Feasibility of the PHYZ X 2U program: a mobile and cloud-based outreach service to improve chronic disease outcomes in underserviced rural communities

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 1h 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.

Physical activity promotion in rural health care settings: A rapid realist review

“…Over half of the articles in our sample originated from the United States (n = 11) ( Batsis et al, 2020 , Batsis et al, 2021 , Currie et al, 2018 , Greaney et al, 2017 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2018 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ), followed by Australia (n = 3) ( Paul et al, 2019 , Eakin et al, 2012 , Sangster et al, 2016 ), Canada (n = 2) ( Miedema et al, 2015 , Davis et al, 2016 ), and the United Kingdom (n = 2; Table 3 ) ( Connelly et al, 2017 , Lee et al, 2007 ). Most studies were longitudinal or prospective cohort studies (n = 8) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ) or randomized control trials (n = 7) ( Reed et al, 2018 , Connelly et al, 2017 , Greaney et al, 2017 , Currie et al, 2018 , Eakin et al, 2012 , Lee et al, 2007 , Sangster et al, 2016 ).…”

“…Most studies were longitudinal or prospective cohort studies (n = 8) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Batsis et al, 2021 , Robles et al, 2014 ) or randomized control trials (n = 7) ( Reed et al, 2018 , Connelly et al, 2017 , Greaney et al, 2017 , Currie et al, 2018 , Eakin et al, 2012 , Lee et al, 2007 , Sangster et al, 2016 ). Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , Peterson and Cheng, 2013 ), and children/youth (n = 2) ( Robles et al, 2014 , Currie et al, 2018 ). The most common type of health care providers involved in intervention delivery were nurses or nurse practitioners (n = 8) ( Connelly et al, 2017 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Lee et al, 2007 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Reed et al, 2018 ), physical therapists (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Paul et al, 2019 , Reed et al, 2018 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), registered dietitians (n = 5) (…”

“…Populations of interest included older adults (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Hsu et al, 2018 , Lee et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), individuals with chronic conditions and/or risk factors (n = 5) ( Sangster et al, 2016 , Miedema et al, 2015 , Connelly et al, 2017 , Paul et al, 2019 , Eakin et al, 2012 ), women (n = 4) ( Melton et al, 2016 , Greaney et al, 2017 , Sherman et al, 2007 , Peterson and Cheng, 2013 ), and children/youth (n = 2) ( Robles et al, 2014 , Currie et al, 2018 ). The most common type of health care providers involved in intervention delivery were nurses or nurse practitioners (n = 8) ( Connelly et al, 2017 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Lee et al, 2007 , Melton et al, 2016 , Peterson and Cheng, 2013 , Reed et al, 2020 , Reed et al, 2018 ), physical therapists (n = 7) ( Batsis et al, 2020 , Batsis et al, 2021 , Davis et al, 2016 , Paul et al, 2019 , Reed et al, 2018 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), registered dietitians (n = 5) ( Batsis et al, 2020 , Batsis et al, 2021 , Greaney et al, 2017 , Miedema et al, 2015 , Batsis et al, 2021 ), physicians (n = 4) ( Hsu et al, 2018 , Miedema et al, 2015 , Melton et al, 2016 , Currie et al, 2018 ), and exercise physiologists (n = 3) ( Paul et al, 2019 , Miedema et al, 2015 , Eakin et al, 2012 ). Two included studies reported on the same intervention delivered in a rural primary care setting, describing the effectiveness ( Reed et al, 2018 ) and feasibility/implementation ( Reed et al, 2020 …”

“…Ten articles ( Hsu et al, 2018 , Paul et al, 2019 , Connelly et al, 2017 , Greaney et al, 2017 , Miedema et al, 2015 , Melton et al, 2016 , Robles et al, 2014 , Sangster et al, 2016 , Batsis et al, 2021 , Currie et al, 2018 ) provided no definition or measure of rurality but were included as they self-identified their study as taking place in a rural setting. Seven articles defined the communities as rural by stating the location’s population (range: 5,495 – 20,613 people) ( Davis et al, 2016 , Lee et al, 2007 , Peterson and Cheng, 2013 , Reed et al, 2020 , Sherman et al, 2007 , Tarazona-Santabalbina et al, 2016 , Batsis et al, 2021 ), and three provided a specific definition of rurality based on national health policies ( Batsis et al, 2020 , Reed et al, 2018 , Eakin et al, 2012 ).…”

“…Nine articles recorded improvements in physical activity behaviour ( Reed et al, 2018 , Hsu et al, 2018 , Paul et al, 2019 , Tarazona-Santabalbina et al, 2016 , Sherman et al, 2007 , Melton et al, 2016 , Robles et al, 2014 , Sangster et al, 2016 , Currie et al, 2018 ) and five of these studies reported a statistically significant increase ( Melton et al, 2016 , Paul et al, 2019 , Sangster et al, 2016 , Sherman et al, 2007 , Robles et al, 2014 ) ( Table 4 ). The five studies with statistically significant increases in physical activity behaviour included a hybrid health coaching and weekly exercise tracking intervention ( Paul et al, 2019 ), a walking intervention ( Sherman et al, 2007 ), a health education campaign at an obstetric and gynecology clinic ( Melton et al, 2016 ), a pedometer-based telephone coaching intervention ( Sangster et al, 2016 ), and a diet and supervised exercise intervention ( Robles et al, 2014 ).…”