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Brief Counseling and Step Count in Peripheral Artery Disease
Quick Takes
- A counseling intervention delivered by allied health personnel did not significantly increase step count in patients with PAD.
- Several quality-of-life measures significantly improved in the intervention group.
Study Questions:
Will a counseling intervention by allied health professionals improve step count in patients with peripheral artery disease (PAD)?
Methods:
This randomized controlled trial (RCT) enrolled patients with symptomatic PAD who were not participating in an exercise program. Patients received written information on PAD and were advised to walk ≥3 times weekly for 40 minutes. The intervention consisted of two in-person counseling sessions lasting 1 hour each (at weeks 1 and 2) and two telephone sessions lasting 15 minutes each (at weeks 6 and 12). These sessions were delivered by allied health personnel trained by the study psychologist. At similar time intervals, control patients received four 15-minute telephone calls involving open-ended questions and nondirective responses. Masking was achieved by telling participants they would receive advice using a range of information modalities and by using different staff to assess outcomes.
Results:
In all, 200 participants were recruited and allocated to treatment (n = 102) or control (n = 98) groups. The primary study outcome was the difference between groups in the change in daily step count between baseline and 4 months. The mean daily step count increased by 529 steps in the intervention group and by 114 steps in the control group. The difference was 415 (95% confidence interval, -62 to 893; p = 0.07), which was not significantly different. Among secondary outcomes, the intervention group showed significant improvement at 4 months and 12 months in several quality-of-life measures.
Conclusions:
A brief counseling intervention by allied health professionals did not significantly influence step count of individuals with PAD.
Perspective:
In a previous small RCT (https://doi.org/10.1002/bjs.9100), a brief counseling intervention by a psychologist who visited patients in their homes found a significantly higher step count difference (1,630 steps; p = 0.01) between intervention and control groups at 2 years. This study assessed whether a similar intervention delivered by allied health professionals trained by a psychologist could increase step count. Several factors may have impacted study results: 1) lack of home visits, 2) only 80% patient participation in all four sessions, 3) patient transportation barriers, and 4) inconsistent counseling quality.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Exercise
Keywords: Allied Health Personnel, Counseling, Exercise, Patient Care Team, Peripheral Arterial Disease, Primary Prevention, Quality of Health Care, Quality of Life, Telephone, Vascular Diseases, Walking
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