title: Late effects of a brief psychological intervention in patients with intermittent claudication in a randomized clinical trial.
abstract: BACKGROUND
  The authors previously reported the early results of a trial of a brief psychological intervention to increase physical activity in patients with intermittent claudication. After 4 months, participants in the intervention group walked a mean of 1576 more steps per day than control group participants. The present study followed the original participants to determine whether this behaviour change was maintained over 2 years.
  
  
  METHODS
  This was a randomized single-centre parallel-group trial. Fifty-eight patients newly diagnosed with intermittent claudication were assigned randomly to one of two groups. The control group (30 patients) received usual care: lifestyle advice and consultation with a vascular surgeon to agree a treatment plan. The treatment group (28) received usual care plus a brief psychological intervention designed to modify illness and walking beliefs, and develop a personalized walking action plan. The primary outcome was daily steps measured by pedometer. Secondary outcomes included revascularization rate, quality of life and perceived pain-free walking distance. Follow-up was conducted at 1 and 2 years. Between-group differences were analysed by analysis of co-variance.
  
  
  RESULTS
  Participants in the brief psychological intervention group walked significantly more than those in the control group. The mean difference at 1 year was 1374 (95 per cent confidence interval 528 to 2220) steps per day and the difference at 2 years was 1630 (495 to 2765) steps per day.
  
  
  CONCLUSIONS
  Modifying illness and walking beliefs, and assisting patients to develop a personalized walking action plan led to increases in walking behaviour in patients with claudication that were maintained for 2 years.
  
  
  BACKGROUND
  ISRCTN28051878 (http://www.controlled-trials.com).
authors.affiliation: Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. margaret.cunningham@jcu.edu.au
authors.forename: M A
authors.initials: MA
authors.lastname: Cunningham
authors.forename: V
authors.initials: V
authors.lastname: Swanson
authors.forename: R J
authors.initials: RJ
authors.lastname: Holdsworth
authors.forename: R E
authors.initials: RE
authors.lastname: O'Carroll
mesh_terms: D000704:Analysis of Variance; D001294:Attitude to Health; D005081:Exercise Therapy / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D011614:Psychotherapy, Brief / Q000379:methods*; D011788:Quality of Life; D015424:Reperfusion; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology