Effects of Educational Interventions for Chronic Airway Disease on Primary Care

Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.     

Increasing Physical Activity in Multiple Sclerosis Using a Behavioral Intervention

The present study adopted an interrupted time-series design for identifying the possibility of behavioral reactivity and examining the effect of an Internet-delivered behavioral intervention for increasing self-reported and objectively-measured physical activity among persons with multiple sclerosis (MS). Participants (n = 18) wore an accelerometer for 7 days and completed a battery of questionnaires to measure physical activity at 3 time points (before and after a 3-month period of no treatment and again after a 3-month period of treatment). There was a small change in objectively-measured, but not self-reported, physical activity in the period of no treatment, whereas there was a large increase in self-reported and objectively-measured physical activity in the period of treatment. These findings both complement and extend previous research and further support the efficacy of the current Internet behavioral intervention for increasing physical activity in persons with MS.     

Effectiveness of Active-Online,an Individually Tailored Physical Activity Intervention,in a Real-Life Setting: Randomized Controlled Trial

Background

Effective interventions are needed to reduce the chronic disease epidemic. The Internet has the potential to provide large populations with individual advice at relatively low cost.

Objective

The focus of the study was the Web-based tailored physical activity intervention Active-online. The main research questions were (1) How effective is Active-online, compared to a nontailored website, in increasing self-reported and objectively measured physical activity levels in the general population when delivered in a real-life setting? (2) Do respondents recruited for the randomized study differ from spontaneous users of Active-online, and how does effectiveness differ between these groups? (3) What is the impact of frequency and duration of use of Active-online on changes in physical activity behavior?

Methods

Volunteers recruited via different media channels completed a Web-based baseline survey and were randomized to Active-online (intervention group) or a nontailored website (control group). In addition, spontaneous users were recruited directly from the Active-online website. In a subgroup of participants, physical activity was measured objectively using accelerometers. Follow-up assessments took place 6 weeks (FU1), 6 months (FU2), and 13 months (FU3) after baseline.

Results

A total of 1531 respondents completed the baseline questionnaire (intervention group n = 681, control group n = 688, spontaneous users n = 162); 133 individuals had valid accelerometer data at baseline. Mean age of the total sample was 43.7 years, and 1146 (74.9%) were women. Mixed linear models (adjusted for sex, age, BMI category, and stage of change) showed a significant increase in self-reported mean minutes spent in moderate- and vigorous-intensity activity from baseline to FU1 (coefficient = 0.14, P = .001) and to FU3 (coefficient = 0.19, P < .001) in all participants with no significant differences between groups. A significant increase in the proportion of individuals meeting the HEPA recommendations (self-reported) was observed in all participants between baseline and FU3 (OR = 1.47, P = .03), with a higher increase in spontaneous users compared to the randomized groups (interaction between FU3 and spontaneous users, OR = 2.95, P = .02). There were no increases in physical activity over time in any group for objectively measured physical activity. A significant relation was found between time spent on the tailored intervention and changes in self-reported physical activity between baseline and FU3 (coefficient = 1.13, P = .03, intervention group and spontaneous users combined). However, this association was no longer significant when adjusting for stage of change.

Conclusions

In a real-life setting, Active-online was not more effective than a nontailored website in increasing physical activity levels in volunteers from the general population. Further research may investigate ways of integrating Web-based physical activity interventions in a wider context, for example, primary care or workplace health promotion.     

Increasing physical activity in multiple sclerosis using a behavioral intervention

The present study adopted an interrupted time-series design for identifying the possibility of behavioral reactivity and examining the effect of an Internet-delivered behavioral intervention for increasing self-reported and objectively-measured physical activity among persons with multiple sclerosis (MS). Participants (n = 18) wore an accelerometer for 7 days and completed a battery of questionnaires to measure physical activity at 3 time points (before and after a 3-month period of no treatment and again after a 3-month period of treatment). There was a small change in objectively-measured, but not self-reported, physical activity in the period of no treatment, whereas there was a large increase in self-reported and objectively-measured physical activity in the period of treatment. These findings both complement and extend previous research and further support the efficacy of the current Internet behavioral intervention for increasing physical activity in persons with MS.     

Testing an integrated model of the theory of planned behaviour and self‐determination theory for different energy balance‐related behaviours and intervention intensities

Objectives The aim of the study was to test the relations between constructs from the self‐determination theory (autonomous and controlled motivation), the theory of planned behaviour (attitudes, self‐efficacy, and intentions), and behaviour change within a theoretically integrated model. Additionally, the aim was to test if these relations vary by behaviour (physical activity or dietary behaviour) or intervention intensity (frequency). Design. It was a randomized controlled trial with a ‘usual care’ condition (medical screening only) and an intervention condition (medical screening+access to a website and coaching). Participants in the latter condition could freely determine their own intervention intensity. Methods. Participants (N= 287) completed measures of the theoretical constructs and behaviour at baseline and after the first intervention year (N= 236). Partial least squares path modelling was used. Results. Changes in autonomous motivation positively predicted changes in self‐efficacy and intentions towards a healthy diet. Changes in controlled motivation positively predicted changes in attitudes towards physical activity, changes in self‐efficacy, and changes in behavioural intentions. The intervention intensity moderated the effect of self‐efficacy on intentions towards physical activity and the relationship between attitude and physical activity. Changes in physical activity were positively predicted by changes in intentions whereas desired changes in fat intake were negatively predicted by the intervention intensity. Conclusions Important relations within the theoretically integrated model were confirmed but others were not. Moderation effects were found for behaviour and intervention intensity.     

Effects of an Obesity Intervention Integrating Physical Activity and Psychological Strategy on BMI,Physical Activity,and Psychological Variables in Male Obese Adolescents

The current study investigated the effect of an obesity intervention incorporating physical activity and behavior-based motivational enhancement intervention on BMI, physical activity levels, and psychological variables toward physical activity in male obese adolescents. Single group study without having a control group was carried out in Korea. Sixty-eight obese male adolescents who had BMI greater than 25 kg/m² participated in the 16-week obesity intervention. During this period, the study participants’ BMI, physical activity levels, self-efficacy, and perceived benefits and barriers were measured at the three time point (baseline, after week 8, and after week 16). Results indicated that obese adolescents’ BMI significantly decreased (F = 3.51, p = .03) and physical activity (F = 4.01, p = .02) significantly increased over the 16-week obesity intervention. In addition, Exercise self-efficacy (F = 5.02) and perceived benefits toward physical activity (F = 5.34) significantly increased but perceived barriers of physical activity (F = 5.10) gradually decreased over the intervention. This study suggests that an obesity intervention combining physical activity and behavior-based motivational enhancement intervention significantly contributed to decreased BMI, increased physical activity, and positively changed psychological variables related to physical activity. This first application has resulted in preliminary support for this intervention modality within non-western obese adolescents.     

Improved physical function and physical activity in older adults following a community-based intervention: Relationships with a history of depression

The purpose of this study was to explore the relationship of a history of depression with moderate physical activity and physical function before and after a physical activity intervention of congregate meal participants in senior centers from all 12 Georgia Area Agencies on Aging (AAA). Participants were a convenience sample of older adults (n=376, mean age=76 years, 82% female, 64% Caucasian, 36% African American, 22% a history of depression). The physical activity intervention included educator-led chair exercises that incorporated balls and bands. Pre- and post-tests assessed moderate physical activity and physical function. At the pre-test, a history of depression was not related to moderate physical activity or physical function. Following the intervention there were significant increases in both moderate physical activity and physical function, but a history of depression was a negative predictor of improvements in physical activity when controlled for site, demographics, and health-related conditions. These results provide an evidence base for the effectiveness of this intervention in improving moderate physical activity and physical function in a community setting, but additional efforts may be needed to improve the impact of this type of intervention among older adults with a history of depression.     

The relationship between sense of community and subjective well-being: A first look

The relationship between sense of community and subjective well-being (SWB) was tested by conducting telephone interviews with three random samples in South Carolina and Alabama (ns = 151, 399, and 442). Respondents answered the 17-item Sense of Community Scale (Davidson & Cotter, 1986), a measure of three facets of SWB (happiness, worrying, and personal coping), and questions about their demographic characteristics and subjective evaluations of their community. Partial correlation coefficients were computed between sense of community and SWB, partialling out the influence of demographic and community-evaluation variables. Sense of community was significantly related to SWB in all three samples. The effects were especially pronounced for the happiness facet of SWB. Implications are drawn for theory and intervention, and recommendations are made for further research.     

Animation or leaflet: Does it make a difference when educating young people about genome sequencing?

ObjectiveTo compare the effectiveness of an animation against two leaflets with and without images, in educating young people about genome sequencing (GS).MethodsAn experimental survey with three assessment points (pre- intervention [T1], post – intervention [T2], 6-week follow-up [T3]). Participants (N = 606) were randomly assigned to receive one of three educational interventions; animation (n = 212); leaflet with images (n = 197); or leaflet with text only (n = 197). Measures of objective and subjective knowledge were completed at T1 (N = 606), T2 (N = 606) and T3 (N = 459). Measures of attitudes, intentions and beliefs towards GS and satisfaction with intervention were completed at T2 only.ResultsThe type of educational intervention young people received had no significant impact on their objective or subjective knowledge at both T2 and T3 (all p > .05), nor did the educational intervention type affect their attitudes, intentions and beliefs towards GS at T2 (p > .05). However, participant satisfaction was significantly higher in the animation group than the leaflet groups (p < .001).ConclusionAnimations and leaflets are both effective ways to deliver genomic education to young people, but the animations lead to higher satisfaction.Practice implicationsDifferent individuals may find different modes of educational resources more accessible than others. Therefore a range of resources should ideally be made available to patients.     

The effectiveness of pharmacist- led discharge medication counselling in the emergency department (ExPLAIN): A pilot quasi-experimental study

ObjectiveTo evaluate the effectiveness of pharmacist-led discharge medication counselling using a structured, multimodal educational strategy with teach-back (intervention) against standard care.MethodsThis was a quasi-experimental study in a public, metropolitan ED. Participants discharged home with new medications were allocated to receive the intervention or standard care using convenience sampling. Participant characteristics (i.e. age, sex, socio-economic status, medications) and health literacy were collected. The outcomes measured were satisfaction with information, ED re-presentation and length of stay.ResultsThere were 51 participants: 14 received intervention, 37 had standard care. Overall, 12% had inadequate health literacy. Group characteristics and health literacy were similar. Participants who received the intervention were significantly reported higher satisfaction with information about their new medications compared to standard care (p = 0.009). Specifically, the intervention was associated with a 98% increase in satisfaction with information relating to side-effects. There were no differences in re-presentation and length of stay.ConclusionPharmacist-led discharge medication counselling incorporating a structured, multimodal educational strategy and teach-back was effective in improving patient satisfaction with medication information in the ED.Practice implicationsA similar intervention could be trialled in other EDs, but outcomes other beyond satisfaction should be considered.     

Effects of a tailored lifestyle self‐management intervention in patients with Type 2 diabetes

Objectives: The aim of the present study was to develop, implement and evaluate a brief intervention to improve adherence to the recommended lifestyle changes for patients with Type 2 diabetes, in particular to help patients to reduce the total amount of fat consumed and to increase lifestyle physical activity levels. Design and method: A brief, tailored lifestyle self‐management intervention for patients with Type 2 diabetes was evaluated in a randomized controlled trial. One hundred participants (aged 40 — 70 yrs) completed assessments at three time points— baseline, three months and one year. Participants were allocated to either an intervention group who received the brief tailored intervention including follow‐up telephone calls, or a usual care control group. Results: Results indicate that the intervention was successful in helping patients to reduce fat intake and, to a lesser extent, increase lifestyle physical activity levels. These self‐reported changes in behaviour were reflected in the objective data with weight maintenance in the intervention group compared to the control group, together with a significant reduction (2 cm) in waist circumference. Conclusions: These results provide further evidence of the effectiveness of tailored interventions for lifestyle change.     

Aspiring to physical health: the role of aspirations for physical health in facilitating long-term tobacco abstinence

OBJECTIVE: To assess aspirations for physical health over 18 months. To examine whether maintained importance of aspirations for physical health mediated and/or moderated the effect of an intensive intervention on long-term tobacco abstinence. METHODS: Participants were randomly assigned to an intervention based on self-determination theory or to community care, and provided data at baseline and at 18 and 30 months post-randomization. RESULTS: Aspirations for physical health were better maintained over 18 months among participants in the intervention (mean change=.05), relative to community care (mean change=-.13), t=2.66, p<.01. Maintained importance of aspirations for physical health partially mediated the treatment condition effects on seven-day point prevalence tobacco abstinence (z'=1.68, p<.01) and the longest number of days not smoking (z'=2.16, p<.01), and interacted with treatment condition to facilitate the longest number of days not smoking (beta=.08, p<.05). CONCLUSION: Maintained importance of aspirations for physical health facilitated tobacco abstinence. PRACTICE IMPLICATIONS: Smokers may benefit from discussing aspirations for physical health within autonomy-supportive interventions. Patients may benefit from discussing aspirations during counseling about therapeutic lifestyle change and medication use.     

Effectiveness of the Genomics ADvISER decision aid for the selection of secondary findings from genomic sequencing: a randomized clinical trial

PurposeTo evaluate the effectiveness of the Genomics ADvISER (www.genomicsadviser.com) decision aid (DA) for selection of secondary findings (SF), compared with genetic counseling alone.MethodsA randomized controlled trial (RCT) was conducted to evaluate whether the Genomics ADvISER is superior to genetic counseling when hypothetically selecting SF. Participants were randomized to use the DA followed by discussion with a genetic counselor, or to genetic counseling alone. Surveys were administered at baseline and post-intervention. Primary outcome was decisional conflict. Secondary outcomes were knowledge, preparation for, and satisfaction with decision-making, anxiety, and length of counseling session.ResultsParticipants (n = 133) were predominantly White/European (74%), female (90%), and ≥50 years old (60%). Decisional conflict (mean difference 0.05; P = 0.60), preparation for decision-making (0.17; P = 0.95), satisfaction with decision (–2.18; P = 0.06), anxiety (0.72; P = 0.56), and knowledge of sequencing limitations (0.14; P = 0.70) did not significantly differ between groups. However, intervention participants had significantly higher knowledge of SF (0.39; P < 0.001) and sequencing benefits (0.97; P = 0.01), and significantly shorter counseling time (24.40 minutes less; P < 0.001)ConclusionsThe Genomics ADvISER did not decrease decisional conflict but reduced counseling time and improved knowledge. This decision aid could serve as an educational tool, reducing in-clinic time and potentially health care costs.     

A randomized controlled trial of a mother-infant or toddler parenting program: demonstrating effectiveness in practice

OBJECTIVE: Describes outcomes of an intervention aimed to improve infant or toddler care and reduce parental distress. METHODS: A randomized controlled trial method was used with 118 mothers. Participants were allocated to an intervention group (n = 65) or an enhanced waitlist group (n = 53). Measures were taken at pre-, post-, and 6-weeks follow-up. RESULTS: Results demonstrated that mothers who attended the program reported improvement in depression, anxiety, stress, parental satisfaction, and decreases in problematic child behavior. Improvements were maintained at the 6-week follow up. Intention-to-treat analysis replicated the results, although with smaller effect sizes. CONCLUSIONS: The results of this study demonstrate that delivery of a 1 day intervention for distressed mothers can contribute to lower levels of parental distress and child problem behavior. Given the importance of early mother-child relationships and the limited number of well-controlled studies on brief interventions this result is of significance to researchers and the service community.     

Text Message and Internet Support for Coronary Heart Disease Self-Management: Results From the Text4Heart Randomized Controlled Trial

BackgroundMobile technology has the potential to deliver behavior change interventions (mHealth) to reduce coronary heart disease (CHD) at modest cost. Previous studies have focused on single behaviors; however, cardiac rehabilitation (CR), a component of CHD self-management, needs to address multiple risk factors.ObjectiveThe aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program (Text4Heart) to improve adherence to recommended lifestyle behaviors (smoking cessation, physical activity, healthy diet, and nonharmful alcohol use) in addition to usual care (traditional CR).MethodsA 2-arm, parallel, randomized controlled trial was conducted in New Zealand adults diagnosed with CHD. Participants were recruited in-hospital and were encouraged to attend center-based CR (usual care control). In addition, the intervention group received a personalized 24-week mHealth program, framed in social cognitive theory, sent by fully automated daily short message service (SMS) text messages and a supporting website. The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score (≥3) at 3 and 6 months. Secondary outcomes included clinical outcomes, medication adherence score, self-efficacy, illness perceptions, and anxiety and/or depression at 6 months. Baseline and 6-month follow-up assessments (unblinded) were conducted in person.ResultsEligible patients (N=123) recruited from 2 large metropolitan hospitals were randomized to the intervention (n=61) or the control (n=62) group. Participants were predominantly male (100/123, 81.3%), New Zealand European (73/123, 59.3%), with a mean age of 59.5 (SD 11.1) years. A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months (AOR 2.55, 95% CI 1.12-5.84; P=.03), but not at 6 months (AOR 1.93, 95% CI 0.83-4.53; P=.13). The intervention group reported significantly greater medication adherence score (mean difference: 0.58, 95% CI 0.19-0.97; P=.004). The majority of intervention participants reported reading all their text messages (52/61, 85%). The number of visits to the website per person ranged from zero to 100 (median 3) over the 6-month intervention period.ConclusionsA mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zealand adults with CHD compared to usual care alone. The effect was not sustained to the end of the 6-month intervention. A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events.

Trial Registration

ACTRN 12613000901707; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364758&isReview=true (Archived by WebCite at http://www.webcitation.org/6c4qhcHKt)     

师范类大学生主观幸福感与社会支持的关系研究

目的探讨师范类大学生尤其是贫困大学生的主观幸福感和社会支持的特点以及二者的关系。方法分别用主观幸福感量表和社会支持量表对1315名大学生进行测量,测量数据用SPSS 10.0整理与统计。结果师范类大学生的家庭满意度（F=8.86,P〈0.01）和自由满意度（F=4.16,P〈0.05）在是否贫困与性别这2个因素上存在交互作用,贫困男生的家庭满意度和自由满意度不仅低于贫困女生,而且显著低于非贫困男生;女生比男生体验到更少的学业满意度（F=21.12,P〈0.01）;贫困生的学校满意度（F=5.57,P〈0.05）和环境满意度（F=5.45,P〈0.05）明显高于非贫困生,但他们的学业满意度（F=3.54,P〈0.05）明显低于非贫困生;社会支持各因子与主观幸福感各维度均呈显著的相关关系。结论师范类大学生的主观幸福感存在性别和贫困与否方面的差异;师范类大学生的社会支持是影响其主观幸福感的一个重要因素。     

Health-Promotion Intervention Increases Self-Reported Physical Activity in Sub-Saharan African University Students: A Randomized Controlled Pilot Study

To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa. Randomly selected second-year students at a university in South Africa were randomized to an intervention based on social cognitive theory: health-promotion, targeting physical activity and fruit, vegetable, and fat consumption; or HIV risk-reduction, targeting sexual-risk behaviors. Participants completed assessments via audio computer-assisted self-interviewing pre-intervention and 6 and 12 months post-intervention. A total of 176 were randomized with 171 (97.2%) retained 12 months post-intervention. Generalized-estimating-equations analyses indicated that the health-promotion-intervention participants were more likely to meet physical-activity guidelines than were control participants, post-intervention, adjusting for pre-intervention physical activity (odds ratio [OR] = 3.35; 95% CI: 1.33–8.41). Health-promotion participants reported a greater number of days they did vigorous-intensity (risk ratio [RR] = 2.01; 95% CI: 1.43–2.83) and moderate-intensity (RR = 1.40; 95% CI: 1.01–1.95) aerobic activity, but not strength-building activity (RR = 1.37; 95% CI: 0.091–2.07). The intervention reduced self-reported servings of fried foods (mean difference = ?0.31; 95% CI: ?0.60, ?0.02). The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa.     

An Internet- and Mobile-Based Tailored Intervention to Enhance Maintenance of Physical Activity After Cardiac Rehabilitation: Short-Term Results of a Randomized Controlled Trial

Background

An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual.

Objective

Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version.

Methods

The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program.

Results

Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression.

Conclusions

Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention.

Trial Registration

ClinicalTrials.gov: NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).     

Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain?

Background

Cognitive behavior therapy (CBT) is considered effective for chronic pain, but little is known about active treatment components. Although acceptance correlates with better health outcomes in chronic pain patients, no study has examined its mediating effect in an experimental design.

Purpose

The aim of the present study is to investigate acceptance as a mediator in acceptance and commitment therapy (ACT), a third wave CBT intervention, for chronic pain.

Method

A bootstrapped cross product of coefficients approach was used on data from a previously published RCT evaluating ACT for chronic pain. To address the specificity of acceptance as a mediator, anxiety and depression were also tested as mediators. Outcome variables were satisfaction with life and physical functioning. Two change scores, pre-assessment to 6-month follow-up (n?=?53) and pre-assessment to 12-month follow-up (n?=?32), were used.

Results

Acceptance was found to mediate the effect of treatment on change in physical functioning from pre-assessment to follow-up at 6 months. Further, a trend was shown from pre-assessment to follow-up at 12 months. No indirect effect of treatment via acceptance was found for change in satisfaction with life.

Conclusion

This study adds to a small but growing body of research using mediation analysis to investigate mediating factors in the treatment of chronic pain. In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain. However, given the small sample size of the study, these findings need to be replicated.

     

Effectiveness of an Activity Tracker- and Internet-Based Adaptive Walking Program for Adults: A Randomized Controlled Trial

Background

The benefits of physical activity are well documented, but scalable programs to promote activity are needed. Interventions that assign tailored and dynamically adjusting goals could effect significant increases in physical activity but have not yet been implemented at scale.

Objective

Our aim was to examine the effectiveness of an open access, Internet-based walking program that assigns daily step goals tailored to each participant.

Methods

A two-arm, pragmatic randomized controlled trial compared the intervention to no treatment. Participants were recruited from a workplace setting and randomized to a no-treatment control (n=133) or to treatment (n=132). Treatment participants received a free wireless activity tracker and enrolled in the walking program, Walkadoo. Assessments were fully automated: activity tracker recorded primary outcomes (steps) without intervention by the participant or investigators. The two arms were compared on change in steps per day from baseline to follow-up (after 6 weeks of treatment) using a two-tailed independent samples t test.

Results

Participants (N=265) were 66.0% (175/265) female with an average age of 39.9 years. Over half of the participants (142/265, 53.6%) were sedentary (<5000 steps/day) and 44.9% (119/265) were low to somewhat active (5000-9999 steps/day). The intervention group significantly increased their steps by 970 steps/day over control (P<.001), with treatment effects observed in sedentary (P=.04) and low-to-somewhat active (P=.004) participants alike.

Conclusions

The program is effective in increasing daily steps. Participants benefited from the program regardless of their initial activity level. A tailored, adaptive approach using wireless activity trackers is realistically implementable and scalable.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02229409","term_id":"NCT02229409"}}NCT02229409, https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT02229409","term_id":"NCT02229409"}}NCT02229409 (Archived by WebCite at http://www.webcitation.org/6eiWCvBYe)