Atriyal fibrilasyonlu hastalarda davranış değişikliği modeli kullanılarak gerçekleştirilen yürüme egzersizlerinin semptom şiddeti ve yaşam kalitesine etkisi: Randomize kontrollü çalışma
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Tarih
2023
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Necmettin Erbakan Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Atriyal fibrilasyon en sık görülen aritmilerden olup hız ve ritim kontrolü sağlanamadığında kalbin pompa fonksiyonunu bozabilir. Tedavi edilmeyen veya kontrol altına alınmayan atriyal fibrilasyon durumlarında kalp yetmezliği ve inmeye zemin hazırlaması açısından da oldukça tehlikelidir. Bu nedenle araştırma, atriyal fibrilasyonlu hastalarda davranış değişikliği modeli kullanılarak gerçekleştirilen yürüme egzersizlerinin semptom şiddeti ve yaşam kalitesine etkisini değerlendirmek amacıyla yapılmıştır. Araştırma, prospektif, paralel grup randomize kontrollü tasarım ile bir üniversite hastanesinin kardiyoloji kliniğinde yürütülmüştür. Örnekleme, blok randomizasyonla 39 müdahale, 39 kontrol grubuna olmak üzere toplam 78 hasta dâhil edilmiştir. Veri toplama aracı olarak, Hasta Tanılama Formu, Toronto Üniversitesi Atriyal Fibrilasyon Şiddeti Ölçeği ve Kısa Form 36 kullanılmıştır. Araştırmanın uygulamasında, COM-B davranış değişikliği modeline göre müdahale grubuna araştırmanın başlangıcında fiziksel aktivitenin yararları konusunda bilgilendirme yapılmış, haftada en az 3 gün ortalama 30 dakika pedometre ile yürüyerek adım sayılarını kaydetmeleri istenmiştir. Motivasyonun sağlanması amacıyla müdahale grubu ile araştırmacı tarafından haftalık telefon görüşmeleri yapılmış ve yürüme durumları da takip edilmiştir. Kontrol grubuna ise müdahalesiz gözlem yapılmıştır. Müdahale ve kontrol grubuna başlangıçta, 4. haftada ve 12. haftada ölçekler uygulanmıştır. Yürüme izlem çizelgesi müdahale grubundan 4. haftada ve 12. haftada teslim alınmıştır. Veriler Nisan 2022-Şubat 2023 tarihleri arasında toplanmıştır. Araştırmanın etik izni ve kayıt numarası alınmıştır. Verilerin analizinde tanımlayıcı veriler için sıklık, yüzde, ortalama, standart sapma; normal dağılım için skewness ve kurtosis değerleri, histogramlar ve Q-Q plot değerleri incelenmiştir. Kategorik değişkenler için ki-kare, gruplar arası karşılaştırmada bağımsız gruplar için t testi, grup içi karşılaştırmada tekrar ölçümlü ANOVA, grup-zaman etkileşimini değerlendirmek için karma ANOVA kullanılmıştır. Anlamlılık düzeyi p<0,05 olarak alınmıştır. Araştırmaya katılan hastaların yaş ortalaması müdahale grubunda 59,13± 10,77 yıl, kontrol grubunda 60,90±9,09 yıl bulunmuştur. Hastaların sosyodemografik özellikler bakımından benzer dağılıma sahip oldukları belirlenmiştir (p>0,05). Müdahale grubunda, 1. haftada ortalama 92,35 dk olan yürüme süresi 12. haftanın sonunda 134,08 dk/hafta olarak tespit edilmiştir. Adım sayıları ortalaması 1. haftada 2048,22 iken 12. haftanın sonunda 2998,97'ye yükselmiştir. Hem egzersiz süresi hem de adım sayıları açısından bu artış anlamlı bulunmuştur (p<0,01). Müdahale grubunda yürüme egzersizi uygulaması sonrası AF semptom şiddeti puan ortamalarının AF yükü boyutunda zamana göre farklılık göstermediği (p>0,05) ancak semptom ciddiyeti puan ortalamalarının azaldığı tespit edilmiştir (p<0,05). Müdahale grubunda Yaşam Kalitesi puan ortalamalarının zamana göre arttığı belirlenmiştir (p<0,05). Müdahale grubunun Yaşam Kalitesi puan ortalamalarında fiziksel rol güçlüğü alt boyutu haricinde 12. haftada kontrol grubu puan ortalamalarından daha yüksek olduğu saptanmıştır (p<0,05). Araştırmada, davranış değişikliği modeli kullanılarak gerçekleştirilen yürüme egzersizlerinin 12 hafta sonunda AF semptom ciddiyetinde azalmaya, yaşam kalitesi alt boyutlarından fiziksel işlevsellik, emosyonel rol güçlüğü, enerji/canlılık, ruhsal sağlık, sosyal işlevsellik, ağrı ve genel sağlıkta iyileşmeye neden olduğu bulunmuştur. Enerji/canlılık alt boyutunda 4. hafta sonunda da anlamlı bir değişim gözlenmiştir. En önemli iyileşme yaşam kalitesinin sosyal işlevsellik alt boyutunda gerçekleşmiştir. Yürüme egzersizleri ile 12 haftalık sürede AF yükünde ve yaşam kalitesinin fiziksel rol güçlüğü alt boyutunda anlamlı bir değişim olmamıştır. AF hastalarında davranış değişikliği modeli kullanılarak yürüme egzersizleri teşvik edilebilir. Her ortamda uygulanabilir olan yürüme egzersizleri için hastalar motive edilmeli, ileri araştırmalarla sağlık yararları daha net ortaya konabilmeli ve adım sayısı ölçme tekniği ile egzersiz etkinliği değerlendirilmelidir.
Atrial fibrillation is one of the most common arrhythmias, and when rate and rhythm control cannot be achieved, it can impair the pump function of the heart. In untreated or uncontrolled atrial fibrillation, it is also very dangerous in terms of preparing the ground for heart failure and stroke. For this reason, the study was conducted to evaluate the effect of walking exercises performed using a behavioral change model on symptom severity and quality of life in patients with atrial fibrillation. The study was conducted in the cardiology clinic of a university hospital with a prospective, parallel group randomized controlled design. A total of 78 patients were included in the sample, 39 in the intervention group and 39 in the control group, with block randomization. Patient Identification Form, University of Toronto Atrial Fibrillation Severity Scale and Short Form 36 were used as data collection tools. In the application of the study, according to the COM-B behavior change model, the intervention group was informed about the benefits of physical activity at the beginning of the study, and they were asked to record the number of steps by walking with a pedometer for an average of 30 minutes at least 3 days a week. In order to provide motivation, weekly phone calls were made by the intervention group and the researcher, and their walking status was also followed. The control group was observed without intervention. The scales were administered to the intervention and control groups at baseline, at week 4, and at week 12. The gait follow-up chart was received from the intervention group at week 4 and week 12. Data were collected between April 2022 and February 2023. Ethical permission and registration number of the study were obtained. Frequency, percentage, mean, standard deviation for descriptive data in data analysis; For normal distribution, skewness and kurtosis values, histograms and Q-Q plot values were examined. Chi-square was used for categorical variables, t-test was used for independent groups for group comparison, repeated measure ANOVA was used for within-group comparison, and mixed ANOVA was used to evaluate group-time interaction. The significance level was taken as p<0.05. The mean age of the patients participating in the study was 59.13± 10.77 years in the intervention group and 60.90±9.09 years in the control group. It was determined that the patients had a similar distribution in terms of sociodemographic characteristics (p>0.05). In the intervention group, the average walking time was 92.35 minutes in the 1st week, and 134.08 minutes/week at the end of the 12th week. While the average number of steps was 2048.22 in the 1st week, it increased to 2998.97 at the end of the 12th week. This increase was found to be significant in terms of both exercise duration and number of steps (p<0.01). It was determined that AF symptom severity score averages in the intervention group did not differ according to time in the AF load dimension after the application of walking exercise (p>0.05), but the symptom severity score averages decreased (p<0.05). It was determined that the mean scores of Quality of Life in the intervention group increased over time (p<0.05). It was determined that the mean scores of the intervention group's Quality of Life were higher than the mean scores of the control group at the 12th week, except for the physical role difficulty sub-dimension (p<0.05). In the study, it was found that walking exercises performed using the behavior change model caused a decrease in the severity of AF symptoms at the end of 12 weeks, and an improvement in physical functionality, emotional role difficulty, energy/vitality, mental health, social functionality, pain and general health, which are sub-dimensions of quality of life. A significant change was also observed in the energy/vitality sub-dimension at the end of the 4th week. The most significant improvement occurred in the social functionality sub-dimension of quality of life. There was no significant change in the AF burden and the physical role difficulty sub-dimension of quality of life during the 12-week period with walking exercises. Walking exercises can be encouraged in AF patients using a behavior modification model. Patients should be motivated for walking exercises, which can be applied in any environment, health benefits should be revealed more clearly with further research, and exercise efficiency should be evaluated with the technique of measuring the number of steps.
Atrial fibrillation is one of the most common arrhythmias, and when rate and rhythm control cannot be achieved, it can impair the pump function of the heart. In untreated or uncontrolled atrial fibrillation, it is also very dangerous in terms of preparing the ground for heart failure and stroke. For this reason, the study was conducted to evaluate the effect of walking exercises performed using a behavioral change model on symptom severity and quality of life in patients with atrial fibrillation. The study was conducted in the cardiology clinic of a university hospital with a prospective, parallel group randomized controlled design. A total of 78 patients were included in the sample, 39 in the intervention group and 39 in the control group, with block randomization. Patient Identification Form, University of Toronto Atrial Fibrillation Severity Scale and Short Form 36 were used as data collection tools. In the application of the study, according to the COM-B behavior change model, the intervention group was informed about the benefits of physical activity at the beginning of the study, and they were asked to record the number of steps by walking with a pedometer for an average of 30 minutes at least 3 days a week. In order to provide motivation, weekly phone calls were made by the intervention group and the researcher, and their walking status was also followed. The control group was observed without intervention. The scales were administered to the intervention and control groups at baseline, at week 4, and at week 12. The gait follow-up chart was received from the intervention group at week 4 and week 12. Data were collected between April 2022 and February 2023. Ethical permission and registration number of the study were obtained. Frequency, percentage, mean, standard deviation for descriptive data in data analysis; For normal distribution, skewness and kurtosis values, histograms and Q-Q plot values were examined. Chi-square was used for categorical variables, t-test was used for independent groups for group comparison, repeated measure ANOVA was used for within-group comparison, and mixed ANOVA was used to evaluate group-time interaction. The significance level was taken as p<0.05. The mean age of the patients participating in the study was 59.13± 10.77 years in the intervention group and 60.90±9.09 years in the control group. It was determined that the patients had a similar distribution in terms of sociodemographic characteristics (p>0.05). In the intervention group, the average walking time was 92.35 minutes in the 1st week, and 134.08 minutes/week at the end of the 12th week. While the average number of steps was 2048.22 in the 1st week, it increased to 2998.97 at the end of the 12th week. This increase was found to be significant in terms of both exercise duration and number of steps (p<0.01). It was determined that AF symptom severity score averages in the intervention group did not differ according to time in the AF load dimension after the application of walking exercise (p>0.05), but the symptom severity score averages decreased (p<0.05). It was determined that the mean scores of Quality of Life in the intervention group increased over time (p<0.05). It was determined that the mean scores of the intervention group's Quality of Life were higher than the mean scores of the control group at the 12th week, except for the physical role difficulty sub-dimension (p<0.05). In the study, it was found that walking exercises performed using the behavior change model caused a decrease in the severity of AF symptoms at the end of 12 weeks, and an improvement in physical functionality, emotional role difficulty, energy/vitality, mental health, social functionality, pain and general health, which are sub-dimensions of quality of life. A significant change was also observed in the energy/vitality sub-dimension at the end of the 4th week. The most significant improvement occurred in the social functionality sub-dimension of quality of life. There was no significant change in the AF burden and the physical role difficulty sub-dimension of quality of life during the 12-week period with walking exercises. Walking exercises can be encouraged in AF patients using a behavior modification model. Patients should be motivated for walking exercises, which can be applied in any environment, health benefits should be revealed more clearly with further research, and exercise efficiency should be evaluated with the technique of measuring the number of steps.
Açıklama
Doktora Tezi
Anahtar Kelimeler
Atriyal Fibrilasyon, Davranış Değiştirme Modeli (COM-B), Semptom Şiddeti, Yaşam Kalitesi, Yürüyüş Egzersizi, Atrial Fibrillation, Behavior Modification Model (COM-B), Symptom Severity, Quality of Life, Walking Exercise
Kaynak
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Scopus Q Değeri
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Künye
Uçar, A. (2023). Atriyal fibrilasyonlu hastalarda davranış değişikliği modeli kullanılarak gerçekleştirilen yürüme egzersizlerinin semptom şiddeti ve yaşam kalitesine etkisi: Randomize kontrollü çalışma. (Yayımlanmamış doktora tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı, Konya.
