A Review of Current Literature on Vital Sign Assessment of Physical Activity in Primary Care

Abstract

Purpose: To conduct an integrated review of the performance and implementation of two physical activity (PA) assessment tools, the exercise vital sign (EVS) and the physical activity vital sign (PAVS), in U.S. primary care practice. Design:An integrative review following Whittemore and Knafl's methodology. Methods: Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched. Search terms were "exercise vital sign" OR "physical activity vital sign" AND "primary care". Additional inclusion criteria were studies conducted in the United States, published in English, in primary care, between 2010 and 2016. Results: Nine studies met inclusion criteria. Five studies reported validity data of the EVS tool, while four studies reported data from the PAVS tool. Compared with the accelerometer, the EVS tool overestimated moderate-vigorous PA, while the PAVS tool demonstrated moderate agreement in identifying those not meeting national PA guidelines. The EVS tool was successfully implemented in large, integrated practices utilizing electronic health record systems. PA documentation increased compared to non-EVS practices. The predictive ability of the PAVS tool for clinical outcomes was shown. Studies of PA assessment tool use in children were not found. Conclusions: Preliminary evidence on the validity of both the EVS and PAVS tools support cautious use of each as a screening tool in primary care. There were no data on reliability, with limited data on tool use in diverse populations or settings. Data in children, older adults, and diverse population subgroups were lacking. Clinical Relevance: Two brief exercise vital signs tools have each shown some initial validity for use by primary care clinicians as measures to identify patients not meeting PA guidelines.

Implementing the physical activity vital sign in an academic preventive cardiology clinic

“…PA screening tools have been infrequently used in clinical care but they can play a role in documenting PA for monitoring and in identifying those who are not meeting PA guidelines who may benefit from an intervention ( Wald and Garber, 2018 ). Brief PA screening has been implemented in two major hospital systems in the U.S. An electronic exercise vital sign was implemented in Kaiser Permanente ( Coleman et al, 2012 ) as well as in Intermountain Healthcare ( Ball et al, 2016 ) for use in primary care.…”

Validity and Reliability of the Exercise Vital Sign Questionnaire in an Ethnically Diverse Group: A Pilot Study

“…4 However, few studies have attempted to determine the validity of the EVS against device-measured estimates of PA, such as with accelerometry. 5…”

“…4 However, few studies have attempted to determine the validity of the EVS against device-measured estimates of PA, such as with accelerometry. 5 Research suggests that self-reported PA volumes may vary between ethnic groups. [6][7][8] For example, nationally representative data have shown no significant differences in accelerometer measured PA between adult non-Hispanic whites and non-Hispanic blacks.…”

“…With regard to the EVS, only one study has validated the questionnaire against accelerometry in a minority group of African American women, 10 and another was conducted in a group of predominantly White adults. 11 However, to date, no studies have evaluated the validity and reliability of the EVS in an ethnically diverse group of adults against an objective measure of PA. 5 The purpose of this pilot study, therefore, was to determine the validity and reliability of the EVS questionnaire in an ethnically diverse sample.…”

Associations Between the Physical Activity Vital Sign and Cardiometabolic Risk Factors in High-Risk Youth and Adolescents

“…Despite its ease of use, little research is available to support this recommendation and its effect on clinical outcomes, and no prior studies have evaluated the use of a PAVS in a pediatric population. 8,20 The purpose of this study was to evaluate the use of a PAVS in a pediatric population and determine its association with common markers of cardiometabolic disease.…”