PDF(Pubmed)
Abstract：
BACKGROUND: Physical activity referral schemes (PARS) are complex multicomponent interventions that represent a promising healthcare-based concept for physical activity (PA) promotion. This systematic review and narrative synthesis aimed to identify the constitutive components of PARS and provide an overview of their effectiveness.
METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness.
RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%).
CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.
METHODS: Following a published protocol, we conducted a systematic search of PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, SpringerLink, HTA, Wiley Online Library, SAGE Journals, Taylor & Francis, Google Scholar, OpenGrey, and CORE from 1990 to January 2023. We included experimental, quasi-experimental, and observational studies that targeted adults participating in PARS and reported PA outcomes, scheme uptake, or adherence rates. We performed an intervention components analysis using the PARS taxonomy to identify scheme components and extracted data related to uptake, adherence, and PA behavior change. We combined these to provide a narrative summary of PARS effectiveness.
RESULTS: We included 57 studies reporting on 36 PARS models from twelve countries. We identified 19 PARS components: a patient-centered approach, individualized content, behavior change theory and techniques, screening, brief advice, written materials, a written prescription, referral, baseline and exit consultation, counselling support session(s), PA sessions, education session(s), action for non-attendance, structured follow-up, a PA network, feedback for the referrer, and exit strategies/routes. The PARS models contained a mean of 7 ± 2.9 components (range = 2-13). Forty-five studies reported PA outcome data, 28 reported uptake, and 34 reported adherence rates. Of these, approximately two-thirds of studies reported a positive effect on participant PA levels, with a wide range of uptake (5.7-100.0%) and adherence rates (8.5-95.0%).
CONCLUSIONS: Physical activity referral scheme components are an important source of complexity. Despite the heterogeneous nature of scheme designs, our synthesis was able to identify 19 components. Further research is required to determine the influence of these components on PARS uptake, adherence, and PA behavior change. To facilitate this, researchers and scheme providers must report PARS designs in more detail. Process evaluations are also needed to examine implementation and increase our understanding of what components lead to which outcomes. This will facilitate future comparisons between PARS and enable the development of models to maximize impact.
摘要：
背景：体力活动转诊计划（PARS）是复杂的多成分干预措施，代表了基于医疗保健的体力活动（PA）促进概念。本系统综述和叙述性综合旨在确定PARS的组成成分，并概述其有效性。
方法：按照已发布的协议，我们对PubMed进行了系统的搜索,Scopus,WebofScience,CINAHL,ScienceDirect,SpringerLink,HTA,Wiley在线图书馆,SAGE日志,泰勒和弗朗西斯，谷歌学者，OpenGrey,和CORE从1990年到2023年1月。我们包括实验性的，准实验,以及针对参与PARS并报告PA结果的成年人的观察性研究，方案吸收，或坚持率。我们使用PARS分类法进行了干预成分分析，以识别方案成分并提取与摄取相关的数据，坚持,和PA行为改变。我们将这些结合起来，以提供PARS有效性的叙述性总结。
结果：我们纳入了57项研究，报告了来自12个国家的36个PARS模型。我们确定了19个PARS组件：以患者为中心的方法，个性化内容，行为改变理论和技术，筛选,简短的建议，书面材料,一张处方,转介,基线和退出咨询，咨询支持会议，PA会议，教育会议，不出席的行动，结构化后续行动，PA网络，给推荐人的反馈，和退出策略/路线。PARS模型包含平均7±2.9个分量(范围=2-13)。45项研究报告了PA结果数据，28个报告的摄取，34例报告依从率。其中,大约三分之二的研究报告对参与者PA水平有积极影响，具有广泛的摄取（5.7-100.0％）和依从率（8.5-95.0％）。
结论：体力活动转诊方案的组成部分是一个重要的复杂性来源。尽管方案设计具有异质性，我们的合成能够识别19种成分。需要进一步的研究来确定这些成分对PARS吸收的影响，坚持,和PA行为改变。为了促进这一点，研究人员和方案提供者必须更详细地报告PARS设计。还需要进行过程评估，以检查实施情况并增加我们对哪些组件导致哪些结果的理解。这将有助于将来进行PARS之间的比较，并使模型的开发能够最大程度地发挥影响。
方法：按照已发布的协议，我们对PubMed进行了系统的搜索,Scopus,WebofScience,CINAHL,ScienceDirect,SpringerLink,HTA,Wiley在线图书馆,SAGE日志,泰勒和弗朗西斯，谷歌学者，OpenGrey,和CORE从1990年到2023年1月。我们包括实验性的，准实验,以及针对参与PARS并报告PA结果的成年人的观察性研究，方案吸收，或坚持率。我们使用PARS分类法进行了干预成分分析，以识别方案成分并提取与摄取相关的数据，坚持,和PA行为改变。我们将这些结合起来，以提供PARS有效性的叙述性总结。
结果：我们纳入了57项研究，报告了来自12个国家的36个PARS模型。我们确定了19个PARS组件：以患者为中心的方法，个性化内容，行为改变理论和技术，筛选,简短的建议，书面材料,一张处方,转介,基线和退出咨询，咨询支持会议，PA会议，教育会议，不出席的行动，结构化后续行动，PA网络，给推荐人的反馈，和退出策略/路线。PARS模型包含平均7±2.9个分量(范围=2-13)。45项研究报告了PA结果数据，28个报告的摄取，34例报告依从率。其中,大约三分之二的研究报告对参与者PA水平有积极影响，具有广泛的摄取（5.7-100.0％）和依从率（8.5-95.0％）。
结论：体力活动转诊方案的组成部分是一个重要的复杂性来源。尽管方案设计具有异质性，我们的合成能够识别19种成分。需要进一步的研究来确定这些成分对PARS吸收的影响，坚持,和PA行为改变。为了促进这一点，研究人员和方案提供者必须更详细地报告PARS设计。还需要进行过程评估，以检查实施情况并增加我们对哪些组件导致哪些结果的理解。这将有助于将来进行PARS之间的比较，并使模型的开发能够最大程度地发挥影响。
