A Systematic Review of Workplace Physical Activity Coaching.

Aim Studies show that about 60 min of moderate physical activity (PA) per day compensate for sitting all day at work. However, the workplace offers an ideal setting for health-promoting interventions such as PA coaching as a person-centered intervention aimed at achieving lasting health behavior changes. Given a good evidence base of health coaching studies in general, this systematic review aims to provide an overview of workplace PA coaching interventions. Methods This review was conducted according to PRISMA guidelines. Studies published up to July 2021 were considered based on the following inclusion criteria: (1) longitudinal intervention studies, (2) analysis of PA at work, (3) sedentary employees, (4) PA coaching in the workplace as intervention, (5) increasing workplace PA. Results Of 4323 studies found, 14 studies with 17 interventions met inclusion criteria. All 17 interventions indicated an increase in at least one PA outcome. Twelve interventions indicated significant improvements in at least one workplace or total PA outcome. There is a high variation within the different coaching parameters, such as behavior change techniques and communication channels. The study quality showed a moderate to high risk of bias. Conclusions The majority of interventions provided evidence for the effectiveness of workplace PA coaching. Nevertheless, the results are inconclusive with regard to the variety of coaching parameters and thus no general statement can be made about the effectiveness of individual parameters. However, this variety of parameters also leads to a high degree of individualization of workplace PA coaching interventions to increase PA for different groups of employees and different types of workplaces.

Family doctors' attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners.

BACKGROUND: Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators. METHODS: In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs'role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers. RESULTS: A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs' who expected long-term benefits for their workload was relatively low (37.6%). CONCLUSIONS: In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice.

Implementation and evaluation of a nurse-led decision-coaching program for healthy breast cancer susceptibility gene (BRCA1/2) mutation carriers: a study protocol for the randomized controlled EDCP-BRCA study.

BACKGROUND: Female BRCA mutation carriers have an increased lifetime risk for breast and ovarian cancer compared to the general population. Women who carry this mutation have several options to deal with their cancer risk, such as risk-reducing surgeries or intensified breast cancer screening. Previous research has shown that preferences in this scenario are highly dependent on affected women's personalities and value systems. To support these women in the decision-making process, a structured decision support consisting of decision coaching combined with a decision aid might be helpful. METHODS/DESIGN: A randomized controlled trial will be conducted in order to compare usual care with structured decision support alongside usual care. The decision support program entails nurse-led decision coaching as well as an evidence-based patient decision aid. Nurses are qualified by a 4-day training program in informed decision-making and decision coaching. Six centers for Familial Breast and Ovarian Cancer in Germany will be included in the study, with a planned sample size of 398 women. The primary outcome is the congruence between the preferred and the actual played role in the decision-making process as measured by the Control Preferences Scale. It is hypothesized that the structured decision support will enable women to play the preferred role in the decision-making process. Secondary outcomes include the knowledge and attitudes about preventive options, decisional conflict, depression and anxiety, coping self-efficacy, impact of event, and self-concept. A process evaluation will accompany the study. DISCUSSION: The EDCP-BRCA study is the first study to implement and evaluate decision coaching combined with a decision aid for healthy BRCA mutation carriers worldwide. TRIAL REGISTRATION {2A}: DRKS-ID: DRKS00015527. Registered 30 October 2019.

Correlation Between the Transplant Evaluation Rating Scale (TERS) and Medical Outcomes in Living-Donor Kidney Transplant Recipients: A Retrospective Analysis.

BACKGROUND: Pretransplant psychosocial evaluation of living-donor kidney transplantation (LDKT) candidates identifies recipients with potentially inferior posttransplant outcomes. Rating instruments, based on semi-standardized interviews, help to improve and standardize psychosocial evaluation. The goal of this study was to retrospectively investigate the correlation between the Transplant Evaluation Rating Scale (TERS) and transplant outcome in LDKT recipients. METHODS: TERS scores were retrospectively generated by 2 raters based on comprehensive interviews of 146 LDKT recipients conducted by mental health professionals (interrater reliability, 0.8-0.9). All patients were eligible for transplantation according to pretransplant psychosocial evaluation. Patients were classified into 2 groups according to their TERS scores, in either two thirds excellent risk (TERS <29) and one third at least moderate risk (TERS ≥29) candidates. Analyzed medical parameters were change in estimated glomerular filtration rate and acute rejection (AR) episodes within the first year posttransplant. In addition, a subgroup of 65 patients was tested for de novo donor-specific HLA antibodies (DSA) posttransplant. RESULTS: There was no significant difference between the excellent (n = 97) and at least moderate (n = 49) risk candidates according to TERS in terms of organ function (estimated glomerular filtration rate decline >25%: 17 of 97 vs 11 of 49; P = .51) and episodes of AR (19 of 97 vs 15 of 49; P = .15). Patients developing de novo DSA (n = 18 [28%]) did not have higher pretransplant TERS scores (DSA positive, 11 of 42 vs 7 of 23; P = .78). CONCLUSIONS: Classifying LDKT recipients according to TERS score did not predict medical outcome at 1 year posttransplant or the occurrence of de novo DSA.

Mobile Technology Affinity in Renal Transplant Recipients.

BACKGROUND: Medication nonadherence is a common problem in renal transplant recipients (RTRs). Mobile health approaches to improve medication adherence are a current trend, and several medication adherence apps are available. However, it is unknown whether RTRs use these technologies and to what extent. In the present study, the mobile technology affinity of RTRs was analyzed. We hypothesized significant age differences in mobile technology affinity and that mobile technology affinity is associated with better cognitive functioning as well as higher educational level. METHODS: A total of 109 RTRs (63% male) participated in the cross-sectional study, with an overall mean age of 51.8 ± 14.2 years. The study included the Technology Experience Questionnaire (TEQ) for the assessment of mobile technology affinity, a cognitive test battery, and sociodemographic data. RESULTS: Overall, 57.4% of the patients used a smartphone or tablet and almost 45% used apps. The TEQ sum score was 20.9 in a possible range from 6 (no affinity to technology) to 30 (very high affinity). Younger patients had significantly higher scores in mobile technology affinity. The only significant gender difference was found in having fun with using electronic devices: Men enjoyed technology more than women did. Mobile technology affinity was positively associated with cognitive functioning and educational level. CONCLUSIONS: Young adult patients might profit most from mobile health approaches. Furthermore, high educational level and normal cognitive functioning promote mobile technology affinity. This should be kept in mind when designing mobile technology health (mHealth) interventions for RTRs. For beneficial mHealth interventions, further research on potential barriers and desired technologic features is necessary to adapt apps to patients' needs.

[Transcranial magnetic stimulation for psychogenic tremor - a pilot study]. / Der Einsatz der transkraniellen Magnetstimulation beim psychogenen Tremor - eine Pilotstudie.

Psychogenic tremor is the most common psychogenic movement disorder. Its prognosis is widely held to be poor and strongly depends on the patient's insight into the psychogenicity of the syndrome. The clinical value of transcranial magnetic stimulation (TMS) for (i) establishing the diagnosis with a high level of certainty, (ii) modulating symptom severity and (iii) facilitating patients' insight into psychogenicity was tested in 11 patients with psychogenic tremor of the upper limb. After explaining the psychogenic origin of the syndrome and providing a neurobiological model, 30 TMS pulses were applied over the hand area of the primary motor cortex contralateral to the affected hand(s) at a rate of 0.2 Hz. 15 pulses were administered at intensities of 120 % and 140 % of the resting motor threshold, respectively. Kinematic motion analysis was used to document the effectiveness of the TMS procedure. All patients met the diagnostic criteria of conversion disorder. Time elapsed since symptom onset was on average 48 to 57 months. Tremor affected both hands in 8 patients, one patient had additional head tremor. The TMS procedure caused a significant reduction of tremor frequency and thus established the diagnosis of documented psychogenic tremor according to the criteria proposed by Fahn and Williams (1988) in each patient. The duration of symptom relief was transient in 7 patients, 4 patients had lasting symptom relief. The present pilot study demonstrates that TMS is a helpful tool to (i) establish the diagnosis of psychogenic hand tremor with a high level of certainty, (ii) reduce tremor intensity and (iii) facilitate the patient's insight into the psychogenic origin of the syndrome as a prerequisite to obtain adherence to psychotherapy.