Mills Kyly, Gatton Michelle L, Mahoney Ray, Nelson Alison
School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
First Peoples Health Unit, Griffith University, Gold Coast, QLD, Australia.
BMC Health Serv Res. 2017 Sep 26;17(1):680. doi: 10.1186/s12913-017-2631-3.
Chronic diseases disproportionately burden Aboriginal and Torres Strait Islander people in Australia, with cardiovascular (CV) diseases being the greatest contributor. To improve quality of life and life expectancy for people living with CV disease, secondary prevention strategies such as rehabilitation and self-management programs are critical. However, there is no published evidence examining the effect of chronic condition self-management (CCSM) group programs for Aboriginal and Torres Strait Islander people who have, or are at risk of, CV disease specifically. This study evaluates the Work It Out program for its effect on clinical outcome measures in urban Aboriginal and Torres Strait Islander participants with or at risk of CV disease.
This study was underpinned by a conceptual framework based on Aboriginal and Torres Strait Islander community control. Participants had at least one diagnosed CV disease, or at least one CV disease risk factor. Short-term changes in clinical outcome measures over (approximately) 12 weeks were evaluated with a quasi-experimental, pre-post test design, using paired t-tests. Factors contributing to positive changes were tested using general linear models. The outcome measures included blood pressure (mmHg), weight (kg), body mass index (kg/m), waist and hip circumference (cm), waist to hip ratio (waist cm/hip cm) and six minute walk test (6MWT).
Changes in several clinical outcome measures were detected, either within the entire group (n = 85) or within specific participant sub-groups. Participant's 6MWT distance improved by an average 0.053 km (95% CI: 0.01-0.07 km). The change in distance travelled was influenced by number of social and emotional wellbeing conditions participants presented with. The weight of participants classified with extreme obesity decreased on average by 1.6 kg (95% CI: 0.1-3.0 kg). Participants with high baseline systolic blood pressure demonstrated a mean decrease of 11 mmHg (95% CI: 3.2-18.8 mmHg). Change in blood pressure was influenced by the number of cardiovascular conditions participants experienced.
Short-term improvements seen in some measures could indicate a trend for improvement in other indicators over the longer term. These results suggest the Work It Out program could be a useful model for cardiovascular rehabilitation and prevention for other urban Aboriginal and Torres Strait Islander populations.
慢性病给澳大利亚原住民和托雷斯海峡岛民带来了不成比例的负担，其中心血管疾病是最大的致病因素。为了提高心血管疾病患者的生活质量和预期寿命，康复和自我管理计划等二级预防策略至关重要。然而，目前尚无已发表的证据来研究慢性病自我管理（CCSM）小组计划对患有心血管疾病或有心血管疾病风险的原住民和托雷斯海峡岛民的影响。本研究评估了“动起来”计划对患有心血管疾病或有心血管疾病风险的城市原住民和托雷斯海峡岛民参与者临床结局指标的影响。
本研究以基于原住民和托雷斯海峡岛民社区控制的概念框架为基础。参与者至少患有一种已确诊的心血管疾病，或至少有一个心血管疾病风险因素。采用配对t检验的准实验前后测试设计，评估（约）12周内临床结局指标的短期变化。使用一般线性模型测试促成积极变化的因素。结局指标包括血压（mmHg）、体重（kg）、体重指数（kg/m）、腰围和臀围（cm）、腰臀比（腰围cm/臀围cm）和六分钟步行试验（6MWT）。
在整个组（n = 85）或特定参与者亚组中均检测到了几种临床结局指标的变化。参与者的6MWT距离平均提高了0.053 km（95%CI：0.01 - 0.07 km）。行走距离的变化受参与者出现的社会和情感健康状况数量的影响。被归类为极度肥胖的参与者体重平均下降了1.6 kg（95%CI：0.1 - 3.0 kg）。基线收缩压高的参与者平均下降了11 mmHg（95%CI：3.2 - 18.8 mmHg）。血压变化受参与者经历的心血管疾病数量的影响。
在某些指标上看到的短期改善可能表明其他指标在长期内有改善趋势。这些结果表明，“动起来”计划可能是其他城市原住民和托雷斯海峡岛民群体进行心血管康复和预防的有用模式。
