Effects of a Recovery-Promoting Program in Patients Undergoing CABG Surgery

N/AActive Not RecruitingNCT07392021

Mahidol University60 enrolled

Overview

Patients undergoing coronary artery bypass graft (CABG) surgery often experience physical limitations, psychological stress, and challenges during recovery after hospital discharge. Inadequate preparation and limited follow-up support may affect patients' confidence in self-care and overall recovery. The purpose of this study is to evaluate the effects of a recovery-promoting program on self-efficacy, quality of recovery, and clinical outcomes in patients undergoing CABG surgery. Participants will receive standard postoperative care. In addition, participants in the intervention group will receive a recovery-promoting program provided by nurses, which includes structured education, guidance on postoperative activity and symptom management, and follow-up support after discharge. The study will assess changes in self-efficacy, quality of recovery, and selected clinical outcomes to compare recovery between participants who receive the recovery-promoting program and those who receive standard care.

Coronary artery bypass graft (CABG) surgery is a standard treatment for patients with advanced coronary artery disease. Although surgical outcomes have improved, patients frequently experience challenges during postoperative recovery, including reduced physical capacity, delayed functional recovery, psychological distress, and difficulties in self-management after hospital discharge. These challenges may contribute to prolonged recovery and suboptimal clinical outcomes. Evidence-based approaches such as Cardiac Rehabilitation (CR) and Enhanced Recovery After Cardiac Surgery (ERAS) have been shown to support postoperative recovery. However, in routine clinical practice, the application of these approaches is often fragmented, and continuity of care after discharge remains limited. In particular, patients may receive insufficient guidance and support to enhance self-efficacy and confidence in managing recovery at home. This study aims to evaluate the effects of a recovery-promoting program on self-efficacy, quality of recovery, and clinical outcomes in patients undergoing CABG surgery. The recovery-promoting program integrates key components of CR and ERAS principles and is delivered by nurses using a structured approach. The intervention includes pre-discharge education, guidance on postoperative activity and symptom management, and follow-up support after discharge through a tele-nursing platform. This approach is designed to enhance patients' engagement in recovery and support continuity of care beyond hospital discharge. A quasi-experimental design is used to compare outcomes between patients receiving standard postoperative care and those receiving the recovery-promoting program in addition to standard care. Eligible patients are assigned to either a control group or an experimental group according to the study protocol. Data are collected at predefined time points to evaluate changes in self-efficacy, quality of recovery, and selected clinical outcomes. Self-efficacy and quality of recovery are assessed using validated instruments, while clinical outcomes are obtained from clinical records and routine assessments. The primary focus of the study is to examine differences between groups over time and to explore the potential role of a structured, nurse-led recovery-promoting program in supporting postoperative recovery following CABG surgery. The findings of this study are expected to contribute to evidence supporting integrated recovery strategies and tele-nursing approaches in postoperative cardiac care and may inform the development of structured nursing interventions to improve recovery outcomes in patients undergoing CABG surgery.

Interventions

Recovery Promotion Program for CABG patientsBEHAVIORAL

An integrated recovery promotion program combining Cardiac Rehabilitation (CR) and Enhanced Recovery After Cardiac Surgery (ERAS) principles. The intervention is delivered by trained nurses and physiotherapists and consists of three phases: (1) preoperative phase including patient education, breathing exercises, and psychological preparation; (2) postoperative in-hospital phase including early mobilization, pulmonary rehabilitation, symptom monitoring, and individualized guidance; and (3) post-discharge phase including weekly follow-up, self-management support, and remote monitoring via LINE Official Account for six weeks. The program is designed to enhance self-efficacy, promote functional recovery, and reduce postoperative complications following CABG.

Standard Postoperative CABG CareOTHER

Standard postoperative care for patients undergoing coronary artery bypass grafting (CABG) according to Rajavithi Hospital protocols. Care includes routine medical and nursing care, postoperative monitoring, physiotherapy, medication management, discharge education, and scheduled follow-up without the structured integrated CR-ERAS program or tele-nursing support.

Eligibility

Sex: ALLMin age: 20 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Thai patients undergoing elective first-time on-pump coronary artery bypass graft (CABG) surgery alone or combined with valve surgery * If age \>60 years, participants must pass cognitive screening using the 6-Item Cognitive Impairment Test (6-CIT) * New York Heart Association (NYHA) functional class I-III * Left ventricular ejection fraction (LVEF) \>30% * Independent in activities of daily living and able to perform the 6-minute walk test (6MWT) Exclusion Criteria: * Severe or acute comorbidities within 24 hours prior to surgery (e.g., chronic obstructive pulmonary disease, renal failure, acute myocardial infarction, severe arrhythmia) * Severe postoperative complications or unstable vital signs (e.g., major bleeding, significant arrhythmia, embolism, need for dialysis, extracorporeal membrane oxygenation) * Disability or limited ambulation or mobility assessed prior to hospital discharge * Failure of extubation within 3 days after surgery or requirement for reoperation

Outcomes

Primary Outcomes

Quality of Recovery after CABG.

Quality of recovery will be assessed using the Quality of Recovery-15 (QoR-15) questionnaire, a validated postoperative recovery instrument consisting of 15 items with a total score ranging from 0 to 150. The questionnaire assesses physical comfort, emotional state, psychological support, and physical independence. Higher scores indicate better postoperative recovery.

Time frame: up to 8 weeks after surgery

Secondary Outcomes

Self Efficacy

Self-efficacy refers to the patient's confidence in managing recovery-related behaviors following coronary artery bypass graft surgery. It will be assessed using the Cardiac Self-Efficacy Scale, a validated questionnaire that measures confidence in managing cardiac symptoms and maintaining functional activities. Total scores range from 0 to 56, with higher scores indicating greater perceived cardiac self-efficacy.

Time frame: Preoperative, baseline; within 2 weeks prior to surgery and immediately prior to surgery

Functional capacity

Functional capacity will be assessed using the 6-Minute Walk Test (6MWT), which measures the distance walked in meters on a flat surface over six minutes. Greater walking distance indicates better functional capacity and postoperative recovery following coronary artery bypass graft surgery.

Time frame: up to 8 weeks after surgery.

Pulmonary Function

Pulmonary function will be assessed using Peak Expiratory Flow Rate (PEFR), measured in liters per minute. PEFR reflects airway function and respiratory muscle performance and is commonly used to evaluate postoperative pulmonary recovery following coronary artery bypass graft surgery. Higher PEFR values indicate better pulmonary function.

Time frame: Baseline (preoperative, at initial patient assessment); perioperative period (at hospital admission); at hospital discharge (postoperative day 7).

Duration of mechanical ventilation

Duration of mechanical ventilation will be measured as the total number of hours from initiation of postoperative mechanical ventilation until successful extubation. This outcome reflects early postoperative respiratory recovery following coronary artery bypass graft surgery. Shorter duration indicates better respiratory recovery.

Time frame: Perioperative period.