小柯机器人

英国伦敦国王大学Julie Bieles团队比较了基于家庭的步行运动行为改变干预与常规护理对成人外周动脉疾病步行功能的影响。该项研究成果发表在2022年4月12日出版的《美国医学会杂志》上。

居家步行运动干预被推荐用于外周动脉疾病（PAD）患者，但其疗效的证据不一。

为了探讨与常规护理相比，物理治疗师在家中对PAD和间歇性跛行成年人进行步行运动行为改变干预的效果，2018年1月至2020年3月，研究组在英国6家医院进行了一项多中心随机临床试验，包括190名患有PAD和间歇性跛行的成年人；最终随访时间为2020年9月8日。将参与者随机分为两组，95例由接受过激励疗法训练的物理治疗师进行步行运动行为改变干预， 95例接受常规护理。

主要结局是3个月随访时的6分钟步行距离（最小临床重要差异，8-20米）。共有8项次要结局，其中3项是通过历史（WELCH）问卷（0[最佳表现]至100分）计算的步行估计限制，简短疾病认知问卷（0至80分[分数越高对疾病的认知越负面]），以及计划行为理论问卷（3到21分[21表示最佳态度、主观规范、感知行为控制或意图]）；这些仪器没有定义最小临床重要差异。

190名随机参与者的平均年龄为68岁，30%为女性，79%为白人，平均基线6分钟步行距离为361.0米，148人（78%）完成了3个月的随访。干预组的6分钟步行距离从基线检查时的352.9米变为3个月时的380.6米，常规护理组从369.8米变为372.1米，组间差异显著。在8项次要结局中，5项无统计学意义。

在6个月的随访中，干预组的基线WELCH评分从18.0变为27.8，常规护理组从20.7变为20.7；干预组的简短疾病认知问卷得分从45.7变为38.9，常规护理组的得分从44.0变为45.8；干预组的计划行为理论问卷的态度部分得分从14.7分变为15.4分，而常规护理组从14.6分变为13.9分，组间差异均显著。干预组发生13起严重不良事件，而常规护理组发生3起。所有不良事件都被确定与研究无关或不太可能相关。

研究结果表明，在患有PAD和间歇性跛行的成年人中，与常规护理相比，基于家庭的步行运动行为改变干预在3个月时改善了步行距离。需要进一步研究来确定这些发现的持久性。

附：英文原文

Title: Effect of a Home-Based, Walking Exercise Behavior Change Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease: The MOSAIC Randomized Clinical Trial

Author: Lindsay M. Bearne, Brittannia Volkmer, Janet Peacock, Mandeep Sekhon, Graham Fisher, Melissa N. Galea Holmes, Abdel Douiri, Aliya Amirova, Dina Farran, Sophia Quirke-McFarlane, Bijan Modarai, Catherine Sackley, John Weinman, Julie Bieles, MOSAIC Trial Collaboration, David French, Esther Williamson, Catherine Minns- Lowe, Nicholas Longford, Sanjay Patel, Peter Holt, Abdullah Jiwabi, Sharlene Greenwood, Janice Tsui, Paritosh Sharma, Helen Creasy, Heather Waring, Joanne Barnes, Jonathan da Costa, Bethany Hedges, Emma Bowen, Stuart Brandom, Leon Palmer Wilson, Heather Pursey, Diana Ascenso, Ellen Castle, Juliet Mayes, Ellie Lyons, Francesca Gowing, Joanna Buckley, Peter May

Issue&Volume: 2022/04/12

Abstract:

Importance  Home-based walking exercise interventions are recommended for people with peripheral artery disease (PAD), but evidence of their efficacy has been mixed.

Objective  To investigate the effect of a home-based, walking exercise behavior change intervention delivered by physical therapists in adults with PAD and intermittent claudication compared with usual care.

Design, Setting, and Participants  Multicenter randomized clinical trial including 190 adults with PAD and intermittent claudication in 6 hospitals in the United Kingdom between January 2018 and March 2020; final follow-up was September 8, 2020.

Interventions  Participants were randomized to receive a walking exercise behavior change intervention delivered by physical therapists trained to use a motivational approach (n=95) or usual care (n=95).

Main Outcomes and Measures  The primary outcome was 6-minute walking distance at 3-month follow-up (minimal clinically important difference, 8-20 m). There were 8 secondary outcomes, 3 of which were the Walking Estimated Limitation Calculated by History (WELCH) questionnaire (score range, 0 [best performance] to 100), the Brief Illness Perceptions Questionnaire (score range, 0 to 80 [80 indicates negative perception of illness]), and the Theory of Planned Behavior Questionnaire (score range, 3 to 21 [21 indicates best attitude, subjective norms, perceived behavioral control, or intentions]); a minimal clinically important difference was not defined for these instruments.

Results  Among 190 randomized participants (mean age 68 years, 30% women, 79% White race, mean baseline 6-minute walking distance, 361.0 m), 148 (78%) completed 3-month follow-up. The 6-minute walking distance changed from 352.9 m at baseline to 380.6 m at 3 months in the intervention group and from 369.8 m to 372.1 m in the usual care group (adjusted mean between-group difference, 16.7 m [95% CI, 4.2 m to 29.2 m]; P=.009). Of the 8 secondary outcomes, 5 were not statistically significant. At 6-month follow-up, baseline WELCH scores changed from 18.0 to 27.8 in the intervention group and from 20.7 to 20.7 in the usual care group (adjusted mean between-group difference, 7.4 [95% CI, 2.5 to 12.3]; P=.003), scores on the Brief Illness Perceptions Questionnaire changed from 45.7 to 38.9 in the intervention group and from 44.0 to 45.8 in the usual care group (adjusted mean between-group difference, 6.6 [95% CI, 9.9 to 3.4]; P<.001), and scores on the attitude component of the Theory of Planned Behavior Questionnaire changed from 14.7 to 15.4 in the intervention group and from 14.6 to 13.9 in the usual care group (adjusted mean between-group difference, 1.4 [95% CI, 0.3 to 2.5]; P=.02). Thirteen serious adverse events occurred in the intervention group, compared with 3 in the usual care group. All were determined to be unrelated or unlikely to be related to the study.

Conclusions and Relevance  Among adults with PAD and intermittent claudication, a home-based, walking exercise behavior change intervention, compared with usual care, resulted in improved walking distance at 3 months. Further research is needed to determine the durability of these findings.

DOI: 10.1001/jama.2022.3391

Source: https://jamanetwork.com/journals/jama/article-abstract/2790937

JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
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