Effectiveness of a supervised physical activity programme on physical activity adherence in patients with cardiovascular risk factors / Eficacia de un programa de actividad física supervisada en la adherencia a la actividad física en pacientes con factores de riesgo cardiovascular

Introduction: Physical activity referral schemes (PARS) in primary care centres increase the level of physical activity (PA) in the general population. However, few studies assess PA adherence after interventions. This study aimed at: (I) to assess PA adherence after a six-month PARS, and at 12-months (after six months of a follow-up period without intervention), (II) and to assess the impact of PARS on health-related quality of life (HRQL) in patients with cardiovascular risk factors (CVRF). Materials and methods: Longitudinal design. A total of 323 patients with ≥2 CVRF, in contemplative stage of change, from 27 primary care centres in Catalonia, were referred during 2010-2011 to a six-month PARS (three sessions/week of 60 min of moderate-intensity PA (MPA)). PA level and HRQL were analysed at baseline, at six-months, and at 12-months follow-up measurement, with the International Physical Activity Questionnaire (short version), and the SF-12, respectively. Results: Out of the total number of patients (323), 75% (n = 242; 62.6 ± 8.5 years; 75% women) completed the PARS, with a mean attendance of 84.1%. A six-month PARS increased PA level, especially MPA and improved HRQL (p < 0.01). At 12-months, the number of physically inactive patients remained lower than baseline; MPA level decreased, and the positive effects on HRQL were retained, especially in social functioning (26.4), physical functioning (18.2), and emotional component (18.3) (p < 0.01). Conclusions: A six-month PARS decrease the number of inactive patients and improves PA level and HRQL. Improvements in physical functioning, social functioning, and emotional component were retained up to one year. PARS appear to be an adequate treatment to improve the health of patients with CVRF

Introducción: Los programas de prescripción de actividad física supervisada (PPAFS) aumentan el nivel de actividad física (AF) en la población general. Sin embargo, pocos estudios evalúan la adherencia a la AF después de las intervenciones. Este estudio evalúa: a) la adherencia a la AF después del PPAFS y en el 12.° mes, y b) el impacto de los PPAFS sobre la calidad de vida (CVRS) en pacientes con factores de riesgo cardiovascular (FRCV). Material y métodos: Diseño longitudinal. Un total de 323 pacientes con 2 o más FRCV, en la estado contemplativo del cambio, se derivaron desde centros de atención primaria de Cataluña, en 2010-2011, a PPAFS de 6 meses (3 sesiones/semana de 60 min de AF intensidad moderada). El nivel de AF y la CVRS fueron analizados al inicio, a los 6 meses y al 12.° mes de seguimiento con el Cuestionario Internacional de Actividad Física (versión corta) y el SF-12, respectivamente. Resultados: El 75% de los pacientes (n = 242; 62,6 ± 8,5 años; 75% mujeres) completaron el PPAFS (asistencia media del 84,1%). Los PPAFS aumentan el nivel de AF y mejoran la CVRS (p < 0,01). A los 12 meses, el número de pacientes físicamente inactivos sigue siendo inferior a los datos basales, el nivel de AF disminuye pero se mantienen los efectos positivos en la CVRS, especialmente en la funcionalidad social (26,4), la funcionalidad física (18,2) y el componente emocional (18,3) (p < 0,01). Conclusiones: Los PPAFS aumentan el nivel de AF y mejoran la CVRS mostrando ser un tratamiento adecuado para mejorar la salud de los pacientes con FRCV

Evaluation of primary care: The “Primary Care Assessment Tools - Facilityversion” for the Spanish health system

Objective: To obtain versions of the Primary Care Assessment Tools (PCAT)-Facility version to evaluateprimary care (PC) in the Spanish context, and to analyze its feasibility, reliability and validity.Methods: Cultural adaptation was performed through the use of forward and backward translationsinto Spanish and Catalan, observations and opinions of a panel of experts, and cognitive interviews withtarget users (PC team managers). A pilot phase was carried out in a sample of 130 managers of PC teamsin Catalonia. A post-test questionnaire was sent 4-5 months later to all 194 managers of PC teams in theBarcelona health region. Analysis of metric properties included: 1) description of items and verificationof Likert assumptions, since domain scores are obtained by summing item scores; 2) reliability analysis(Cronbach’s alpha coefficient, Pearson’s correlation coefficient, test-retest analysis); and 3) validityanalysis (expert panel, cognitive interviews, and convergent and discriminant validity).Results: Substantial adaptation was required for the accessory section of the questionnaire, but less wasrequired in PC domain measurements. Items were added to the comprehensiveness domain to reflectservices usually available in Spain. The lowest Cronbach’s alpha scores were found for Access (0.62) andCoordination (0.59 and 0.65), while values were >0.70 for the remaining domains.Conclusion: The Spanish version of the PCAT-Facility questionnaire is now available and shows adequatereliability and validity. The Spanish PCAT version will facilitate national and international comparisonsof PC and analysis of the determinants of quality of service provision (AU)

Objetivo: Obtener versiones del Primary Care Assessment Tools–Facility version como herramienta deevaluación de la atención primaria (AP) para la aplicación en el contexto espanol, y analizar su fiabilidad ˜y validez.Métodos: Se realizó una adaptación cultural con traducciones y retrotraducciones al espanol y al catalán, ˜observaciones y opiniones de un panel de expertos y entrevistas cognitivas con usuarios finales (directivos del equipo de AP). Se realizó una fase piloto con una muestra de 130 directivos de AP de Cataluna. ˜Una versión final se envió 4-5 meses después a los 194 directivos de los equipos de la región sanitaria deBarcelona. El análisis de las propiedades métricas incluyó: 1) descripción de ítems y verificación de lasasunciones de la escala Likert, porque las puntuaciones de los dominios se obtienen sumando los ítems;2) análisis de fiabilidad (alfa de Cronbach, coeficiente de correlación de Pearson, análisis test-retest); y3) análisis de validez (panel de expertos, entrevistas cognitivas, validez convergente y discriminante). Resultados: Se requirió una importante adaptación de las secciones accesorias del cuestionario, pero no enlas de los dominios de AP. Se anadieron ítems en la dimensión de globalidad. Las menores puntuaciones ˜del alfa de Cronbach se encontraron en acceso (0,62) y coordinación (0,59 y 0,65); el resto de los dominiostuvieron valores > 0,70. Conclusión: Disponemos de una versión espanola del PCAT - Equipo de Atención Primaria con unas adecuadas fiabilidad y validez, que facilitará comparaciones nacionales e internacionales, y el análisis de losdeterminantes de una provisión de servicios de calidad (AU)

Evaluation of primary care: The "Primary Care Assessment Tools - Facility version" for the Spanish health system.

OBJECTIVE: To obtain versions of the Primary Care Assessment Tools (PCAT)-Facility version to evaluate primary care (PC) in the Spanish context, and to analyze its feasibility, reliability and validity. METHODS: Cultural adaptation was performed through the use of forward and backward translations into Spanish and Catalan, observations and opinions of a panel of experts, and cognitive interviews with target users (PC team managers). A pilot phase was carried out in a sample of 130 managers of PC teams in Catalonia. A post-test questionnaire was sent 4-5 months later to all 194 managers of PC teams in the Barcelona health region. Analysis of metric properties included: 1) description of items and verification of Likert assumptions, since domain scores are obtained by summing item scores; 2) reliability analysis (Cronbach's alpha coefficient, Pearson's correlation coefficient, test-retest analysis); and 3) validity analysis (expert panel, cognitive interviews, and convergent and discriminant validity). RESULTS: Substantial adaptation was required for the accessory section of the questionnaire, but less was required in PC domain measurements. Items were added to the comprehensiveness domain to reflect services usually available in Spain. The lowest Cronbach's alpha scores were found for Access (0.62) and Coordination (0.59 and 0.65), while values were >0.70 for the remaining domains. CONCLUSION: The Spanish version of the PCAT-Facility questionnaire is now available and shows adequate reliability and validity. The Spanish PCAT version will facilitate national and international comparisons of PC and analysis of the determinants of quality of service provision.