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How physically active are primary care patients?
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Ethics approval: This research study was approved by the Institutional Review Board of Tennessee State University, Nashville TN, USA (protocol number #HS2014-3388). http://dx.doi.org/10.1016/j.physio.2015.03.256 Research Report Poster Presentation Number: RR-PO-18-18-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 A DESCRIPTIVE ANALYSIS OF SITTING IN THE PRIMARY CARE POPULATION E. Barrett 1 , J. Hussey 1 , C. Darker 2 1 Trinity
College Dublin, Discipline of Physiotherapy, Dublin, Ireland; 2 Trinity College Dublin, Public Health and Primary Care, Dublin, Ireland Background: There is a growing body of evidence to suggest that sedentary behaviour is a distinct risk factor, independent of physical activity, for multiple adverse health outcomes. Other than prevalence estimates, there is almost no research providing a descriptive analysis of sitting time or sedentary behaviour in the Irish population. Purpose: The purpose of this study was to describe the prevalence and patterns of sitting time in an Irish primary care population. A secondary objective was to determine whether there was an association between sitting time and physical activity. Methods: Computer generated, stratified random sampling was used to identify three primary care centres from which the sample was drawn. Stratification was based on the urban/rural location of the centre and a national measure of deprivation. The short version International Physical Activity Questionnaire (IPAQ) was used to collect data on the weekday sitting time of participants and to determine their physical activity level. Weekday sitting time was compared by gender, age group, educational attainment, and primary care location. Results: Data was collected from a total of 885 adult participants between the ages of 18 and 69. The median weekday sitting time for all participants was 240 (IQR 150–480) minutes per day which is equivalent to four hours sitting a day. Overall 20.6% (n = 179) of all participants reported sitting for less than two hours a day and 15.2% (n = 133) reported sitting for more than eight hours. Males reported significantly higher sitting times than females (M: median 360, IQR 187–480; F: median 240, IQR 120–420) (p < 0.001). There were significant differences in the sitting times of participants attending the three different primary care locations with the urban non deprived group reporting the highest sitting time (median 345, IQR 180–480) and the rural group reporting the least sitting (median 180, IQR 120–360) (p < 0.001). Age and education were not associated with sitting time. There was a weak, negative correlation between sitting time and physical activity
indicating that as people became more active, the less time they spent in sitting (r = −0.069, p = 0.05). Conclusion(s): This study demonstrates the high sitting times reported by many of the primary care population. There are emerging patterns highlighting particular groups that are at increased risk from sedentary behaviour. Implications: In addition to physical activity promotion, physiotherapists should use every opportunity to screen and address sedentary time in their patients, as a distinct and independent risk factor for chronic disease. Keywords: Sedentary behaviour; Primary care; Population health Funding acknowledgements: Unfunded. Ethics approval: Ethics approval for this research was granted by the Research Committee of St James’s and Tallaght Hospitals, Dublin, Ireland. http://dx.doi.org/10.1016/j.physio.2015.03.257 Research Report Platform Rapid 5 Presentation Number: RR-PLR5-3615 Sunday 3 May 2015 10:45 Room 324–326 HOW PHYSICALLY ACTIVE ARE PRIMARY CARE PATIENTS? E. Barrett 1 , C. Darker 2 , J. Hussey 1 1 Trinity
College Dublin, Discipline of Physiotherapy, Dublin, Ireland; 2 Trinity College Dublin, Public Health and Primary Care, Dublin, Ireland Background: Physical inactivity is one of the most common and persistent risk factors contributing to poor health throughout the world. There is accumulating evidence that certain interventions delivered in primary care are effective at increasing physical activity levels. In order to direct and target these interventions appropriately it is necessary to have accurate surveillance data from the primary care population. Purpose: The purpose of this study was to describe the prevalence and patterns of physical activity in an Irish primary care population. Methods: Computer generated, stratified random sampling was used to identify three primary care centres from which the sample was drawn. Stratification was based on the urban/rural location of the centre and a national measure of deprivation. The short version International Physical Activity Questionnaire (IPAQ) was used to collect data on the physical activity undertaken by participants in the previous seven days. A standardised scoring protocol was used to classify participants into low, moderate and high levels of physical activity. Physical activity was compared by gender, age group, educational attainment and primary care location. Results: Data was collected from a total of 885 participants between the ages of 18 and 69. Overall 47.2% (n = 418) of all participants were classified within the low
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
activity category and therefore failed to meet the public health recommendations for physical activity. Significantly more participants classified as low active were female (χ2 = 10.76, df = 2, p = 0.005), of older age (χ2 = 12.39, df = 6, p = 0.054) and with low educational attainment (χ2 = 18.14, df = 6, p = 0.006). Almost 60% (n = 177) of participants attending the rural primary care centre failed to meet the physical activity recommendations compared to 37.6% (n = 111) of the urban deprived sample and 44.5% (n = 130) of the urban non deprived sample (p < 0.001). The difference in activity levels between the three primary care groups was explained by significant differences in their walking practice, with rural participants reporting the least amount of walking (median 229, IQR 0–544) and participants attending the urban deprived centre reporting the most (median 693, IQR 297–1386) (p < 0.001). Conclusion(s): This study highlights the high prevalence of physical inactivity among the primary care population. Several factors including personal, environmental and social influence a person’s decision to be physically active and are important considerations for health promotion. Implications: Understanding the physical activity profile of the primary care population helps direct public health funding and ensures that physical activity interventions are designed to target those most in need. Keywords: Physical activity; Population health; Primary care Funding acknowledgements: Unfunded. Ethics approval: Ethics approval for this research was granted by the Research Committee of St James’s and Tallaght Hospitals, Dublin, Ireland. http://dx.doi.org/10.1016/j.physio.2015.03.258 Research Report Platform Presentation Number: RR-PL-3963 Monday 4 May 2015 16:29 Room 303–304 IS A PHYSICAL ACTIVITY CARE PATHWAY AN ACCEPTABLE APPROACH TO PHYSICAL ACTIVITY PROMOTION IN PRIMARY CARE? E. Barrett 1 , C. Darker 2 , J. Hussey 1 1 Trinity
College Dublin, Discipline of Physiotherapy, Dublin, Ireland; 2 Trinity College Dublin, Public Health and Primary Care, Dublin, Ireland Background: There is increasing emphasis on the importance of physical activity promotion as a key task of a primary care clinician. In 2007, the National Health Service in the UK introduced a physical activity care pathway “Lets Get Moving” as a means of systematically screening and promoting physical activity to the primary care population. This pathway consists of five key stages and uses a simple screening
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tool; the General Practice Physical Activity Questionnaire (GPPAQ,) to identify patients who do not meet the public health recommendations. These patients are then offered a brief intervention based on the principles of motivational interviewing and dependant on their clinical risk, personal preferences and readiness to change their behaviour are signposted to local physical activity opportunities. Purpose: The aim of this study was to agree, through a Delphi consensus process, a physical activity pathway suitable for use by physiotherapists in Irish primary care services. Methods: Purposive sampling was used to identify 41 senior physiotherapists experienced in primary care. A modified three round Delphi approach was used to establish consensus. Following an introductory session detailing the physical activity care pathway, a series of three rounds of questionnaires were distributed to participants. Participants were asked to review each component of the pathway in the context of their own role and expertise, to determine if the pathway, as a model, was the most appropriate fit for their services. Open ended questions captured details on the best mechanism for recruiting patients onto the pathway and on training and resource requirements. Results: The response rate to the Delphi process was 97.6%, with all but one participant completing all three rounds of the process. Participants were predominately female (95%, n = 39) and had worked in primary care for a mean of 6.8 years (range 1–23). Overall there was a high degree of consensus for many components of the original pathway with a number of suggested modifications and additions. Participants agreed that all patients attending physiotherapy should be eligible for recruitment onto the pathway. However, they also suggested a more active approach to recruitment including other professionals referring patients to physiotherapy for physical activity promotion and permitting members of the public to self refer. Participants also suggested the use of a pedometer in addition to the GPPAQ to assess physical activity, the use of an additional health risk questionnaire to determine safety for exercise and the option for other professionals to complete the screening part of the pathway and then refer to physiotherapy for intervention. Physiotherapists identified training needs particularly with respect to population approaches to physical activity screening and motivational interviewing. Conclusion(s): This study demonstrates that a physical activity pathway such as “Let’s Get Moving” is an acceptable model, with some modifications, to Irish primary care physiotherapists. Implications: The introduction and resourcing of a physical activity pathway in primary care has the potential to improve the screening and promotional practices of health professionals and impact positively on public health. Keywords: Physical activity pathway; Primary care; Population health Funding acknowledgements: Unfunded.
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Ethics approval: This research study was approved by the Institutional Review Board of Tennessee State University, Nashville TN, USA (protocol number #HS2014-3388). http://dx.doi.org/10.1016/j.physio.2015.03.256 Research Report Poster Presentation Number: RR-PO-18-18-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 A DESCRIPTIVE ANALYSIS OF SITTING IN THE PRIMARY CARE POPULATION E. Barrett 1 , J. Hussey 1 , C. Darker 2 1 Trinity
College Dublin, Discipline of Physiotherapy, Dublin, Ireland; 2 Trinity College Dublin, Public Health and Primary Care, Dublin, Ireland Background: There is a growing body of evidence to suggest that sedentary behaviour is a distinct risk factor, independent of physical activity, for multiple adverse health outcomes. Other than prevalence estimates, there is almost no research providing a descriptive analysis of sitting time or sedentary behaviour in the Irish population. Purpose: The purpose of this study was to describe the prevalence and patterns of sitting time in an Irish primary care population. A secondary objective was to determine whether there was an association between sitting time and physical activity. Methods: Computer generated, stratified random sampling was used to identify three primary care centres from which the sample was drawn. Stratification was based on the urban/rural location of the centre and a national measure of deprivation. The short version International Physical Activity Questionnaire (IPAQ) was used to collect data on the weekday sitting time of participants and to determine their physical activity level. Weekday sitting time was compared by gender, age group, educational attainment, and primary care location. Results: Data was collected from a total of 885 adult participants between the ages of 18 and 69. The median weekday sitting time for all participants was 240 (IQR 150–480) minutes per day which is equivalent to four hours sitting a day. Overall 20.6% (n = 179) of all participants reported sitting for less than two hours a day and 15.2% (n = 133) reported sitting for more than eight hours. Males reported significantly higher sitting times than females (M: median 360, IQR 187–480; F: median 240, IQR 120–420) (p < 0.001). There were significant differences in the sitting times of participants attending the three different primary care locations with the urban non deprived group reporting the highest sitting time (median 345, IQR 180–480) and the rural group reporting the least sitting (median 180, IQR 120–360) (p < 0.001). Age and education were not associated with sitting time. There was a weak, negative correlation between sitting time and physical activity
indicating that as people became more active, the less time they spent in sitting (r = −0.069, p = 0.05). Conclusion(s): This study demonstrates the high sitting times reported by many of the primary care population. There are emerging patterns highlighting particular groups that are at increased risk from sedentary behaviour. Implications: In addition to physical activity promotion, physiotherapists should use every opportunity to screen and address sedentary time in their patients, as a distinct and independent risk factor for chronic disease. Keywords: Sedentary behaviour; Primary care; Population health Funding acknowledgements: Unfunded. Ethics approval: Ethics approval for this research was granted by the Research Committee of St James’s and Tallaght Hospitals, Dublin, Ireland. http://dx.doi.org/10.1016/j.physio.2015.03.257 Research Report Platform Rapid 5 Presentation Number: RR-PLR5-3615 Sunday 3 May 2015 10:45 Room 324–326 HOW PHYSICALLY ACTIVE ARE PRIMARY CARE PATIENTS? E. Barrett 1 , C. Darker 2 , J. Hussey 1 1 Trinity
College Dublin, Discipline of Physiotherapy, Dublin, Ireland; 2 Trinity College Dublin, Public Health and Primary Care, Dublin, Ireland Background: Physical inactivity is one of the most common and persistent risk factors contributing to poor health throughout the world. There is accumulating evidence that certain interventions delivered in primary care are effective at increasing physical activity levels. In order to direct and target these interventions appropriately it is necessary to have accurate surveillance data from the primary care population. Purpose: The purpose of this study was to describe the prevalence and patterns of physical activity in an Irish primary care population. Methods: Computer generated, stratified random sampling was used to identify three primary care centres from which the sample was drawn. Stratification was based on the urban/rural location of the centre and a national measure of deprivation. The short version International Physical Activity Questionnaire (IPAQ) was used to collect data on the physical activity undertaken by participants in the previous seven days. A standardised scoring protocol was used to classify participants into low, moderate and high levels of physical activity. Physical activity was compared by gender, age group, educational attainment and primary care location. Results: Data was collected from a total of 885 participants between the ages of 18 and 69. Overall 47.2% (n = 418) of all participants were classified within the low
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
activity category and therefore failed to meet the public health recommendations for physical activity. Significantly more participants classified as low active were female (χ2 = 10.76, df = 2, p = 0.005), of older age (χ2 = 12.39, df = 6, p = 0.054) and with low educational attainment (χ2 = 18.14, df = 6, p = 0.006). Almost 60% (n = 177) of participants attending the rural primary care centre failed to meet the physical activity recommendations compared to 37.6% (n = 111) of the urban deprived sample and 44.5% (n = 130) of the urban non deprived sample (p < 0.001). The difference in activity levels between the three primary care groups was explained by significant differences in their walking practice, with rural participants reporting the least amount of walking (median 229, IQR 0–544) and participants attending the urban deprived centre reporting the most (median 693, IQR 297–1386) (p < 0.001). Conclusion(s): This study highlights the high prevalence of physical inactivity among the primary care population. Several factors including personal, environmental and social influence a person’s decision to be physically active and are important considerations for health promotion. Implications: Understanding the physical activity profile of the primary care population helps direct public health funding and ensures that physical activity interventions are designed to target those most in need. Keywords: Physical activity; Population health; Primary care Funding acknowledgements: Unfunded. Ethics approval: Ethics approval for this research was granted by the Research Committee of St James’s and Tallaght Hospitals, Dublin, Ireland. http://dx.doi.org/10.1016/j.physio.2015.03.258 Research Report Platform Presentation Number: RR-PL-3963 Monday 4 May 2015 16:29 Room 303–304 IS A PHYSICAL ACTIVITY CARE PATHWAY AN ACCEPTABLE APPROACH TO PHYSICAL ACTIVITY PROMOTION IN PRIMARY CARE? E. Barrett 1 , C. Darker 2 , J. Hussey 1 1 Trinity
College Dublin, Discipline of Physiotherapy, Dublin, Ireland; 2 Trinity College Dublin, Public Health and Primary Care, Dublin, Ireland Background: There is increasing emphasis on the importance of physical activity promotion as a key task of a primary care clinician. In 2007, the National Health Service in the UK introduced a physical activity care pathway “Lets Get Moving” as a means of systematically screening and promoting physical activity to the primary care population. This pathway consists of five key stages and uses a simple screening
eS119
tool; the General Practice Physical Activity Questionnaire (GPPAQ,) to identify patients who do not meet the public health recommendations. These patients are then offered a brief intervention based on the principles of motivational interviewing and dependant on their clinical risk, personal preferences and readiness to change their behaviour are signposted to local physical activity opportunities. Purpose: The aim of this study was to agree, through a Delphi consensus process, a physical activity pathway suitable for use by physiotherapists in Irish primary care services. Methods: Purposive sampling was used to identify 41 senior physiotherapists experienced in primary care. A modified three round Delphi approach was used to establish consensus. Following an introductory session detailing the physical activity care pathway, a series of three rounds of questionnaires were distributed to participants. Participants were asked to review each component of the pathway in the context of their own role and expertise, to determine if the pathway, as a model, was the most appropriate fit for their services. Open ended questions captured details on the best mechanism for recruiting patients onto the pathway and on training and resource requirements. Results: The response rate to the Delphi process was 97.6%, with all but one participant completing all three rounds of the process. Participants were predominately female (95%, n = 39) and had worked in primary care for a mean of 6.8 years (range 1–23). Overall there was a high degree of consensus for many components of the original pathway with a number of suggested modifications and additions. Participants agreed that all patients attending physiotherapy should be eligible for recruitment onto the pathway. However, they also suggested a more active approach to recruitment including other professionals referring patients to physiotherapy for physical activity promotion and permitting members of the public to self refer. Participants also suggested the use of a pedometer in addition to the GPPAQ to assess physical activity, the use of an additional health risk questionnaire to determine safety for exercise and the option for other professionals to complete the screening part of the pathway and then refer to physiotherapy for intervention. Physiotherapists identified training needs particularly with respect to population approaches to physical activity screening and motivational interviewing. Conclusion(s): This study demonstrates that a physical activity pathway such as “Let’s Get Moving” is an acceptable model, with some modifications, to Irish primary care physiotherapists. Implications: The introduction and resourcing of a physical activity pathway in primary care has the potential to improve the screening and promotional practices of health professionals and impact positively on public health. Keywords: Physical activity pathway; Primary care; Population health Funding acknowledgements: Unfunded.