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Brown RCC, Keating SE, Jegatheesan DK, Mayr HL, Barnett A, Conley MM, Webb L, Kelly JT, Snoswell CL, Staudacher HM, Macdonald GA, Burton NW, Coombes JS, Campbell KL, Isbel NM, Hickman IJ. Utilizing technology for diet and exercise change in complex chronic conditions across diverse environments (U-DECIDE): feasibility randomised controlled trial. BMC Health Serv Res 2024; 24:935. [PMID: 39148084 PMCID: PMC11325816 DOI: 10.1186/s12913-024-11383-4] [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: 11/16/2023] [Accepted: 07/31/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Diet and exercise are important components of treatment for complex chronic conditions, however access to allied health support is limited. When available, support is often siloed and fragmented. Digital health incorporating patient choice may help to align health care services with preferences and goals. This study evaluated the implementation of a ubiquitously accessible patient-centred digital health diet and exercise service. METHODS U-DECIDE was a single-centre, 26-week randomised controlled trial set in kidney and liver disease clinics in a tertiary hospital in Brisbane, Australia. Participants were adults with a complex chronic condition referred for dietetic consultation with at least one feature of the metabolic syndrome. All participants received a dietary consultation, an activity monitor and usual care. Intervention participants were offered one text message per week and access to additional digital health options (increased text message frequency, nutrition app, exercise app, group-based diet and/or exercise video consultations). The primary outcome of feasibility was determined by safety (study-related serious adverse events: SRSAEs), recruitment (≥ 50% eligible patients), retention (≥ 70%), exposure uptake (≥ 75% of intervention group had greater access to health professional contact than comparator) and video consultation adherence (≥ 80% attendance). Secondary outcomes included process evaluation metrics and clinical outcomes. RESULTS Of 67 participants (intervention n = 33, comparator n = 34), 37 (55%) were men, median (IQR) age was 51 (41-58) years. The most chosen digital health options were the nutrition app (n = 29, 88%) and exercise video consultations (n = 26, 79%). Only one participant chose no additional digital health options. The intervention group had no SRSAEs. The study exceeded targets for recruitment (52%), retention (81%) and exposure uptake (94%). Video consultation adherence was 42%. Engagement across digital health options was inconsistent. CONCLUSIONS Digital health options incorporating patient choice were feasible and can be offered to people with complex chronic disease as a service model option. TRIAL REGISTRATION Australia and New Zealand Trials Register: Trial Registration Number: ACTRN12620001282976. Registered 27th November 2020.
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Affiliation(s)
- Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia
| | - Dev K Jegatheesan
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Heidi M Staudacher
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Centre for Mental Health, Griffith University, Brisbane, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Healthcare Excellence and Innovation, Metro North Health, Brisbane, Australia
| | - Nicole M Isbel
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, 199 Ipswich Road Woolloongabba, Brisbane, 4012, Australia.
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Peterson G, Nilsing Strid E, Jönsson M, Hävermark J, Peolsson A. Effect of neck-specific exercises with and without internet support on cervical range of motion and neck muscle endurance in chronic whiplash-associated disorders: analysis of functional outcomes of a randomized controlled trial. J Rehabil Med 2024; 56:jrm34785. [PMID: 39072427 DOI: 10.2340/jrm.v56.34785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE To compare the effects of a neck-specific exercise programme with internet support and 4 physiotherapist sessions (NSEIT) and the same neck-specific exercises supervised by a physiotherapist (NSE) on neck muscle endurance and cervical range of motion. DESIGN Randomized controlled trial. PATIENTS A total of 140 participants with chronic whiplash-associated disorders grade II or grade III were randomly assigned to the NSEIT or NSE groups. METHODS Outcomes were changes in active cervical range of motion, cranio-cervical flexion test, neck muscle endurance, and neck pain, at 3- and 15-month follow-ups. RESULTS There were no significant differences between the NSEIT and NSE groups. There was a significant group-by-time inter-action effect in active cervical range of motion flexion/extension where the NSEIT group improved to 3-month follow-up, but the NSE group did not. Both groups were significantly improved over time in all other outcomes (p < 0.001) at 3- and 15-month follow-ups, with effect size between 0.64 and 1.35 in active cervical range of motion, cranio-cervical flexion test, dorsal neck muscle endurance, and neck pain, and effect size between 0.22 and 0.42 in ventral neck muscle endurance. CONCLUSION Both NSE and NSEIT led to improved neck function. Depending on the patients' needs, either NSE or NSEIT could be used as treatment for patients with chronic whiplash-associated disorders.
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Affiliation(s)
- Gunnel Peterson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden.
| | - Emma Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Margaretha Jönsson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Jesper Hävermark
- Centre for Clinical Research, Development and Education, County Council Uppsala, Sweden
| | - Anneli Peolsson
- Department of Health, Medicine and Caring Sciences, Physiotherapy, Linköping University, Linköping, Sweden; Occupational and Environmental Medicine Centre and Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden
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Hoch JS, Kohatsu ND, Fleuret J, Backman DR. Cost-Effectiveness Analysis of a Community-Based Telewellness Weight Loss Program. AJPM FOCUS 2024; 3:100182. [PMID: 38304023 PMCID: PMC10832372 DOI: 10.1016/j.focus.2024.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Introduction The purpose of this study was to perform a cost-effectiveness analysis of the Koa Family Program, a community-based telewellness weight reduction intervention for overweight and obese women aged 21-45 years with low income. The Koa Family Program resulted in an approximately 8-pound weight loss as demonstrated in an RCT published previously. Methods Estimates for the cost-effectiveness were derived from the prospective 25-week RCT including 70 women (25 kg/m2≤BMI<40 kg/m2). The analysis was from a program-funder perspective. Base case costs, as well as low and high scenario costs, were estimated from the services provided to intervention participants. The incremental costs were compared with the incremental effectiveness, with weight loss being the outcome of interest. Costs were in 2021 U.S. dollars. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and the incremental net benefit. The statistical uncertainty was characterized using an incremental net benefit by willingness-to-pay plot and a cost-effectiveness acceptability curve. Results The base case average cost per participant was $564.39. The low and high scenario average costs per participant were $407.34 and $726.22, respectively. Over the 25-week study timeframe, participants lost an average 7.7 pounds, yielding a base case incremental cost-effectiveness ratio of approximately $73 per extra pound lost. The probability that the Koa Family Program is cost-effective is 90%, assuming a willingness-to-pay of $115 for a 1-pound reduction, and is 95%, assuming a willingness-to-pay of $140. Conclusions The Koa Family Program provides good value with cost-effectiveness in line with other weight-loss interventions. This is a striking finding given that the Koa Family Program serves a more vulnerable population than is typically engaged in weight loss research studies.
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Affiliation(s)
- Jeffrey S. Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, California
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Neal D. Kohatsu
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Julia Fleuret
- Center for Healthcare Policy and Research, University of California, Davis, California
| | - Desiree R. Backman
- Center for Healthcare Policy and Research, University of California, Davis, California
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Beer J, Lambert K, Lim W, Keane C, Boudville N. Can Telehealth Improve Access to Dietary Management in Patients Receiving Dialysis? Insights from Consumers. Nutrients 2023; 16:105. [PMID: 38201934 PMCID: PMC10780464 DOI: 10.3390/nu16010105] [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: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Timely, effective, and individualised dietary interventions are essential for patients undergoing dialysis. However, delivery of dietary advice is challenging due to limited access to renal dietitians, as well as logistic and scheduling difficulties for patients receiving dialysis. The objectives of this study were to explore consumer perspectives regarding dietary advice utilising telehealth technology. Twenty-two participants (seventeen patients receiving dialysis, five caregivers) were purposively recruited from a local dialysis centre and participated in one of three focus groups. Each focus group was recorded, transcribed, and analysed using inductive thematic analysis. One overarching theme: "a desire to learn" was apparent. The four themes that facilitated this process are herein described: Meaningful communication-a need for improved and individualised communication about diet using positively framed messages with consistency among clinicians. Conducive information-a preference for tailored, current, and clear dietary information (plain language was preferred, with practical advice on making dietary changes). Appropriate timing-health advice at the right time (consumers felt overwhelmed, not supported enough with timely advice, and experienced difficulty attending appointments in addition to dialysis treatments). Contemporary modalities-delivering information using different technologies (consumers preferred a combination of delivery methods for dietetic advice including text/SMS/App messages as an adjunct to face-to-face care). The results showed that consumers believe that telehealth options are an acceptable adjunct to receive dietary advice in a timely manner, and feedback from patients and caregivers has informed the design of a clinical trial to incorporate the use of telehealth to improve the management of serum phosphate.
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Affiliation(s)
- Joanne Beer
- Nutrition and Dietetics Department, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Wai Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (W.L.); (N.B.)
| | | | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia; (W.L.); (N.B.)
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
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Kelly JT, Law L, De Guzman KR, Hickman IJ, Mayr HL, Campbell KL, Snoswell CL, Erku D. Cost-effectiveness of telehealth-delivered nutrition interventions: a systematic review of randomized controlled trials. Nutr Rev 2023; 81:1599-1611. [PMID: 37016937 PMCID: PMC10639107 DOI: 10.1093/nutrit/nuad032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
CONTEXT Telehealth-delivered nutrition interventions are effective in practice; however, limited evidence exists regarding their cost-effectiveness. OBJECTIVE To evaluate the cost-effectiveness of telehealth-delivered nutrition interventions for improving health outcomes in adults with chronic disease. DATA SOURCES PubMed, CENTRAL, CINAHL, and Embase databases were systematically searched from database inception to November 2021. Included studies were randomized controlled trials delivering a telehealth-delivered diet intervention conducted with adults with a chronic disease and that reported on cost-effectiveness or cost-utility analysis outcomes. DATA EXTRACTION All studies were independently screened and extracted, and quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. DATA ANALYSIS All extracted data were grouped into subcategories according to their telehealth modality and payer perspective, and were analyzed narratively. RESULTS Twelve randomized controlled trials comprising 5 phone-only interventions, 3 mobile health (mHealth), 2 online, and 1 each using a combination of phone-online or phone-mHealth interventions, were included in this review. mHealth interventions were the most cost-effective intervention in all studies. Across all telehealth interventions and cost analyses from health service perspectives, 60% of studies were cost-effective. From a societal perspective, however, 33% of studies reported that the interventions were cost-effective. Of the 10 studies using cost-utility analyses, 3 were cost saving and more effective, making the intervention dominant, 1 study reported no difference in costs or effectiveness, and the remaining 6 studies reported increased cost and effectiveness, meaning payers must decide whether this falls within an acceptable willingness-to-pay threshold for them. Quality of study reporting varied with between 63% to 92%, with an average of 77% of CHEERS items reported. CONCLUSION Telehealth-delivered nutrition interventions in chronic disease populations appear to be cost-effective from a health perspective, and particularly mHealth modalities. These findings support telehealth-delivered nutrition care as a clinically beneficial, cost-effective intervention delivery modality.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lynette Law
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Keshia R De Guzman
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital; and the School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah L Mayr
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital; and the School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Queensland, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland; and the Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Centaine L Snoswell
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Centre for Applied Health Economics, Griffith University, Nathan, Queensland; and the Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Titcomb TJ, Sherwood M, Ehlinger M, Saxby SM, Shemirani F, Eyck PT, Wahls TL, Snetselaar LG. Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial. Mult Scler Relat Disord 2023; 77:104858. [PMID: 37399671 PMCID: PMC11071624 DOI: 10.1016/j.msard.2023.104858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/22/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Wellness is a promising area of research in multiple sclerosis (MS); however, considerable questions remain regarding the efficacy of behavioral interventions to improve wellness and which delivery methods yield favorable results. OBJECTIVE To evaluate the efficacy of a wellness intervention consisting of diet, stress reduction techniques, sleep hygiene, and exercise, delivered via a 7-week web-based program with no tailored intervention support (e.g., counseling or resources) from the study team, on quality of life (QoL) and fatigue among people with MS. METHODS Individuals (n = 100) with self-reported physician's diagnosis of relapsing-remitting MS or clinically isolated syndrome were recruited to enroll in this randomized waitlist-control trial consisting of three timepoints at 0, 12, and 24 weeks. Participants were randomized to begin the intervention at baseline (INT; n = 51) or to a waitlist to begin the intervention after the 12-week timepoint (WLC; n = 49), and both groups were followed for 24 weeks. RESULTS At 12-weeks, 95 participants (46 INT and 49 WLC) completed the primary endpoint and 86 (42 INT and 44 WLC) completed the 24-week follow-up. Compared to baseline, the INT group had a significant increase in physical QoL (5.43 ± 1.85; P = 0.003) at 12-weeks which was maintained at 24-weeks. Physical QoL values in the WLC group did not significantly increase between weeks 12 and 24 (3.24 ± 2.03; P = 0.11); however, physical QoL values significantly improved compared to week 0 values (4.00 ± 1.87; P = 0.033). Neither group had significant changes in mental QoL. The INT group had a mean baseline to 12-week change of ‑5.06 ± 1.79 (P = 0.005) for MFIS and -0.68 ± 0.21 (P = 0.002) for FSS, both of which were maintained at 24-weeks. The 12- to 24-week changes for the WLC group were -4.50 ± 1.81 (P = 0.013) for MFIS and -0.44 ± 0.17 (P = 0.011) for FSS. At 12-weeks, the INT group had significantly greater reductions in fatigue compared to the WLC (P = 0.009 for both MFIS and FSS). There were no between-group mean differences for physical or mental QoL, but a significantly higher proportion of participants had clinically significant improvement in physical QoL in the INT group (50%) compared to the WLC group (22.5%) at 12-weeks (P = 0.006). The 12-week intervention effect was similar during the active intervention phase (i.e., baseline to 12 weeks for INT and 12 to 24 weeks for WLC) in each group. Course completion rates significantly differed between groups with 47.9% of the INT group and 18.8% of the WLC group completing the course (P = 0.01). CONCLUSION A wellness intervention delivered via a web-based program, without tailored support, resulted in significant improvements in fatigue compared to control. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT05057676.
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Affiliation(s)
- Tyler J Titcomb
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA.
| | - Max Sherwood
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Mary Ehlinger
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Solange M Saxby
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Terry L Wahls
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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Lange O. Health economic evaluation of preventive digital public health interventions using decision-analytic modelling: a systematized review. BMC Health Serv Res 2023; 23:268. [PMID: 36932436 PMCID: PMC10024449 DOI: 10.1186/s12913-023-09280-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Digital public health (DiPH) provides novel approaches for prevention, potentially leading to long-term health benefits in resource-limited health systems. However, cost-effectiveness of DiPH interventions is unclear. This systematized review investigates the use of decision-analytic modelling in health economic evaluations of DiPH primary prevention and health promotion interventions, focusing on intervention's design, methods used, results, and reporting quality. METHODS PubMed, CINAHL, and Web of Science were searched for studies of decision-analytic economic evaluations of digital interventions in primary prevention or health promotion, published up to June 2022. Intervention characteristics and selected items were extracted based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratios (ICERs) were then extracted and price-adjusted to compare the economic evaluation results. Finally, the included studies' reporting quality was assessed by building a score using CHEERS. RESULTS The database search (including search update) produced 2,273 hits. After removing duplicates, 1,434 titles and abstracts were screened. Of the 89 studies meeting the full-text search criteria, 14 were ultimately reviewed. The most common targets were physical activity (five studies) and weight loss (four). Digital applications include text messages, web-based inventions, app-based interventions, e-learning devices, and the promotion of smartphone apps. The mean ICER of the 12 studies using quality-adjusted life years (QALYs) is €20,955 per QALY (min. - €3,949; max. €114,211). The mean of reported CHEERS items per study is 81% (min. 59%; max. 91%). CONCLUSIONS This review only includes primary prevention and health promotion, and thus excludes other DiPH fields (e.g. secondary prevention). It also focuses on decision-analytic models, excluding study-based economic evaluations. Standard methods of economic evaluation could be adapted more to the specifics of DiPH by measuring the effectiveness of more current technologies through alternative methods, incorporating a societal perspective, and more clearly defining comparators. Nevertheless, the review demonstrates using common thresholds that the new field of DiPH shows potential for cost-effective preventive interventions.
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Affiliation(s)
- Oliver Lange
- Department of Health Care Management, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany.
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Mahdi S, Buckland NJ, Chilcott J. Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study. Front Nutr 2023; 10:1125542. [PMID: 37006945 PMCID: PMC10061026 DOI: 10.3389/fnut.2023.1125542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionThe UK Government developed the Change4Life Food Scanner app to provide families with engaging feedback on the nutritional content of packaged foods. There is a lack of research exploring the cost-effectiveness of dietary health promotion apps.MethodsThrough stakeholder engagement, a conceptual model was developed, outlining the pathway by which the Food Scanner app leads to proximal and distal outcomes. The conceptual model informed the development of a pilot randomized controlled trial which investigated the feasibility and acceptability of evaluating clinical outcomes in children and economic effectiveness of the Food Scanner app through a cost-consequence analysis. Parents of 4–11 years-olds (n = 126) were randomized into an app exposure condition (n = 62), or no intervention control (n = 64). Parent-reported Child Health Utility 9 Dimension (CHU9D) outcomes were collected alongside child healthcare resource use and associated costs, school absenteeism and parent productivity losses at baseline and 3 months follow up. Results for the CHU9D were converted into utility scores based on UK adult preference weights. Sensitivity analysis accounted for outliers and multiple imputation methods were adopted for the handling of missing data.Results64 participants (51%) completed the study (intervention: n = 29; control: n = 35). There was a mean reduction in quality adjusted life years between groups over the trial period of –0.004 (SD = 0.024, 95% CI: –0.005; 0.012). There was a mean reduction in healthcare costs of –£30.77 (SD = 230.97; 95% CI: –£113.80; £52.26) and a mean reduction in workplace productivity losses of –£64.24 (SD = 241.66, 95% CI: –£147.54; £19.07) within the intervention arm, compared to the control arm, over the data collection period. Similar findings were apparent after multiple imputation.DiscussionModest mean differences between study arms may have been due to the exploration of distal outcomes over a short follow-up period. The study was also disrupted due to the coronavirus pandemic, which may have confounded healthcare resource data. Although measures adopted were deemed feasible, the study highlighted difficulties in obtaining data on app development and maintenance costs, as well as the importance of economic modeling to predict long-term outcomes that may not be reliably captured over the short-term.Clinical trial registrationhttps://osf.io/, identifier 62hzt.
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Affiliation(s)
- Sundus Mahdi
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Sundus Mahdi,
| | - Nicola J. Buckland
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Jim Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Turner J, Clanchy K, Vincze L. Telehealth interventions for physical activity and exercise participation in postpartum women: A quantitative systematic review. Prev Med 2023; 167:107413. [PMID: 36603606 DOI: 10.1016/j.ypmed.2022.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/14/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
Postpartum women are one of the least physically active vulnerable populations globally and telehealth has been proposed as a potential method of delivering effective exercise interventions for this population. However, clinical practice guidelines are based upon the recommendations for the general population and therefore, the most efficacious exercise dose and the delivery method for this population is unclear. This quantitative systematic review will examine the implementation and outcomes of telehealth exercise interventions in the postpartum population to synthesise the degree to which these outcomes have been assessed and evaluated. Five databases were searched from January 2001 to March 2022. Studies implementing synchronous telehealth exercise interventions for postpartum women were included. Interventions were examined against the Template for Intervention Description and Replication (TIDieR) checklist that assesses intervention reporting completeness and replicability. Of the 1036 records identified, 16 studies progressed to data extraction. Six interventions provided individualised exercise prescription, and only four were delivered by university-level exercise practitioners. Physical activity participation was well reported, however health-related outcomes (i.e., muscular strength and aerobic capacity) were very minimally assessed. Only one intervention utilised modern video conferencing as the primary telehealth communication method. With the minimal assessment of health-related outcomes, there is limited scope to assess the effectiveness of these interventions for postpartum women. Future research interventions need to be reported according to a validated trial reporting system and focus on relevant health related outcomes including postpartum depressive symptoms, quality of life, cardiovascular fitness, muscular strength and body composition.
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Affiliation(s)
- Jemma Turner
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Kelly Clanchy
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Lisa Vincze
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
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Brown RCC, Jegatheesan DK, Conley MM, Mayr HL, Kelly JT, Webb L, Barnett A, Staudacher HM, Burton NW, Isbel NM, Macdonald GA, Campbell KL, Coombes JS, Keating SE, Hickman IJ. U-DECIDE: Utilising technology for Diet & Exercise Change In complex chronic conditions across Diverse Environments: Protocol for a Randomised Controlled Trial (Preprint). JMIR Res Protoc 2022; 11:e37556. [PMID: 35900834 PMCID: PMC9377441 DOI: 10.2196/37556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background The metabolic syndrome is common across many complex chronic disease groups. Advances in health technology have provided opportunities to support lifestyle interventions. Objective The purpose of this study is to test the feasibility of a health technology-assisted lifestyle intervention in a patient-led model of care. Methods The study is a single-center, 26-week, randomized controlled trial. The setting is specialist kidney and liver disease clinics at a large Australian tertiary hospital. The participants will be adults with a complex chronic condition who are referred for dietetic assessment and display at least one feature of the metabolic syndrome. All participants will receive an individualized assessment and advice on diet quality from a dietitian, a wearable activity monitor, and standard care. Participants randomized to the intervention group will receive access to a suite of health technologies from which to choose, including common base components (text messages) and optional components (online and mobile app–based nutrition information, an online home exercise program, and group-based videoconferencing). Exposure to the optional aspects of the intervention will be patient-led, with participants choosing their preferred level of engagement. The primary outcome will be the feasibility of delivering the program, determined by safety, recruitment rate, retention, exposure uptake, and telehealth adherence. Secondary outcomes will be clinical effectiveness, patient-led goal attainment, treatment fidelity, exposure demand, and participant perceptions. Primary outcome data will be assessed descriptively and secondary outcomes will be assessed using an analysis of covariance. This study will provide evidence on the feasibility of the intervention in a tertiary setting for patients with complex chronic disease exhibiting features of the metabolic syndrome. Results The study was funded in 2019. Enrollment has commenced and is expected to be completed by June 2022. Data collection and follow up are expected to be completed by December 2022. Results from the analyses based on primary outcomes are expected to be submitted for publication by June 2023. Conclusions The study will test the implementation of a health technology–assisted lifestyle intervention in a tertiary outpatient setting for a diverse group of patients with complex chronic conditions. It is novel in that it embeds patient choice into intervention exposure and will inform health service decision-makers in regards to the feasibility of scale and spread of technology-assisted access to care for a broader reach of specialist services. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12620001282976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378337 International Registered Report Identifier (IRRID) DERR1-10.2196/37556
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Affiliation(s)
- Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Dev K Jegatheesan
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Hannah L Mayr
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Nutrition and Dietetics Research Group, Bond University, Robina, Australia
| | - Jaimon T Kelly
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Amandine Barnett
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Heidi M Staudacher
- Food & Mood Centre, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Melbourne, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Nicole M Isbel
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Health, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Ingrid J Hickman
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
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