THE INVOLVEMENT OF THE SPOUSE IN CARDIAC REHABILITATION

The family, and particularly the spouse, deserve considerable attention in the cardiac context. This concern is partly as a support to the rehabilitative efforts of both patients and of staff but also as an acknowledgement of the considerable potential for distress and health problems among spouses themselves. The literature on spouse problems and concerns following acute cardiac events is described. The first phase of a longitudinal study comparing spouse and patient on quality of life and on preceptions of lifestyle change is outlined. On the Quality of Life Questionnaire for Spouses (QL-SP), spouses of patients starting an out-patient cardiac rehabilitation programme (N=30) reported significantly poorer scores on the emotional concerns dimension than did patients. There was no difference in couples' scores on the physical and social concerns dimension. Seven behaviours associated with an unhealthy lifestyle were examined with regard to patient and spouse views on their harmfulness, perceived difficulty (self-efficacy) for the patient, and perceived certainty (outcome expectancy) of maintaining the behaviour. The behaviours were smoking, alcohol consumption, regular exercise, a low fat diet, body weight control, stress management and adherence to prescribed medication. There was general agreement within couples on the harm associated with the various behaviours. Spouses were significantly more likely to expect they would be difficult for the patient to maintain and, correspondingly, were less certain that partners would succeed. Both partners rated stress management as being particularly difficult and unlikely to be achieved in the subsequent months. Results illustrate a high level of emotional concerns for cardiac spouses and differing estimates of the rehabilitative demands and potential of patients by patients themselves and their spouses. Longitudinal study will document patient and spouse quality of life over time and the relative predictability of the differing patient and spouse estimates of patient rehabilitation.