A systematic review and narrative synthesis of physical activity referral schemes' components.

BACKGROUND: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness. METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness. RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%). CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.

What do spontaneous coronary artery dissection survivors want to support their recovery? a qualitative study.

AIMS: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction predominantly affecting women aged younger than 50 years. There is limited research addressing female and male SCAD survivors' experience of, or requirements for, support post-SCAD. This study explored what SCAD survivors wanted to support recovery. METHODS AND RESULTS: A qualitative study using semi-structured video and telephone interviews. Data were analysed through thematic analysis using the framework approach. We interviewed 20 participants (19 females) with a mean age of 54.6 (+/-SD 8.5 years). Three overarching themes encapsulated participants' views about support requirements. (i) Education and information. Participants thought healthcare professionals involved in diagnosis and supporting recovery required greater awareness of SCAD and the psychological effect of SCAD. They wanted accessible SCAD information immediately post-event and during the educational component of cardiac rehabilitation. (ii) Physical activity. Requirements were for advice tailored to individuals' specific needs, physical capabilities, and physical activity preferences. Participants suggested that utilizing wearable technology was helpful to encourage a safe return to activity. (iii) Psychosocial support. Participants wanted formal psychosocial support immediately post-event, during cardiac rehabilitation and in the longer term. CONCLUSION: Better healthcare professional training may improve diagnosis, and increase support and awareness of SCAD. SCAD support programmes should provide early SCAD specific education utilizing online sources, individually tailor physical activity prescription, offer wearable technology to support a return to being active, and provide short- and long-term psychosocial support. As SCAD is predominately a female condition, programmes should consider female physical activity preferences.

Completeness of intervention reporting in randomised trials of technology-enabled remote or hybrid exercise-based cardiac rehabilitation: a systematic review using the TIDieR framework.

BACKGROUND: Exercise-based cardiac rehabilitation improves clinical outcomes and quality of life. Technology-enabled delivery of remote cardiac rehabilitation is as effective in improving health outcomes as in-person delivery and has the potential to transform clinical service delivery. However, for the successful translation of research to clinical practice, interventions must be adequately reported in the literature. METHODS: Systematic review of MedLine, CINAHL, PubMed and SPORT Discus databases applying PRISMA guidance. Randomised controlled trials of remote or hybrid technology-enabled exercise-based cardiac rehabilitation interventions were included. Completeness of reporting was evaluated against the TIDieR checklist. RESULTS: The search strategy returned 162 articles which, following screening, resulted in 12 randomised trials being included containing data for 1588 participants. No trial fully reported their rehabilitation intervention as per the 12-item TIDieR checklist, with a median score of eight out of 12 categories. Notably, intervention detail, dosage and modification were comparatively poorly reported. CONCLUSION: Technology-enabled remotely delivered cardiac rehabilitation may be effective at improving cardiovascular fitness; however, the quality of reporting of these interventions in randomised trials is insufficient for replication which has material implications for translation into clinical practice.

Patients' experiences and perspectives of post-hospital follow-up care to improve physical recovery for intensive care survivors: A systematic review of qualitative research.

Background: Intensive care units deliver care to a heterogeneous group of patients with pre-existing co-morbid disease. Focus has shifted to improving health related quality of life with more patients surviving beyond hospital discharge. Randomised controlled trials evaluating follow-up interventions, to improve physical recovery, have not demonstrated a health-related quality of life benefit. Qualitative research may provide the context to understand the experiences of intensive care survivors during follow-up care addressing physical limitations. Objective: To synthesise qualitative studies and explore Intensive Care survivors' experiences and perspectives of physical symptoms in the context of follow-up care. Settings: A systematic search of electronic databases (MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Web of Science, Applied Social Sciences Index and Abstracts, Ovid Nursing and Ovid Emcare) was conducted to identify peer-reviewed primary qualitative studies. No date parameters were applied. Inclusion/exclusion criteria guided the screening process. Participants: The data from eligible primary research studies was extracted into NVivo (v12). Methods: Critical appraisal was completed using the Joanna Briggs Critical Appraisal Tool. Thematic analysis, guided by Braun and Clarke (2022), informed the data synthesis. Results: From 2457 studies, ten relevant studies were included. Two main themes were identified: 1. Recovery as uncertain; which outlines the uncertainty experienced by intensive care unit survivors during recovery. This theme pertained to system-level factors (role of healthcare professional and information provision) which provides the context for delivering follow-up care. 2. Self-determination of recovery; outlines individual characteristics in determining recovery which is conceptualised by patient-level factors (motivation, support network and perception of health). Conclusions: For intensive care survivors, the recovery trajectory is uncertain with a gap in information provision during the acute phase following hospital discharge. Patients' self-determination of recovery is an important consideration to ensure follow-up care addresses the needs of individual patients. The impact of pre-existing co-morbid disease and subgroups of patients deriving benefit from follow-up care remains uncertain. Registration: PROSPERO Registration no. CRD42022355711. Tweetable abstract: Patients' experiences of post-hospital follow-up care to improve physical recovery for intensive care survivors: A Systematic Review of Qualitative Research.

Exploring the patient experience of remote hypertension management in Scotland during COVID-19: a qualitative study.

OBJECTIVES: The aim of this study was to understand how patients experienced hypertension management, with or without blood pressure (BP) telemonitoring, during the COVID-19 pandemic. DESIGN, METHODS, PARTICIPANTS AND SETTING: This qualitative study conducted between April and November 2022 consisted of 43 semistructured telephone interviews (23 men and 20 women) from 6 primary care practices in one area of Scotland. RESULTS: From the views of 25 participants with experience of using the Connect Me telemonitoring service and 18 participants without such experience, 5 themes were developed. These were: (1) navigating access to services. There were challenges to gaining timely and/or in-person access to services and a reluctance to attend clinical settings because participants were aware of their increased risk of contracting the COVID-19 virus. (2) Adapting National Health Service services. All six practices had adapted care provision in response to potential COVID-19 transmission; however, these adaptations disrupted routine management of in-person primary care hypertension, diabetes and/or asthma checks. (3) Telemonitoring feedback. Telemonitoring reduced the need to attend in-person primary care practices and supported access to remote healthcare monitoring and feedback. (4) Self-management. Many non-telemonitoring participants were motivated to use self-management strategies to track their BP using home monitoring equipment. Also, participants were empowered to self-manage lifestyle and hypertension medication. (5) Experience of having COVID-19. Some participants contracting the COVID-19 virus experienced an immediate increase in their BP while a few experienced ongoing increased BP readings. CONCLUSIONS: The COVID-19 pandemic disrupted routine in-person care for patients with hypertension. Both telemonitoring and some non-telemonitoring patients were motivated to self-manage hypertension, including self-adjusting medication; however, only those with access to telemonitoring had increased access to hypertension monitoring and feedback. BP telemonitoring permitted routine care to continue for participants in this study and may offer a service useful in pandemic proofing hypertension healthcare in the future.

Research priorities relating to the delivery of cardiovascular prevention and rehabilitation programmes: results of a modified Delphi process.

OBJECTIVE: The purpose of this British Association for Cardiovascular Prevention and Rehabilitation (BACPR) research priority setting project (PSP) was to identify a top 10 list of priority research questions for cardiovascular prevention and rehabilitation (CVPR). METHODS: The PSP was facilitated by the BACPR clinical study group (CSG), which integrates as part of the British Heart Foundation Clinical Research Collaborative. Following a literature review to identify unanswered research questions, modified Delphi methods were used to engage CVPR-informed expert stakeholders, patients, partners and conference delegates in ranking the relevance of research questions during three rounds of an anonymous e-survey. In the first survey, unanswered questions from the literature review were ranked and respondents proposed additional questions. In the second survey, these new questions were ranked. Prioritised questions from surveys 1 and 2 were incorporated in a third/final e-survey used to identify the top 10 list. RESULTS: From 459 responses across the global CVPR community, a final top 10 list of questions were distilled from an overall bank of 76 (61 from the current evidence base and a further 15 from respondents). These were grouped across five broad categories: access and remote delivery, exercise and physical activity, optimising programme outcomes, psychosocial health and impact of the pandemic. CONCLUSIONS: This PSP used a modified Delphi methodology to engage the international CVPR community to generate a top 10 list of research priorities within the field. These prioritised questions will directly inform future national and international CVPR research supported by the BACPR CSG.

Spontaneous coronary artery dissection: a systematic review of physical and psychosocial recovery following discharge from hospital.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction, particularly among women. Spontaneous coronary artery dissection survivors may not know what physical activity is safe and effective, and there may be a psychosocial burden of living with a SCAD diagnosis. OBJECTIVES: This review aimed to determine the evidence regarding physical activity, cardiovascular risk factors, or associated factors, and the psychosocial impact of SCAD for SCAD survivors after hospital discharge. DESIGN: A systematic review was completed in accordance with PRISMA guidelines. DATA SOURCES: We searched Medline, Embase, CinAHL, PsychInfo, and Google Scholar until November 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Outcomes of interest were physical activity participation levels, cardiovascular risk factors and associated risk factors, and psychosocial recovery from SCAD. We included any study (qualitative or quantitative) that reported data pertinent to understanding the impact of SCAD on physical activity and psychosocial aspects of recovery. We also included papers that reported cardiovascular risk or associated risk factors where studies reported outcomes of SCAD survivors. We excluded papers that only provided information on in-hospital management. Any reports that were non-empirical were excluded. RESULTS: The review included 28 studies. These used a range of methods. None were randomized controlled trials. There were 4167 SCAD participants although some were sourced from the same SCAD registries, so they may not be unique. They were mainly female (n = 3897, 93.5%, range = 57.7-100%), with mean age 48.0 ± 9.8 years at index event. Participants mostly came from the USA, Canada, or The Netherlands. We found very limited evidence for cardiorespiratory fitness improvements following cardiac rehabilitation (CR). Existing CR was not tailored to SCAD specific needs and SCAD survivors lacked guidance about appropriate physical activity. Some participants had high levels of psychosocial distress. Spontaneous coronary artery dissection survivors highlighted the need for tailored support that included family members. Many SCAD survivors have traditional risk factors including hypertension, hyperlipidaemia, and overweight/obesity. Chest pain following SCAD is common. CONCLUSION: There is an urgent need to develop physical and psychological recovery programmes for SCAD survivors and test effectiveness via randomized controlled trials. Psychosocial support is particularly required, given the high burden of psychosocial issues. DATA REGISTRATION: Prospero CRD42021254798.

Gender Differences in Uptake, Adherence and Experiences: A Longitudinal, Mixed-Methods Study of a Physical Activity Referral Scheme in Scotland, UK.

Physical activity referral schemes (PARS) are implemented internationally to increase physical activity (PA), but evidence of effectiveness for population subgroups is equivocal. We examined gender differences for a Scottish PARS. This mixed-methods, concurrent longitudinal study had equal status quantitative and qualitative components. We conducted 348 telephone interviews across three time points (pre-scheme, 12 and 52 weeks). These included validated self-reported PA and exercise self-efficacy measures and open-ended questions about experiences. We recruited 136 participants, of whom 120 completed 12-week and 92 completed 52-week interviews. PARS uptake was 83.8% (114/136), and 12-week adherence for those who started was 43.0% (49/114). Living in less deprived areas was associated with better uptake (p = 0.021) and 12-week adherence (p = 0.020), and with male uptake (p = 0.024) in gender-stratified analysis. Female adherers significantly increased self-reported PA at 12 weeks (p = 0.005) but not 52 weeks. Males significantly increased exercise self-efficacy between baseline and 52 weeks (p = 0.009). Three qualitative themes and eight subthemes developed; gender perspectives, personal factors (health, social circumstances, transport and attendance benefits) and scheme factors (communication, social/staff support, individualisation and age appropriateness). Both genders valued the PARS. To increase uptake, adherence and PA, PARS should ensure timely, personalised communication, individualised, affordable PA and include mechanisms to re-engage those who disengage temporarily.

Atrial fibrillation self-management: a mobile telephone app scoping review and content analysis.

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for 'atrial fibrillation' and 'anticoagulation', and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management.

Green Health Partnerships in Scotland; Pathways for Social Prescribing and Physical Activity Referral.

Increased exposure to green space has many health benefits. Scottish Green Health Partnerships (GHPs) have established green health referral pathways to enable community-based interventions to contribute to primary prevention and the maintenance of health for those with established disease. This qualitative study included focus groups and semi-structured telephone interviews with a range of professionals involved in strategic planning for and the development and provision of green health interventions (n = 55). We explored views about establishing GHPs. GHPs worked well, and green health was a good strategic fit with public health priorities. Interventions required embedding into core planning for health, local authority, social care and the third sector to ensure integration into non-medical prescribing models. There were concerns about sustainability and speed of change required for integration due to limited funding. Referral pathways were in the early development stages and intervention provision varied. Participants recognised challenges in addressing equity, developing green health messaging, volunteering capacity and providing evidence of success. Green health interventions have potential to integrate successfully with social prescribing and physical activity referral. Participants recommended GHPs engage political and health champions, embed green health in strategic planning, target mental health, develop simple, positively framed messaging, provide volunteer support and implement robust routine data collection to allow future examination of success.

A systematic review and thematic synthesis exploring how a previous experience of physical activity influences engagement with cardiac rehabilitation.

BACKGROUND: Exercise-based cardiac rehabilitation is recognised internationally as an effective therapy to improve quality of life and reduce the risk of hospital readmission for individuals diagnosed with acute coronary syndrome. Despite this, half of eligible individuals choose not to engage and the main reason is lack of interest. Furthermore, prior to attending, 40% of eligible individuals report meeting physical activity guidelines. It is unclear whether this influences decisions about engagement. AIMS: The aim of this review is to examine systematically qualitative evidence describing patients' perceptions and experiences, and synthesise what is known about how a previous experience of physical activity in adults diagnosed with acute coronary syndrome influences engagement with physical activity during cardiac rehabilitation. METHODS: A systematic review and thematic synthesis was conducted of primary qualitative studies to examine peer-reviewed literature published between1990 and 2017, accessed from database searches of MEDLINE, CINHAL, PsycINFO and Embase. RESULTS: The initial search produced 486 studies, and of these 12 relevant studies were included in this review. Studies included 388 participants from six countries. For previously active individuals, communication factors, self-perceptions of an exercise identity and experience of cardiac rehabilitation influence engagement in physical activity during cardiac rehabilitation. CONCLUSION: In adults diagnosed with acute coronary syndrome, communication post event and during cardiac rehabilitation is a source of self-appraisal and creates expectations of cardiac rehabilitation. In addition, perceptions of an exercise identity and experience of exercise-based cardiac rehabilitation influence decisions about engagement. To improve uptake and adherence, health professionals should consider previous physical activity levels and tailor information to optimise physical activity post event.