Activity counseling early postelective percutaneous coronary intervention (ACE-PCI): Mixed-methods pilot randomized controlled trial

Nicole Freene; Suzanne J Carroll; Allyson Flynn; Sarah Bowen; Roslyn Holley; Kerry Rodway; Theo Niyonsenga; Rachel Davey

doi:10.1002/hsr2.1963

Activity counseling early postelective percutaneous coronary intervention (ACE-PCI): Mixed-methods pilot randomized controlled trial

Health Sci Rep. 2024 Mar 18;7(3):e1963. doi: 10.1002/hsr2.1963. eCollection 2024 Mar.

Authors

Nicole Freene^{1

2}, Suzanne J Carroll², Allyson Flynn¹, Sarah Bowen³, Roslyn Holley³, Kerry Rodway³, Theo Niyonsenga², Rachel Davey²

Affiliations

¹ Department of Physiotherapy University of Canberra Bruce Australian Capital Territory Australia.
² Health Research Institute University of Canberra Bruce Australian Capital Territory Australia.
³ National Capital Private Hospital Garran Australian Capital Territory Australia.

Abstract

Background: Physical activity (PA) levels of people with coronary heart disease are low in the first 30 days after percutaneous coronary intervention (PCI), increasing the risk of recurrent cardiac events. Following PCI, PA counseling delivered by a physiotherapist before discharge may increase the PA levels of patients. Preliminary work is required to determine the effects of the counseling session compared to usual care.

Objectives: To investigate the feasibility and potential efficacy of a brief physiotherapist-led PA counseling session immediately after an elective PCI compared to usual care for improved PA early post-PCI.

Methods: Using concealed allocation and blinded assessments, eligible participants (n = 30) were randomized to a physiotherapist-led PA counseling session (30 min) or usual care (nurse-led PA advice < 5 min). The primary outcome was daily minutes of moderate-to-vigorous PA (accelerometry; 3 weeks). Secondary outcomes included cardiac rehabilitation intention, anxiety and depression levels (Hospital Anxiety and Depression Scale), and quality-of-life (MacNew questionnaire). Recruitment, retention, and attrition were assessed for feasibility. Semistructured interviews were conducted with 13 participants to determine intervention acceptability, and barriers and enablers to PA.

Results: Between and within-group comparisons were not significant in intention-to-treat analyses. All feasibility criteria were met except for retention and attrition of participants. At 3 weeks, only 25% of participants were planning to attend cardiac rehabilitation, with no between-group differences. Increased PA at 3 weeks was associated with participants that were younger, without other chronic disease,s and more active immediately following discharge. Interviews revealed personal, environmental, and program-based themes for barriers and enablers to PA.

Conclusions: A physiotherapist-led PA counseling session may not improve PA levels early post-elective PCI compared to very brief PA advice delivered by nurses. A larger multicentre randomized controlled trial is feasible with minor modifications to participant follow-up. Further research is required.

Keywords: accelerometry; coronary heart disease; physical activity; physiotherapy.