Paris Descartes University of Medicine, Sorbonne Paris Cité University, Paris, France.
Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), G. Montpied Hospital, INRA, UMR 1019, UNH, CRNH Auvergne, Clermont University, University of Auvergne, Clermont-Ferrand, France.
Adv Ther. 2020 May;37(5):2317-2336. doi: 10.1007/s12325-020-01336-8. Epub 2020 Apr 15.
Regular physical activity (PA) is recommended by all type 2 diabetes mellitus (T2DM) management guidelines. The OPADIA study aimed to determine whether using a specific patient questionnaire (Optima-PA©) could help T2DM patients increase their PA by leading to better physician-patient communication and improved levels of shared decision making concerning Specific, Measurable, Acceptable, Realistic, Timely (SMART)-PA micro-objectives.
Physicians participating in this multicentre, prospective, randomised, real-life study were allocated to a standard group (T2DM patients managed according to usual clinical practice, n = 24) or the OPTIMA-PA group (additional use of the questionnaire, n = 30). The main outcome was the percentage of inclusion visits ending with the setting up of at least one SMART-PA micro-objective. Other outcomes were the impact of the OPTIMA-PA questionnaire on patient perceptions of shared decision making (ENTRED questionnaire) and the impact of the OPTIMA-PA questionnaire and establishing SMART-PA micro-objectives as well as patient-perceived physician empathy (ENTRED questionnaire) and GP aptitude for patient-centredness (SEPCQ scores) on patient PA levels over a 3-month period (IPAQ-SF scores).
One hundred twenty-two patients were included in the standard group and 134 in the OPTIMA-PA group. Unexpectedly, more inclusion visits ended with SMART-PA micro-objectives being set up in the standard group (p < 0.001): 81.1% (n = 99/122) versus 59.7% (n = 80/134). However, fewer patients in the OPTIMA-PA group felt that GPs made decisions alone (32% versus 60%; p < 0.0001). Positive correlations were also observed between GP patient-centredness and patient-perceived GP empathy or increased patient PA over the study period.
Although the OPTIMA-PA questionnaire did not directly promote setting up of SMART-PA micro-objectives in T2DM patients, the OPADIA study demonstrated that this tool was effective at improving patient-physician relationships by increasing patient involvement in therapeutic decision making. Our study also highlighted the importance of GP aptitude for patient-centredness for improving PA in T2DM patients.
所有 2 型糖尿病（T2DM）管理指南都建议进行有规律的身体活动（PA）。OPADIA 研究旨在确定使用特定的患者问卷（Optima-PA©）是否可以通过改善医患沟通和提高特定、可衡量、可接受、现实、及时（SMART）-PA 微观目标的共享决策水平，帮助 T2DM 患者增加 PA。
参与这项多中心、前瞻性、随机、真实世界研究的医生被分配到标准组（根据常规临床实践管理 T2DM 患者，n=24）或 OPTIMA-PA 组（额外使用问卷，n=30）。主要结果是至少设定一个 SMART-PA 微观目标的纳入就诊百分比。其他结果是 OPTIMA-PA 问卷对患者共享决策感知的影响（ENTRED 问卷）以及 OPTIMA-PA 问卷和设定 SMART-PA 微观目标以及患者感知医生同理心（ENTRED 问卷）和 GP 以患者为中心的能力（SEPCQ 评分）对患者 PA 水平的影响在 3 个月的时间内（IPAQSF 评分）。
122 例患者纳入标准组，134 例纳入 OPTIMA-PA 组。出乎意料的是，标准组更多的纳入就诊结束时设定了 SMART-PA 微观目标（p<0.001）：81.1%（n=99/122）与 59.7%（n=80/134）。然而，OPADIA 研究表明，在 OPTIMA-PA 组中，更少的患者认为全科医生独自做出决定（32%对 60%；p<0.0001）。在研究期间，还观察到 GP 以患者为中心与患者感知的 GP 同理心或增加患者 PA 之间存在正相关关系。
尽管 OPTIMA-PA 问卷并未直接促进 T2DM 患者设定 SMART-PA 微观目标，但该研究表明，该工具通过增加患者对治疗决策的参与，有效改善了医患关系。我们的研究还强调了 GP 以患者为中心的能力对改善 T2DM 患者 PA 的重要性。
