IntroductionThe Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation.MethodsWe conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies.ResultsThe 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies.ConclusionCCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making.

The purpose of the present study was to identify factors that contribute to adherent or nonadherent behavior during sport injury rehabilitation programs. Thirty-nine male and female college-age recreational athletes participated. The variables under examination were self-motivation/apathy, perceived exertion, social support, scheduling concerns, the clinical environment, and pain tolerance. Independent t tests (p < .05) were used to determine the difference between the adherer and nonadherer groups on each of the six variables. A discriminant function analysis (DFA) was employed to determine which of the six variables contributed most to the overall difference. Results of the t tests indicated that significant differences were seen for self-motivation, scheduling concerns, and pain tolerance. The DFA indicated that scheduling concerns contributed most to the overall group difference.

Patients with intermittent claudication due to peripheral arterial disease (PAD) experience muscle aching during walking secondary to ischemia. The purpose of this study was to examine the effects of low-intensity pain-free exercise (LIPFE) on functional capacity of individuals with PAD. A total of 12 participants with PAD underwent training on treadmill for 6 weeks, twice a week, for about 45 minutes. Outcome measures included walking distance (WDI), walking duration (WDU), mean walking rate (WR), estimated oxygen consumption (EVO2), metabolic equivalent (MET), estimated total energy expenditure (ETEE), and estimated rate of energy expenditure (EREE). Mean improvement of WDI, WDU, and MWR were 104% (an addition of 1.0 km), 55% (an addition of 13.3 minutes), and 41% (0.9 km/h faster), respectively. Mean improvement of EVO2, MET, ETEE, and EREE, were 20%, 20%, 80%, and 20%, respectively. In conclusion, it appears that LIPFE training is an effective intervention for individuals presenting with PAD.

Individuals with an intellectual disability (ID) have higher rates of obesity, lower rates of physical activity, cardiorespiratory fitness, and muscular endurance than do typically developed individuals (TDI) and are twice as likely to develop chronic disease, living half as long as TDIs do. The purpose of this study was to examine the improvements in physical capacity and functional ability in Special Olympic Athletes (SOAs) aged 19-22 years after participating in a functional training (FT) program and compare these scores with those of the SOAs in a resistance weight training (WT) program. Twenty SOAs (13 men, 7 women with mild to moderate ID) participated in a 1-hour FT program, twice a week, for 10 weeks, compared with 22 same-aged SOAs (14 men, 8 women) participating in a 1-hour WT program (2× week for 8 weeks). Prefitness and postfitness tests consisting of heart rate (HR) for the 3-minute step test, static plank, body weight squats, static bar hang, and knee push-ups were conducted. Two-tailed, paired sample t-tests (p < 0.05) were used to evaluate the differences in the FT group. Change scores were used to compare FTG with the WT group. The HR decreased by 31.8 b·min⁻¹ pre-post in the FTG (p < 0.001). Static plank duration improved by 22.4 seconds in the FTG (p = 0.016); static plank change scores improved (p = 0.037) for the FTG (26.5 ± 32.1 seconds compared with that for the WT group (4.6 ± 22 seconds). Height and weight values were unchanged in both the groups. The results of this study demonstrate the value of FT programs for this population, because weight equipment is not always available in many settings.

This study introduces a new method of low-intensity treadmill walking exercise, which seems to be an effective nonpharmacologic treatment even within a 6-week period for patients with IC due to PAD. It also supports the benefits of walking exercise to increase the mobility of these patients, thus improving functional capacity of life.