Katz David L, Shuval Kerem, Comerford Beth P, Faridi Zubaida, Njike Valentine Y
Yale Prevention Research Center, Derby, CT 06418, USA.
J Eval Clin Pract. 2008 Apr;14(2):294-9. doi: 10.1111/j.1365-2753.2007.00853.x.
RATIONALE, AIMS AND OBJECTIVES: Systematic reviews point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing adults' physical activity (PA) levels. This study evaluates the impact of an innovative physician counselling programme on physicians' PA counselling behaviour and their patients' PA levels.
A controlled educational study conducted at six Yale School of Medicine hospitals. Sixty-five internal medicine residents and 316 primary care patients were randomized to intervention or control groups. Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model, while control physicians received usual residency training. Intervention and control patients' PA levels and residents counselling behaviour were assessed using a validated questionnaire and compared pre- and post intervention. Data analysis was performed using paired t-tests and repeated measures anova.
At 6-month follow-up intervention, patients' PA levels increased significantly from baseline (1.77 +/- 0.84; P = 0.0376). A similar pattern was observed after 12 months (1.94 +/- 0.98; P = 0.0486). Control patients' PA did not change significantly from baseline at 6 or 12 months (0.35 +/- 1.00; P = 0.7224 and 0.99 +/- 1.52; P = 0.5160, respectively). At 12 months, intervention residents provided PA counselling 1.5 times more than they did at baseline (P < 0.05) compared with no significant changes in the control group.
The present study has shown that providing residents with a practical tool, enabling them to deal with patients' barriers and previous failure in behavioural change, is efficacious in increasing PA levels of adult patients.
原理、目的和目标：系统评价指出，在初级保健环境中为患者提供咨询是否能有效提高成年人的身体活动（PA）水平，证据尚无定论。本研究评估了一项创新的医生咨询计划对医生PA咨询行为及其患者PA水平的影响。
在耶鲁大学医学院的六家医院进行了一项对照教育研究。65名内科住院医师和316名初级保健患者被随机分为干预组或对照组。干预组医生参加了五次互动课程，概述了压力系统模型的细节，而对照组医生接受常规住院医师培训。使用经过验证的问卷评估干预组和对照组患者的PA水平以及住院医师的咨询行为，并在干预前后进行比较。数据分析采用配对t检验和重复测量方差分析。
在6个月的随访干预中，患者的PA水平较基线显著提高（1.77±0.84；P = 0.0376）。12个月后观察到类似模式（1.94±0.98；P = 0.0486）。对照组患者的PA在6个月或12个月时与基线相比无显著变化（分别为0.35±1.00；P = 0.7224和0.99±1.52；P = 0.5160）。在12个月时，干预组住院医师提供PA咨询的次数比基线时多1.5倍（P < 0.05），而对照组无显著变化。
本研究表明，为住院医师提供一种实用工具，使他们能够应对患者的障碍和以往行为改变的失败，对提高成年患者的PA水平是有效的。
