PERFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

DISSERTATION PROPOSAL

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL

MODULE ON KNOWLEDGE REGARDING CARDIAC REHABILITATION

AMONG PATIENTS WITH ANGINA PECTORIS IN SELECTED HOSPITALS,

TUMKUR.

SUBMITTED BY:

Mr. VISHNU PRASAD.P.V

1st YEAR M.Sc. NURSING,

MEDICAL SURGICAL NURSING,

SRI RAMANAMAHARSHI COLLEGE OF NURSING, TUMKUR.

(2009-2011)

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA .

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1

1. NAME OF THE CANDIDATE AND ADDRESS

VISHNU PRASAD.P.V 1st YEAR M.Sc. NURSING, MEDICAL SURGICAL NURSING SRI RAMANAMAHARSHI COLLEGE OF NURSING TUMKUR.

2

2.NAME OF THE INSTITUTION

SRI RAMANAMAHARSHI COLLEGE OF NURSING, TUMKUR, KARNATAKA.

3.1.

COURSE STUDY AND SUBJECT

I st YEAR M.Sc. NURSING,MEDICAL SURGICAL NURSING.

4.4

DATE OF ADMISSION TO COURSE

15-10-2009

55. TITLE OF THE

STUDY

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING CARDIAC REHABILITATION AMONG PATIENTS WITHANGINA PECTORIS IN SELECTED HOSPITALS,TUMKUR.

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION-2-

“Hear your heart. Heart your health”

-Faith Seehill

Science is the search for truth.Caridology is a branch of science which deals with

disorders of heart. The term cardiology is derived from Greek word kardia meaning “heart” or

“inner self” and logia. The field includes diagnosis and treatment of congenital heart defects,

coronary artery diseases, heart failure, valvular heart diseases and electrophysiology1.

Cardio vascular diseases are the disorders that will distract the normal functioning of

heart. The burden of cardio vascular diseases worldwide is one of the great concerns to patients and

health care agencies alike. Cardio vascular disorders are the leading cause of mortality and

morbidity in the industrialized world, accounting for 50 percentages of all deaths annually. Over 20

million people worldwide suffer from some form of cardio vascular diseases or its complications,

including coronary heart diseases such as congestive heart failure, angina pectoris and arrhythmias2.

In India, cardio vascular diseases comprise the first and second leading causes responsible

for one-third of all deaths. Angina pectoris is usually a symptom of coronary artery disease (CAD)

the most common type of heart disease. Angina pectoris refers to chest pain that is typically severe

and crushing with a feeling just behind the breast bone (the sternum) of pressure and suffocation

due to an inadequate supply of oxygen to the heart muscles. It was first described by Heberden

(1710-1801).The term angina pectoris come from the Latin “angere” meaning to ‘choke or

throttle’+ “pectus” meaning ‘chest’3.

In 1950s Hellerstein presented his methodology for the comprehensive rehabilitation of

patients recovering from an acute cardiac event. He advocated a multi-disciplinary approach to the

rehabilitation programme. His approach was adopted as cardiac rehabilitation program throughout

the world2.

According to the US Public Health Service (USPHS), a cardiac rehabilitation

programme is defined as a programme that involves medical evaluation, prescribed exercise, and

cardiac risk factor modification, education, counselling and training of patients with cardiac

diseases. Cardiac rehabilitation aims to reverse limitations experienced by patients who have

suffered the adverse pathophysiologic and psychologic consequences of cardiac events4.

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Cardiac rehabilitation is a medically supervised programme to help heart patients recover

quickly and improve their overall physical and mental functioning. This is to reduce the risk of

another cardiac event or to keep an already present heart condition from getting worse.4

Traditionally cardiac rehabilitation has been provided to somewhat lower risk-patients

who could exercise without getting in to trouble. However, astonishingly rapid evolution in the

management of coronary artery disease has now changed the demographics of the patients who can

be the candidates of cardiac rehabilitation training. Currently about 400,000 patients who undergo

coronary angioplasty each year make up a sub group that could benefit from cardiac rehabilitation.5

Furthermore, approximately 4.7 million patients with congestive heart failure (CHF) are

also eligible for a slightly modified programme of rehabilitation, as are the ever-increasing number

of patients who have undergone heart transplantation. Multifactorial intervention, including

aggressive risk factor modification has become an integral part of present day cardiac

rehabilitation.5

Cardiac rehabilitation services are, therefore, an effective and safe intervention. These

services are undoubtedly an essential component of the contemporary treatment of patients with

multiple presentations of coronary heart diseases and heart failure.2

6.1. NEED FOR STUDY

“He who takes medicine and neglects to diet

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wastes the skill of his doctor.”

-Chinese proverb

“Nothing on earth is more international than disease” said Paul Russell. Health and

disease have no barriers across the world. Diseases will last as long as humanity itself. In the

present scenario, more life threatening diseases are emerging in the universe and will remain as a

big threat to mankind. Interestingly, advancement in medical science and research ensures a better

quality in future life and helps the human beings to live up to their expectations.

Coronary artery disease is the most prevalent type of cardio vascular disease in this

twenty first century, which is characterised by an accumulation of lipid or fatty substances and

fibrous tissue in the vessel wall. These substances create blockages or narrow the vessel in a way

that reduces the blood flow to the myocardium, usually causing a condition called myocardial

ischemia. Angina pectoris refers to a clinical syndrome characterised by episodes or paroxysms of

pain or pressure in the anterior chest that is brought about by myocardial ischemia. Angina is

caused by significant atherosclerosis.6

Cardiac rehabilitation (CR) is an important element of a comprehensive plan for

secondary prevention of cardiovascular diseases, which can reduce the age adjusted cardio vascular

mortality rate by nearly fifty percentages. These programmes were specifically designed to “limit

the physiologic and psychological effect of cardiac illness, reduce the risk for sudden death or re-

infraction, control cardiac symptoms, stabilize or reverse the atherosclerosis process and enhance

the psychosocial and vocational status of selected patients.7

Comprehensive cardiac rehabilitation programme has been shown to reduce re-

hospitalization rates, lessen the need for cardiac medications and increase the rate of person

returning work. Worldwide cardio vascular diseases is the leading cause of mortality and

morbidity .The goal of cardiac rehabilitation are to reduce cardio vascular risk factors through life

style modifications, physical exercises, education and counselling.8

Despite evidence that cardiac rehabilitation programme improve survival duration as

well as quality of life for patients, these services are underused in the present scenario. Numerous

investigations have revealed that cardiac rehabilitation is an important component of current

multidisciplinary approach to the management of patients with various presentations of coronary

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artery disease, including angina pectoris. With a specifically designed exercise programme, an

individual with angina pectoris can decrease his or her chest pain and substantially improve fitness

level.9

A comprehensive cardiac rehabilitation programme for the treatment of angina consists

several phases. Physical exercises, life style modifications, education and counselling provided

through cardiac rehabilitation possibly reduce the progression of atherosclerosis causing angina and

decreases the frequency and severity of angina.10

According to the recent estimates in India, cases of coronary artery disease may increase

from about 2.9 crore in 2000 to as 6.4 crore in 2015,and the number of deaths due to ischemic

heart disease was increased from 1.17 million in 1990 to 1.59 million in 2000 and 2.03 million by

2010.10

A study performed on screening the patients over the age of 30 years by a 12 lead ECG

in Chandigarh (urban population) reveals that the prevalence of coronary heart disease was found to

be 65.4 and 47.8 per 1000 males and females respectively. In a village in Haryana the prevalence

was 22.8 and 17.3 per 1000 males and females respectively. The study concluded that coronary

heart disease appears a decade earlier compared with the age incidence in developed countries. The

peak period is attained between 51-60 years. Males are affected more than females. Hypertension

and diabetes mellitus account for about 40 percentages of all cases. Heavy smoking is responsible

aetiologically in good number of cases. 11

A study conducted by STRUBER B et al (2006) hypothesized that aerobic exercise

training could improve Health Rate Recovery (HRR) in patients who have suffered heart failure,

because athletes are known to have accelerated HRR, while cardiac rehabilitation(CR) has been

shown to positively affect such recovery in patients with coronary artery disease(CAD).Author

conducted a retrospective study of 46 patients with heart failure who had completed phase 2 aerobic

cardiac rehabilitation programme with entry and exit maximal stress programme. The result

indicated that in patient with heart failure who has low exercise capacity, even short term aerobic

training can aid HRR.4

KUTNER.N. (2006) performed a study and was found that in comparison with dialysis

patients who did not undergo cardiac rehabilitation there was a 35% risk reduction for all-cause

mortality, as well as a 36% risk reduction for cardiac death in dialysis patients who had cardiac

rehabilitation following CABG; the findings were independent of socio-demographic and clinical

risk factors such as recent hospitalization. In the study, 10% of patients received cardiac -6-

rehabilitation after CABG, less than half the estimated share of patients in the general population

who such rehabilitation. Women and black patients aged 65 or older; along with lower-income

patients of all ages were significantly less likely to receive cardiac rehabilitation services. The study

was concluded as that following CABG, cardiac rehabilitation increases a dialysis patient's

likelihood of survival.12

Cardiac rehabilitation improves physiological and psychological condition of the angina

patients and more significantly it reduces mortality. Moreover research indicates that cardiac

rehabilitation is not only clinically effective, but is cost-effective as well. Cardiac rehabilitation

compares favourably with other medical interventions performed commonly in patients with

coronary heart disease.13

The scope of cardiac rehabilitation has increased dramatically in recent years. Inpatient

and outpatient programs in the hospital and at community sites are being implemented all over the

country. Equally significant, research over the last 10 years has provided empirical data suggesting

that cardiac rehabilitation programs are a safe and effective method of improving physical,

physiological, and psychological wellbeing and greatly enhance the quality of life for cardiac

patients. 2

The researcher therefore has chosen this study, as an opportunity to educate the patients

regarding cardiac rehabilitation so that they (clients) can incredibly enhance the quality of their

health and continues to contribute for the development of our nation.

6.2. REVIEW OF LITERATURE

1.STUDIES RELATED TO INCIDENCE AND PREVALANCE OF ANGINA PECTORIS.

Singh R.B. et al. (2005) conducted a study to determine the prevalence of coronary artery disease

(CAD) and its risk factors and lifestyle factors in an elderly population from north India. The study -7-

was done on a random sample of 595 elderly subjects between 50 to 84 years of age obtained from

the urban population of Moradabad. The study revealed that total prevalence of CAD based on

clinical history and electrocardiogram was 121/1000 and Rose questionnaire for diagnosis of angina

pectoris was 57/1000. CAD was significantly higher in the elderly (65 to 84 years) group than in the

middle-aged (50 to 64 years) group (168 vs. 97 per 1000), respectively. While the prevalence of

hypertension was significantly higher in the elderly than middle-aged group respectively (214 vs.

168 per 1000), the prevalence of central obesity was significantly higher in the middle-aged than

elderly group (674 vs632 per 1000). Prevalence of CAD and physical inactivity (93.3%) was higher

in the middle and higher socio-economic groups compared to the lower income group. In

conclusion, the study showed that CAD and its risk factors are of sufficient magnitude in the elderly

population of India to be a major public health problem.14

Bettencourt N.et al.(2005) undertook a study to evaluate the impact of cardiac rehabilitation

programs (CRP) on quality of life (QL) and depression at one-year follow-up after acute coronary

syndrome (ACS).QL and depression were evaluated by self-reported responses to the SF-36 QL

survey and the Beck Depression Inventory(BDI) respectively. The study revealed that 31 patients

randomized to CRP (group A) and 95 patients allocated to standard follow-up (group B) responded

to the questionnaires. At one-year evaluation, the average BDI score (8 vs. 11, p = 0.05)and the

prevalence of depressive symptoms (37.5vs.56.1%) were lower in the CRP group.SF-36 found

significant differences in the evaluation of Vitality (average 62 points in A vs. 47 in B, p < 0.02),

General Health (57points in A vs. 46 points in B, p < 0.02) and mental health (70.6 vs. 56.9, p =

0.02).The study was concluded proving that there was a significant improvement in the Vitality and

General Health parameters, as well as the mental health component after CRP.15

Briffa T.G. et al. (2005) conducted a study to estimate the incremental effects on cost and quality

of life of cardiac rehabilitation after an acute coronary syndrome. The research design was Open

randomized controlled trial.113 patients aged 41-75 were provided an 18 sessions of exercise based

cardiac rehabilitation. The result of the study was estimated that incremental cost per QALY saved

for rehabilitation relative to standard care was 42,535 US dollars when modeling included the

reported treatment effect on survival. This increased to 70,580 US dollars per QALY saved if

treatment effect on survival was not included. In conclusion the effects on quality of life tend to

reinforce treatment advantages on survival for patients having post discharge rehabilitation after an

acute coronary syndrome. The estimated base case incremental cost per QALY saved is consistent

with those historically accepted by decision making authorities such as the Pharmaceutical Benefits

Advisory Committee.16

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2.STUDIES RELATED TO ASSESSMENT OF KNOWLEDGE OF PATIENTS

REGARDING ANGINA PECTORIS.

Enas.E.A. et al.(2005) conducted a study to determine the knowledge and practice of risk factors

regarding coronary artery diseases. The study did among 150 coronary artery disease patients in

Christian Medical College, India. The study finding has showed that majority of patients were

found to have adequate knowledge in relation to smoking and alcoholism (95 percentages),

medication regularity (92.5 percentages) and those who came for follow-up(82percentages), only 57

percentages of the patients were adequately following the dietary restriction. Majority of patients

(77.53 percentages) did not practice physical exercises and 20 percentages of the patients had the

habit of sharing their emotional problems with others.17

3.STUDIES RELATED TO CARDIAC REHABILITATION.

Meyer P. et al.(2010) performed a study on high-intensity aerobic interval training in a patient with

stable angina pectoris. The study presented the acute cardiopulmonary responses of a 67-yr-old

man with stable angina pectoris during a 34-min session of high-intensity aerobic interval training.

Exercise was well tolerated with neither significant arrhythmia nor elevation of cardiac troponin-T.

They observed a complete disappearance of symptoms and a sign of myocardial ischemia after 24

minutes of exercise. The study was concluded as that high-intensity aerobic interval training is a

promising mode of training for patients with stable coronary heart disease and was shown to be

more effective than continues moderate –intensity exercise for improving maximal aerobic

capacity.18

Asbury E.A.et al.(2008) conducted a study to explore cardiac rehabilitation (CR) as a treatment for

psychological and physiological morbidity in women with chest pain and normal coronary arteries

(cardiac syndrome X). Sixty-four women aged 57.3+/-8.6 years (mean +/- SD) with cardiac

syndrome X were randomly assigned to an 8-week phase III CR exercise program or symptom

monitoring control. After cardiac rehabilitation, patients showed significant improvement in

symptom severity (2.0+/-0.8 vs 1.26+/-1.1,P=0.009), Hospital Anxiety and Depression Scale (8.0+/-

3.4 vs6.4+/-3.1, P=0.04), health worry (4.5+/-3.1 vs 3.52+/-2.4, P=0.025) and interference (2.4+/-

1.8 vs 1.6+/-1.8, P=0.004), general health(48.8+/-17.9 vs 57.6+/-17.0, P=0.01), diastolic blood

pressure (84.7+/-9.4 vs 79.7+/-7.3 mm Hg, P=0.007), and body mass index (29.1+/-6.0 vs 28.4+/-

6.17 kg/m2, P=0.003).The study concluded that CR program improves exercise tolerance, quality of

life, psychological morbidity, symptom severity, and cardiovascular risk factors in women with

cardiac syndrome X.19

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Mezey b.et al. (2008) conducted a study to prove the importance of cardiac rehabilitation, both

inpatient and outpatient, after the hospital treatment of cardiac emergencies. The study was

conducted on 531 patients were of which 167 patients were ranked into the outpatients group

(Group A), 311 were rehabilitated in hospital (Group B) and 53 served as control (group C). After

physical, ergo metric and echocardiography examinations and psychometric evaluation (Beck and

WHOBREF questionnaires) the patients of both groups conducted training three times weekly for 3

months. All the patients were examined 3 and 12 months later. The result was found as significant

improvement of ergo metric data in both groups of patients who underwent rehabilitation. The

number of angina attacks and the need of hospital treatment also seen to be reduced. Thus the study

was concluded that cardiac rehabilitation has an extremely important role in the stabilisation of

heart functions and general health of patients.20

Ades P.A. et al.(2006) conducted a study on aerobic capacity in patients entering cardiac

rehabilitation(CR).The aim which was to establish normative values for peak aerobic capacity (peak

V(O2)) for patients entering CR and to create nomograms for conversion of peak V(O2) to a

percentage of predicted exercise capacity, stratified by age, gender, and diagnosis. The study was

conducted by measuring the peak V(O2) in 2896 patients entering CR from 1996 to 2004.It was

found that Peak V(O2) was higher in men than in women: 19.3 +/- 6.1 mL.kg(-1).min(-1) (range,

5.2 to 49.7 mL.kg(-1).min(-1)) versus 14.5 +/- 3.9 mL.kg(-1).min(-1) (range, 3.8 to 29.8 mL.kg(-

1).min(-1)) (P < 0.0001). Peak V(O2) decreased steadily with age with a greater rate of decline in

men than women (0.242 versus 0.116 mL.kg(-1).min(-1) per year) (P < 0.01). Thus it was

concluded that values of peak V(O2) on entry to CR are extremely low, particularly in women

which underscores the importance of CR after a major cardiac event to improve physical function

and long-term prognosis.21

Taylor R.S.et al.(2006) did a study to quantify the cardiac mortality benefits of exercise-based

rehabilitation attributable to risk factor reductions. The study included 2984 patients who were

receiving cardiac rehabilitation following angina pectoris. The finding of the study were identified

as exercise training reduced pooled cardiac mortality by 28% (relative risk, 0.72, 95% confidence

interval 0.55-0.95), with 30 fewer deaths than in the control group. 7.1 deaths (minimum estimate

6.2, maximum estimate 9.5) attributable to an 18% reduction in smoking prevalence; 5.9 deaths

(minimum -0.6, maximum 12.6) to a 0.11 mmol/l reduction in cholesterol, and 4.4 deaths (-1.0

minimum, 6.7 maximum) to a 2.0 mmHg reduction in systolic blood pressure. The study was

concluded that approximately half of the 28% reduction in cardiac mortality achieved with exercise-

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based cardiac rehabilitation may be attributed to reductions in major risk factors, particularly

smoking.22

Ballegaard S.et al. (2004) conducted a study to evaluate effectiveness of Integrative Rehabilitation

(IR) of patients with angina pectoris with respect to death rate, the need for invasive treatment, and

cost effectiveness. Out of 168 patients with angina pectoris, of whom 103 were candidates for

invasive treatment and 65 for whom this had been rejected. The study revealed that 3-year

accumulated risk of death was 2.0% (95% confidence limits: 0.0%-4.7%) for the 103 candidates for

invasive treatment. For the 65 inoperable patients the risk of death due to heart disease was 7.7%

(3.9%-11.5%). Of the 103 candidates for invasive treatment, only 19 (18%) still required surgery.

Cost savings over 3 years were US 36,000 dollars and US 22,000 dollars for surgical and

nonsurgical patients respectively, and 95% reduction in-hospital days. In conclusion, Integrative

rehabilitation was found to be cost effective, and added years to the lives of patients with severe

angina pectoris.23

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON

KNOWLEDGE REGARDING CARDIAC REHABILITATION AMONG PATIENTS WITH

ANGINA PECTORIS IN SELECTED HOSPITALS ,TUMKUR.

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6.3. OBJECTIVES OF THE STUDY

1.To assess the pre test knowledge about cardiac rehabilitation among angina pectoris patients.

2.To develop and implement the self instruction module on cardiac rehabilitation.

3.To assess the post test knowledge about cardiac rehabilitation among angina pectoris patients.

4. To find out significant difference between pre-test and post-test knowledge score on cardiac

rehabilitation.

5. To find association between post-test knowledge and selected demographic variables.

6.4. OPERATIONAL DEFINITIONS

ASSESSMENT:- It refers to the organised systemic process of collecting information about

pre-test ant post- test knowledge from patients regarding cardiac rehabilitation.

EFFECTIVENESS:-It refers to the extent to which the self instructional module on cardiac

rehabilitation achieves desired effect in improving the knowledge of patients as evidence

from gain in knowledge score.

SELF INSTRUCTIONAL MODULE:-It refers to the written material designed for

patients in order to provide information regarding cardiac rehabilitation.

KNOWLEDGE:-It is the patients cognitive ability to interpret the information regarding

cardiac rehabilitation and to answer the questions regarding it reasonably and correctly.

CARDIAC REHABILITATION:-It refers to a professionally supervised programme to

help patients recover from cardiac disorders through life style modifications, physical

exercises, education and counselling; in order to improve health and reduce the risk of

future heart problems.

PATIENT:-It refers to the persons affected with angina pectoris between the age group of

35-80.

ANGINA PECTORIS:-It refers to severe chest pain due to ischemia (lack of blood and

hence oxygen supply) of the heart muscle generally due to obstruction or spasm of coronary

arteries (the heart blood vessels).

6.5. RESEARCH HYPOTHESES

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H1: There will be significant increase in the mean post-test score on knowledge regarding cardiac

rehabilitation among patients who have learned through self instructional module than the level of

pre-test knowledge.

H2: There will be a statistically significant association between post test knowledge score regarding

cardiac rehabilitation and the selected demographic variables.

6.6. ASSUMPTIONS

The tool prepared by the researcher will be adequate to measure the level of knowledge of

patients and the effectiveness of self instructional module about cardiac rehabilitation.

The patients admitted in selected hospital may not have adequate knowledge regarding

cardiac rehabilitation.

Patients could positively utilise the knowledge regarding cardiac rehabilitation as an

effective means to reduce risk factors.

Self instructional module will improve the knowledge level of patients regarding cardiac

rehabilitation.

6.7. DELIMITATIONS OF THE STUDY

The study is delimited to only the patients who are suffering from angina pectoris.

Assessment of the knowledge of the patients will be done through written responses as

elicited by structured questionnaire; hence the knowledge displayed might not be

comprehensive.

The study is delimited to patients who are admitted in selected hospitals, TUMKUR.

6.8. VARIABLES

Variables are an attribute of a person or objects that varies or takes different values.

INDEPENDENT VARIABLE : Self instructional module on cardiac rehabilitation.

DEPENDENT VARIABLE: Knowledge level of the patients regarding cardiac

rehabilitation.

DEMOGRAPHIC VARIABLES: Age, sex, occupation, dietary pattern, personal habits.

6.9. PILOT STUDY

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The pilot study will be conducted on 10 samples.

The purpose of the pilot study is to:

Find out feasibility of conducting the final study.

Determine the method of data analysis.

Assess the practicability of carrying out the main study.

7. MATERIALS AND METHODES OF THE STUDY

7.1.1 SOURCES OF DATA COLLECTION

The data will be collected from the patients in selected hospitals at TUMKUR.

7.1.2 RESEARCH DESIGN

One group pre-test post-test research design is selected to assess the knowledge of the patients

regarding cardiac rehabilitation therapy.

7.1.3 RESEARCH APPROACH

An evaluative approach is considered appropriate for this study.

7.1.4 RESEARCH SETTING

The study will be conducted in selected hospitals at TUMKUR.

7.1.5 POPULATION

The population of the present study includes the patients suffering from angina pectoris.

7.1.6 METHODES OF DATA COLLECTION

The data collection procedure will be carried out for a period of one month.

The study will be initiated after obtaining prior permission from the concerned authorities.

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The data will be collected from the patients by using structured questionnaire to assess the pre-

existing knowledge regarding cardiac rehabilitation. After distributing the self instructional module,

the data will be collected 7 days later from the patients by using structured questionnaire to assess

the improvement in the knowledge.

7.2.1 SAMPLING TECHNIQUE

In this study, non-probability convenient sampling technique will be used to select the sample.

7.2.2 SAMPLE SIZE

The sample size of the study consists of 60 patients admitted in selected hospitals, TUMKUR.

SAMPLING CRITERIA

7.2.3 INCLUSIVE CRITERIA

Patients who are suffering from angina pectoris.

Patients who are available in the hospital during the period of data collection.

Both male and female patients are included in the study.

7.2.4 EXCLUSIVE CRITERIA

Patients who are not willing to participate in the study.

Patients who are suffering from cardiac disorders apart from angina pectoris.

7.2.5 TOOL FOR DATA COLLECTION

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The structured questionnaire is used to collect the data from the patients. Content validity will be

established by requesting the experts to go through the developed tool and give their valuable

suggestions.

The structured questionnaire should consist of the following sections.

Section A: Questions related to the demographic data.

Section B: Questionnaire to assess the level of knowledge regarding cardiac rehabilitation therapy.

7.2.6 DATA ANALYSIS METHOD

The data will be organized, tabulated, and analysed by using descriptive and inferential statistics.

The will be planned to present in the form of tables and figures.

DESCRIPTIVE STATISTICS:

Frequency and percentage for analysis of demographic data; mean percentage and standard

deviation will be used for assessing the level of knowledge.

INFERENTIAL STATISTICS:

“Chi-square test” will be used to find out the association between knowledge and selected

demographic variables.

“Paired t-test” will be conducted to find out the significant difference between pre-test and post-test

knowledge of patients regarding cardiac rehabilitation therapy.

7.2.7 TIME AND DURATION

The time and duration of the study will be limited to three months as per the guidelines of the

university.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMAN BEINGS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

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Yes. Self instructional module is the intervention that is going to be given to the patients.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTIONS?

The pilot study and the main study will be conducted after the approval of the research committee.

Permission will be obtained from the concerned head of the institution. The purpose and details of

the study will be explained to the study subjects and an informed consent will be obtained from

them. Assurance will be given to the study subjects regarding the confidentiality and anonymity of

the data collected from them.

8. LIST OF REFERENCES

1.Available from: http://www.mdguidlines.com/patients/pdffiles/anginapectoris.pdf

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2.Available from: http://www.emedicine.medscape.com/view article/319683.

3.Available from: http://www.wikimedpedia.com/angina

4.Available from :http://www.sciencedirect.com

5.Available from: http://www.allina.com/ahs/news.nsf/newspage/owacardiacrehabweek08.

6.Brunner and Suddarth’s. Textbook of Medical Surgical Nursing.10th Edition. New York: Lippincott Williams; 2004. P.713-720.

7.Saunder.S. Textbook of Rehabilitation.2nd Edition.New Delhi:Jaypee Brothers;2005. p.366-369.

8.Grace S.L,Gravely-Witte s, Brual j. Contribution of Patient and Physician Factors to Cardiac Rehabilitation Referral: A Prospective Multilevel Study. Clinical Practice and Cardiovascular Medicine. 2008 june;63(11):76-82.Available from: URL:http://www.medscape.com/medline/abstract/10685138

9.Ades P.A,Coello C E. Effects of exercise and Cardiac Rehabilitation on Cardiovascular Outcomes. Medical Journel North America. 2000 January ; 84(1):251-65.Available from: URL:http:// www.ncbi.nlm.nih.gov/pubmed/18769476

10.Joyce. M. Black .Medical Surgical Nursing. 7th Edition .New Delhi:Elseveir;2005.p.655-58.

11.Park.K. Textbook of Preventive and Social Medicine. 18th edition.Jabalpur: Bhanot Publishers;2006.p.270-71.

12.Kutner N .G, Zhang R,Huang Y. Cardiac Rehabilitation and Survival of Dialysis Patients after Coronary Bypass. American Journal of Cardiology.2006 April; 17(4):1175-80.Available from: URL:http://www.ncbi.nlm.nih.gov/pubmed/18769476.

13.Brochu M,Poehlman ET,Savage P. Modest Effects of Exercise Training Alone on Coronary Risk Factors and Body Composition in Coronary Patients. Journel of Cardiopulmonary Rehabilitation. 2000 May-Jun ;20(3):180-86.Available from:URL: http://www.ncbi.nlm.nih.gov/pubmed/18769476.

14.Singh R.B, Niaz MA, Gosh S, Beegom R, Chibo H, Agrwal P et al. Epidemiological Study of Coronary Artery Diseases and its Risk Factors. Indian Heart Journel. 2005 December; 14(6): 628-34.

15.Bettencourt. N, Dias C, Mateus P, Sampaio F, Santos L, Adao L .et al. Impact of Cardiac Rehabilitation on Quality of Life and Depression. Review of Cardiology. 2005 May; 24(5): 687-96.Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed/18769476.

16.Briffa.T.G, Eckermann SD, Griffiths AD, Harris PJ, Heath MR, Freedman SB et al. Cost Effectiveness of Rehabilitation After an Acute Coronary Event. Medical Journal Australia.2005 November7;188(9):450-55.Available from: URL: http://www.ncbi.nlm.nih.gov/pubmed /14614567

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