Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

INTRODUCTION: Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD). METHODS AND ANALYSIS: A pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records. ETHICS AND DISSEMINATION: The trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03959631). Pre-results.

[Relaxation workshops in primary care]. / Talleres de relajación en atención primaria.

Primary Health Care Centers provide access to relaxation workshops to the general population. As objectives, these try to teach or train citizens how to manage their stress and how to confront life. These workshops make up a health sector, an educational one which teaches how to use one's personal resources and social skills to be able to manage conflicts which occur in life and how to relax. It is important to highlight the benefits of relaxation as a procedure to provide calmness to the body, confidence to the heart and clarity to the mind. The author proposes a guideline to use to set up relaxation groups in Primary Health Care Centers.

[Evaluation of relaxation workshops in primary care]. / Evaluación de los talleres de relajación en atención primaria.

After an extensive review which the author has presented in her previous articles on relaxation, in this article she tries to evaluate the workshops set up in Primary Health Care Centers. She evaluates relaxation exercises, those problems which may occur while performing these and possible exercises which may be carried out at home. Finally, the author comments on the need to establish a personal relaxation plan adjusted to the necessities of each individual.

[Relaxation. The art of loosening and releasing]. / La relajación. El arte de aflojar y soltar.

Relaxation is a procedure which provides calmness to the body, confidence to the heart and clarity to the mind. Relaxation is much more than resting. Relaxation brings about a state in which we feel tranquility and peacefullness, in which our emotions are tamed and our thoughts are appeased. If we relax, our entire body relaxes. Our muscles loosen up and rest, our aches and rigidity disappear. And from this state of well-being, our mind is lucid and open to confront life and to develop its maximum potential. Relaxation is not just a procedure to free us from stress and tension. It is a positive, multidimensional skill which we should learn from our infancy as a necessary resource to live and develop fully.

[Main relaxation techniques]. / Principales técnicas de relajación.

After having provided a detailed explanation on what relaxation consists of (see Rev. Rol Enf 2002; 25(9):582-586), the author presents a recap of the major known relaxation techniques including progressive muscular therapy, yoga stretching exercises, breathing techniques, therapeutic massages, meditation,... emphasizing the theoretical basis and practical experience as a function of each technique; each person ought to adopt those techniques which are most appropriate.