乳腺癌术后患者转介至心脏康复、休闲中心或电话咨询的体育活动：一项混合方法过程评估。
Physical activity referral to cardiac rehabilitation, leisure centre or telephone-delivered consultations in post-surgical people with breast cancer: a mixed methods process evaluation.
作者信息
Hubbard Gill, Campbell Anna, Fisher Abi, Harvie Michelle, Maltinsky Wendy, Mullen Russell, Banks Elspeth, Gracey Jackie, Gorely Trish, Munro Julie, Ozakinci Gozde
机构信息
1Department of Nursing, University of the Highlands and Islands, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH Scotland UK.
2School of Life Science, Sport and Social Science, Edinburgh Napier University, Edinburgh, EH11 4B Scotland UK.
出版信息
Pilot Feasibility Stud. 2018 Jun 1;4:108. doi: 10.1186/s40814-018-0297-1. eCollection 2018.
BACKGROUND
Physical activity (PA) programmes effective under 'research' conditions may not be effective under 'real-world' conditions. A potential solution is to refer patients to existing PA community-based PA services.
METHODS
A process evaluation of referral of post-surgical patients with early-stage breast cancer to cardiac rehabilitation exercise classes, leisure centre with 3-month free leisure centre membership or telephone-delivered PA consultations for 12 weeks. Quantitative data were collected about PA programme uptake and reach, patient engagement with the PA programme, delivery and fidelity and PA dose. Qualitative data were collected about patient experiences of taking part in the PA programmes. Audio-recorded qualitative interviews of participants about the programmes were analysed thematically. Quantitative data were reported descriptively using means and SD.
RESULTS
In Phase I, 30% ( = 20) of eligible patients ( = 20) consented, 85% ( = 17) chose referral to leisure centre, and 15% ( = 3) chose cardiac rehabilitation. In Phase II, 32% ( = 12) consented, 25% ( = 3) chose leisure centre and 75% ( = 9) chose telephone-delivered PA consultations. Walking at light intensity for about an hour was the most common PA. All Phase I participants received an induction by a cardiac rehabilitation physiotherapist or PA specialist from the leisure centre but only 50% of Phase II participants received an induction by a PA specialist from the leisure centre. Four themes were identified from qualitative interviews about programme choice: concerns about physical appearance, travel distance, willingness to socialise and flexibility in relation to doing PA. Four themes were identified about facilitators and barriers for engaging in PA: feeling better, feeling ill, weight management, family and friends.
CONCLUSIONS
The current community-based PA intervention is not yet suitable for a definitive effectiveness randomised controlled trial. Further work is needed to optimise PR programme reach, PA dose and intervention fidelity.
TRIAL REGISTRATION
ISRCTN11183372.
背景
在“研究”条件下有效的体育活动（PA）项目在“现实世界”条件下可能无效。一个潜在的解决方案是将患者转介到现有的基于社区的PA服务机构。
方法
对早期乳腺癌术后患者转介至心脏康复运动课程、提供3个月免费休闲中心会员资格的休闲中心或进行为期12周的电话PA咨询进行过程评估。收集了关于PA项目的参与率和覆盖范围、患者对PA项目的参与度、实施情况和保真度以及PA剂量的定量数据。收集了关于患者参与PA项目体验的定性数据。对参与者关于这些项目的录音定性访谈进行了主题分析。定量数据采用均值和标准差进行描述性报告。
结果
在第一阶段，30%（n = 20）的符合条件的患者（N = 20）同意参与，85%（n = 17）选择转介至休闲中心，15%（n = 3）选择心脏康复。在第二阶段，32%（n = 12）同意参与，25%（n = 3）选择休闲中心，75%（n = 9）选择电话PA咨询。轻度强度步行约一小时是最常见的PA。所有第一阶段的参与者都接受了心脏康复物理治疗师或休闲中心的PA专家的入门指导，但只有50%的第二阶段参与者接受了休闲中心的PA专家的入门指导。关于项目选择的定性访谈确定了四个主题：对身体外观的担忧、出行距离、社交意愿以及进行PA的灵活性。关于参与PA的促进因素和障碍确定了四个主题：感觉更好、感觉不适、体重管理、家人和朋友。
结论
当前基于社区的PA干预尚不适用于确定性有效性随机对照试验。需要进一步开展工作以优化PR项目的覆盖范围、PA剂量和干预保真度。
试验注册
ISRCTN11183372
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