Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada.
Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Diabetes Res Clin Pract. 2018 May;139:314-322. doi: 10.1016/j.diabres.2018.03.008. Epub 2018 Mar 10.
The integration of pedometers into clinical practice has the potential to enhance physical activity levels in patients with chronic disease. Our SMARTER randomized controlled trial demonstrated that a physician-delivered step count prescription strategy has measurable effects on daily steps, glycemic control, and insulin resistance in patients with type 2 diabetes and/or hypertension. In this study, we aimed to understand perceived barriers and facilitators influencing successful uptake and sustainability of the strategy, from patient and physician perspectives.
Qualitative in-depth interviews were conducted in a purposive sample of physicians (n = 10) and participants (n = 20), including successful and less successful cases in terms of pedometer-assessed step count improvements. Themes that achieved saturation in either group through thematic analysis are presented.
All participants appreciated the pedometer-based monitoring combined with step count prescriptions. Accountability to physicians and support offered by the trial coordinator influenced participant motivation. Those who increased step counts adopted strategies to integrate more steps into their routines and were able to overcome weather-related barriers by finding indoor alternative options to outdoor steps. Those who decreased step counts reported difficulty in overcoming weather-related challenges, health limitations and work constraints. Physicians indicated the strategy provided a framework for discussing physical activity and motivating patients, but emphasized the need for support from allied professionals to help deliver the strategy in busy clinical settings.
A physician-delivered step count prescription strategy was feasibly integrated into clinical practice and successful in engaging most patients; however, continual support is needed for maximal engagement and sustained use.
将计步器融入临床实践有潜力提高慢性病患者的身体活动水平。我们的 SMARTER 随机对照试验表明，医生提供的计步处方策略对 2 型糖尿病和/或高血压患者的日常步数、血糖控制和胰岛素抵抗有可衡量的影响。在这项研究中，我们旨在从患者和医生的角度了解影响策略成功采用和可持续性的感知障碍和促进因素。
采用目的抽样法对医生（n=10）和参与者（n=20）进行深入定性访谈，包括根据计步器评估的步数改善情况，成功和不太成功的案例。通过主题分析呈现出在任何一组中达到饱和的主题。
所有参与者都赞赏基于计步器的监测与计步处方相结合。对医生的责任和试验协调员提供的支持影响了参与者的动力。那些增加步数的人采用了将更多步数融入日常生活的策略，并能够通过寻找室内替代户外的选择来克服与天气相关的障碍。那些减少步数的人报告说，他们难以克服与天气相关的挑战、健康限制和工作限制。医生表示，该策略为讨论身体活动和激励患者提供了一个框架，但强调需要来自专业辅助人员的支持，以帮助在繁忙的临床环境中实施该策略。
医生提供的计步处方策略可以切实融入临床实践，并成功地吸引大多数患者；然而，需要持续支持以实现最大程度的参与和持续使用。
