Study designs of evaluations included in the review
Original research studies were eligible for inclusion. Randomised controlled trials (RCTs), non-randomised controlled trials, two-group quasi-experimental studies and pre-test post-test studies were included.
Specific interventions included in the review
Studies of interventions designed to promote family functioning were eligible for inclusion. Acute phase interventions (in which the intervention occurred solely during the patients' hospitalisation) and recovery phase interventions (in which a major component occurred after hospital discharge) were included in the review. Studies of acute phase interventions were aimed at providing support for family members through psychological support groups and education or orientation sessions. Most of the acute phase intervention studies were conducted in large teaching hospitals or university medical centres in the United States, and consisted of a single session. The control interventions, where present, consisted of usual care.
Most of the recovery phase studies were conducted in cardiac rehabilitation centres or the patients' homes, and consisted of multiple sessions with a total delivery time ranging from 1 week to 3 months after the patients' hospital discharge. The recovery phase interventions included: educationally orientated discussion groups; counselling sessions; physical conditioning; home visits; telephone calls by nurse; and wives observing and/or participating in their husband's treadmill exercise, plus counselling. The control interventions, where present, included no information provided and usual care with and without slide/tape.
Participants included in the review
Studies of cardiac patients and their families during the acute or recovery phase of a cardiac event were eligible for inclusion. Most of the acute phase studies were conducted with family members (primarily spouses; most respondents were female) of the patients in coronary care units. However, studies of family members of patients in medical, surgical and neurosurgical intensive care settings were also included in the review. Most of the recovery phase studies recruited white, middle-class male patients (post myocardial infarction or coronary artery bypass grafting or valve surgery) from cardiac rehabilitation centres and university, community or metropolitan hospitals in the United States.
Outcomes assessed in the review
The inclusion criteria were not defined in terms of the outcomes. The acute phase studies assessed the following outcomes in family members: heart rate; blood-pressure; stress using the Kerle and Bialek subjective stress scale, or scales developed by the investigators; social support and hope; anxiety levels using the State-Trait Anxiety Inventory or a visual analogue scale; anxiety and depression using the Hospital Anxiety and Depression scale; and knowledge of nature and causes of heart attack, and confidence as a care giver. The recovery phase studies assessed the following outcomes in family members: anxiety and self esteem using a questionnaire; the wives perception of their husbands' physical and cardiac self-sufficiency; Family Inventory of Resources for Management; Family APGAR; Locke-Wallace Marital Adjustment Scale; social network and support using a questionnaire developed by the researchers; State-Trait Anxiety Inventory; Affect Adjective Check List; and Family Control Attitudes Scale.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the reviewers performed the selection.