セルフマネジメント能力の獲得を主眼にした包括的心臓リハビリテーションプログラムの有効性の検討

A Study of the Efficacy of a Comprehensive Cardiac Rehabilitation Program with a Focus on Acquisition of Self-management Skills

要旨

　目的：セルフマネジメント能力の獲得によって生活スタイルの是正と冠危険因子の除去を図る包括的心臓リハビリテーションプログラムを作成し，その効果を検討した．

　方法：2病院に通院する虚血性心疾患患者46名にプログラムを適用し，看護師と管理栄養士が月1回30分の面接と月1回電話モニタリングを行う，非ランダム化前後比較試験を実施した．

　結果：初回に7名が中断したが，39名は最後まで継続し(完了率84.8％)，すべての指標が改善・向上した．特に，体重，腹囲，HbA1c，食事・運動目標達成率，QOL，自己効力感は統計的に有意に改善した．抑うつを示す者とタイプA行動と評価される者の数が減少した．目標達成率と自己効力感の向上，ステージの変化が連動しており，関連性が示唆された．

　結論：セルフマネジメント能力の獲得が冠危険因子の是正とQOLの向上につながることが示唆され，プログラムの有効性が確認された．

Abstract

　Purpose：A comprehensive cardiac rehabilitation program was designed in order to modify lifestyle and to remove coronary risk factors through acquisition of self-management skills. The purpose of this study was to examine the efficacy of the program.

　Method：The program was implemented to 46 outpatients with ischemic heart disease at two hospitals.A nonrandomized,before-after trial was conducted on the program,where the patients were met by a nurse and a registered dietitian once a month for 30 minutes and were monitored monthly via a telephone.

　Results：Seven subjects dropped out from the program after the first session while the remaining 39 completed the program (the completion rate：84.8％), resulting in an improvement of all the indicators. Statistically significant improvements were observed in the following areas：The weight, abdominal circumference, HbA1c, dietary and exercise goal achievement rates, QOL, and sense of self-efficacy. The numbers of subjects showing Type A and depression were decreased. Relationships among an improvement in achievement rate, the sense of selfefficacy, and a betterment in the behavioral stage were observed.

　Conclusion：The results showed that the acquisition of self-management skills led to rectifying coronary risk factors and an improvement of QOL. The efficacy of the present program was thus confirmed.