RESUMEN
BACKGROUND: The value of cardiac rehabilitation (CR) after a transient ischaemic attack (TIA) or minor stroke is untested despite these conditions sharing similar pathology and risk factors to coronary heart disease. We aimed to evaluate the feasibility of conducting a trial of an adapted home-based CR programme, 'The Healthy Brain Rehabilitation Manual', for patients following a TIA/minor stroke, participants' views on the intervention and, to identify the behaviour change techniques (BCTs) used. METHODS: Clinicians were asked to identify patients attending the Ulster Hospital, Belfast within 4 weeks of a first TIA or minor stroke. Those who agreed to participate underwent assessments of physical fitness, cardiovascular risk, quality of life and mental health, before random allocation to: Group (1) standard/usual care; (2) rehabilitation manual or (3) manual plus pedometer. All participants received telephone support at 1 and 4 weeks, reassessment at 6 weeks and an invitation to a focus group exploring views regarding the study. Two trained review authors independently assessed the manual to identify the BCTs used. RESULTS: Twenty-eight patients were invited to participate, with 15 (10 men, 5 women; 9 TIA, 6 minor stroke; mean age 69 years) consenting and completing the study. Mean time to enrolment from the TIA/stroke was 20.5 days. Participants completed all assessment measures except VO2max testing, which all declined. The manual and telephone contact were viewed positively, as credible sources of advice. Pedometers were valued highly, particularly for goal-setting. Overall, 36 individual BCTs were used, the commonest being centred around setting goals and planning as well as social support. CONCLUSION: Recruitment and retention rates suggest that a trial to evaluate the effectiveness of a novel home-based CR programme, implemented within 4 weeks of a first TIA/minor stroke is feasible. The commonest BCTs used within the manual revolve around goals, planning and social support, in keeping with UK national guidelines. The findings from this feasibility work have been used to further refine the next stage of the intervention's development, a pilot study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02712385 . This study was registered prospectively on 18/03/2016.
Asunto(s)
Terapia por Ejercicio/métodos , Servicios de Atención a Domicilio Provisto por Hospital , Ataque Isquémico Transitorio/rehabilitación , Prevención Secundaria/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Actigrafía/instrumentación , Anciano , Terapia por Ejercicio/instrumentación , Estudios de Factibilidad , Femenino , Monitores de Ejercicio , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Ataque Isquémico Transitorio/psicología , Masculino , Manuales como Asunto , Persona de Mediana Edad , Motivación , Irlanda del Norte , Cooperación del Paciente , Educación del Paciente como Asunto , Factores Protectores , Recuperación de la Función , Recurrencia , Factores de Riesgo , Prevención Secundaria/instrumentación , Apoyo Social , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente Cerebrovascular/instrumentación , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To examine influences on the behaviour of General Practitioner (GP) in relation to prostate-specific antigen (PSA) testing. SUBJECTS AND METHODS: In Northern Ireland in 2003-2004, all GPs (1067) were invited to complete a self-administered postal questionnaire survey that was then matched with a regional PSA-testing database. The main outcome measures were individual GP responses for demographic, practice and training characteristics, PSA testing behaviour and perceived influences, matched against GP-initiated first PSA tests performed in 2003 and 2004 (22 207 tests). RESULTS: In all, 704 GPs (66%) responded and 49% of these reported awareness of the national guidelines, which was highest among those attending postgraduate meetings. PSA tests were more likely to be ordered by full-time male GPs who had attended a local postgraduate urology meeting; ran a 'well-man' clinic; tested men with unrelated complaints; and were not in a training practice. Testing levels were highest among GPs who had been practising for 21-30 years and those in rural practices. Awareness of national guidelines or having had a postgraduate post in urology did not affect testing behaviour. After adjusting for gender, working hours, duration in practice and urban/rural setting, independent influences increasing testing behaviour were: testing men with a positive family history or unrelated complaints; testing any man who requests it; and previous experience of prostate cancer being detected in an asymptomatic patient by PSA testing. Working in an accredited training practice was associated with lower testing levels. CONCLUSION: There are complex influences on the PSA testing behaviour of GPs; addressing these influences could contribute to the rationalization of testing. A low awareness of national guidelines indicates a need for new strategies to disseminate and implement guidelines. The influence of local educational meetings on PSA testing is an unharnessed force.