Published online October 23,

Transcription

1 Author, year (country) Agurs- Collins, (USA) n (completing), mean age, % male, other characteristics 64 (55), 61 7years, 33% male, All >55 years, African American Recruitment Follow-up Description of Duration or Hospital clinics, community adverts 3 and 6 (written information) (2) Weight loss and exercise (based on social action theory. Included nutrition education, exercise, problem solving, relapse prevention, goal setting, self monitoring) 1 session 1 5 h per week for 12 weeks and 1 5 h per fortnight for 3 and 1 individual session Delivered by Dietician and exercise physiologist Findings 2 significantly better than group 1 at 3 and 6 (p<0 01) 2 significantly better than group 1 on exercise (p<0 001) and some diet behaviours at 3, but no significant differences at 6 Smith, (USA) Samaras, (Australia) Jablon, (USA) 22 (16), 62 years, 0% male, all >50 years, obese 26 (not 61 years, 38% male, none exercising 20 (20), Advert, letter from physicians Outpatient clinic Outpatient clinics 6 and 12 (1) Behavioural weight control (information, behaviour modification, selfmonitoring) (2) Behavioural weight control and motivational interviewing (information, behaviour modification, self monitoring, motivational interviews including exploring ambivalence to behaviour change, setting goals, problem solving) (2) Exercise and support group (based on precedeproceed model. Overcoming barriers, building selfesteem and motivation and providing support and exercise) 16 sessions over 4 19 sessions over 4 >1 h per month for 6 Multidisciplinary team Multidisciplinary team Multidisciplinary team 2 significantly better than group 1 post 2 significantly more frequent blood glucose monitoring than group 1 post. No significant difference between groups in exercise frequency although trend for group 2 to be better than group 1 post (p=0 07) Differences between groups unclear. No significant change in group 2 at 6 but significant deterioration at 12. At 6 and 12, group 1 had significant deterioration from between groups on diet or exercise at 6 or 12 between groups on SF-36 at 6 or Published online October 23,

2 Henry, (Australia) Aikens, (USA) Vazquez, (USA) Lustman, (USA) 50% male (2) Progressive relaxation and biofeedback (information on stress, relaxation training and biofeedback, audiotapes) 21 (19), 60 years, 47% male 22 (not 61 0 years, 39% male 38 (not Caribbean Latinos, obese 51 (42), 55 years, 88% male, all depressed Outpatient clinics Urban diabetes clinic Community, hospital, adverts, participant referral Advertised to physicians and in media (2) Cognitive behavioural stress management (progressive muscular relaxation, cognitive coping skills training and problem solving) 2 (2) Relaxation training (information and discussion on stress, progressive muscle relaxation and imagery, audiotape) 3 Intervention, 6 (2) Nutrition (based on social learning theory. Discussion, demonstration, practical skills, problem solving, consideration of beliefs, role-playing) (1) Diabetes education (information) (2) Diabetes education and cognitive behaviour therapy (behavioural strategies, problem solving, cognitive techniques) 8 1-h sessions over 4 weeks and practice with 20-min tape twice per day 1 5hrs per week for 6 weeks 6 1-h sessions over 8 weeks and practice with 30-min tape 12 weekly sessions and 8 bimonthly sessions 2 h per week for 10 weeks 3 h per week for 10 weeks Not stated between groups post between groups post for anxiety, but group 2 significantly improved from at, while group 1 showed no change 2 significantly better than Psychologist group 1 post 2 significantly better than group 1 for depression and anxiety (p<0 01) post Psychologist at 2 Differences between groups 1 and 2 at 2 were not reported, but group 2 significantly improved on scores of general distress whereas group 1 showed no change. Neither group showed change in anxiety Nutritionist and Educator Educator and 2 significantly better diet behaviour at 3 than group 1 post but at 6 group 2 significantly better than group 1 2 significantly better for depression than group 1 post and 6 (p<0 01) Published online October 23,

3 Ridgeway, (USA) Kirk, (UK) McKay, (USA) Miller, 54 McKay, (38), 64 years, 29% male 26 (23), 49 years, 44% male, all patients contemplation/ preparation 78 (68), 52 years, 47% male 98 (92), 73 years, 47% male, all >65 years 160 (133), 47% male Physicians recommended to patients Database and outpatients and online invitations Adverts, news letters Letters from primary-care physician 6 and12 5 weeks from 8 weeks from (2) Education/behaviour modification programme (information, goal setting, contracts) (1) Standard information (standard leaflet on exercise, general discussion) (2) Exercise consultation (based on transtheoretical model, aimed to increase motivation, set goals and develop strategies to maintain exercise) (1) Internet Information only (diabetes information) (2) Internet exercise programme (based on social-ecological model. Identified benefits, barriers of exercise, set goals, exercise database, online support from personal coach & other users) (2) Nutrition education programme (based on theory of meaningful learning, information processing model and social cognitive theory. Monitoring, goal setting, and rewards) 3 month (1) Internet information only (information only) (2) Internet selfmanagement 1 5 h per month for 6 and 1 session at min session 30-min session Varied 8 weeks h per week for 10 weeks Varied over 3 Contacts twice per week for 3 Nurse and dietician Researcher Researcher Internet Internet and occupational therapist Dietician Not applicable Professional with dietary at 6 or 12 but both groups improved from at 6 at 6 or 12 2 significantly better than group 1 at 5 weeks (98% CI) on exercise measured by accelerometer but not questionnaire. No differences on wellbeing questionnaire. 2 significantly better than group 1 on mental health subscale of SF-36 (98%CI). No differences between groups on other subscales of SF-36. post for exercise. at post- on depression. 2 significantly better than group 1 post (p<0 01) although significance levels not reported. Published online October 23,

4 Levetan, 56 Kenardy, (Australia) Keyserling, (USA) 150 (128), 33% male, diabetes type not stated (we assume type 2) 34 (not 55 years, 0% male, All binge eaters 200 (varied), 0% male, African American Education programme Clinic Clinician invitation 6 from 6 and12 (goal setting, problem solving with professional coach) (3) Internet peer support (information and peer interaction) (4) Internet selfmanagement and peer support (goal setting, problem solving with professional coach and information and peer support) (completed an education programme in 3 before enrolment) (2) Computerised goals (completed an education programme in 3 before enrolment and poster with personal goals for HbA1c, wallet card, postcards) (1) Non-prescriptive therapy (non-directive counselling and focused evocative unfolding to become aware and accept negative affect) (2) Cognitive behaviour therapy (cognitive restructuring, problem solving) (1) Minimum (2) Clinic (exercise counselling, Varied over 3 Varied over 3 10-min phone call 1 5 h per week for 10 weeks 1 5 h per week for 10 weeks monthly sessions for 4 experience Not applicable Professional with dietary experience Educator Psychologist Psychologist Nutritionist Differences between groups not reported statistically although apparent improvement of all groups at 3 Differences between groups not reported statistically although no apparent improvement for any group on depression Differences between groups not reported statistically although no apparent improvement for any group on SF-12 2 significantly better post compared to but no change for group 1. For patients with HbA1c >7 0%, group 2 was significantly better than group 1 at 6 No significant difference between groups or from No significant difference between groups. Significant change over time at post (p<0 01) for combined groups on frequency of binge eating No significant difference between groups. Significant change over time post (p<0 01) for combined groups on frequency of wellbeing. at 6 Exercise groups (2 and 3) Published online October 23,

5 Glasgow, 111 women >40 years 320 (285), 58 years, 43% male Letter from primary-care physician negotiated goals, information) (3) Clinic and community Intervention (exercise counselling, negotiated goals, telephone calls from peer supporter) 12 (1) Brief dietary problem solving and reinforcement) (2) Brief dietary and community resources problem solving, reinforcement, social support, resource binder) (3) Brief dietary and telephone follow-up problem solving and reinforcement, lapse and relapse counselling) 4. Brief Dietary, telephone follow-up, and community resources problem solving and reinforcement, lapse and relapse counselling, social support, resource binder) Published online October 23, monthly sessions for 4 and 2 group sessions and telephone calls 1 2 h at, 3 and h at, 3 and h at, 3 and 6, and 7, min phone calls over h at, 3 and 6, and 7, min phone calls over 12 Nutritionist and peer counsellor significantly better than group 1 (p<0 05, p<0 01 respectively). between 2 and 3. No differences between groups for diet in mental or social wellbeing at either 6 or 12 at 12 but significant improvements of all groups from (p<0 001). At 3 and 6 no significant effect from or differences between groups at 12 but significant improvements of all groups from (p<0.001) for diet. At 3 and 6, groups with telephone follow-up were significantly better than other groups for fat behaviour or changes from for illness intrusiveness at 12. At 3 and 6 there were no changes from on illness intrusiveness but participants with community resources showed less change than others conditions at 3 but more at 6 Brown, (not Databases of 6 and 24

6 54 years, 19 5% male, Mexican American Trento, (Italy) 112 (90), 62 years, 54% male other research studies Clinic database 24,36 and 48 (2) Self-management education (information, skills training, problem solving and group support) (2) Interactive group visits (based on systemic education approach. Included group work, problem solving, real life simulations, role playing and homework) 2 h per week for 3 and 2 h per fortnight for 6 and 2 h per month for 3 15 sessions over 4 years and community workers Physician and educator 2 significantly better than group 1 at 6 (p<0 001) and 12 (p<0 01) 2 significantly better than group 1 at 24, 36, and 48 (p<0 001) 2 significantly better than group 1 at 12, 24, and 48 (p<0 001) 2 significantly better than group 1 at 24 and 48 (p<0 001), but no significant differences at 12 Surwit, 62 Rickheim, (USA) 108 (72), 57 years, 58% male 170 (92), 52 years, 66% male Adverts, medical facilities, education and support groups Referred by primary care 2,4,6, and 12 6 from (1) Diabetes education (information) (2) Stress management and diabetes education (progressive muscle relaxation, cognitive, behavioural skills, information on stress and diabetes) (1) diabetes education (based on adult learning, nursing, Health Belief and transtheoretical models. Information, problem solving, goal setting) (2) diabetes 0 5 hrs per week for 5 weeks 0 5hrs per week for 5 weeks 2 h at, 1 h at 2 weeks and at 3 and 6 Not stated Not stated Nurse and nutrition specialist Nurse and 2 significantly better than group 1 at 12 mths (p<0.05) but no significant difference at 2,4, or 6 between groups at 2,4,6,or 12 for diet or exercise between groups at 2,4,6,or 12 for anxiety, perceived stress or psychological health 2 significantly better at 6 than group 1 but both groups improved significantly from to 6 (p<0 01) between groups at 6 month Published online October 23,

7 education (based on adult learning, nursing, Health Belief and transtheoretical models. Information, problem solving, goal setting) 3 h at, 2 h at 2 weeks and 1 h at 3 and 6 nutrition specialist follow-up for exercise between groups on psychological adjustment (p<0 01), but both groups improved at 6 between groups, although both groups improved at 6 on the mental but not the physical subscale of the SF-36 Clinical assessments included HbA1c as indicator of glycaemic control. Other clinical assessments (eg, blood lipids, weight, body-,ass index, etc) were excluded. Behaviour included measures of diabetes self-management behaviours (eg, diet, exercise, HBGM, etc), but behaviours specifically related to (eg, use of community resources) excluded. Psychological wellbeing included any composite measures of wellbeing or assessments of mood (eg, depression or anxiety). Perceived stress also included in this category. diabetes specific and generic quality of life measures included under quality-of-life category. One measure of illness intrusiveness included under this subsection to reflect reporting in original paper. Studies with mixed populations in which results were not explained separately were excluded (includes Glasgows studies). Description of every aims to provide reflective summary of what each entailed; all elements of all s could not be included. Where duration of session is range, higher figure taken. Where mean age is presented by group, mean of those presented taken, same applies for sex. n = number randomised (available at follow-up). =follow-up period from post. Table 1: Type 2 diabetes Published online October 23,