Two-Year Longitudinal Analysis of a Cluster Randomized Trial of Physical Activity Promotion by General Practitioners
Two-Year Longitudinal Analysis of a Cluster Randomized Trial of Physical Activity Promotion by General Practitioners
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DOI：
10.1371/journal.pone.0018363
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发表时间：
2011-03-29
期刊：
影响因子：
3.7
通讯作者：
Torcal, Jesus
中科院分区：
文献类型：
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作者：
Grandes, Gonzalo;Sanchez, Alvaro;Torcal, Jesus
背景资料：我们评估的有效性进行了体力活动的促进计划，由全科医生与非活动患者在常规care.Methods和结果：务实，集群随机临床试验在西班牙的11个公共初级保健中心。五十六全科医生（GP）被随机分配到干预组（29）或标准治疗组（27）。他们评估了常规实践中系统样本患者的体力活动水平，并招募了4317名不符合最低体力活动建议的人（2248名干预组和2069名对照组）。干预全科医生为所有患者提供建议，并为参加额外预约的亚组（30%）提供体力活动处方。这些处方中有三分之一被机会主义地重复。对照组全科医生提供标准护理。主要结果指标是自报体力活动从基线到6个月、12个月和24个月的变化。次要结果包括心肺功能和健康相关的生活质量。共有3691例患者（85%）被纳入纵向分析，干预组在整个24个月随访期间的总体趋势明显更好（p < 0.01）。在6个月时观察到与对照组的最大差异（校正差异1.7 MET*hr/wk [95% CI，0.8 - 2.6]，25 min/wk [95% CI，11.3 - 38.4]，符合最低建议的患者百分比高5.3%[95% CI：2.1%-8.8%] NNT = 19）。这些差异在12个月和24个月时不具有统计学显著性。次要结局无差异。在接受重复处方的亚组中，达到最低推荐值的患者比例保持显著差异，直至24个月（校正差异10.2%，95% CI 1.5%至19.4%）。全科医生是有效的，在增加他们的非活动的病人在最初的六-但这种影响在12个月和24个月时逐渐消失。只有在接受重复体力活动处方的患者亚组中，其效果才能长期维持。
Background: We evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care.Methods and Findings: Pragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p < 0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%).Conclusions: General practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention but this effect wears off at 12 and 24 months. Only in the subgroup of patients receiving repeat prescriptions of physical activity is the effect maintained in long-term.