Health coaching for promoting physical activity in low back pain patients: a secondary analysis on the usage and acceptance.

BACKGROUND: Multicomponent interventions combined with health coaching are widely recommended to improve a healthy lifestyle. The aim of the present study was to analyse the usage and acceptance of a multicomponent intervention (telephone, web and face-to-face coaching) for low back pain patients, and thereby gain an understanding of why this intervention was not as effective as expected. METHODS: A secondary analysis of a randomised controlled trial, aimed at promoting physical activity, was conducted. It was a cross-sectional study based on data of a multicomponent intervention group (baseline = 201 participants). For evaluating the usage and acceptance, descriptive statistics were applied. RESULTS: Over half (n = 118) of the patients participated at least once in the telephone coaching. Approximately half of the participants (44 of 90) rated the telephone coaching as "good".34 of 92 (37%) participants reported of visiting the web-platform. The web-platform was comprehensible for nearly one-quarter (n = 8 of 33) and very useful for one participant.The face-to-face-contact was rated highly (range: 79.4-88.2 out of 100). CONCLUSION: Usage of the telephone coaching approach was moderate with even fewer participants visiting the web-platform. In addition, these approaches were not rated as very useful. The acceptance of the face-to-face contact was high.Since the usage and acceptance could influence the effectiveness, utilisation and acceptance studies might help to explain the reason for non-effective lifestyle interventions. Therefore, more studies analysing the usage and acceptance are needed. To improve the usage and acceptance, a stronger participatory orientation in the design of interventions and the integration of face-to-face contact could be helpful.

Influence of Health Literacy on the Physical Activity of Working Adults: A Cross-Sectional Analysis of the TRISEARCH Trial.

Studies show that high health literacy (HL) can support the promotion and maintenance of healthy behavior such as physical activity (PA). However, most studies rely on subjective data. The aim of the present study is to investigate the relationship between HL and PA, not only with subjectively but also with objectively measured PA data. The present study is a pooled analysis of baseline data from the research association TRISEARCH (2015-2018), which focused on the HL of working adults. HL was measured by Lenartz' questionnaire, and PA by the Global Physical Activity Questionnaire (GPAQ; n = 1056). A subsample (n = 124) also received accelerometers (Actigraph GT3X+) to provide more objective PA data. Partial correlations and regression models were used to investigate the relationship between HL and questionnaire- and accelerometer-derived PA. Very low and medium partial correlations could be found for HL subscales and daily PA by questionnaire (r = -0.06, p < 0.05) and accelerometer (r = 0.26, p < 0.01). No subscale of HL made a significant contribution to the amount of daily PA (all p > 0.05). Not all subscales of HL seem to have an influence on the occurrence of healthy behavior, such as PA. This should be considered when HL-based interventions are designed. Further investigation of the relationship between HL and PA is needed. Objective assessments of both HL and PA can provide additional information for this task.

Expectations Regarding Workplace Health Coaching: A Qualitative Study With Stakeholders.

The integration of health coaching in workplace interventions has increased over the past several years. However, the tasks and the qualifications of the coaches have not been clearly defined. The objective of this qualitative study was to assess workplace stakeholders' expectations regarding a health coach. Systematic field notes of 11 meetings and 14 semi-structured interviews with stakeholders of a workplace intervention, including employees, company doctors, and representatives of health insurances, were analyzed according to the structured content analysis. Stakeholders reported that the main aspect of a health coach's work should be the motivation of clients (workers) to achieve their internally developed goals. Regarding the coach's competencies, personal, methodological, and social skills were desired. They also expected that the health coach use a range of different approaches to develop contacts and, in terms of content, focus on physical activity. These findings provide a step toward establishing criteria for professional health coaching and an evidence-based curriculum for coach training.

Effectiveness Studies in Health Promotion: A Review of the Methodological Quality of Studies Reporting Significant Effects on Physical Activity in Working Age Adults.

The methodology of intervention studies on physical activity (PA) promotion is of great importance regarding evidence development in complex interventions. The aim of this review was to provide an overview of the methodological quality of those studies which reported statistically significant effects of interventions promoting PA. PUBMED was searched for reviews on PA promotion to identify studies reporting effective interventions with participants of working age (16⁻67 years). Selected reviews were screened and data from primary studies with effective interventions were extracted to assess methodological quality. Forty-six reviews with 600 primary studies were identified, of which 33 met the inclusion criteria. Twenty-one studies were conducted as randomized controlled trials, 13 included an intervention control group, 25 measured PA by questionnaire, and 13 included objective measurements. Information on used statistics was often scarce, and long-term follow-up measurements were frequently missing. The overall methodological quality was moderate for randomized studies and low for non-randomized studies; information on methods and results was often lacking. To overcome these methodological issues, standardized guidelines for reporting study results should be considered, not only when publishing results but also when designing studies. This review provides a solid foundation for the development of practical advice for planning application-oriented studies in PA promotion.

Long-term effectiveness of health coaching in rehabilitation and prevention: A systematic review.

OBJECTIVE: This systematic review aims to evaluate the long-term effectiveness of health coaching interventions in rehabilitation and prevention. METHODS: Databases and a manual search were used to identify randomized controlled trials (RCTs) in English through to June 2015. Studies were included if: (1) the target population were people of employment age, (2) the intervention addressed either people suffering from a diagnosed disease or healthy people, (3) the intervention included health coaching to influence health-related outcomes and/or processes and (4) the study had a follow-up of at least 24 weeks after the end of the intervention period. RESULTS: Out of 90 RCTs, 14 studies were selected using the inclusion criteria: seven were designed for the rehabilitative setting and seven for the preventive setting. Three studies of each setting found statistically significant long-term effectiveness. CONCLUSIONS: The high number of studies evaluating health coaching underlines the relevance of this approach. Despite the increasing popularity of health coaching, a research gap exists in regard to its long-term effectiveness. PRACTICE IMPLICATIONS: It is of utmost importance to consider the sustainability already during planning of health coaching interventions. The involvement of the target group and the setting seems to be a promising strategy.

Promoting physical activity and health literacy: study protocol for a longitudinal, mixed methods evaluation of a cross-provider workplace-related intervention in Germany (The AtRisk study).

BACKGROUND: Physical activity and health literacy are topics of utmost importance in the prevention of chronic diseases. The present article describes the study protocol for evaluating a cross-provider workplace-related intervention promoting physical activity and health literacy. METHODS: The RE-AIM Framework will be the conceptual framework of the AtRisk study. A controlled natural experiment and a qualitative study will be conducted. The cross-provider intervention is based on the cooperation of the German Pension Fund Rhineland and cooperating German Statutory Health Insurances. It combines two components: a behavior-oriented lifestyle intervention and the assignment of a health coach. The single-provider intervention only includes the behavior-oriented lifestyle intervention. The quantitative study (natural experiment) encompasses three measuring points (T0 = start of the behavior-oriented lifestyle intervention (baseline); T1 = end of the behavior-oriented lifestyle intervention (16 weeks); T2 = 6 month follow-up) and will compare the effectiveness of the cross-provider workplace-related intervention compared with the single provider intervention. Participants are employees with health related risk factors. ANCOVA will be used to evaluate the effect of the intervention on the outcome variables leisure time physical (primary outcome) activity and health literacy (secondary outcome). The qualitative study comprises semi-structured interviews, systematic field notes of stakeholder meetings and document analyses. DISCUSSION: The AtRisk study will contribute towards the claim for cross-provider interventions and workplace-related approaches described in the new Preventive Health Care Act. The results of this study will inform providers, payers and policy makers about the effectiveness of a cross-provider workplace-related lifestyle intervention compared to a single-provider intervention. Beyond, the study will identify challenges for implementing cross-provider preventive interventions. With respect to the sustainability of preventive interventions the AtRisk study will give insight in the expectations and needs on health coaching from the perspective of different stakeholders. TRIAL REGISTRATION: DRKS00010693 .

Influencing Factors on the Overestimation of Self-Reported Physical Activity: A Cross-Sectional Analysis of Low Back Pain Patients and Healthy Controls.

Introduction. The aim of the present study was to determine the closeness of agreement between a self-reported and an objective measure of physical activity in low back pain patients and healthy controls. Beyond, influencing factors on overestimation were identified. Methods. 27 low back pain patients and 53 healthy controls wore an accelerometer (objective measure) for seven consecutive days and answered a questionnaire on physical activity (self-report) over the same period of time. Differences between self-reported and objective data were tested by Wilcoxon test. Bland-Altman analysis was conducted for describing the closeness of agreement. Linear regression models were calculated to identify the influence of age, sex, and body mass index on the overestimation by self-report. Results. Participants overestimated self-reported moderate activity in average by 42 min/day (p = 0.003) and vigorous activity by 39 min/day (p < 0.001). Self-reported sedentary time was underestimated by 122 min/day (p < 0.001). No individual-related variables influenced the overestimation of physical activity. Low back pain patients were more likely to underestimate sedentary time compared to healthy controls. Discussion. In rehabilitation and health promotion, the application-oriented measurement of physical activity remains a challenge. The present results contradict other studies that had identified an influence of age, sex, and body mass index on the overestimation of physical activity.

Physical activity and health-related quality of life in chronic low back pain patients: a cross-sectional study.

BACKGROUND: The aim of the present study was to identify the relationship of physical activity (PA) and Health-Related Quality of Life (HRQoL) in patients suffering from low back pain (LBP). METHODS: The present evaluation was conducted as a cross-sectional study based on baseline data of an randomized controlled trial on the effectiveness of an intervention promoting PA. Patients answered a questionnaire on domain specific PA (GPAQ) and HRQoL (EQ-5D-5 L). Furthermore, sociodemographic and indication-specific variables as well as work-related aspects were assessed. Associations of PA and HRQoL were estimated by means of regression analysis: one regression model only included domain specific PA (model 1) and a second regression model additionally included further variables (model 2). RESULTS: 412 patients completed the questionnaire. Model 1 showed opposed effects of workplace and leisure time PA: while workplace PA showed a negative association (ß = -0.064; p = 0.04), a positive association of leisure time PA could be proved (ß = 0.068; p = 0.01). Model 2 showed that only the variables "current work ability" (ß = -0.030; p < 0.01) and "intensity of pain" (ß = 0.104; p < 0.01) significantly contributed to explain the variance in HRQoL (model 2). CONCLUSIONS: The present results indicate the necessity of a differentiation of workplace and leisure time PA in the context of assessing health-enhancing effects of PA in LBP patients. In the context of HRQoL it must be assumed that the relevance of PA might be overestimated. Further research should be performed on predictors of HRQoL and thereby particular attention should be paid on the patients' work-related and indication-specific aspects.