Effect of an orientation group for patients with chronic heart failure: randomized controlled trial.

Only 27 of 56 randomized patients were analysed, so the result is based on a small completed sample. Attendance was poor: 18 intervention-group patients were lost, 17 because they attended fewer than three orientation meetings. The control group also received several forms of care: nursing, nutritional, physiotherapy and medical consultations, plus guideline-based education, so the effect of the orientation group cannot be separated from the added nurse-led contact and usual clinic care. Participants mostly had elementary education and low income, and baseline adherence and self-care scores were below adequate thresholds, which may limit generalisability to more advantaged populations. Follow-up was four months, and the authors said longer follow-up may be needed to detect clinically meaningful change. The intervention and control groups differed significantly in alcoholism at baseline.

Do not read the drop in self-care confidence as proof the orientation group harmed patients. The significant negative change was only within the intervention group, only 27 patients were analysed, and the authors say the result may reflect more realistic self-assessment rather than worse self-care.