Key result
Adding Learning and Coping strategies to cardiac rehabilitation fails to improve one-year return to work.
Why the study?
Does adding Learning and Coping strategies to standard cardiac rehabilitation improve return to work at one year in patients with ischaemic heart disease or heart failure?
RCT (n=244)
Open-label
Block-randomized in a 1:1 ratio
Yes
Does adding Learning and Coping strategies to standard cardiac rehabilitation improve return to work at one year in patients with ischaemic heart disease or heart failure?
Odds Ratio: 0.76 (95% CI 0.43–1.31)
Absolute Event Rate: 64.7% vs 68.8%
p-value: p=0.32
Adding Learning and Coping strategies to standard cardiac rehabilitation does not improve return to work rates at one year for working-age patients with ischemic heart disease or heart failure.
Does not support adding Learning and Coping strategies to cardiac rehabilitation; challenges efficacy of psychosocial adjuncts for return to work.
BACKGROUND: Personal resources are identified as important for the ability to return to work (RTW) for patients with ischaemic heart disease (IHD) or heart failure (HF) undergoing cardiac rehabilitation (CR). The patient education 'Learning and Coping' (LC) addresses personal resources through a pedagogical approach. This trial aimed to assess effect of adding LC strategies in CR compared to standard CR measured on RTW status at one-year follow-up after CR. METHODS: In an open parallel randomised controlled trial, patients with IHD or HF were block-randomised in a 1:1 ratio to the LC arm (LC plus CR) or the control arm (CR alone) across three Danish hospital units. Eligible patients were aged 18 to ≤60 and had not left the labour market. The intervention was developed from an inductive pedagogical approach consisting of individual interviews and group based teaching by health professionals with experienced patients as co-educators. The control arm consisted of deductive teaching (standard CR). RTW status was derived from the Danish Register for Evaluation of Marginalisation (DREAM). Blinding was not possible. The effect was evaluated by logistic regression analysis and reported as crude and adjusted odds ratios (OR) with 95% confidence interval (CI). RESULTS: The population for the present analysis was N = 244 (LC arm: n = 119 versus control arm: n = 125). No difference in RTW status was found at one year across arms (LC arm: 64.7% versus control arm: 68.8%, adjusted odds ratio OR: 0.76, 95% CI: 0.43-1.31). CONCLUSION: Addition of LC strategies in CR showed no improvement in RTW at one year follow-up. TRIAL REGISTRATION: www.clinicaltrials.gov identifier NCT01668394. First Posted: August 20, 2012.
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Bitsch et al. (2018) conducted an RCT in Ischaemic heart disease or heart failure (n=244). Learning and Coping (LC) strategies plus standard cardiac rehabilitation vs. Standard cardiac rehabilitation alone was evaluated on Return to work (RTW) status at one-year follow-up (adjusted OR 0.76, 95% CI 0.43-1.31, p=0.32). Addition of Learning and Coping strategies to standard cardiac rehabilitation did not improve return to work status at one year compared to standard rehabilitation alone (adjusted OR 0.76).
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