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Bendrik R, Kallings LV, Bröms K, Emtner M. Follow-up of individualised physical activity on prescription and individualised advice in patients with hip or knee osteoarthritis: A randomised controlled trial. Clin Rehabil 2024; 38:770-782. [PMID: 38409798 DOI: 10.1177/02692155241234666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. DESIGN Randomised, assessor-blinded, controlled trial. SETTING Primary care. SUBJECTS Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40-74. INTERVENTION The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. MAIN MEASURES Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. RESULTS There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74-130) minutes/week at baseline to 214 (95% CI 183-245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103-157) to 176 (95% CI 145-207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by -514 (95% CI -567-462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was -852 (95% CI -900-804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5-8.2) and in the prescription group by 14.7 points (95% CI 14.3-15.1) from baseline to 24 months (p = 0.024 between groups). CONCLUSIONS There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis.
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Affiliation(s)
- Regina Bendrik
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala University/ Region Gävleborg, Gävle, Sweden
| | - Lena V Kallings
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
- Department of Physical Activity and Health, the Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Kristina Bröms
- Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Wiklund E, Wiklund M, Hedenborg S. Physical Activity on Prescription "Not a Quick Fix": School Nurses' Experiences of Promoting and Tailoring Physical Activity to Children in Swedish Compulsory School. J Sch Nurs 2023:10598405231166124. [PMID: 36974431 DOI: 10.1177/10598405231166124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
This study aimed to explore school nurses' experience of using physical activity on prescription with children in Swedish compulsory school. Semistructured interviews were conducted with 24 school nurses who had the educational qualification to prescribe physical activity. The analysis resulted in one overarching theme, "A delicate process of tailoring physical activity on prescription to a child's social context," and two categories: "Promoting joyful physical activity through individualization and support" and "Dealing with dilemmas and challenges," with related subcategories. The results demonstrate the importance of tailoring prescribed physical activity to each individual child, their living conditions, and the school context. In addition, they highlight the nurses' working conditions and collaborations as important prerequisites when initiating physical activity on prescription. In conclusion, the results suggest that school nurses perceive physical activity on prescription as a useful tool in the school context, but it needs to be tailored to each individual child.
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Affiliation(s)
- Emelie Wiklund
- Department of Sports Sciences, Malmö University, Malmö, Sweden
| | - Maria Wiklund
- Physiotherapy Unit, Department of Community Medicine and Rehabilitation, 8075Umeå University, Umeå, Sweden
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Boman C, Bernhardsson S, Lauruschkus K, Lundqvist S, Melin K. Prerequisites for implementing physical activity on prescription for children with obesity in paediatric health care: A cross-sectional survey. Front Health Serv 2022; 2:1102328. [PMID: 36925834 PMCID: PMC10012761 DOI: 10.3389/frhs.2022.1102328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023]
Abstract
Background Physical inactivity is a main driver of childhood obesity that tracks into adulthood, making it crucial to address early in life. Swedish physical activity on prescription (PAP) is an effective intervention for increasing physical activity levels in adults and is being implemented in primary care in Sweden. Before implementing PAP for children, both intervention effectiveness and implementation prerequisites need to be examined. Framed by the Normalization Process Theory (NPT) domains, this study aimed to investigate perceptions of PAP amongst paediatric staff and managers working with children with obesity, as well as acceptability, appropriateness, feasibility, and barriers and facilitators for implementing PAP in paediatric health care. Methods Staff and managers in 28 paediatric outpatient clinics in western Sweden were surveyed using validated implementation instruments and open-ended questions. Data were analysed using Mann-Whitney U tests and Kruskal-Wallis tests. Qualitative data were categorised into NPT domains. Results The survey response rate was 54% (125/229). Most respondents (82%) reported PAP to be familiar and many (56%) perceived it as a normal part of work; nurses and physiotherapists to a greater extent (p < 0.001). This was anticipated to increase in the future (82%), especially amongst those with the longest work experience (p = 0.012). Respondents reported seeing the potential value in their work with PAP (77%), being open to working in new ways to use PAP (94%), and having confidence in their colleagues' ability to use PAP (77%). Barriers and facilitators were found in all the NPT domains, mainly collective action and reflexive monitoring, where, for example, inadequacies of education, resources, and research on PAP for children were reported as barriers. Most respondents agreed that PAP was acceptable, appropriate, and feasible (71% to 88%). Conclusions PAP is familiar and perceived as an acceptable, appropriate, and feasible intervention, and by many viewed as a normal part of clinical routines in paediatric outpatient clinics in western Sweden, especially by physiotherapists and nurses. Barriers and faciliators are mainly related to collective action and reflexive monitoring. The wide acceptance demonstrates receptiveness to PAP as an intervention to promote an active lifestyle for children with obesity.
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Affiliation(s)
- Charlotte Boman
- Centre for Physical Activity, Region Västra Götaland, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Katarina Lauruschkus
- Faculty of Medicine, Institution of Health Sciences, Lund University, Lund, Sweden.,Department of Habilitation, Committee on Psychiatry, Habilitation and Technical Aids, Region Skåne, Lund, Sweden
| | - Stefan Lundqvist
- Centre for Physical Activity, Region Västra Götaland, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Andersen P, Holmberg S, Årestedt K, Lendahls L, Nilsen P. Physical Activity on Prescription in Routine Health Care: 1-Year Follow-Up of Patients with and without Counsellor Support. Int J Environ Res Public Health 2020; 17:ijerph17165679. [PMID: 32781558 PMCID: PMC7460230 DOI: 10.3390/ijerph17165679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 12/21/2022]
Abstract
The effectiveness of counsellor support in addition to physical activity on prescription (PAP) from health care professionals has rarely been evaluated. This observational follow-up study investigated differences in physical activity levels and health-related quality of life (HRQoL) one year after PAP regarding patients’ use of counsellor support in addition to PAP in routine care. The study was conducted in a Swedish health care region in which all patients receiving PAP from health care professionals were offered counsellor support. Data were collected from medical records and questionnaires (baseline and follow-up). Of the 400 study participants, 37% used counsellor support. The group of counsellor users attained a higher level of physical activity one year after receiving PAP compared to the group of non-users (p < 0.001). The level of physical activity was measured by a validated index (score 3–19) calculated from weekly everyday activity and exercise training. Comparison of the change in scores between baseline and follow-up showed a significant difference between the two groups, (p < 0.001). The median difference in the PAP + C group was 2.0 (interquartile range, 7.0) and 0.0. among non-users (interquartile range, 4.0). Significant differences in HRQoL were due to positive improvements among counsellor users, with the main improvement in general health. The conclusion is that patients using counsellor support after receiving PAP from health care professionals had higher physical activity and better HRQoL one year after compared with patients who did not use this support.
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Affiliation(s)
- Pia Andersen
- Department of Research and Development, Region Kronoberg, SE-351 88 Växjö, Sweden; (S.H.); (L.L.)
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83 Linköping, Sweden;
- Correspondence:
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, SE-351 88 Växjö, Sweden; (S.H.); (L.L.)
- Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, SE-221 00 Lund, Sweden
- Faculty of Health and Life Sciences, Department of Medicine and Optometry, Linnaeus University, SE-391 82 Kalmar, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden;
- The Research Section, Region Kalmar County, SE-391 26 Kalmar, Sweden
| | - Lena Lendahls
- Department of Research and Development, Region Kronoberg, SE-351 88 Växjö, Sweden; (S.H.); (L.L.)
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, SE-391 82 Kalmar, Sweden;
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, SE-581 83 Linköping, Sweden;
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Marcacci A. [Sustainably Anchoring Exercise as a Therapy in Health Care]. Praxis (Bern 1994) 2018; 107:937-942. [PMID: 30131031 DOI: 10.1024/1661-8157/a003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sustainably Anchoring Exercise as a Therapy in Health Care Abstract. Regular exercise reduces the risk of suffering from noncommunicable diseases such as cancer or diabetes. Within the framework of the National Strategy for the Prevention of Non-communicable Diseases, movement as a form of therapy is therefore to be anchored in health care in the future. Sports physicians have an important role as multipliers.
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Affiliation(s)
- Alberto Marcacci
- 1 Abteilung NCD, Direktionsbereich Öffentliche Gesundheit, Bundesamt für Gesundheit BAG, Bern
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Romé Å, Persson U, Ekdahl C, Gard G. Physical activity on prescription (PAP): costs and consequences of a randomized, controlled trial in primary healthcare. Scand J Prim Health Care 2009; 27:216-22. [PMID: 19929183 PMCID: PMC3413913 DOI: 10.3109/02813430903438734] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse costs and consequences of changing physical activity behaviour due to the "Physical Activity on Prescription" (PAP) programme. DESIGN A randomized controlled trial with a four-month intervention, with comparison between intervention and control group. Intervention. The PAP programme, with exercise twice a week, education, and motivational counselling. SUBJECTS 525 sedentary individuals, 20-80 years (intervention group n = 268, control group n = 257), with lifestyle-related health problems. A total of 245 returned for the four-month assessment. MAIN OUTCOME MEASURE Programme costs based on intention-to-treat estimations, direct and indirect costs of inactivity, and physical activity behaviour analysed with IPAQ (International Physical Activity Questionnaire), self-reported physical activity, and measures of functional capacity. RESULTS The intention-to-treat programme costs for the four-month programme period was SEK (Swedish Kronor) 6475 (euro [Euro] 684) for the intervention group and SEK 3038 (euro 321) for the control group. Of this, healthcare providers' costs were 24% in the intervention group, and 31% in the control group. The physical activity behaviour was significantly improved in both groups, but no differences were found between the groups. Implications. The largest share of the PAP programme costs was the participants' costs. Significant improvements were shown in physical activity behaviour in both groups, but no differences were found between the intervention and control groups. Due to many non-completers, the potential for improvements of the motivating assignment with sedentary individuals in primary healthcare is obvious. Long-term follow-up can determine the sustainability of the results, and can be used in a future cost-effectiveness analysis.
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Affiliation(s)
- Åsa Romé
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund
| | - Ulf Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Charlotte Ekdahl
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund
| | - Gunvor Gard
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund
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