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Wintle E, Taylor NF, Harding K, O'Halloran P, Peiris CL. Physical therapist-delivered motivational interviewing and health-related behaviour change: A systematic review and meta-analysis. Braz J Phys Ther 2025; 29:101168. [PMID: 39742737 PMCID: PMC11751405 DOI: 10.1016/j.bjpt.2024.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/06/2024] [Accepted: 12/17/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Motivational interviewing (MI) promotes health-related behaviour change and improves patient health outcomes, but the effect of physical therapist-delivered MI is unclear. OBJECTIVE To evaluate the effect of physical therapist-delivered MI on health-related behaviour change in adults attending physical therapy or rehabilitation. METHODS CINAHL, Medline, PubMed, PEDro, Embase, and Cochrane databases were searched in August 2023. Randomised controlled trials evaluating physical therapist-delivered MI and health-related behaviour change were included. Internal validity was evaluated using the PEDro scale. GRADE approach was used for each meta-analysis. RESULTS Ten publications from nine randomised controlled trials involving 909 participants were included. Physical therapist-delivered MI likely increased physical activity slightly (SMD 0.21, 95 % CI -0.05, 0.47) when compared to minimal intervention; however the evidence is very uncertain in relation to self-efficacy (SMD 0.51, 95 % CI -0.35, 1.38) and health-related quality of life (SMD 0.73, 95 % CI -0.64, 2.11). When physical therapist-delivered MI was combined with and compared to rehabilitation, there were no additional effects on physical activity (SMD 0.02, 95 % CI -0.37, 0.41), health-related quality of life (SMD 0.18, 95 % CI -0.27, 0.63), or endurance (SMD 0.15, 95 % CI -0.21, 0.52) and a likely small effect on self-efficacy (SMD 0.23, 95 % CI -0.1, 0.55). CONCLUSION Physical therapist-delivered MI is likely to produce a small improvement in physical activity, but only in the absence of other comprehensive rehabilitation. The most beneficial application of MI may be for patients who are not receiving rehabilitation or who have low levels of motivation and self-efficacy.
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Affiliation(s)
- Elizabeth Wintle
- Community Rehabilitation Program, Eastern Health, Melbourne, Victoria, Australia; La Trobe University Academic and Research Collaborative in Health (ARCH), Melbourne, Australia.
| | - Nicholas F Taylor
- La Trobe University Academic and Research Collaborative in Health (ARCH), Melbourne, Australia; Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Katherine Harding
- La Trobe University Academic and Research Collaborative in Health (ARCH), Melbourne, Australia; Eastern Health Allied Health Clinical Research Office, Box Hill, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health La Trobe University, La Trobe University, Melbourne, Australia
| | - Casey L Peiris
- La Trobe University Academic and Research Collaborative in Health (ARCH), Melbourne, Australia; Allied Health, The Royal Melbourne Hospital, Parkville, Australia
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2
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Voss ML, Brick R, Padgett LS, Wechsler S, Joshi Y, Ammendolia Tomé G, Arbid S, Campbell G, Campbell KL, El Hassanieh D, Klein C, Lam A, Lyons KD, Sabir A, Sleight AG, Jones JM. Behavior change theory and behavior change technique use in cancer rehabilitation interventions: a secondary analysis. Eur J Phys Rehabil Med 2024; 60:1036-1050. [PMID: 39445735 PMCID: PMC11713631 DOI: 10.23736/s1973-9087.24.08452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 09/10/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness. AIM This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions. DESIGN Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability. SETTING In-person and remotely delivered rehabilitation interventions. POPULATION Adult cancer survivors. METHODS Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT). RESULTS Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios. CONCLUSIONS While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness. CLINICAL REHABILITATION IMPACT Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.
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Affiliation(s)
- M Lauren Voss
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Rachelle Brick
- Division of Cancer Control and Population Sciences, National Cancer Institute, Behavioral Research Program, Basic Biobehavioral and Psychological Sciences Research Branch, Rockville, MD, USA
| | - Lynne S Padgett
- Veterans Affairs, Office of Research Development, Washington DC, USA
| | - Stephen Wechsler
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Yash Joshi
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Genevieve Ammendolia Tomé
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Sasha Arbid
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Grace Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Duquesne University, School of Nursing, University of Pittsburgh School of Medicine, Pittsburgh, MA, USA
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Dima El Hassanieh
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Caroline Klein
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Adrienne Lam
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Kathleen D Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Aisha Sabir
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Alix G Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer M Jones
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada -
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Dennett AM, Shields N, Barton C, Ezzat A, Physiother GTB, Taylor NF, Harding KE, Peiris CL. 'Making a connection': a qualitative study of experiences from a cancer telerehabilitation program. Support Care Cancer 2024; 32:636. [PMID: 39235650 PMCID: PMC11377521 DOI: 10.1007/s00520-024-08803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE Specialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilitation program for people with cancer. METHOD A qualitative study using semi-structured interviews was completed. Twenty-two cancer survivors were purposively sampled from the experimental group of a randomised controlled trial evaluating exercise-based cancer telerehabilitation delivered in groups using synchronous videoconferencing. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed inductively by thematic analysis. RESULTS 'A feeling of connection' was the overarching theme. Participants perceived they connected with the health service, expert health professionals, and peers through participating in the telerehabilitation program. These connections provided a personalised rehabilitation experience and improved perceptions of physical and emotional well-being. Two subthemes suggested connection was facilitated by (1) the acceptability of telerehabilitation and (2) enhanced accountability to exercise. Participants felt disconnected when they were unable to participate in the program due to cancer treatment and side effects (e.g. fatigue), feeling unwell, and co-morbidities. CONCLUSION We identified that telerehabilitation facilitated connections that enhanced the reach of exercise to cancer survivors. Our findings support using telerehabilitation to deliver specialised group-based exercise programs alongside more traditional models of care to increase participation in exercise among people with cancer.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, VIC, Australia.
| | - Nora Shields
- School of Psychology and Public Health, Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Christian Barton
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Allison Ezzat
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | | | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, VIC, Australia
| | - Katherine E Harding
- School of Allied Health, Human Services and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, VIC, Australia
| | - Casey L Peiris
- Allied Health Department, The Royal Melbourne Hospital and School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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Zhu S, Sinha D, Kirk M, Michalopoulou M, Hajizadeh A, Wren G, Doody P, Mackillop L, Smith R, Jebb SA, Astbury NM. Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ 2024; 386:e078713. [PMID: 38986547 PMCID: PMC11234249 DOI: 10.1136/bmj-2023-078713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults. DESIGN Systematic review and meta-analysis. STUDY SELECTION A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined. RESULTS 129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples. CONCLUSIONS Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020219881.
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Affiliation(s)
- SuFen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Deepra Sinha
- St Hugh's College, University of Oxford, Oxford, UK
| | - Megan Kirk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gina Wren
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Doody
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Ralph Smith
- Sport and Exercise Medicine Department, Nuffield Orthopaedic Centre Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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5
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Tan GA, Peiris CL, Dennett AM. Cancer survivors maintain health benefits 6 to 12 months after exercise-based rehabilitation: a systematic review and meta-analysis. J Cancer Surviv 2024; 18:651-672. [PMID: 36547801 DOI: 10.1007/s11764-022-01322-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months. METHODS Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied. RESULTS Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I2 = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I2 = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I2 = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I2 = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I2 = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I2 = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence. CONCLUSION Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation.
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Affiliation(s)
- Germaine A Tan
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia.
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia.
| | - Casey L Peiris
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Melbourne, VIC, Australia
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
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Takemura N, Ho MH, Cheung DST, Lin CC. Effectiveness of motivational strategies on physical activity behavior and associated outcomes in patients with cancer: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2024; 21:253-262. [PMID: 37940607 DOI: 10.1111/wvn.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Motivational interviewing is a client-centered counseling technique widely applied as a behavior change strategy. It has been adopted to help cancer patients modify health behaviors. The effectiveness of motivational interviewing on physical activity behavior and its associated outcomes in cancer patients is unclear. AIM The aim of this review was to determine the effect of motivational interviewing with other motivational strategies on physical activity behavior and associated outcomes in cancer patients. METHODS This is a systematic review and meta-analysis of randomized controlled trials, following PRISMA guidelines. Eight English databases were searched from inception to October 2022. The outcomes were evaluated using standardized mean differences (SMDs) with fixed- and random-effects models. Methodological quality of the studies was assessed by Cochrane Risk of Bias Tool 2.0. RESULTS Eight trials with 450 participants were identified, with sample sizes ranging from 25 to 87. The number of motivational interviewing sessions ranged from one to 12. The types of motivational strategy intervention varied. Apart from motivational interviewing, pedometers were frequently used as a strategy. The quality of the included studies differed, with one out of eight scoring low in the overall risk of bias. Our meta-analysis indicated that motivational interviewing with other motivational strategies significantly promoted the total physical activity level (SMD = 0.34, 95% confidence interval [0.10, 0.58], p = .005; low certainty), but not did not affect other physical and psychosocial outcomes. CONCLUSION The combination of motivational interviewing with other motivational strategies was beneficial in increasing the total physical activity level of cancer patients. LINKING EVIDENCE TO ACTION Motivational interviewing can be a clinical communication skill that healthcare professionals, especially nurses, can acquire to motivate patients to change their behaviors to promote health. Future studies adopting motivational interviewing interventions could consider additional motivational strategies, such as pedometers, to maximize the benefits on physical activity behaviors.
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Affiliation(s)
- Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
- Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Pok Fu Lam, Hong Kong
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7
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Brick R, Padgett L, Jones J, Wood KC, Pergolotti M, Marshall TF, Campbell G, Eilers R, Keshavarzi S, Flores AM, Silver JK, Virani A, Livinski AA, Ahmed MF, Kendig T, Khalid B, Barnett J, Borhani A, Bernard G, Lyons KD. The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review. J Cancer Surviv 2023; 17:1725-1750. [PMID: 35218521 PMCID: PMC8881759 DOI: 10.1007/s11764-022-01181-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.
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Affiliation(s)
- Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Lynne Padgett
- VA Central Office, Health Services Research and Development, 1100 1st St NE, Suite 6, Washington, DC, 20002, USA
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kelley Covington Wood
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Timothy F Marshall
- Ivy Rehab Network, 1311 Mamaroneck Ave, Suite 140, White Plains, NY, 10605, USA
| | - Grace Campbell
- Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences and UPMC Hillman Cancer Center at UPMC Magee, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Rachel Eilers
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Center, 610 University Ave, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
- Brigham and Women's Hospital, 55 Fruit Street, Boston, MA, USA
- Spaulding Rehabilitation Hospital, 55 Fruit Street, Boston, MA, USA
| | - Aneesha Virani
- Department of Rehabilitation Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA, 30342, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, OD, NIH, MSC 1150, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mohammed Faizan Ahmed
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Tiffany Kendig
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Bismah Khalid
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1VT, Canada
| | - Jeremy Barnett
- George Washington University School of Medicine and Health Sciences, 2300 I St. NW, Washington, DC, 20052, USA
| | - Anita Borhani
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Graysen Bernard
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, Building 79/96, 79 13th Street, Boston, MA, 02129, USA
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8
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Seven M, Reid A, Abban S, Madziar C, Faro JM. Motivational interviewing interventions aiming to improve health behaviors among cancer survivors: a systematic scoping review. J Cancer Surviv 2023; 17:795-804. [PMID: 36100801 PMCID: PMC10652272 DOI: 10.1007/s11764-022-01253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The scoping review aimed to map out the literature on the utilization of motivational interviewing (MI) to improve health behaviors (i.e., physical activity, nutrition) in adult cancer survivors. METHODS This scoping review was conducted following the methods and protocol outlined by the Joanna Briggs Institute Methods Manual. Five databases, including PubMed, CINAHL, Web of Science, and SPORTDiscus, were searched in February 2022 to identify MI interventions to improve health behaviors among cancer survivors. RESULTS The review included 22 interventions mostly designed to optimize exercise/physical activity (50%). The number of sessions ranged from 2 to 19, and most MI sessions were offered via telephone calls combined with face-to-face sessions (31.8%). Of the interventions, 81.8% improved at least one outcome measurement. Most studies used principles of MI such as empathy expression, developing discrepancy, roll with resistance, and supporting self-efficacy. CONCLUSION The use of MI appears to have the potential to improve health behaviors in various settings for individuals on different cancer care trajectories. IMPLICATIONS FOR CANCER SURVIVORS Healthcare providers can use MI to support physical activity and a healthy diet. Future research should focus on providing evidence on the utilization of MI with minimum standards and longitudinal outcome assessment for developing and maintaining sustainable healthy behaviors.
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Affiliation(s)
- Memnun Seven
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, 230 Skinner Hall, 651 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Allecia Reid
- Department of Psychological and Brain Sciences, College of Natural Sciences, University of Massachusetts Amherst, Tobin 628, Amherst, MA, 01003, USA
| | - Sabriye Abban
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, 230 Skinner Hall, 651 North Pleasant Street, Amherst, MA, 01003, USA
| | - Camilla Madziar
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
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9
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Dennett AM, Porter J, Ting SB, Taylor NF. Prehabilitation to improve outcomes afteR Autologous sTem cEll transplantation (PIRATE): A pilot randomised controlled trial protocol. PLoS One 2023; 18:e0277760. [PMID: 37104482 PMCID: PMC10138261 DOI: 10.1371/journal.pone.0277760] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/04/2022] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Autologous stem cell transplant is a common procedure for people with haematological malignancies. While effective at improving survival, autologous stem cell transplant recipients may have a lengthy hospital admission and experience debilitating side-effects such as fatigue, pain and deconditioning that may prolong recovery. Prehabilitation comprising exercise and nutrition intervention before stem cell transplant aims to optimise physical capacity before the procedure to enhance functional recovery after transplant. However, few studies have evaluated prehabilitation in this setting. We aim to explore preliminary efficacy of improving physical capacity of prehabilitation for people undergoing autologous stem cell transplant. METHODS The PIRATE study is a single-blinded, parallel two-armed pilot randomised trial of multidisciplinary prehabilitation delivered prior to autologous stem cell transplantation. Twenty-two patients with haematological malignancy waitlisted for transplant will be recruited from a tertiary haematology unit. The intervention will include up to 8 weeks of twice-weekly, supervised tailored exercise and fortnightly nutrition education delivered via phone, in the lead up to autologous stem cell transplant. Blinded assessments will be completed at week 13, approximately 4 weeks after transplant and health service measures collected at week 25 approximately 12 weeks after transplant. The primary outcome is to assess changes in physical capacity using the 6-minute walk test. Secondary measures are time to engraftment, C-reactive protein, physical activity (accelerometer), grip strength, health-related quality of life (EORTC QLQ-C30 and HDC29 supplement), self-efficacy and recording of adverse events. Health service data including hospital length of stay, hospital readmissions, emergency department presentations and urgent symptom clinic presentation at will also be recorded. DISCUSSION This trial will inform design of a future definitive randomised controlled trial and implementation of prehabilitation for people receiving autologous stem cell transplant by providing data on efficacy and safety. TRIAL REGISTRATION The PIRATE Trial has been approved by the Eastern Health Human Research Ethics Committee (E20/003/61055) and is funded by the Eastern Health Foundation. This trial is registered with the Australian New Zealand Clinical Trials Registry ACTRN12620000496910. Registered April 20, 2020.
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Affiliation(s)
- Amy M. Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Stephen B. Ting
- Department of Clinical Haematology, Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Nicholas F. Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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Harkin K, Apostolopoulos V, Tangalakis K, Irvine S, Tripodi N, Feehan J. The impact of motivational interviewing on behavioural change and health outcomes in cancer patients and survivors. A systematic review and meta-analysis. Maturitas 2023; 170:9-21. [PMID: 36736204 DOI: 10.1016/j.maturitas.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cancer patients and survivors commonly have poorer health behaviours and subsequent outcomes, often as a result of negative impacts of diagnosis and treatment. Motivational interviewing is reported to be an effective psychological tool to produce a shift in one's behaviour resulting in improved outcomes. However, there is a lack of analyses investigating this tool's impact on healthy behaviours and health outcomes in cancer populations. OBJECTIVE To investigate the effect of motivational interviewing on behaviours and health outcomes in cancer populations. METHODS The studies were identified from four databases using variations of the terms "cancer" and "motivational interviewing". Randomised trials, non-randomised trials and quasi-experimental studies which contained control (or usual care) comparators were included. Risk of bias was assessed using the Cochrane Risk of Bias Version 5.1.0 and the Risk of Bias In Non-Randomised Studies of Interventions tools. The quality of evidence was assessed using the GRADE framework. Means difference and standardised mean differences and 95 % confidence intervals were used to report the pooled effects using a random effects model. RESULTS Twenty-one studies were included in the review and 17 studies were included in the meta-analysis. A total of 1752 cancer patients and survivors received MI as an intervention (or part thereof). Quality of life, anxiety, depression, functional tasks (6-minute walk test), body mass index and body weight (BMI/BW), physical activity (PA), self-efficacy and fatigue were outcomes measured in the selected studies. Effects were seen in functional tasks, physical activity, BMI/BW, depression and self-efficacy. All of these outcomes were from studies that were classed as very low-quality evidence except for BMI/BW and PA, which were from moderate-quality evidence. CONCLUSION Motivational interviewing had positive effects on functional tasks, PA, BMI/BW, depression and self-efficacy in people diagnosed with cancer. However, more higher-quality studies need to be conducted to further ascertain the effect of this intervention.
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Affiliation(s)
- Katherine Harkin
- Institute for Health and Sport, Victoria University, Melbourne, Australia; First Year College, Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, The University of Melbourne and Western Health, St. Albans, Australia
| | - Kathy Tangalakis
- First Year College, Victoria University, Melbourne, Australia; Institute for Sustainable Industries & Liveable Cities, Victoria University, Melbourne, Australia
| | - Susan Irvine
- First Year College, Victoria University, Melbourne, Australia
| | - Nicholas Tripodi
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, The University of Melbourne and Western Health, St. Albans, Australia; First Year College, Victoria University, Melbourne, Australia.
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, The University of Melbourne and Western Health, St. Albans, Australia.
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11
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Dennett AM, Harding KE, Peiris CL, Shields N, Barton C, Lynch L, Parente P, Lim D, Taylor NF. Efficacy of Group Exercise-Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e38553. [PMID: 35849441 PMCID: PMC9345024 DOI: 10.2196/38553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise-based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. OBJECTIVE We aimed to evaluate the efficacy of a group exercise-based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. RESULTS The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38553.
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Affiliation(s)
- Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Christian Barton
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Lauren Lynch
- Community Health, Eastern Health, Healesville, Australia
| | - Phillip Parente
- Department of Cancer Services, Eastern Health, Box Hill, Australia
- Eastern Health Clinical School, Monash University, Clayton, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Campbelltown, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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12
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Dennett A, Harding KE, Reimert J, Morris R, Parente P, Taylor NF. Telerehabilitation's Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation. JMIR Cancer 2021; 7:e33130. [PMID: 34854817 PMCID: PMC8768007 DOI: 10.2196/33130] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. OBJECTIVE Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. METHODS A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. RESULTS The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus $1104 (US $790). CONCLUSIONS Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation.
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Affiliation(s)
- Amy Dennett
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Jacoba Reimert
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Rebecca Morris
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Phillip Parente
- Department of Cancer Services, Eastern Health, Box Hill, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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13
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Vaikuntharajan P, Tobis M, Richardson J. Telephone-Delivered Physiotherapy Interventions Improve Physical Function for Adults With a Chronic Condition: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:131-144.e14. [PMID: 34416249 DOI: 10.1016/j.apmr.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/02/2021] [Accepted: 05/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the efficacy of telephone-delivered physiotherapy interventions to improve lower extremity physical function and walking in adults aged ≥45 years with a chronic condition. DATA SOURCES A literature search was conducted using health databases (MEDLINE, PsychINFO, EMBASE, The Allied and Complementary Medicine Database, Web of Science, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature) up to April 26, 2020. Reference lists of relevant studies were explored to identify additional studies. STUDY SELECTION The original search resulted in 3465 studies. Five other studies were included from hand searches. After duplicates were removed, 2820 studies remained. Title and abstract screening was completed independently by 2 authors and resulted in the exclusion of 2596 studies. The full-texts of the remaining 224 articles were assessed and 204 studies were excluded. Twenty articles were examined. DATA EXTRACTION Data were extracted independently by 2 authors, including study, population, and intervention details; assessment timings; outcome characteristics; appropriateness of statistical methods; adverse events; and reasons for loss to follow-up. Study quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS Twenty studies were included in the systematic review. One study was not meta-analyzed owing to insufficient data. Telephone-delivered physiotherapy had a small to moderate effect on distance walked compared with control groups with no exercise intervention (standardized mean difference [SMD], 0.28; 95% confidence interval [CI], 0.00-0.56; I2, 45%) and no effect when compared with control groups with an exercise intervention not delivered by telephone (SMD, 0.08; 95% CI, -0.19 to 0.36; I2, 0%). CONCLUSION Telephone-delivered physiotherapy may be an effective method to improve walking. Further research is required to validate these findings.
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Affiliation(s)
| | | | - Julie Richardson
- School of Rehabilitation, McMaster University, Hamilton, Ontario, Canada.
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14
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Dennett AM, Zappa B, Wong R, Ting SB, Williams K, Peiris CL. Bridging the gap: a pre-post feasibility study of embedding exercise therapy into a co-located cancer unit. Support Care Cancer 2021; 29:6701-6711. [PMID: 33963458 PMCID: PMC8105143 DOI: 10.1007/s00520-021-06261-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE To establish the feasibility of embedding a flexible, exercise-based rehabilitation program into a cancer treatment unit to allow cancer survivors early exercise support. METHOD A pre-post study was conducted using Bowen's Framework to describe key domains of feasibility: demand (referrals), acceptability (uptake, attendance, satisfaction), implementation (resources), practicality (adverse events, costs) and limited-efficacy (function, quality of life, self-efficacy). Participants were medically stable, adult cancer survivors receiving curative or palliative treatment for cancer at the health service. Participants completed an 8-week home or hospital-based exercise program. Data were analysed descriptively. Standardised mean differences (Hedge's g) and mean differences were calculated to determine effect size and clinical significance. RESULTS The exercise-based rehabilitation service received 155 referrals over 6 months. Of those eligible, 73/119 (61%) commenced. Participants opting for twice-weekly, hospital-based exercise attended 9/16 (56%) sessions. Participants reported high satisfaction and there were no major adverse events. The program utilised existing resources, with the predominant cost being staff. The average health service cost per participant was AUD $1,104. Participants made clinically significant gains in function (6-min walk distance; + 73 m, 95% confidence interval 49 to 96) and quality of life (EORTC QLQ-C30 Global quality of life; + 8 units, 95% confidence interval 3 to 13). CONCLUSION Implementation of exercise-based rehabilitation in a co-located cancer unit was safe and feasible. Access, patient and staff education and establishing funding streams are important implementation considerations. Implications for cancer survivors Access to exercise in a cancer unit provides opportunity for early intervention to optimise function during treatment.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, VIC, Australia.
| | - Bernadette Zappa
- North Eastern Melbourne Cancer Services and Department of Cancer Services, Eastern Health, Box Hill, VIC, Australia
| | - Rachel Wong
- Department of Oncology, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Stephen B Ting
- Department of Clinical Haematology, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kimberley Williams
- Department of Physiotherapy, Specialty Medicine and Ambulatory Care, Eastern Health, Box Hill, VIC, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
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15
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Dennett AM, Peiris CL, Shields N, Taylor NF. From Cancer Rehabilitation to Recreation: A Coordinated Approach to Increasing Physical Activity. Phys Ther 2020; 100:2049-2059. [PMID: 32737975 DOI: 10.1093/ptj/pzaa135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/22/2020] [Accepted: 06/26/2020] [Indexed: 12/24/2022]
Abstract
Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes.
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Affiliation(s)
- Amy M Dennett
- School of Allied Health, Human Services, and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, Victoria, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services, and Sport, La Trobe University
| | - Nora Shields
- School of Allied Health, Human Services, and Sport, La Trobe University
| | - Nicholas F Taylor
- School of Allied Health, Human Services, and Sport, La Trobe University and Allied Health Clinical Research Office, Eastern Health
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16
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Aguiar LT, Nadeau S, Britto RR, Teixeira-Salmela LF, Martins JC, Samora GAR, da Silva Júnior JA, Faria CDCDM. Effects of aerobic training on physical activity in people with stroke: A randomized controlled trial. NeuroRehabilitation 2020; 46:391-401. [DOI: 10.3233/nre-193013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- École de Réadaptation, Université de Montréal (UdeM), and Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), CIUSSS Centre-sud-de-l’Ile-de-Montréal, Montréal, Canada
| | - Sylvie Nadeau
- École de Réadaptation, Université de Montréal (UdeM), and Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), CIUSSS Centre-sud-de-l’Ile-de-Montréal, Montréal, Canada
| | - Raquel Rodrigues Britto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Lion A, Backes A, Duhem C, Ries F, Delagardelle C, Urhausen A, Vögele C, Theisen D, Malisoux L. Motivational Interviewing to Increase Physical Activity Behavior in Cancer Patients: A Pilot Randomized Controlled Trials. Integr Cancer Ther 2020; 19:1534735420914973. [PMID: 32202163 PMCID: PMC7092651 DOI: 10.1177/1534735420914973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/17/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA) behavior in cancer patients. METHODS Participants were randomly assigned to an experimental group with standard care plus 12 MI sessions within 12 weeks or a control group with standard care only. The number of recruited participants and the modality of recruitment were recorded to describe the reach of the study. The acceptability of the study was estimated using the attrition rate during the intervention phase. The potential efficacy of the intervention was evaluated by analyzing the PA behavior. RESULTS Twenty-five participants were recruited within the 16-month recruitment period (1.6 participants per month). Five participants (38.5%) from the experimental group (n = 13) and one participant (8.3%) from the control group (n = 12) dropped out of the study before the end of the intervention phase. No group by time interaction effect for PA behavior was observed at the end of the intervention. CONCLUSION Due to the low recruitment rate and compliance, no conclusion can be drawn regarding the efficacy of MI to increase PA behavior in cancer patients. Moreover, the current literature cannot provide any evidence on the effectiveness of MI to increase PA in cancer survivors. Future RCTs should consider that the percentage of uninterested patients to join the study may be as high as 60%. Overrecruitment (30% to 40%) is also recommended to accommodate the elevated attrition rate.
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Affiliation(s)
- Alexis Lion
- Fédération Luxembourgeoise des Associations de Sport de Santé, Strassen, Luxembourg
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Luxembourg Institute of Health, Strassen, Luxembourg
| | - Anne Backes
- Luxembourg Institute of Health, Strassen, Luxembourg
| | - Caroline Duhem
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Fernand Ries
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Charles Delagardelle
- Fédération Luxembourgeoise des Associations de Sport de Santé, Strassen, Luxembourg
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Axel Urhausen
- Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science, Luxembourg, Luxembourg
- Luxembourg Institute of Health, Strassen, Luxembourg
- Centre Hospitalier Luxembourg—Clinique d’Eich, Luxembourg, Luxembourg
| | - Claus Vögele
- University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Daniel Theisen
- Luxembourg Institute of Health, Strassen, Luxembourg
- ALAN Maladies Rares Luxembourg, Bascharage, Luxembourg
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