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. 2019 Mar 14;2019(3):CD010748. doi: 10.1002/14651858.CD010748.pub2

Horlick 1984.

Methods Study design: parallel RCT
Recruitment: consecutive post‐MI patients
Allocation: not reported
Blinding: not reported
Randomisation: no method described
Follow‐up(s): 6 months
Description: educational‐group discussion programme
Participants Baseline characteristics
Intervention group
  • Number of participants randomised: 83

  • Working before CHD: 83

  • Mean age (SD): 53.8 (8.1) years

  • Sex (male %): 91.6


Control group
  • Number of participants randomised: 33

  • Working before CHD: 33

  • Mean age (SD): 52.7 (7.8) years

  • Sex (male %): 90.9


Inclusion criteria
  • < 66 years of age

  • Lived within 30 miles and physically able to attend classes

  • Employed for 6 months prior to MI and not intending to retire within 12 months


Exclusion criteria: none
Baseline imbalances:
Physically demanding work: white‐collar
Severity of CHD: unknown
Interventions Intervention
  • Educational‐group discussion programme beginning within 3 weeks of discharge from the hospital.

    • Initial interview (accompanied by a spouse or another family member) conducted by the nurse co‐ordinator:

      • to assess the participant's and spouse's knowledge of heart disease (by questionnaire)

      • to provide information using a standard (in‐hospital) education programme

      • to explain the elements of the treatment programme

  • The education‐group discussion programme consisted of 6 weekly classes

    • Educational component (30‐45 min) involving a presentation upon a certain topic (expanded on information presented in the audio‐visual programme provided at discharge from hospital); spouses were encouraged to attend; topics were:

      • how the heart works in health and disease

      • physical recovery

      • emotional recovery

      • risk factors and intervention

      • nutrition, and

      • living with heart disease

  • Group discussion (45 min) for 4‐8 participants only:

    • Free discussion of ideas, thoughts and feelings about the heart attack and its effects (no lecturing or direction provided by the leader) to help participants to "normalize" their experience.

  • Duration of intervention: 6 weeks

  • Providers: nurse co‐ordinator, nurse, clinical psychologist, cardiovascular nurse, nutritionist, nurse educator, recovered patient


Control group
  • Usual care

Outcomes Proportion at work at < 6 months (short term): 3 months
Proportion at work at 6 months–12 months (medium term): 6 months
Self‐developed personal adjustment questionnaires
Identification Sponsorship source: grant from the Saskatchewan Heart Foundation
Country: Canada
Setting: multi‐centred: three Saskatoon hospitals; in‐ and outpatient
Possible conflicts of interest: no information provided
Ethics committee approval: not reported
Notes Number of participants returning to work calculated from percents given in text and number of study participants followed at 3 and 6 months.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Only the ratios of distribution to treatment versus control group over time are described, i.e. 3:1 and later 2.5:1. The method of sequence generation is not described.
Allocation concealment (selection bias) Unclear risk No method of allocation concealment is described.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Due to the nature of the intervention (outpatient educational group discussions), blinding of participants would not have been possible.
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk No concealment of outcome assessors is described, and assessment of "intention to return to work or retire" was described as self‐reported. Information regarding RTW was also obtained from a physician's report, but it is unclear if the physicians were aware of their participant's group allocation.
Incomplete outcome data (attrition bias) 
 All outcomes High risk The proportion of study participants lost to follow‐up was 12% in the control group and 22% in the Intervention group.
Selective reporting (reporting bias) Unclear risk Unable to determine, no study protocol was available
Other bias Unclear risk None identified