title: The patient education - Learning and Coping Strategies - improves adherence in cardiac rehabilitation (LC-REHAB): A randomised controlled trial.
abstract: BACKGROUND
  Despite proven benefits of cardiac rehabilitation (CR), adherence to CR remains suboptimal. This trial aimed to assess the impact of the patient education 'Learning and Coping Strategies' (LC) on patient adherence to an eight-week CR program.
  
  
  METHODS
  825 patients with ischaemic heart disease or heart failure were open label randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. Both arms received same amount of training and education hours. LC consisted of individual clarifying interviews, participation of experienced patients as co-educators, situational, reflective and inductive teaching. The control arm received structured deductive teaching. The primary outcomes were patient adherence to at least 75% of the exercise training or education sessions. We tested for subgroup effects on the primary outcomes using interaction terms. The primary outcomes were compared across arms using logistic regression.
  
  
  RESULTS
  More patients in the LC arm adhered to at least 75% of the exercise training sessions than control (80% versus 73%, adjusted odds ratio (OR):1.48; 95% CI:1.07 to 2.05, P=0.018) and 75% of education sessions (79% versus 70%, adjusted OR:1.61, 1.17 to 2.22, P=0.003). Some evidence of larger effects of LC on adherence was seen for patients with heart failure, low education and household income.
  
  
  CONCLUSIONS
  Addition of LC strategies improved adherence in rehabilitation both in terms of exercise training and education. Patients with heart failure, low levels of education and household income appear to benefit most from this adherence promoting intervention.
  
  
  BACKGROUND
  www.clinicaltrials.gov identifier NCT01668394.
authors.affiliation: Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark. Electronic address: viblyn@rm.dk.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Lynggaard
authors.affiliation: Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark. Electronic address: claus.vinther@rm.dk.
authors.forename: Claus Vinther
authors.initials: CV
authors.lastname: Nielsen
authors.affiliation: Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark. Electronic address: ann.dorthe.olsen.zwisler@rsyd.dk.
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: Danish Knowledge Centre for Rehabilitation and Palliative Care, University Hospital Odense and University of Southern Denmark, Denmark; Institute of Health Research, University of Exeter Medical School, Exeter, England, UK. Electronic address: r.taylor@exeter.ac.uk.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.affiliation: Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark. Electronic address: olemay@rm.dk.
authors.forename: Ole
authors.initials: O
authors.lastname: May
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000379:methods / Q000523:psychology; D004493:Education / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000523:psychology / Q000534:rehabilitation; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life; D013663:Teaching; D016896:Treatment Outcome
keywords: Cardiovascular diseases; Coping; Learning; Patient adherence; Patient education; Rehabilitation