomes in this population.
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| 9. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(författare)
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Comparison of the 6-minute walk distance measured on a 30 m track with guidance of a healthcare professional and those measured with a mobile application outdoors by participants themselves : a validation study
- 2023
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 22:5, s. 544-546
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Tidskriftsartikel (refereegranskat)abstract
- To improve the practical application of measuring exercise capacity, the purpose of this study was to compare the 6 min walk distance (6MWD) obtained at a 30 m track with the guidance of healthcare professionals vs. the 6MWD obtained by participants themselves using an app. In total, 37 participants performed both tests. The mean of the differences between the 6MWD on the tests was -4 +/- 45 m (95% limits of agreement: 84 to -99 m). The overall agreement between the two 6MWD measures was 97% with an intraclass correlation coefficient of 0.96 (95% confidence interval: 0.91-0.98, P < 0.001). The use of an app is feasible, reliable, and valid to assess the 6MWD.
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| 10. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(författare)
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Costs of an Off-the-Shelve Exergame Intervention in Patients with Heart Failure
- 2023
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Ingår i: Games for Health Journal. - : MARY ANN LIEBERT, INC. - 2161-783X .- 2161-7856. ; 12:3, s. 242-248
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programs involving traditional modes of physical activity. Although no effect on exercise capacity was found for an off-the-shelf exergame, it is important to gain insights into aspects related to costs to develop such interventions further.Materials and Methods: In a randomized controlled trial, the Heart Failure Wii study (HF-Wii study), the intervention group (exergame group) received an introduction to the exergame, the exergame was installed at home and help was offered when needed for 3 months. Patients received telephone follow-ups at 2, 4, 8, and 12 weeks after the installation. The control group (motivational support group) received activity advice and telephone follow-ups at 2, 4, 8, and 12 weeks. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs, and willingness to pay.Results: No significant differences were found between the exergame group (n = 300) versus the motivational support group (n = 305) in hospital use or costs (1-year number of hospitalizations: P = 0.60, costs: P = 0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros. Of the total estimated costs for the intervention, 287 Euros, patients were willing to pay, on average, 58%.Conclusion: This study shows that the costs of an intervention using an off-the-shelve exergame are relatively low and that the patients were willing to pay for more than half of the intervention costs. The trial is registered in ClinicalTrials.gov (NCT01785121).
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