Effects of Intensive Early Physiotherapy Intervention After Myocardial Infarction on Quality of Life, Anxiety and Depression Scores: A Controlled Clinical Trial.

چکیده اصلی

BACKGROUND AND PURPOSE: Early mobilisation after myocardial infarction (MI) is strongly recommended. However, evidence regarding the benefits of structured physiotherapy during the acute in-hospital phase remains limited. This controlled clinical trial (CCT) aimed to evaluate whether an intensive early physiotherapy programme could improve health-related quality of life (HRQoL) and psychological well-being. METHODS: This CCT included 172 adults hospitalised after MI and treated with primary percutaneous coronary intervention (PCI). The participants were quasi-randomly allocated (1:1) to the intervention or control group based on the hospital room number. They received either an intensive physiotherapy programme (daily supervised mobilisation, education and graded activity) or standard medical care and an informational flyer. Primary outcomes included HRQoL (MacNew) and psychological well-being (Hospital Anxiety and Depression Scale, HADS-D). Clinically important changes were evaluated using the standardised response mean (SRM, which reflects the clinical relevance of observed changes), and the minimal clinically important difference (MCID, the smallest change in an outcome perceived as important by patients). Statistical analysis was conducted to assess group-by-time and pre-post interaction effects. RESULTS: Clinical significance metrics: The intervention group showed less deterioration in overall HRQoL (SRM: 0.04 vs. 0.1) and an enhancement in the MacNew emotional subscale (SRM: 0.22 vs. 0.09) compared with the control group. The HADS-D improved to a greater extent in the intervention group, exceeding the MCID (1.7 points). There were no statistically significant interaction effects between groups by time (interaction factor group * factor time; HRQoL p = 0.68 and anxiety/depression p = 0.15) or between the time points (pre-post, main effect factor time; HRQoL p = 0.35 and anxiety/depression p = 0.4). DISCUSSION: Clinically, intensive early in-hospital physiotherapy may lead to improved psychological outcomes and an attenuation of HRQoL decline. Although the change in HADS-D in the intervention group did not reach statistical significance, it exceeded the MCID, indicating a clinically meaningful improvement from the patients' perspective. The implementation of structured early mobilisation protocols may provide clinically relevant benefits during the acute post-PCI hospitalisation period and warrants further investigation. TRAIL REGISTRATION: Ethical approval was first submitted in January 2023, then resubmitted after minor revision in March 2023, and was then accepted on 15 March 2023 (Reg.Nr. K-2023-001).

ترجمه فارسی چکیده

این آزمایش بالینی کنترل‌شده (CCT) هدف داشت بررسی اینکه آیا یک برنامه فیزیوتراپی اصولی و زودهنگام می‌تواند کیفیت زندگی مرتبط با سلامت (HRQoL) و رفاه روانی را بهبود بخشد. ۱۷۲ بالغ بستری شده پس از سکته قلبی (MI) که تحت درمان با تزریق داخل عروق کورونری اولیه (PCI) قرار داشتند، در این مطالعه شرکت کردند. شرکت‌کنندگان به صورت تقریبی (۱:۱) بر اساس شماره اتاق بیمارستان به گروه مداخله یا کنترل اختصاص یافتند. گروه مداخله یک برنامه فیزیوتراپی اصولی (متحرک‌سازی روزانه نظارت‌شده، آموزش و فعالیت‌های مقیاس‌دار) دریافت کرد، در حالی که گروه کنترل مراقبت‌های پزشکی استاندارد و یک برگه اطلاع‌رسانی دریافت کردند. شاخص‌های معناداری بالینی شامل کیفیت زندگی (MacNew) و رفاه روانی (HADS-D) بودند. نتایج نشان داد که گروه مداخله در کاهش کیفیت زندگی کلی (SRM: ۰.۰۴ در مقابل ۰.۱) و بهبود زیرمجموعه عاطفی MacNew (SRM: ۰.۲۲ در مقابل ۰.۰۹) نسبت به گروه کنترل بهتر بود. HADS-D در گروه مداخله به طور قابل توجهی بهبود یافت و از حداقل تغییر بالینی مهم (MCID) فراتر رفت (۱.۷ امتیاز). هیچ تأثیر تعاملی معناداری آماری بین گروه‌ها و زمان وجود نداشت.

متن کامل اصلی