Dataset Information

Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect.

ABSTRACT:

Background

Organised follow-up is a common feature of several strategies at the primary health care level to promote health behaviour change, e.g. to increase physical activity. In Norway, municipal 'healthy living' centres run by health care personnel are established to offer counselling and organised follow-up of health behaviour change during a 12-week programme. We report the results of a systematic review commissioned by the Norwegian Directorate of Health concerning organised follow-up to improve physical activity.

Methods

We searched ten electronic databases up to June 2012, reference lists of included publications, and relevant journals. Study selection and quality risk of bias assessment were carried out independently. Data were synthesised narratively due to heterogeneity of measurements of physical activity. The GRADE approach was used to assess our confidence in the effect estimate for each outcome in each comparison.

Results

Fourteen randomised controlled trials from seven countries and with a total of 5,002 participants were included in the systematic review. All studies were carried out in primary care or community settings. The interventions comprised referral to supervised group physical activity (2 studies), referral to local resources with follow-up (6 studies), and self-organised physical activity with follow-up (6 studies). The narrative synthesis, comprising a total of 39 comparisons, indicated effects of self-organised physical activity with follow-up (compared to both advice and no treatment) and referral to local resources with follow-up (compared to advice) in some of the comparisons where we rated our confidence in the effect estimates as moderate. However, the results indicated no difference between intervention and control groups for the majority of comparisons. Follow-up in the studies was mainly short-term with the longest follow-up 9 months post-treatment. We rated our confidence in the effect estimates as low or very low in most comparisons, both for positive and neutral results.

Conclusions

The results of this systematic review indicate considerable uncertainty concerning effects of organised follow-up during 10-14 weeks on physical activity. Major methodological problems concerning the measurement of physical activity are discussed.

Trial registration

Systematic review registration: PROSPERO CRD42011001598.

SUBMITTER: Denison E

PROVIDER: S-EPMC4075600 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Publications

Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect.

Denison Eva E Vist Gunn E GE Underland Vigdis V Berg Rigmor C RC

BMC family practice 20140617

<h4>Background</h4>Organised follow-up is a common feature of several strategies at the primary health care level to promote health behaviour change, e.g. to increase physical activity. In Norway, municipal 'healthy living' centres run by health care personnel are established to offer counselling and organised follow-up of health behaviour change during a 12-week programme. We report the results of a systematic review commissioned by the Norwegian Directorate of Health concerning organised follo ...[more]

PMID: 24934215

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Project description:BackgroundChronic musculoskeletal pain is highly prevalent, affecting around one in five people across Europe. Osteoarthritis, low back pain, neck pain and other musculoskeletal disorders are leading causes of disability worldwide and the most common source of chronic pain. Exercise and/or physical activity interventions have the potential to address not only the pain and disability associated with chronic pain but also the increased risk of morbidity and mortality seen in this population. Although exercise and/or physical activity is widely recommended, there is currently a paucity of research that offers an evidence base upon which the development or optimisation of interventions can be based. This systematic review will investigate the components of interventions associated with changes in physical activity levels in adults with chronic musculoskeletal pain.Methods/designThis systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: CENTRAL in the Cochrane Library, the Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two review authors will independently screen articles retrieved from the search for eligibility, extract relevant data on methodological issues and code interventions according to the behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques. As complex healthcare interventions can be modified by a wide variety of factors, data will be summarised statistically when the data are available, are sufficiently similar and are of sufficient quality. A narrative synthesis will be completed if there is insufficient data to permit a formal meta-analysis.DiscussionThis review will be of value to clinicians working in chronic pain services and to researchers involved in designing and evaluating interventions.Systematic review registrationPROSPERO reference: CRD42014010640.

Project description:BackgroundIndividuals with persistent musculoskeletal pain (PMP) have an increased risk of developing co-morbid health conditions and for early-mortality compared to those without pain. Despite irrefutable evidence supporting the role of physical activity in reducing these risks; there has been limited synthesis of the evidence, potentially impacting the optimisation of these forms of interventions. This review examines the effectiveness of interventions in improving levels of physical activity and the components of these interventions.MethodsRandomised and quasi-randomised controlled trials were included in this review. The following databases were searched from inception to March 2016: CENTRAL in the Cochrane Library, Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two reviewers independently screened citations, assessed eligibility, extracted data, assessed risk of bias and coded intervention content using the behaviour change taxonomy (BCTTv1) of 93 hierarchically clustered techniques. GRADE was used to rate the quality of the evidence.ResultsThe full text of 276 articles were assessed for eligibility, twenty studies involving 3441 participants were included in the review. Across the studies the mean number of BCTs coded was eight (range 0-16); with 'goal setting' and 'instruction on how to perform the behaviour' most frequently coded. For measures of subjective physical activity: interventions were ineffective in the short term, based on very low quality evidence; had a small effect in the medium term based on low quality evidence (SMD 0.25, 95% CI 0.01 to 0.48) and had a small effect in the longer term (SMD 0.21 95% CI 0.08 to 0.33) based on moderate quality evidence. For measures of objective physical activity: interventions were ineffective - based on very low to low quality evidence.ConclusionsThere is some evidence supporting the effectiveness of interventions in improving subjectively measured physical activity however, the evidence is mostly based on low quality studies and the effects are small. Given the quality of the evidence, further research is likely/very likely to have an important impact on our confidence in effect estimates and is likely to change the estimates. Future studies should provide details on intervention components and incorporate objective measures of physical activity.

Project description:ObjectiveTo identify randomised controlled trials (RCTs) of physical activity (PA) interventions with objective PA outcomes in adults and to evaluate whether intervention effects were sustained beyond 12 months.DesignSystematic review and meta-analysis.Data sourcesSeven databases (Medline, Embase, PsycINFO, Web of Science, Cochrane library, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and ASSIA (Applied Social Sciences Index and Abstracts)) were searched from January 2000 until December 2019.Eligibility criteriaRCTs reporting objective PA outcomes beyond 12 months with community-based participants aged ?18 years were included; those where controls received active interventions, including advice to increase PA levels, were excluded.Data extraction and synthesisTwo independent reviewers completed extraction of aggregate data and assessed risk of bias. Meta-analyses used random-effects models at different follow-up points. Primary outcomes were daily steps and weekly minutes of moderate-to-vigorous PA (MVPA).ResultsOf 33 282 records identified, nine studies (at generally low risk of bias) were included, five in meta-analyses with 12 months to 4 year follow-up. We observed 12 month increases for intervention vs control participants in steps/day (mean difference (MD)=554 (95% CIs: 384 to 724) p<0.0001, I2=0%; 2446 participants; four studies) and weekly MVPA minutes (MD=35 (95% CI: 27 to 43) p<0.0001, I2=0%; 2647 participants; four studies). Effects were sustained up to 4 years for steps/day (MD=494 (95% CI: 251 to 738) p<0.0001, I2=0%; 1944 participants; four studies) and weekly MVPA minutes (MD=25 (95% CI: 13 to 37) p<0.0001, I2=0%; 1458 participants; three studies).ConclusionsThere are few PA interventions with objective follow-up beyond 12 months, more studies are needed. However, this review provided evidence of PA intervention effects beyond 12 months and sustained up to 4 years for both steps/day and MVPA. These findings have important implications for potential long-term health benefits.Prospero registration numberCRD42017075753.

Project description:BACKGROUND:The risk of falling and associated injuries increases with age. Therefore, the prevention of falls is a key priority in geriatrics and is particularly based on physical exercising, aiming to improve the age-related decline in motor performance, which is crucial in response to postural threats. Although the benefits and specifications of effective exercise programs have been well documented in pre-post design studies, that is during the treatment, the definitive retention and transfer of these fall-related exercise benefits to the daily life fall risk during follow-up periods remains largely unclear. Accordingly, this meta-analysis investigates the efficacy of exercise interventions on the follow-up risk of falling. METHODS:A systematic database search was conducted. A study was considered eligible if it examined the number of falls (fall rate) and fallers (fall risk) of healthy older adults (??65?years) during a follow-up period after participating in a randomized controlled physical exercise intervention. The pooled estimates of the fall rate and fall risk ratios were calculated using a random-effects meta-analysis. Furthermore, the methodological quality and the risk of bias were assessed. RESULTS:Twenty-six studies with 31 different intervention groups were included (4739 participants). The number of falls was significantly (p <0.001) reduced by 32% (rate ratio 0.68, 95% confidence interval 0.58 to 0.80) and the number of fallers by 22% (risk ratio 0.78, 95% confidence interval 0.68 to 0.89) following exercising when compared with controls. Interventions that applied posture-challenging exercises showed the highest effects. The methodological quality score was acceptable (73?±?11%) and risk of bias low. CONCLUSIONS:The present review and meta-analysis provide evidence that physical exercise interventions have the potential to significantly reduce fall rate and risk in healthy older adults. Posture-challenging exercises might be particularly considered when designing fall prevention interventions.

Project description:BACKGROUND:Patients are frequently discharged from the hospital before all test results have been finalized. Thirty to 40% of tests pending at discharge (TPADs) return potentially actionable results that could necessitate change in the patients' management, often unbeknownst to their physicians. Delayed follow-up of TPADs can lead to patient harm. We sought to synthesize the existing literature on interventions intended to improve the management of TPADs, including interventions designed to enhance documentation of TPADs, increase physician awareness when TPAD results finalize post-discharge, decrease adverse events related to missed TPADs, and increase physician satisfaction with TPAD management. METHODS:We searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Database of Controlled Clinical Trials and Medline (January 1, 2000-November 10, 2016) for randomized controlled trials and prospective, controlled observational studies that evaluated interventions to improve follow-up of TPADs for adult patients discharged from acute care hospitals or emergency department settings. From each study we extracted characteristics of the intervention being evaluated and its impact on TPAD management. RESULTS:Nine studies met the criteria for inclusion. Six studies evaluated electronic discharge summary templates with a designated field for documenting TPADs, and three of six of these studies reported a significant improvement in documentation of TPADs in discharge summaries in pre- and post-intervention analysis. One study reported that auditing discharge summaries and providing feedback to physicians were associated with improved TPAD documentation in discharge summaries. Two studies found that email alerts when TPADs were finalized improved physicians' awareness of the results and documentation of their follow-up actions. Of the four studies that assessed patient morbidity, two showed a positive effect; however, none specifically measured the impact of their interventions on downstream patient harm due to delayed follow-up of TPADs. Three studies surveyed physicians' attitudes towards the interventions, of which two studies reported improved physician satisfaction with TPAD management with the implementation of an enhanced discharge template and a notification system when TPADs finalize. DISCUSSION:Discharge summary templates, educational interventions for discharging physicians, and email alerts when TPAD results are finalized show promise in improving management of TPADs. Given the complexity of the processes necessary to ensure follow-up of TPADs, rigorous evaluations of multifaceted interventions (e.g., improved discharge documentation of TPADs combined with email alerts when results become available) is needed.

Project description:Background:Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. Purpose:To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical). Data Sources:English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. Study Selection:Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. Data Extraction:Two reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type. Data Synthesis:Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of -7.4 percentage points (95% CI, -19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points). Limitation:More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. Conclusion:Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient. Primary Funding Source:National Cancer Institute. (PROSPERO: CRD42016048286).

Project description:BackgroundNursing work environments (NWEs) in Canada and other Western countries have increasingly received attention following years of restructuring and reported high workloads, high absenteeism, and shortages of nursing staff. Despite numerous efforts to improve NWEs, little is known about the effectiveness of interventions to improve NWEs. The aim of this study was to review systematically the scientific literature on implemented interventions aimed at improving the NWE and their effectiveness.MethodsAn online search of the databases CINAHL, Medline, Scopus, ABI, Academic Search Complete, HEALTHstar, ERIC, Psychinfo, and Embase, and a manual search of Emerald and Longwoods was conducted. (Quasi-) experimental studies with pre/post measures of interventions aimed at improving the NWE, study populations of nurses, and quantitative outcome measures of the nursing work environment were required for inclusion. Each study was assessed for methodological strength using a quality assessment and validity tool for intervention studies. A taxonomy of NWE characteristics was developed that would allow us to identify on which part of the NWE an intervention targeted for improvement, after which the effects of the interventions were examined.ResultsOver 9,000 titles and abstracts were screened. Eleven controlled intervention studies met the inclusion criteria, of which eight used a quasi-experimental design and three an experimental design. In total, nine different interventions were reported in the included studies. The most effective interventions at improving the NWE were: primary nursing (two studies), the educational toolbox (one study), the individualized care and clinical supervision (one study), and the violence prevention intervention (one study).ConclusionsLittle is known about the effectiveness of interventions aimed at improving the NWE, and published studies on this topic show weaknesses in their design. To advance the field, we recommend that investigators use controlled studies with pre/post measures to evaluate interventions that are aimed at improving the NWE. Thereby, more evidence-based knowledge about the implementation of interventions will become available for healthcare leaders to use in rebuilding nursing work environments.

Dataset Information

Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect.

Background

Methods

Results

Conclusions

Trial registration

Publications

Interventions aimed at increasing the level of physical activity by including organised follow-up: a systematic review of effect.

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