1
|
Anastasiadou D, Herrero P, Garcia-Royo P, Vázquez-De Sebastián J, Slater M, Spanlang B, Álvarez de la Campa E, Ciudin A, Comas M, Ramos-Quiroga JA, Lusilla-Palacios P. Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial. J Med Internet Res 2024; 26:e51558. [PMID: 38578667 PMCID: PMC11031704 DOI: 10.2196/51558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. OBJECTIVE This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. METHODS A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. RESULTS Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89). CONCLUSIONS This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.
Collapse
Affiliation(s)
- Dimitra Anastasiadou
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Pol Herrero
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Paula Garcia-Royo
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Julia Vázquez-De Sebastián
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d'Hebron Research Institute & Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Mel Slater
- Virtual Bodyworks S.L., Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Andreea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Comas
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- Psychiatry Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Pilar Lusilla-Palacios
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- Psychiatry Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| |
Collapse
|
2
|
Development and Validation of a Short Questionnaire on Dietary and Physical Activity Habits for Patients Submitted to Bariatric Endoscopic Therapies. Obes Surg 2021; 32:142-151. [PMID: 34664149 PMCID: PMC8752550 DOI: 10.1007/s11695-021-05754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
Purpose Individuals with obesity frequently regain weigh after endoscopic bariatric therapies (EBT) unless they adhere to healthy habits. The objective was to create and validate a short, self-administered questionnaire (EMOVE) to assess healthy dietary and physical activity (PA) habits’ adherence to be used in clinical practice. Materials and Methods In this prospective, unicentric study, 463 patients completed the short, Spanish EMOVE questionnaire, to be validated following the Medical Outcome Trust Criteria. Conceptual and measurement model, reliability (internal consistency and test–retest [subgroup of 93 patients]), construct validity, responsiveness, interpretability, and burden were evaluated. Patients enrolled from January 2017 through August 2018 and auto-filled the EMOVE at baseline and at 3, 6, and 12 months. Results Patients submitted to intragastric ballon for 6 and 12 months or POSE were 82.7% women with a mean age of 42.7 years, and a mean BMI of 37.1 kg/m2. Four factors were extracted with exploratory factor analysis related to intake frequency, portions and proportions, time and place of eating, and physical activity. EMOVE showed adequate internal consistency (α = 0.73), very good test–retest (r = 0.91, CI: 0.86–0.94; p < 0.001), moderate construct validity of dietary (r = 0.24, CI: 0.11–0.37, p < 0.001), and PA habits (r = 0.44, CI 0.30–0.58; p < 0.001). Stable responsiveness, with correlations from 0.29 to 0.39 (p < 0.001) between the EMOVE scores and the % of total weight loss at 3, 6, and 12 months. Participants categorized as having good or excellent habits (score ≥ 30 points) lost significantly more weight (p < 0.05). Finally, the administration burden was 2.96 min. Conclusion The EMOVE is a useful tool in Spanish language to easily assess the level of adherence to healthy dietary and PA habits to be used routinely in clinical practice. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05754-7.
Collapse
|
3
|
Martínez-Momblán MA, Gómez C, Santos A, Porta N, Esteve J, Úbeda I, Halperin I, Campillo B, Guillaumet M, Webb SM, Resmini E. A specific nursing educational program in patients with Cushing's syndrome. Endocrine 2016; 53:199-209. [PMID: 26400845 DOI: 10.1007/s12020-015-0737-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/04/2015] [Indexed: 11/28/2022]
Abstract
Cushing's syndrome (CS) is a rare endocrine disease, due to cortisol hypersecretion. CS patients have comorbidities, often still present after biochemical cure. Specific nursing healthcare programs to address this disease and achieve improved health related quality of life (HRQoL) are lacking. Thus, an educational nursing intervention, through the development and promotion of specific educational tools, appears to be justified. The objective of this study is to assess the effectiveness of an educational nursing program in CS patients on HRQoL, clinical parameters, level of pain and physical activity, patterns of rest, and use of health resources. A prospective, randomized study was conducted in two reference hospitals for CS. Sixty-one patients (mean age 47 ± 12.7 years, 83.6 % females) were enrolled and divided into 2 groups: an "intervention" group where educational sessions were performed over 9 months and a "control" group, without these sessions. Specific questionnaires were used at the beginning and end of the study. After educational sessions, the intervention group had a better score in the CushingQoL questionnaire (p < 0.01), reduced level of pain (p < 0.05), improved physical activity (p < 0.01) and healthy lifestyle (p < 0.001) compared to the control group. A correlation between the CushingQoL score and reduced pain (r = 0.46, p < 0.05), improved physical activity (r = 0.89, p < 0.01), and sleep (r = 0.53, p = 0.01) was observed. This educational nursing program improved physical activity, healthy lifestyle, better sleep patterns, and reduced pain in CS patients, influencing HRQoL and reducing consumption of health resources. Moreover, the brief nature of the program suggests it as a good candidate to be used in CS patients.
Collapse
Affiliation(s)
- M Antonia Martínez-Momblán
- University School of Nursing, Hospital Sant Pau, Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unit 747, ISCIII, Madrid, Spain
| | - Carmen Gómez
- Intensive Care Department, Hospital Sant Pau, Barcelona, Spain
| | - Alicia Santos
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unit 747, ISCIII, Madrid, Spain
- Endocrinology/Medicine Department, Hospital de Sant Pau, IIB Sant Pau, C. S. Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Nuria Porta
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Julia Esteve
- University School of Nursing, Hospital Sant Pau, Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain
| | - Inmaculada Úbeda
- Department of Nursing, Universitat de Barcelona (UB), Barcelona, Spain
| | - Irene Halperin
- Department Endocrinology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Campillo
- University School of Nursing, Hospital Sant Pau, Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain
| | - Montserrat Guillaumet
- University School of Nursing, Hospital Sant Pau, Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain
| | - Susan M Webb
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unit 747, ISCIII, Madrid, Spain
- Endocrinology/Medicine Department, Hospital de Sant Pau, IIB Sant Pau, C. S. Antoni Maria Claret n.167, 08025, Barcelona, Spain
| | - Eugenia Resmini
- Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra (Cerdanyola del Vallès), Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Unit 747, ISCIII, Madrid, Spain.
- Endocrinology/Medicine Department, Hospital de Sant Pau, IIB Sant Pau, C. S. Antoni Maria Claret n.167, 08025, Barcelona, Spain.
| |
Collapse
|
5
|
Long-term Effects of Plant Stanols on the Lipid Profile of Patients With Hypercholesterolemia. A Randomized Clinical Trial. ACTA ACUST UNITED AC 2014; 68:665-71. [PMID: 25541227 DOI: 10.1016/j.rec.2014.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 07/23/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Plant stanol consumption may improve long-term cholesterol control. The aim of the present study was to evaluate the effectiveness of 2g/day of plant stanols in reducing low-density lipoprotein cholesterol levels in patients with hypercholesterolemia. METHODS This randomized, double-blind, and placebo-controlled study included 182 adults diagnosed with hypercholesterolemia. A yogurt drink containing 2g of plant stanols was administered to 91 participants in the intervention group; 91 participants in the control group received unsupplemented yogurt. The primary end point was the change in the lipid profile at 12 months. RESULTS Low-density lipoprotein cholesterol levels at 12 months were significantly more reduced in the stanol intervention group than in the control group: 13.7 (95% confidence interval, 3.2-24.1) mg/dL (P=.011). A reduction of more than 10% in low-density lipoprotein cholesterol was achieved by a significantly higher proportion of participants in the intervention group (relative risk=1.7; 95% confidence interval, 1.1-2.7). In this group, the mean (standard deviation) level of low-density lipoprotein cholesterol decreased by 11.0% (23.9%). CONCLUSIONS Our results confirm that administration of plant stanols at a dosage of 2 g/day for 12 months significantly reduces (by slightly more than 10%) the concentrations of low-density lipoprotein cholesterol in individuals with hypercholesterolemia. Trial registration (www.ClinicalTrials.gov): Current Controlled Trials NCT01406106.
Collapse
|