Feasibility of the PHYZ X 2U program: a mobile and cloud-based outreach service to improve chronic disease outcomes in underserviced rural communities
Serene S. Paul
A E , Tania Gardner A , Angela Hubbard B , Justin Johnson B , Colleen G. Canning A , Andrew Leaver A , Jacqueline Raymond A and Sarah M. Dennis A C D
+ Author Affiliations
- Author Affiliations
A Faculty of Health Sciences, University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia.
B PhyzX, PO Box 117, Orange, NSW 2800, Australia.
C South Western Sydney Local Health District, Locked Bag 7279, Liverpool, BC 1871, Australia.
D Ingham Institute of Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170, Australia.
E Corresponding author. Email: serene.paul@sydney.edu.au
Australian Journal of Primary Health 25(6) 539-546 https://doi.org/10.1071/PY19090
Submitted: 25 April 2019 Accepted: 11 July 2019 Published: 11 November 2019
Abstract
Chronic disease is prevalent in rural communities, but access to health care is limited. Allied health intervention, incorporating behaviour change and exercise, may improve health outcomes. PHYZ X 2U is a new service delivery model incorporating face-to-face consultations via a mobile clinic and remote health coaching, delivered by physiotherapy and exercise physiology clinicians and university students on clinical placement, to provide exercise programs to people living with chronic disease in rural New South Wales, Australia. This pilot study evaluated the feasibility and acceptability of PHYZ X 2U by evaluating participants’ goal attainment, exercise, quality of life and behaviour change following participation in the 12-week program, and amount of health coaching received. Sixty-two participants with one or more chronic diseases set a total of 123 goals. Thirty-nine (63%) participants completed the program, with 59% of these achieving their goals and 43% progressing in their attitudes and behaviour towards exercise. Weekly exercise increased by 1 h following program participation (P = 0.02), but quality of life remained unchanged (P = 0.24). Participants who completed the program received more health coaching than those lost to follow up. PHYZ X 2U can increase access to allied health for people with chronic disease living in rural and remote areas. Refining the service to maximise program adherence and optimally manage a broad range of chronic diseases is required.
Additional keywords: exercise, health coaching, mobile technology, rural health, self-management.
References
Ahrendt AD, Kattelmann KK, Rector TS, Maddox DA (2014) The effectiveness of telemedicine for weight management in the MOVE! Program. The Journal of Rural Health 30, 113–119.| The effectiveness of telemedicine for weight management in the MOVE! Program.Crossref | GoogleScholarGoogle Scholar | 24112223PubMed |
Australian Institute of Health and Welfare (2017) Rural & remote health. (Australian Institute of Health and Welfare: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/rural-health/rural-remote-health/contents/health-conditions-remoteness [Verified 1 July 2019]
Armit CM, Brown WJ, Marshall AL, Ritchie CB, Trost SG, Green A, Bauman AE (2009) Randomized trial of three strategies to promote physical activity in general practice. Preventive Medicine 48, 156–163.
| Randomized trial of three strategies to promote physical activity in general practice.Crossref | GoogleScholarGoogle Scholar | 19100282PubMed |
Battye K, McTaggart K (2003) Development of a model for sustainable delivery of outreach allied health services to remote north-west Queensland, Australia. Rural and Remote Health 3, 194
| Development of a model for sustainable delivery of outreach allied health services to remote north-west Queensland, Australia.Crossref | GoogleScholarGoogle Scholar | 15882095PubMed |
Dao J, Spooner C, Lo W, Harris MF (2019) Factors influencing self-management in patients with type 2 diabetes in general practice: a qualitative study. Australian Journal of Primary Health 25, 176–184.
| Factors influencing self-management in patients with type 2 diabetes in general practice: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 30890241PubMed |
Delbaere K, Hauer K, Lord SR (2010) Evaluation of the incidental and planned activity questionnaire (IPEQ) for older people. British Journal of Sports Medicine 44, 1029–1034.
| Evaluation of the incidental and planned activity questionnaire (IPEQ) for older people.Crossref | GoogleScholarGoogle Scholar | 19474003PubMed |
Dennis SM, Zwar N, Griffiths R, Roland M, Hasan I, Powell Davies G, Harris M (2008) Chronic disease management in primary care: from evidence to policy. The Medical Journal of Australia 188, S53–S56.
| Chronic disease management in primary care: from evidence to policy.Crossref | GoogleScholarGoogle Scholar | 18429737PubMed |
Duckett S, Breadon P (2013) Access all areas: new solutions for GP shortages in rural Australia. (Grattan Institute: Melbourne, Vic., Australia) Available at https://grattan.edu.au/wp-content/uploads/2014/04/196-Access-All-Areas.pdf [Verified 1 July 2019]
Euroqol (1990) EQ-5D. (EuroQol Research Foundation: Rotterdam, The Netherlands) Available at https://euroqol.org/ [Verified 8 February 2019]
Gardner T, Refshauge K, McAuley J, Hübscher M, Goodall S, Smith L (2019) Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial. British Journal of Sports Medicine
| Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 30808666PubMed |
Glynn LG, Hayes PS, Casey M, Glynn F, Alvarez-Iglesias A, Newell J, OLaighin G, Heaney D, O’Donnell M, Murphy AW (2014) Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial. The British Journal of General Practice 64, e384–e391.
| Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 24982490PubMed |
Habbous S, Chu KP, Harland LT, La Delfa A, Fadhel E, Sun B, Xu W, Wong A, Howell D, Ringash J, Waldron J, O’Sullivan B, Goldstein D, Huang SH, Liu G (2013) Validation of a one-page patient-reported Charlson comorbidity index questionnaire for upper aerodigestive tract cancer patients. Oral Oncology 49, 407–412.
| Validation of a one-page patient-reported Charlson comorbidity index questionnaire for upper aerodigestive tract cancer patients.Crossref | GoogleScholarGoogle Scholar | 23291295PubMed |
Health Workforce Australia (2014) ‘Australia’s Health Workforce Series - Physiotherapists in Focus.’ (Health Workforce Australia: Adelaide, SA, Australia)
Kirby SE, Dennis SM, Bazeley P, Harris MF (2013) Activating patients with chronic disease for self-management: comparison of self-managing patients with those managing by frequent readmissions to hospital. Australian Journal of Primary Health 19, 198–206.
| Activating patients with chronic disease for self-management: comparison of self-managing patients with those managing by frequent readmissions to hospital.Crossref | GoogleScholarGoogle Scholar | 22950823PubMed |
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine 346, 393–403.
| Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.Crossref | GoogleScholarGoogle Scholar | 11832527PubMed |
Kolip P, Schaefer I (2013) Goal attainment scaling as a tool to enhance quality in community-based health promotion. International Journal of Public Health 58, 633–636.
| Goal attainment scaling as a tool to enhance quality in community-based health promotion.Crossref | GoogleScholarGoogle Scholar | 23619722PubMed |
Lawn S, Schoo A (2010) Supporting self-management of chronic health conditions: common approaches. Patient Education and Counseling 80, 205–211.
| Supporting self-management of chronic health conditions: common approaches.Crossref | GoogleScholarGoogle Scholar | 19931372PubMed |
Marcus B, Forsyth L (2003) ‘Motivating People to Be Physically Active.’ (Human Kinetics: Champaign, IL, USA)
Neupert SD, Lachman ME, Whitbourne SB (2009) Exercise self-efficacy and control beliefs: effects on exercise behavior after an exercise intervention for older adults. Journal of Aging and Physical Activity 17, 1–16.
| Exercise self-efficacy and control beliefs: effects on exercise behavior after an exercise intervention for older adults.Crossref | GoogleScholarGoogle Scholar | 19299835PubMed |
Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, Mutrie N (2007) Interventions to promote walking: systematic review. BMJ (Clinical Research Ed.) 334, 1204
| Interventions to promote walking: systematic review.Crossref | GoogleScholarGoogle Scholar |
Petrella RJ, Stuckey MI, Shapiro S, Gill DP (2014) Mobile health, exercise and metabolic risk: a randomized controlled trial. BMC Public Health 14, 1082
| Mobile health, exercise and metabolic risk: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 25326074PubMed |
Troiano RP, Gabriel KKP, Welk GJ, Owen N, Sternfeld B (2012) Reported physical activity and sedentary behavior: why do you ask? Journal of Physical Activity & Health 9, S68–S75.
| Reported physical activity and sedentary behavior: why do you ask?Crossref | GoogleScholarGoogle Scholar |
Tudor-Locke C, Lutes L (2009) Why do pedometers work?: a reflection upon the factors related to successfully increasing physical activity. Sports Medicine (Auckland, N.Z.) 39, 981–993.
| Why do pedometers work?: a reflection upon the factors related to successfully increasing physical activity.Crossref | GoogleScholarGoogle Scholar |
Wakerman J, Humphreys JS, Wells R, Kuipers P, Entwistle P, Jones J (2008) Primary health care delivery models in rural and remote Australia – a systematic review. BMC Health Services Research 8, 276
| Primary health care delivery models in rural and remote Australia – a systematic review.Crossref | GoogleScholarGoogle Scholar | 19114003PubMed |
West SP, Lagua C, Trief PM, Izquierdo R, Weinstock RS (2010) Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project. Telemedicine Journal and e-Health 16, 405–416.
| Goal setting using telemedicine in rural underserved older adults with diabetes: experiences from the informatics for diabetes education and telemedicine project.Crossref | GoogleScholarGoogle Scholar | 20507198PubMed |
