Lifestyle interventions in primary care: systematic review of randomized controlled trials - PubMed (original) (raw)

Review

. 2008 Dec;54(12):1706-13.

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Review

Lifestyle interventions in primary care: systematic review of randomized controlled trials

Patrick Fleming et al. Can Fam Physician. 2008 Dec.

Abstract

in English, French

Objective: To determine whether lifestyle counseling interventions delivered in primary care settings by primary care providers to their low-risk adult patients are effective in changing factors related to cardiovascular risk.

Data sources: MEDLINE (PubMed), EMBASE, and CINAHL were searched from January 1985 to December 2007. The reference lists of all articles collected were checked to ensure that all suitable randomized controlled trials (RCTs) had been included.

Study selection: We chose RCTs on lifestyle counseling in primary care for primary prevention of cardiovascular disease. The search was limited to English-language articles involving human subjects. Studies had to have been conducted within the context of primary care, and interventions had to have been carried out by primary care providers, such as family physicians or practice nurses. Studies had to have had a control group who were managed with usual care. Outcomes of interest were cardiovascular risk scores, blood pressure, lipid levels, weight or body mass index, and morbidity and mortality.

Synthesis: Seven RCTs were included in the review. Only 4 studies showed any significant positive effect on the outcomes of interest, and only 2 of these showed consistent effects across several outcomes. The main effects were on blood pressure and lipid levels, but the size of these effects, while statistically significant, was small. There was no obvious benefit to one provider doing the intervention over another (eg, physician vs nurse), nor of the focus of the intervention (eg, on diet vs on exercise).

Conclusion: Lifestyle counseling interventions delivered by primary care providers in primary care settings to patients at low risk (primary prevention) appeared to be of marginal benefit. Resources and time in primary care might be better spent on patients at higher risk of cardiovascular disease, such as those with existing heart disease or diabetes.

OBJECTIF: Déterminer si les conseils sur le at de vie donnés par les soignants de première ligne à leurs patients adultes à faible risque sont efficaces pour modifier les facteurs de risque cardiovasculaires.

SOURCES DES DONNÉES: On a consulté MEDLINE (PubMed), EMBASE et CINAHL entre janvier 1985 et décembre 2007. On a vérifié la bibliographie de chaque article pour s’assurer d’inclure tous les essais cliniques randomisés (ECR) pertinents.

CHOIX DES ÉTUDES: Nous avons retenu les ECR portant sur les conseils donnés en première ligne pour la prévention primaire des maladies cardiovasculaires. La recherche était limitée aux articles de langue anglaise comportant des sujets humains. Les études devaient être menées dans un contexte de soins primaires, et les interventions effectuées par des soignants de première ligne, tels que des médecins de famille ou des infirmières praticiennes. Les études devaient inclure un groupe témoin recevant les soins usuels. Les issues principales étaient l’indice de risque cardiovasculaire, la tension artérielle, le niveau des lipides, le poids et l’indice de masse corporelle ainsi que la morbidité et la mortalité.

SYNTHÈSE: La revue a finalement porté sur 7 ECR. Seulement 4 revues ont montré un effet positif significatif sur les issues principales et seulement 2 d’entreelles montraient des effets positifs réguliers sur plus d’une issue. Les principaux effets concernaient la tension artérielle et le taux des lipides, mais l’amplitude de ces effets, quoique statistiquement significative, était faible. Il n’y avait pas d’avantage évident associé à un type d’intervenant (p. ex. médecin vs infirmière) ou à un type d’intervention (p. ex. régime ou exercice).

CONCLUSION: Les conseils sur le mode de vie donnés aux patients à faible risque par les intervenants de première ligne (prévention primaire) semblaient avoir peu d’effets bénéfiques. Dans un contexte de soins primaires, les ressources et le temps pourraient être mieux utilisés en ciblant les patients à risque plus élevé de maladie cardiovasculaire, comme ceux souffrant déjà d’une maladie cardiaque ou de diabète.

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