Videophone Counseling for the Self-Management of Peripheral Arterial Disease

Tuesday, 13 July 2010: 8:50 AM

Karen Stonecypher, MSN, RN
Clinical Practice Office, Michael E. DeBakey VA Medical Center, Houston, TX
Pamela Willson, RN, PhD, FNP, BC
Elsevier Review and Testing, Elsevier Publishing, Houston, TX

Learning Objective 1: The participant will be able to discuss the value of self-management motivational counseling for patients with PAD.

Learning Objective 2: The participant will be able to explain the study outcomes and implications for nursing practice.

Introduction: The purpose of this prospective, randomized controlled trial was to determine the effects of a videophone patient exercise self-management and motivational counseling intervention on exercise endurance (6-minute walk test, daily steps walked, and minutes of resistive peddler used) and quality of life/health status (SF-36) PAD patients.
Methods: A 2-arm randomized control trial was conducted with measures taken at baseline, 3 and 6 months. A consecutive sample of 30 peripheral arterial disease (PAD) patients were recruited from primary care clinics; they attended an exercise counseling session that demonstrated exercises, pedometer use, and described walking regimen and exercise diary recording. After completing the initial visit activities, patients were randomly assigned to control or videophone intervention group (15 participants per group). The nurse intervention consisted of videophone motivational counseling sessions in the home that was based on the patient’s stage of change at 2, 4, and 6 weeks post-enrollment.
 Results:  Patients randomized to videophone counseling had significantly improved health related quality of life than the controls at 3 months for vitality (p=0.0442), social functioning (p=0.0301), and mental health (p=0.0063). Their summary mental health component scores were also significantly improved (p= 0.0147). At 6-months follow-up, physical functioning scores showed statistically significantly improvement (p=0.0123). Hospitalizations decreased from 7 to 4; ER visits from 9 to 3; and provider visits from 28 to 14 compared to 3-months prior to the study. Adherence with exercise prescription was 83% (N=25) at 3-months follow-up and 70% (N=21) at 6-months follow-up. Patient’s with PAD who receive self-management motivational counseling comply with their exercise regimens and have improved health-related quality of life, increased physical exercise endurance, and used fewer health services (e.g., office visits and hospitalizations). Ninety-five percent of the participants would recommend implementing an exercise prescription. Using videophones for in-home health consultations was convenient for this sample of veterans.