• Does a community based heart failure disease management programme improve quality of life, knowledge and self-care of participants?: A service evaluation

      Buckley, John P.; Baron, Clare E. (University of ChesterBurnley Borough Council, 2011-09-30)
      Heart failure also has poor clinical outcomes with around 40% of people dying within one year of initial diagnosis. Heart failure patients have a five-year survival rate of just 58% compared to 93% in the age- and gender-matched general population. It has long been identified that education and improving self-care behaviour is an important aspect of managing heart failure to aid in reducing costs to the economy as well as, more importantly for patients, improving quality of life. The aim of this service evaluation is to assess the impact of the Living Well with Heart Failure Programme on participants in terms of knowledge, quality of life and self-care behaviour. 21 participants (14 males, 67 yrs ±13, 7 females, 72 yrs ± 9) with diagnosed heart failure took part in a pilot six week disease management programme consisting of education, social interaction and relaxation practice facilitated by a community cardiac rehabilitation practitioner. Participants' quality of life was assessed via the Minnesota Living with Heart Failure questionnaire and self-care behaviour was measured via the Self-Care of Heart Failure Index at week one and week six along with a knowledge questionnaire. Paired t tests were conducted on the overall sample with further analysis being carried out on genders, NYHA classifications and age groups both within and between groups. There was a significant improvement in quality of life of 12% (p=0.005) and participant knowledge improved by 100% (p=0.005). Self-care behaviour also significantly improved - maintenance 70% (p=0.005), management 66% (p=0.005) and confidence 63% (p=0.005). Whilst all groups showed significant improvements in quality of life, knowledge and self-care behaviour, no significant differences were found between them. Statistically significant improvements in quality of life, knowledge and self-care behaviour were seen in the participants of the Living Well Programme. The design of this programme of not only educating participants but also encouraging self-care behaviours with continued support and motivation would seem to be key in promoting behaviour change which in turn improve well being. On the basis of the evidence provided in this service evaluation local primary care trust should look to commission the Living Well Programme across East Lancashire allowing all heart failure patients in the area the opportunity to empower themselves to improve their health and well being.
    • Evaluation of an adult weight management service delivered by pharmacies and GP practices

      Mills, Sarah (University of Chester, 2011-10-10)
      This study aimed to determine whether an adult weight management programme delivered by pharmacies and GP practices in Birmingham was effective and if there was a difference between pharmacy and GP led programmes. In this repeated measures study (n=450) of a 12 week weight management programme consisting of weekly appointments and three follow up appointments delivered in pharmacies (n=183) and GP practices (n=267). Participants at baseline had a mean age of 42 (±12.4) years, and mean BMI of 34.5 (±6.0) kg/m² and were measured at baseline (n=450), 12 weeks (n=166) and 6 month follow up (n=82). Weight, BMI, waist circumference and quality of life (QoL) measurements were taken at each time point. Overall there was a significant decrease in weight (3.10kg (±4.32)), waist (6.20cm (±6.21)) and BMI (1.12kg/m² (±1.76)) between baseline and 12 weeks (p=0.000), and baseline and six month follow up (p=0.000). With 39% of participants losing more than 5% of their weight and 54% losing more than 5cm from their waist at 6 month follow up. QoL significantly increased between baseline and 12 weeks (p=0.000), and baseline and six month follow up (p=0.000). GP led programmes had a significantly (p=0.043) higher percentage weight loss than the pharmacy led programmes at 12 weeks. However, the pharmacy led programme demonstrated significant (p=0.009) weight loss between completing the 12 week programme and 6 month follow up, compared to the GP led programme where weight increased. The pharmacy led programme had a considerably higher retention rate and resulted in a 4.03%(±5.24) weight loss at follow up with significantly (p=0.019) more participants achieving more than 5% weight loss at the 6 month follow up compared with the GP led programme. The adult weight management programme is effective, resulting in a significant decrease in weight, BMI and waist circumference and a significant increase in quality of life at 12 weeks and maintained 6 months post intervention. The pharmacy led programme appears more effective than the GP led programme demonstrating a significantly greater retention rate with a significant percentage of participants maintaining their weight loss 6 months post intervention.
    • Exercise and physical activity practices of males in an Irish prison and its impact on quality of life.

      Fallows, Stephen; Dooley, Fiona (University of Chester, 2018-09-03)
      People in prison are generally deemed to be at a higher risk of several physiological and psychological conditions due to demographic factors and the prison environment, where overcrowding, lack of cleanliness and unhealthy lifestyle practices are common. In response to these influences prisoners tend to have lower quality of life and health related quality of life scores compared to the general population. While exercise provision is in place in prisons, sedentary behaviour is very common among prisoners. Physical inactivity such as this is described as a key modifiable risk factor for several health conditions. Exercise and physical activity has been widely recognised to be effective in managing an individuals’ health and the same is true in a prison perspective. Prison-based exercise programmes have increased the overall quality of life scores of prisoners most notably in the domains of physical and mental health. Cardiovascular and resistance training programmes have produced significant improvements in the cardiovascular health of prisoners reducing the risk of cardiovascular disease. Various exercise and sport interventions have also significantly improved the psychological wellbeing of prisoners reducing levels of depression, anxiety, stress and improving self-esteem.
    • An exploratory study to determine if younger patients’ with implantable cardioverter defibrillators have an improved quality of life following cardiac rehabilitation

      Fallows, Stephen; Morris, Mike; Grieger, Andréa (University of Chester, 2012-11-19)
      The quality of life and anxieties of young patients with implantable cardioverter defibrillators (ICD) are not clearly understood. A small number of studies have looked at both physical and psychological issues in this group however not by evaluating attendance and outcomes of ICD patients’ participating in cardiac rehabilitation (CR). The study aims to establish whether a CR programme offered to young ICD patients (less than 50 years of age) helps improve their quality of life and reduces stress and anxiety levels. A comparison was made to a group of young ICD patients who had not yet completed a CR programme. The sample size was twenty ICD patients with inherited cardiac conditions who had an ICD implanted in the last eighteen months. Ages ranged from 23-49 years, mean age was 40 (± 7.83). The CR group (n=10) had enrolled on an eight week CR programme at Imperial College Healthcare NHS Trust and completed a quality of life questionnaire and Hospital Anxiety and Depression Scale (HADS) at baseline and after the programme. The non-CR group (n=10) were asked to complete the same questionnaires. Retrospective questionnaire data was analysed pre and post CR using repeated measures and compared with prospective data collected from the non-CR group. Quality of life components included physical fitness, feelings, daily activities, social activities, pain, change in health, overall health, social support and quality of life. In total five patients in the CR group completed the CR programme within the study timeframe and 80% of patients in the non-CR group returned the questionnaires. None of the CR group quality of life scores were found to be statistically significant following CR. There was a reduction between pre and post questionnaire median scores in components ‘quality of life’ (12.5%), ‘daily activities’ (25%), and ‘physical fitness’ (25%). A reduction of 14.29% was observed in the CR group depression scores, however differences in both anxiety and depression scores were not found to be significant (p=0.680, p=0.06 respectively). Post CR scores and non-CR group quality of life scores were not significantly different. This exploratory study identified areas of quality of life where younger ICD patients experience problems and how CR may assist them in their initial recovery after ICD implant. A reduction was found in depression scores following CR, however it is not clear whether CR improves quality of life for this population. There may be scope for specific ICD follow up in the future as these patients currently have access to specialist advice from healthcare professionals within Cardiology.
    • Living with Multiple Sclerosis – exploring the effects of physical activity on quality of life

      Kennedy, Lynne; McGregor, Linda J. (University of Chester, 2017-08-31)
      Objective: To examine the effect of exercise on quality of life and investigate the perceived barriers to exercise participation. Methods: A qualitative study using semi-structured one-to-one interviews on 12 participants with multiple sclerosis. Results: Five qualitative themes were identified: environmental, personal, knowledge, quality of life, and taking control. Participants felt that discussing the benefits of physical activity engagement with a health professional and addressing problems such as transport would be helpful strategies for exercise engagement. All participants perceived that physical activity helped with quality of life. Conclusions: These findings indicate that exercise therapy is beneficial to quality of life and that physical activity should be promoted by the neurologist at diagnosis.
    • Long‐term outcomes of cardiovascular rehabilitation: One year follow‐up concerning quality of life, physical activity and psychological state of health – a pilot study

      Buckley, John P.; Fallows, Stephen; Morris, Mike; Ilina, Viktoriia (University of Chester, 2014-10)
      Cardiovascular rehabilitation is known to be beneficial in short‐term and long‐term disease management and enhancing physical and psychological well‐being: the majority of recent evidence outlines that comprehensive cardiac rehabilitation has positive short term improvements in physical fitness, quality of life and psychological status, however, there is less data regarding similar long‐term outcomes of the programme. A recent systematic review highlighted the efficacy of exercise‐based cardiac rehabilitation towards reduction in mortality (medium to longer term studies) and in hospital admissions (short‐term studies). Further research should focus on evaluation of comprehensive programmes as far as quality of life, social and psychological status are less explored in research literature, compared to mortality and morbidity levels. Special considerations are advised to contribute into monitoring and management of anxiety and depression levels which may alter patients` quality of life and general health state. Lastly, the analysis of prolonged rehabilitation outcomes should be in a high priority, according to confirmation of continuous 12 months improvement in physical activity, depression and anxiety reduction after rehabilitation. Consequently, the future studies are recommended to investigate whether participants of cardiac rehabilitation services maintain the physical and psychological benefits, at one year, following programme and, consequently, to reveal effectiveness of these services.
    • A text message based weight management intervention

      Fallows, Stephen; Donaldson, Eleanor L. (University of ChesterLeicestershire Nutrition & Dietetic Service, 2010-10-21)
      Purpose: This study aimed to determine whether a text message based intervention helped participants maintain or lose weight following completion of a weight loss programme. Low fat diet, regular exercise, breakfast consumption, goal setting and self monitoring are behaviours of weight losers and maintainers (Wing & Hill, 2001). Weight management interventions can be enhanced using mobile telephone technology to deliver support in real time, real world settings (Heron & Smyth, 2010) Methods: In this controlled study, overweight adults completing a weight management programme participated in an additional 12-week text message based intervention (‘LEAP Beep’). Participants (n=17, 7 males; 10 females; mean age 58.3 ± 12.1 years) were allocated daily targets for steps, fruit, vegetable and breakfast consumption. Twice weekly, participants ‘texted’ with progress and received practitioner feedback. Pre and post intervention body mass, waist circumference, Body Mass Index (BMI), quality of life (QOL), anxiety and depression measurements were collected and compared retrospectively to a control group (n=17; 4 males, 13 females; mean age 59.1 ± 9.5 years) receiving optional weight checks only (standard care). Paired t tests and Wilcoxon signed ranks tests evaluated differences between pre and post intervention variables. Results: Compared to the control, intervention group body mass, waist circumference and BMI reduced significantly (p=0.006; p=0.0005; p=0.03). QOL and depression scores improved, but not significantly (p=0.134; p=0.228). No difference was found between group anxiety scores (table 1.) Satisfaction surveys showed 100% (n=14) of participants strongly agreed they were satisfied with the overall programme. Conclusions: ‘LEAP Beep’ resulted in weight and waist circumference losses, improved quality of life parameters and was highly acceptable to participants. Text messaging is a cheap, portable, convenient and innovative contact medium that promotes goal setting, self monitoring and facilitates information exchange with patients. Text messaging inclusive of practitioner feedback opens up increasing possibilities for practitioner to patient support and helps maintain a positive weight outcome following initial weight loss. Further improvements to automation whilst maintaining individual support are necessary to ease practitioner burden.