BMJ 2000;321:49 ( 1 July )

Letters

Behavioural counselling in general practice about risk of CHD

    Study was grossly underpowered
    Study had several methodological flaws
    Non-attendance for follow up distorts results and shows that people don't like counselling
    Authors' reply

Study was grossly underpowered

The first 150 words of the full text of this article appear below.

EDITOR---Steptoe et al draw unreliable conclusions from their randomised controlled trial of a brief behavioural counselling intervention, led by nurses, to promote healthy behaviour among adults at increased risk of coronary heart disease.1 Because of considerable difficulties in recruitment and retention the study is grossly underpowered, with only 316 intervention patients and 567 control patients recruited against the required target of 2000. The authors cannot therefore report that "brief counselling on the basis of systematic applications of behavioural principles is more efficacious in stimulating lifestyle modification than conventional counselling."

The authors have further overinterpreted these unreliable data, since the only changes in behaviour were self reported reductions in dietary fat intake and number of cigarettes smoked and increases in physical activity. Objective measurements, such as body mass index, weight, blood pressure, and smoking cessation (validated by cotinine assay), did not change. Given the unreliability of self reporting as a primary outcome, . . . [Full text of this article]
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