Comparing the effect of the Model of Therapeutic Engagement in cardiac rehabilitation on the sense of coherence and adherence to treatment: a randomized clinical trial

Abstract

Purpose

The study aimed to compare the effectiveness of a traditional cardiac rehabilitation (CR) program with an enhanced program incorporating the model of therapeutic engagement (MTE) and extended remote support for patients undergoing coronary artery bypass graft (CABG) patients.

Materials and Methods

In a randomized controlled trial, 88 CABG patients were assigned to experimental and control groups. The experimental group received integrated MTE cardiac rehabilitation, and assessments were conducted at three time points: pre-CR, one month later, and three months post-CR. The study measured medication adherence (MARS-5) and sense of coherence (SoC-13) scales.

Results

The study found no significant differences in demographic factors between the experimental and control groups. However, significant differences were observed in MARS and individuals’ SoC scores over time in the experimental group, with notable improvements (p < 0.001). The control group showed significant changes only up to one month. Group effects were evident, with consistent increases in the experimental group’s outcomes at each assessment point.

Conclusion

Integrating the MTE into CR programs offers benefits in terms of medication adherence and individuals’ sense of coherence, which warrants further investigation and clinical implementation.

IMPLICATIONS FOR REHABILITATION

• Cardiac rehabilitation (CR) is recognized as one of the most effective interventions for secondary prevention, but its accessibility is limited in middle-income countries (MICs).

• This study represents one of the first theoretically-informed CR trials in a MIC that incorporates the model of therapeutic engagement (MTE) combined with extended remote support services into CR program.

• The MTE model, as a theoretical framework, was highly suitable for CR settings and demonstrated favorable outcomes.

• This approach has the potential to greatly benefit cardiac patients, particularly those who may initially show hesitance or reluctance towards engaging in CR.

Keywords:

• Cardiac rehabilitation
• coronary artery bypass grafting
• engagement
• motivation
• medication adherence
• sense of coherence
• RTC
• randomized controlled trial

Acknowledgements

The authors express their gratitude to the Vice-Chancellor for Research and Technology of the Hamadan University of Medical Sciences for their approval and support of this study (No. 9804182979). Additionally, the authors would like to extend their appreciation to the staff of Farshchian Heart Center for their valuable collaboration in conducting this research.

Disclosure statement

Authors report there are no competing interests to declare.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.