Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
Syst Rev. 2013 May 11;2:29. doi: 10.1186/2046-4053-2-29.
Successful chronic care self-management requires adherence to healthy lifestyle behaviors, but many healthcare-based health promotion interventions have resulted in small and unsustainable changes in patient behavior. Patients with chronic conditions may already be overwhelmed by burdensome illnesses and treatments, and not have the capacity to respond well to the additional work required of behavior modifications. To explore this phenomenon, we will apply the cumulative complexity model (CCM), a patient-centered model of patient complexity, to a systematic review and meta-analysis of healthcare-based health behavior interventions.
METHODS/DESIGN: This systematic review will include randomized trials published between 2002 and 2012 that compared healthcare-based interventions aimed at improving healthy diet and physical activity in community dwelling adult patients with chronic conditions. After extracting study and risk of bias features from each trial, we will classify the interventions according to the conceptual model. We will then use meta-analysis and subgroup analysis to test hypotheses based on the conceptual model.
Healthcare providers need evidence of successful health promoting interventions for patients with chronic conditions who display common behavioral risk factors. To better understand how patients respond to interventions, we will apply the CCM, which accounts for both the capacity of patients with chronic conditions and their treatment-related workload, and posits that a balance between capacity and workload predicts successful enactment of self-care. Analysis will also include whether patients with multiple chronic conditions respond differently to interventions compared to those with single chronic conditions. The results of this review will provide insights as to how patients with chronic conditions respond to health-promoting interventions.
PROSPERO registration number: CRD42012003428.
成功的慢性病自我管理需要患者坚持健康的生活方式行为，但许多基于医疗保健的健康促进干预措施仅导致患者行为发生微小且不可持续的变化。患有慢性病的患者可能已经被繁重的疾病和治疗所压垮，没有能力很好地应对行为改变所需要的额外工作。为了探索这一现象，我们将应用累积复杂性模型（CCM），即一种以患者为中心的患者复杂性模型，对基于医疗保健的健康行为干预措施进行系统评价和荟萃分析。
方法/设计：本系统评价将包括 2002 年至 2012 年期间发表的随机试验，这些试验比较了旨在改善社区居住的慢性病成年患者健康饮食和身体活动的基于医疗保健的干预措施。从每项试验中提取研究和偏倚风险特征后，我们将根据概念模型对干预措施进行分类。然后，我们将使用荟萃分析和亚组分析根据概念模型检验假设。
医疗保健提供者需要为表现出常见行为风险因素的慢性病患者提供成功的促进健康干预措施的证据。为了更好地了解患者对干预措施的反应，我们将应用 CCM，该模型既考虑了慢性病患者的能力，又考虑了他们与治疗相关的工作量，并假设能力和工作量之间的平衡预测自我护理的成功实施。分析还将包括患有多种慢性病的患者与患有单一慢性病的患者相比，对干预措施的反应是否不同。本综述的结果将提供有关慢性病患者对促进健康干预措施的反应的见解。
PROSPERO 注册号：CRD42012003428。
