The effects of a nurse-led smartphone-based intervention after coronary artery bypass grafting: A randomised controlled trial

IF 8.7 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2026-04-01 Epub Date: 2026-01-13 DOI:10.1016/j.ijnurstu.2026.105341

Mohammadamin Mahmoodi , Mahnaz Antikchi , Shaghayegh Saeidinasab , Fatemeh Bakhshi

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引用次数: 0

Abstract

Background

Patients after coronary artery bypass grafting often face suboptimal recovery, including pain, reduced quality of life, and haemodynamic instability, worsened by limited self-care knowledge and inadequate post-discharge support. Nurse-led smartphone-based interventions may offer a scalable solution for resource-limited settings.

Objective

To evaluate the effects of a nurse-led, smartphone-based educational and follow-up intervention on pain, quality of life, and haemodynamic stability in patients undergoing elective coronary artery bypass grafting.

Design

Single-blind, randomized controlled trial.

Settings

A tertiary cardiac surgery center in Shiraz, Iran, from July 2024 to April 2025.

Participants

Eighty-four adults undergoing elective coronary artery bypass grafting, randomized (1:1) to intervention or control groups, with 80 completing the study (40 per group).

Methods

The intervention group received a three-phase programme: (1) pre-operative education via videos, messages, and a face-to-face session; (2) in-hospital education and daily symptom monitoring for pain and self-care; (3) 30-day post-discharge follow-up with weekly nurse-led calls and real-time messaging. Controls received standard care with one handout. Outcomes included pain (visual analog scale), quality of life (SF-36 Health Survey), and hemodynamic indices (blood pressure, heart rate). Pain and haemodynamic indices were assessed at baseline, three times daily for four days in the general ward following post-intensive care unit discharge (12 time points), and weekly post-discharge (days 7, 14, 21, 30; 4 time points), totaling 17 assessments. Quality of life was assessed at baseline and 30 days post-discharge. Data were analyzed using Mann–Whitney U tests, t-tests, and repeated-measures analysis of variance.

Results

The intervention group had lower pain scores (in-hospital: 3.96 ± 0.42 vs. 4.29 ± 0.35, p < 0.001, d = − 0.85, 95% CI -0.50 to − 0.16; post-discharge: 1.45 ± 0.38 vs. 2.01 ± 0.50, p < 0.001, d = − 1.26, 95% CI -0.76 to − 0.36) and reduced post-discharge blood pressure and heart rate. Total quality of life scores showed no significant between-group differences at 30 days (adjusted ANCOVA: adjusted mean difference = 0.15, 95% CI − 1.27 to 1.57, p = 0.832), while the pain domain improved significantly in the intervention group (p = 0.002, r = − 0.35). Group-by-time interactions were significant for pain and haemodynamic outcomes (p < 0.05).

Conclusions

This nurse-led, smartphone-based intervention reduced pain, improved pain-related quality of life, and stabilized haemodynamic parameters post-coronary artery bypass grafting. Easily integrated into nursing practice, it supports recovery in resource-limited settings and merits further study.

Registration

Registered at the Iranian Registry of Clinical Trials, IRCT20240426061574N1, registered June 05, 2024, https://irct.behdasht.gov.ir/search/result?query=IRCT20240426061574N1.

Social media abstract

Nurse-led smartphone intervention reduces pain and stabilizes haemodynamics in post-coronary artery bypass grafting patients over 30 days.

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冠状动脉旁路移植术后护士主导的智能手机干预的效果：一项随机对照试验

背景：冠状动脉旁路移植术后的患者往往面临不理想的恢复，包括疼痛、生活质量下降和血流动力学不稳定，由于有限的自我护理知识和不充分的出院后支持而恶化。护士主导的基于智能手机的干预措施可能为资源有限的环境提供可扩展的解决方案。目的评价护士主导、基于智能手机的教育和随访干预对择期冠状动脉旁路移植术患者疼痛、生活质量和血流动力学稳定性的影响。设计：单盲、随机对照试验。从2024年7月到2025年4月，位于伊朗设拉子的三级心脏手术中心。参与者：84名接受选择性冠状动脉旁路移植术的成年人，随机（1:1）分为干预组或对照组，80人完成研究（每组40人）。方法干预组采用三阶段方案：(1)术前教育，包括视频教育、信息教育和面授教育；(2)住院教育和日常疼痛症状监测及自我护理；(3)出院后30天随访，每周由护士主导电话和实时短信。对照组接受标准治疗，并提供一份讲义。结果包括疼痛（视觉模拟量表）、生活质量（SF-36健康调查）和血流动力学指标（血压、心率）。在基线时评估疼痛和血流动力学指标，在重症监护室出院后的普通病房每天评估3次，持续4天（12个时间点），并在出院后每周评估（第7、14、21、30天；4个时间点），共计17次评估。在基线和出院后30天评估生活质量。数据分析采用Mann-Whitney U检验、t检验和重复测量方差分析。结果干预组疼痛评分较低（住院：3.96±0.42比4.29±0.35,p < 0.001, d = - 0.85, 95% CI -0.50 ~ - 0.16；出院后：1.45±0.38比2.01±0.50,p < 0.001, d = - 1.26, 95% CI -0.76 ~ - 0.36），出院后血压和心率降低。总生活质量评分在30天组间无显著差异（校正ANCOVA：校正平均差= 0.15,95% CI = - 1.27 ~ 1.57, p = 0.832），而干预组疼痛域明显改善（p = 0.002, r = - 0.35）。按时间分组的相互作用对疼痛和血流动力学结果有显著影响（p < 0.05）。结论这种以护士为主导的智能手机干预减少了冠状动脉旁路移植术后的疼痛，改善了疼痛相关的生活质量，并稳定了血流动力学参数。它很容易融入护理实践，支持资源有限环境下的康复，值得进一步研究。注册于伊朗临床试验注册中心，IRCT20240426061574N1，注册于2024年6月5日，https://irct.behdasht.gov.ir/search/result?query=IRCT20240426061574N1.Social媒体摘要护士主导的智能手机干预可减少冠状动脉搭桥术后患者30天内的疼痛并稳定血流动力学。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).