Challenges in recruitment of persons with peripheral artery disease for exercise studies.

This article describes feasibility of direct and indirect recruitment methods for exercise studies designed for older adults with peripheral artery disease (PAD). Recruitment of older adults with PAD for participation in exercise studies has been particularly challenging. Age, risk factors, and comorbid conditions affect physical activity in older adults with PAD. Barriers to exercise, such as safety, health, and age-related changes, contribute to lack of participation in exercise studies. Various direct and indirect recruitment approaches and participant responses, along with reasons for nonparticipation, are categorized into participant demographic, community, and research-related barriers. At a cost of $1,330.00, indirect recruitment strategies of social marketing and community outreach resulted in two referrals and no enrollments. Recruitment-site champions and education resulted in no referrals and no enrollments. Direct recruitment approaches such as health system recruitment and referrals paired with flyers resulted in 44 referrals and one enrollment. Only one referral was obtained from a physician practice. Reasons for nonparticipation included lack of follow-up, presence of one or more exclusion criteria, lack of transportation, and comorbid disease burden that limited activity. Community- and research-related barriers included recruitment competition for other studies, budget limitations, lack of recruitment staff, and strict inclusion/exclusion criteria. Successful recruitment of older adults with PAD for participation in exercise clinical trials may require substantial time and budget. Interventions to address identified barriers such as personal attitudes and socioeconomic factors, lack of social support, and lack of transportation, combined with community factors such as rural location, and research study design considerations may facilitate recruitment efforts.

An integrative review: application of self-efficacy instruments for walking in populations with peripheral arterial disease.

OBJECTIVE: The study objective was to identify which self-efficacy measurement instruments are being used for walking in patients with peripheral arterial disease (PAD), the psychometrics of these instruments, and recommendations for use in research on patients with PAD. BACKGROUND: PAD is a common problem for individuals with similar risk factors as cardiovascular disease (CVD). Experts recommend a supervised walking program with incremental increases in speed and distance as an initial treatment for patients with intermittent claudication. Because patients may experience pain while walking, there is a tendency to be nonadherent with exercise therapy, and many limit or avoid walking all together, resulting in a sedentary lifestyle. Self-efficacy plays a role in determining a person's confidence in his or her ability to participate in an exercise program. Data sources for this study were PubMed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and the Cochrane database. METHODS: The integrative review method described by Wittemore and Knafl was used for this review (Wittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs 2005;52:546-53.). Publications were retrieved electronically and reviewed for inclusion on the basis of studies that measured self-efficacy for walking in populations with PAD, peripheral vascular disease, and CVD. The analysis consisted of 9 publications. RESULTS: Only 2 studies were specific to the population with PAD. The remaining studies addressed self-efficacy issues in CVD or congestive heart failure. The analysis identified 4 instruments based on Bandura's Social Cognitive Theory that were used to assess self-efficacy: (1) the Self-Efficacy Expectation Scale, (2) the Self-Efficacy for Managing Chronic Disease Scale, (3) the Performance-Based Efficacy Scale, and (4) the Barriers Self-Efficacy Scale. The Self-Efficacy Expectation Scale was most frequently used in these studies. CONCLUSIONS: The use of the Self-Efficacy Expectation Scale instruments for walking in patients with PAD is limited because reliability and validity have been demonstrated in an older, mostly white population with CVD and congestive heart failure. Instruments that encompass the key constructs of self-efficacy, including physical, personal, and environmental aspects, would allow full evaluation with identification of potential explanations for success or failure for the chosen outcome. This should be taken into consideration in future studies when using instruments of self-efficacy.