加拿大“运动即良药”研讨会参与者的医疗保健提供者信心与运动处方实践

Health care provider confidence and exercise prescription practices of Exercise is Medicine Canada workshop attendees.

作者信息

O'Brien Myles W, Shields Christopher A, Oh Paul I, Fowles Jonathon R

机构信息

a School of Kinesiology, Acadia University, 550 Main Street, Wolfville, NS B4P 2R6, Canada.

b Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute/University Health Network, Toronto, ON, Canada.

出版信息

Appl Physiol Nutr Metab. 2017 Apr;42(4):384-390. doi: 10.1139/apnm-2016-0413. Epub 2016 Dec 14.

Abstract

The Exercise is Medicine Canada (EIMC) initiative promotes physical activity counselling and exercise prescription within health care. The purpose of this study was to evaluate perceptions and practices around physical activity counselling and exercise prescription in health care professionals before and after EIMC training. Prior to and directly following EIMC workshops, 209 participants (physicians (n = 113); allied health professionals (AHPs) (n = 54), including primarily nurses (n = 36) and others; and exercise professionals (EPs) (n = 23), including kinesiologists (n = 16), physiotherapists (n = 5), and personal trainers (n = 2)) from 7 provinces completed self-reflection questionnaires. Compared with AHPs, physicians saw more patients (78% > 15 patients/day vs 93% < 15 patients/day; p < 0.001) and reported lower frequencies of exercise counselling during routine client encounters (48% vs 72% in most sessions; p < 0.001). EPs had higher confidence providing physical activity information (92 ± 11%) compared with both physicians (52 ± 25%; p < 0.001) and AHPs (56 ± 24%; p < 0.001). Physicians indicated that they experienced greater difficulty including physical activity and exercise counselling into sessions (2.74 ± 0.71, out of 5) compared with AHPs (2.17 ± 0.94; p = 0.001) and EPs (1.43 ± 0.66; p < 0.001). Physicians rated the most impactful barriers to exercise prescription as lack of patient interest (2.77 ± 0.85 out of 4), resources (2.65 ± 0.82 out of 4), and time (2.62 ± 0.71 out of 4). The majority of physicians (85%) provided a written prescription for exercise in <10% of appointments. Following the workshop, 87% of physician attendees proposed at least one change to practice; 47% intended on changing their practice by prescribing exercise routinely, and 33% planned on increasing physical activity and exercise counselling, measured through open-ended responses.

摘要

加拿大运动即医疗(EIMC)倡议在医疗保健领域推广身体活动咨询和运动处方。本研究的目的是评估EIMC培训前后医疗保健专业人员对身体活动咨询和运动处方的认知及实践情况。在EIMC研讨会之前及之后,来自7个省份的209名参与者(医生(n = 113);专职医疗专业人员(AHP)(n = 54),主要包括护士(n = 36)及其他人员;运动专业人员(EP)(n = 23),包括运动机能学家(n = 16)、物理治疗师(n = 5)和私人教练(n = 2))完成了自我反思问卷。与专职医疗专业人员相比,医生看诊的患者更多(78%>每天15名患者 vs 93%<每天15名患者;p<0·001),且报告在常规看诊时进行运动咨询的频率较低(大多数就诊中为48% vs 72%;p<0·001)。运动专业人员在提供身体活动信息方面比医生(52±25%;p<0·001)和专职医疗专业人员(56±24%;p<0·001)更有信心(92±11%)。医生表示,与专职医疗专业人员(2.17±0.94;p = 0.001)和运动专业人员(1.43±0.66;p<0·001)相比,他们在将身体活动和运动咨询纳入诊疗过程中遇到更大困难(满分5分,为2.74±0.71)。医生将运动处方最具影响力的障碍评为患者缺乏兴趣(满分4分,为2.77±0.85)、资源(2.65±0.82)和时间(2.62±0.71)。大多数医生(85%)在不到10%的预约中开具运动书面处方。研讨会之后,87%的医生参会者提出至少一项实践改进建议;47%打算通过常规开具运动处方来改变其诊疗方式,33%计划增加身体活动和运动咨询,这通过开放式回答进行衡量。

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