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Effect of pedometer use and goal setting on walking and functional status in overweight adults with multimorbidity: a crossover clinical trial.

ABSTRACT: Walking can improve functional status, and a pedometer and goal setting can increase walking and, potentially, gait speed. The efficacy of pedometer use and goal setting for increasing step counts among overweight and obese adults with multiple comorbid conditions has not been evaluated.We recruited and randomly assigned obese or overweight adults with multimorbidity to immediate pedometer use with goal setting or delayed pedometer use, using a crossover design. The primary outcome of interest was step count, with secondary outcomes of gait speed and grip strength, with comparison between the intervention and delayed pedometer groups.Mean (standard deviation [SD]) age of the 130 participants was 63.4 (15.0) years. At 2 months, mean (SD) steps for the immediate pedometer use group (n=64) was 5,337 (3,096), compared with 4,446 (2,422) steps in the delayed pedometer group (n=66) (P=0.08). Within-group step count increased nonsignificantly, by 179 steps in the immediate pedometer group and 212 steps in the delayed pedometer group after 2 months of intervention, with no significant difference between the groups. Gait speed significantly increased by 0.08 m/s (P<0.05) and grip strength significantly increased by 1.6 kg (P<0.05) in the immediate pedometer group.Pedometer use and goal setting did not significantly increase step count among overweight and obese adults with multimorbidity. The absolute step count was lower than many reported averages. Gait speed and grip strength increased with immediate pedometer use. The use of pedometers and goal setting may have an attenuated response in this population.

SUBMITTER: Takahashi PY

PROVIDER: S-EPMC5012619 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Effect of pedometer use and goal setting on walking and functional status in overweight adults with multimorbidity: a crossover clinical trial.

Takahashi Paul Y PY Quigg Stephanie M SM Croghan Ivana T IT Schroeder Darrell R DR Ebbert Jon O JO

Clinical interventions in aging 20160901

<h4>Background</h4>Walking can improve functional status, and a pedometer and goal setting can increase walking and, potentially, gait speed. The efficacy of pedometer use and goal setting for increasing step counts among overweight and obese adults with multiple comorbid conditions has not been evaluated.<h4>Methods</h4>We recruited and randomly assigned obese or overweight adults with multimorbidity to immediate pedometer use with goal setting or delayed pedometer use, using a crossover design ...[more]

PMID: 27621602

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Project description:ObjectiveTo map the extant literature evaluating the use of technology for goal setting in adult rehabilitation and the impact of technology for patient outcomes.DesignScoping review.MethodsMEDLINE (via Ovid), CINAHL (via EBSCO), AMED and Scopus were searched for articles describing observational or interventional studies. ProQuest Dissertations and Theses database were searched for grey literature. Two review authors independently screened all titles and abstracts for potentially relevant articles. We included articles describing studies that had evaluated the development or application of technology to facilitate goal setting in rehabilitation for adults. Articles were excluded if the technology described did not include features to facilitate goal setting or were not in English. Narrative reviews, opinion pieces and editorials were also excluded.ResultsAfter screening 1640 publications of potential interest, we identified 27 studies for inclusion. These 27 articles described studies involving a total of 16 different technologies including, seven mobile apps, three websites, two mobile apps/website hybrids, two apps and two websites connected to a pedometer. We found that most technologies described were designed to facilitate self-management with goal setting as a feature and that only five included a shared decision moment around goal setting. Only six of the 16 technologies had research providing evidence of effectiveness in terms of improved patient outcomes, with the best evidence of beneficial effects associated with technologies that linked goal setting to pedometer use.ConclusionsThe identified technologies for use in adult rehabilitation that included goal setting as a feature were largely accepted and valued by patients and health professionals. The limited data suggest that there is a need for further research; specific foci may include the impact of incorporation of a shared decision-making moment and evaluation of effectiveness on patient outcomes.

Project description:BackgroundIt is challenging to use shared decision-making with patients who have a chronic health condition or, especially, multimorbidity. A patient-goal-oriented approach can thus be beneficial. This study aims to identify and evaluate studies on the effects of interventions that support collaborative goal setting or health priority setting compared to usual care for elderly people with a chronic health condition or multimorbidity.MethodsThis systematic review was based on EPOC, PRISMA and MOOSE guidelines. Pubmed, PsychInfo, CINAHL, Web of Science, Embase and the Cochrane Central Register of Controlled Trials were searched systematically. The following eligibility criteria were applied: 1. Randomised (cluster) controlled trials, non-randomised controlled trials, controlled before-after studies, interrupted time series or repeated measures study design; 2. Single intervention directed specifically at collaborative goal setting or health priority setting or a multifactorial intervention including these elements; 3. Study population of patients with multimorbidity or at least one chronic disease (mean age ± standard deviation (SD) incl. age 65). 4. Studies reporting on outcome measures reducible to outcomes for collaborative goal setting or health priority setting.ResultsA narrative analysis was performed. Eight articles describing five unique interventions, including four cluster randomised controlled trials and one randomised controlled trial, were identified. Four intervention studies, representing 904, 183, 387 and 1921 patients respectively, were multifactorial and showed statistically significant effects on the application of goal setting (Patient Assessment of Chronic Illness Care (PACIC) goal setting subscale), the number of advance directives or the inclusion of goals in care plans. Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions. One study, which implemented a single-factor intervention on 322 patients, did not have significant effects on doctor-patient agreement. All the studies had methodological concerns in varying degrees.ConclusionsCollaborative goal setting and/or priority setting can probably best be integrated in complex care interventions. Further research should determine the mix of essential elements in a multifactorial intervention to provide recommendations for daily practice. In addition, the necessity of methodological innovation and the application of mixed evaluation models must be highlighted to deal with the complexity of goal setting and/or priority setting intervention studies.

Project description:BackgroundExercise-based cardiac rehabilitation reduces morbidity and mortality. Walking is a convenient activity suitable for people with cardiac disease. Pedometers count steps, measure walking activity and motivate people to increase physical activity. In this study, patients participating in cardiac telerehabilitation were provided with a pedometer to support motivation for physical activity with the purpose of exploring pedometer use and self-determined motivation for walking experienced by patients and health professionals during a cardiac telerehabilitation program.MethodsA qualitative research design consisting of observations, individual interviews and patient documents made the basis for a content analysis. Data was analysed deductively using Self Determination Theory as a frame for analysis and discussion, focusing on the psychological needs of autonomy, competence and relatedness. Twelve cardiac patients, 11 health professionals, 6 physiotherapists and 5 registered nurses were included.ResultsThe pedometer offered independence from standardised rehabilitation since the pedometer supported tailoring, individualised walking activity based on the patient's choice. This led to an increased autonomy. The patients felt consciously aware of health benefits of walking, and the pedometer provided feedback on walking activity leading to an increased competence to achieve goals for steps. Finally, the pedometer supported relatedness with others. The health professionals' surveillance of patients' steps, made the patients feel observed, yet supported, furthermore, their next of kin appeared to be supportive as walking partners.ConclusionCardiac patients' motivation for walking was evident due to pedometer use. Even though not all aspects of motivation were autonomous and self determined, the patients felt motivated for walking. The visible steps and continuous monitoring of own walking activity made it possible for each individual patient to choose their desired kind of activity and perform ongoing adjustments of walking activity. The immediate feedback on step activity and the expectations of health benefits resulted in motivation for walking. Finally, pedometer supported walking made surveillance possible, giving the patients a feeling of being looked after and supported.Trial registrationCurrent study is a part of The Teledi@log project.

Project description:IntroductionGoal-setting is recommended for patients with multimorbidity, but there is little evidence to support its use in general practice.ObjectiveTo assess the feasibility of goal-setting for patients with multimorbidity, before undertaking a definitive trial.Design and settingCluster-randomised controlled feasibility trial of goal-setting compared with control in six general practices.ParticipantsAdults with two or more long term health conditions and at risk of unplanned hospital admission.InterventionsGeneral practitioners (GPs) underwent training and patients were asked to consider goals before an initial goal-setting consultation and a follow-up consultation 6 months later. The control group received usual care planning.Outcome measuresHealth-related quality of life (EQ-5D-5L), capability (ICEpop CAPability measure for Older people), Patient Assessment of Chronic Illness Care and healthcare use. All consultations were video-recorded or audio-recorded, and focus groups were held with participating GPs and patients.ResultsFifty-two participants were recruited with a response rate of 12%. Full follow-up data were available for 41. In the goal-setting group, mean age was 80.4 years, 54% were female and the median number of prescribed medications was 13, compared with 77.2 years, 39% female and 11.5 medications in the control group. The mean initial consultation time was 23.0 min in the goal-setting group and 19.2 in the control group. Overall 28% of patient participants had no cognitive impairment. Participants set between one and three goals on a wide range of subjects, such as chronic disease management, walking, maintaining social and leisure interests, and weight management. Patient participants found goal-setting acceptable and would have liked more frequent follow-up. GPs unanimously liked goal-setting and felt it delivered more patient-centred care, and they highlighted the importance of training.ConclusionsThis goal-setting intervention was feasible to deliver in general practice. A larger, definitive study is needed to test its effectiveness.Trial registration numberISRCTN13248305; Post-results.

Project description:ObjectivesTo enhance understanding of the relationship between multimorbidity, symptom burden, and functional status in individuals with life-limiting illness.DesignSecondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group. Group differences were tested using a t-test; multivariate regression analysis was used to determine the effect of multiple variables on functional status and symptom burden.SettingFifteen Palliative Care Research Cooperation sites.ParticipantsAdults who participated in a parent statin-discontinuation clinical trial were included in the analysis (N = 381). Inclusion criteria were diagnosis of a life-limiting illness, statin use for 3 months or longer, life expectancy longer than 1 month, and declining functional status.MeasurementsCancer diagnosis (solid organ and hematologic malignancies), multimorbidity (Charlson Comorbidity Index (CCI) score), symptom burden (Edmonton Symptom Assessment Scale (ESAS) score, number of symptoms with ESAS severity score >4), functional status (Australia-modified Karnofsky Performance Scale (AKPS)).ResultsFifty-one percent had a primary diagnosis of cancer; mean age 74.1 ± 11.6. Participants had multiple comorbid illnesses (CCI score 4.9 ± 2.8), multiple symptoms (ESAS score 27.2 ± 15.9), and poor functional status (AKPS = 53 ± 13). In univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs 3.1 moderate or severe symptoms (t = -3.2, P = .002), 12% vs 6% with severe symptoms (t = -3.7, P < .001)), but cancer diagnosis was not. In univariate and multivariate analyses, higher symptom burden was associated with poorer functional status (F = 11.6, P < .001), but multimorbidity was not.ConclusionSymptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in individuals with multimorbidity.

Dataset Information

Effect of pedometer use and goal setting on walking and functional status in overweight adults with multimorbidity: a crossover clinical trial.

Publications

Effect of pedometer use and goal setting on walking and functional status in overweight adults with multimorbidity: a crossover clinical trial.

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