ABSTRACT

Heart failure (HF) is characterised by breathlessness and fatigue that impacts negatively on patients’ intentions to prioritise physical activity (PA). As such, healthcare professionals (HCPs) experience challenges when motivating patients to increase and maintain PA. It is therefore important to enhance our understanding on how to better equip HCPs with the skills required to deliver interventions to increase physical activity levels of patients with HF. We conducted a systematic review to identify active ingredients of training interventions for HCPs to enable them to deliver corresponding PA interventions to adults with HF. Nine databases were searched. Two reviewers assessed study eligibility. Data were extracted on study characteristics, active ingredients, outcomes, and fidelity measures. The Cochrane Collaboration Risk of Bias tool for RCTs was used to assess methodological quality. Data were synthesised narratively, and a promise analysis conducted on key intervention features. Ten RCTs, which reported on a training intervention for HCPs to deliver a concomitant patient intervention, fulfilled the review criteria (N = 22 HCPs: N = 1,414 HF patients). Two studies reported use of theory to develop training interventions for HCPs. Seven behaviour change techniques (BCTs) were identified across the 10 HCP training interventions. The most ‘promising’ BCTs were ‘instruction on how to perform the behaviour’ (PA) and ‘problem solving’ (Quality of Life). Two studies reported that HCP training interventions had been formally evaluated. Fidelity domains relating to study design, monitoring, and improving delivery of treatment, intervention delivery and provider training were infrequently reported. Future research should prioritise theory-informed development and robust evaluation of training interventions for HCPs to enable faithful and quality delivery of patient interventions.

摘要

心力衰竭 (HF) 的特点是呼吸困难和疲劳，这会对患者优先进行体力活动 (PA) 的意愿产生负面影响。因此，医疗保健专业人员 (HCP) 在激励患者增加和维持 PA 时面临挑战。因此，重要的是要加深我们对如何更好地为医护人员提供提供干预措施以提高心力衰竭患者体力活动水平所需的技能的理解。我们进行了系统回顾，以确定 HCP 培训干预措施的有效成分，使他们能够向心力衰竭成人提供相应的 PA 干预措施。检索了九个数据库。两名评审员评估了研究资格。提取有关研究特征、活性成分、结果和保真度测量的数据。使用随机对照试验的 Cochrane 协作偏倚风险工具来评估方法学质量。以叙述方式综合数据，并对关键干预特征进行承诺分析。十项 RCT 报告了对 HCP 进行培训干预以提供伴随患者干预的情况，满足审查标准（N = 22 HCP：N = 1,414 名心力衰竭患者）。两项研究报告了利用理论为医护人员制定培训干预措施的情况。在 10 项 HCP 培训干预措施中确定了 7 种行为改变技术 (BCT)。最“有前途”的 BCT 是“行为指导”（PA）和“解决问题”（生活质量）。两项研究报告称，HCP 培训干预措施已得到正式评估。与研究设计、监测和改善治疗实施、干预实施和提供者培训相关的保真领域很少被报道。未来的研究应优先考虑基于理论的开发和对 HCP 培训干预措施的稳健评估，以便能够忠实、高质量地提供患者干预措施。