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Prats-Arimon M, Puig-Llobet M, Barceló-Peiró O, Ribot-Domènech I, Vilalta-Sererols C, Fontecha-Valero B, Heras-Ojeda M, Agüera Z, Lluch-Canut T, Moreno-Poyato A, Moreno-Arroyo MC. An Interdisciplinary Intervention Based on Prescription of Physical Activity, Diet, and Positive Mental Health to Promote Healthy Lifestyle in Patients with Obesity: A Randomized Control Trial. Nutrients 2024; 16:2776. [PMID: 39203911 PMCID: PMC11357149 DOI: 10.3390/nu16162776] [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: 06/21/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
This study used a multimodal approach to address the issue of obesity among individuals with a Body Mass Index (BMI) between 30 and 40 residing in a rural region of north-east Spain. A pretest-posttest model was employed in a clinical trial design, comparing an intervention group with a control group. The intervention, which lasted for a period of nine months, was based on three main strategies: the prescription of physical activity, the promotion of healthy nutritional habits, and the management of emotional wellbeing through Positive Mental Health (PMH). A variety of assessment tools were employed, including the CLASS-AF scale and a stress test for physical activity levels; advanced anthropometry and blood analysis for metabolic and body composition variables; a Mediterranean diet adherence questionnaire for nutritional habits; and a PMH multifactorial questionnaire for the assessment of emotional management. The results revealed significant improvements in the level of physical activity and adherence to the Mediterranean diet in favor of the intervention group, where 89.4% (n = 17) of the participants went from being not very active/sedentary to being active. Also, adherence to the Mediterranean diet improved with a mean increase of 2.2 points on the scale [mean: 10.5 (CI 95%: 9.90, 11.09)]. In addition, significant reductions in body fat [mean: -2.50 kg (CI 95%: -3.56, -1.44)] and free fat mass [mean: -3.38% (IC 95%: -4.34, -2.41), along with decreased cholesterol levels (196 vs. 182 mg/dL), were observed, suggesting a decrease in cardiovascular and metabolic risk. In conclusion, this multimodal intervention was effective at improving the lifestyle of people with obesity and reducing their cardiovascular and metabolic risk. The combination of interventions focused on physical activity, diet, Positive Mental Health, and metabolic changes and were perceived as a comprehensive and complementary strategy in obesity care. These findings highlight the importance of approaching this condition from multiple perspectives to ensure optimal health outcomes.
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Affiliation(s)
- Marta Prats-Arimon
- Department of Fundamental and Medical-Surgical Nursing, Faculty of Nursing, University of Barcelona, 08036 Barcelona, Spain; (M.P.-A.); (M.C.M.-A.)
- Sports Medicine Department, Hospital Transfronterer de Cerdanya (AECT), Puigcerdà, 17520 Girona, Spain; (O.B.-P.); (I.R.-D.)
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal-Child Nursing, Faculty of Nursing, University of Barcelona, 08036 Barcelona, Spain; (Z.A.); (T.L.-C.); (A.M.-P.)
| | - Oriol Barceló-Peiró
- Sports Medicine Department, Hospital Transfronterer de Cerdanya (AECT), Puigcerdà, 17520 Girona, Spain; (O.B.-P.); (I.R.-D.)
| | - Ivet Ribot-Domènech
- Sports Medicine Department, Hospital Transfronterer de Cerdanya (AECT), Puigcerdà, 17520 Girona, Spain; (O.B.-P.); (I.R.-D.)
| | - Cristina Vilalta-Sererols
- Primary Care Centre, Fundació Hospital de Puigcerdà, Puigcerdà, 17520 Girona, Spain; (C.V.-S.); (B.F.-V.)
| | - Bárbara Fontecha-Valero
- Primary Care Centre, Fundació Hospital de Puigcerdà, Puigcerdà, 17520 Girona, Spain; (C.V.-S.); (B.F.-V.)
| | - Mati Heras-Ojeda
- Sports Council of Cerdanya, Girona Provincial Council, 17004 Girona, Spain;
| | - Zaida Agüera
- Department of Public Health, Mental Health and Maternal-Child Nursing, Faculty of Nursing, University of Barcelona, 08036 Barcelona, Spain; (Z.A.); (T.L.-C.); (A.M.-P.)
| | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal-Child Nursing, Faculty of Nursing, University of Barcelona, 08036 Barcelona, Spain; (Z.A.); (T.L.-C.); (A.M.-P.)
| | - Antonio Moreno-Poyato
- Department of Public Health, Mental Health and Maternal-Child Nursing, Faculty of Nursing, University of Barcelona, 08036 Barcelona, Spain; (Z.A.); (T.L.-C.); (A.M.-P.)
| | - Mª Carmen Moreno-Arroyo
- Department of Fundamental and Medical-Surgical Nursing, Faculty of Nursing, University of Barcelona, 08036 Barcelona, Spain; (M.P.-A.); (M.C.M.-A.)
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García-Álvarez D, Sempere-Rubio N, Faubel YR. Evaluaciones económicas en promoción de la actividad física: una revisión sistemática. Glob Health Promot 2024:17579759241245413. [PMID: 39086317 DOI: 10.1177/17579759241245413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- David García-Álvarez
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Núria Sempere-Rubio
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Y Raquel Faubel
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
- Unidad de Investigación Conjunta en Ingeniería Biomédica, IIS La Fe-Universitat Politècnica de València, Valencia, España
- PTinMOTION, Fisioterapia en movimiento, Grupo de Investigación Multiespecialidad, Departamento de Fisioterapia, Universitat de València, Valencia, España
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Xu Z, Zheng X, Ding H, Zhang D, Cheung PMH, Yang Z, Tam KW, Zhou W, Chan DCC, Wang W, Wong SYS. The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e48355. [PMID: 39045858 PMCID: PMC11287235 DOI: 10.2196/48355] [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: 04/20/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 07/25/2024] Open
Abstract
Background Previous literature lacks summative information on the mental health benefits achieved from different forms of walking. Objective The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety. Methods This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool. Results This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69). Conclusions Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.
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Affiliation(s)
- Zijun Xu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Xiaoxiang Zheng
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Hanyue Ding
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Dexing Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Peter Man-Hin Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zuyao Yang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - King Wa Tam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Weiju Zhou
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Dicken Cheong-Chun Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wenyue Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Samuel Yeung-Shan Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Prenner A, Ziegl A, Wiesmüller F, El Moazen G, Hayn D, Prenner A, Brodmann M, Seinost G, Modre-Osprian R, Schreier G, Silbernagel G. Usability of a telehealth-nurse supported home-based walking training for peripheral arterial disease - The Keep Pace! pilot study. VASA 2024; 53:246-254. [PMID: 38808475 DOI: 10.1024/0301-1526/a001127] [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] [Indexed: 05/30/2024]
Abstract
Background: Guidelines recommend walking trainings for peripheral arterial disease (PAD) management. Supervised walking training is superior to walking advise to improve the walking distance. Telehealth service with nurse support may close this gap. Patients and methods: This study introduces a telehealth service, "Keep pace!", which has been developed for patients with symptomatic PAD (Fontaine stage IIa and IIb), enabling a structured home-based walking training while monitoring progress via an app collecting unblinded account of steps and walking distance in self-paced 6-minute-walking-tests by geolocation tracking to enhance intrinsic motivation. Supervision by nurses via telephone calls was provided for 8 weeks, followed by 4 weeks of independent walking training. Patient satisfaction, walking distance and health-related quality of life were assessed. Results: 19 patients completed the study. The analysis revealed an overall high satisfaction with the telehealth service (95.4%), including system quality (95.1%), information quality (94.4%), service quality (95.6%), intention to use (92.8%), general satisfaction with the program (98.4%) and health benefits (95.8%). 78.9% asserted that the telehealth service lacking nurse calls would be less efficacious. Pain-free walking distance (76.3±36.8m to 188.4±81.2m, +112.2%, p<0.001) as well as total distance in 6-minute-walking test (308.8±82.6m to 425.9±107.1m, +117.2%, p<0.001) improved significantly. The telehealth service significantly reduced discomfort by better pain control (+15.5%, p=0.015) and social participation (+10.5%, p=0.042). Conclusions: In conclusion, patients were highly satisfied with the telehealth service. The physical well-being of the PAD patients improved significantly post vs. prior the telehealth program.
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Affiliation(s)
- Andreas Prenner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Andreas Ziegl
- telbiomed Medizintechnik und IT Service GmbH, Graz, Austria
- AIT Austrian Institute of Technology GmbH, Graz, Austria
| | - Fabian Wiesmüller
- AIT Austrian Institute of Technology GmbH, Graz, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | | | - Dieter Hayn
- AIT Austrian Institute of Technology GmbH, Graz, Austria
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | | | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Gerald Seinost
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria
| | | | | | - Günther Silbernagel
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Austria
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Silva CS, Godinho C, Encantado J, Rodrigues B, Carraça EV, Teixeira PJ, Silva MN. Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review. BMC Health Serv Res 2023; 23:1082. [PMID: 37821932 PMCID: PMC10568782 DOI: 10.1186/s12913-023-09881-y] [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: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral. METHODS A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The "Tailored Implementation for Chronic Diseases" (TICD) framework was adapted to extract and synthesize barriers and facilitators. RESULTS Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals' knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions' cost and financial incentives; tools and materials; and professionals' cognitions and attitudes. "Social, political and legal factors" domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains. CONCLUSION The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions' effectiveness.
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Affiliation(s)
- Catarina Santos Silva
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal.
| | - Cristina Godinho
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Jorge Encantado
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Bruno Rodrigues
- CIAFEL, Faculdade de Desporto da Universidade Do Porto, Porto, Portugal
| | - Eliana V Carraça
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
| | - Pedro J Teixeira
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Marlene Nunes Silva
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
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Bellanger W, Peurois M, Connan L, Navasiolava N, Missud D, Py T, Bègue C. Comparing physical activity prescription with verbal advice for general practice patients with cardiovascular risk factors: results from the PEPPER randomised controlled trial. BMC Public Health 2023; 23:1402. [PMID: 37475036 PMCID: PMC10360325 DOI: 10.1186/s12889-023-16302-6] [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: 10/04/2021] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Regular physical activity improves health and quality of life for people with cardiovascular risk factors. However, few studies have demonstrated the applicability of strategies in health care to promote physical activity. OBJECTIVE To evaluate if a written physical activity prescription combined with pedometer increases physical activity over one year compared with verbal advice in patients with cardiovascular disease risk in primary care. METHODS The randomised-controlled, interventional, 12-month PEPPER study recruited patients aged 35 to 74 years, having quarterly followed-ups for hypertension, dyslipidaemia, or diabetes, and judged insufficiently active. Seventeen practices randomised patients into either the experimental group, who received a written, personalised prescription for daily step numbers, pedometer and logbook, or control group, who received verbal advice to do at least 15 min of rapid walking or equivalent daily. The primary outcome was the change in total weekly energy expenditure measured using an accelerometer at 3 months. The secondary outcomes were changes in step count, physical activity levels, quality of life, perceived obstacles to physical activity, and biomedical indicators at 3 and 12 months. RESULTS One hundred and twenty-one participants were randomised. Although, weekly energy expenditure did not differ between the prescription and verbal instruction group, the estimated time spent doing moderate-intensity activity was significantly higher in the prescription group than the verbal group by an average of four minutes/week (p = 0.018)(95% CI [0.7 - 7.4]) reaching 48 min after 12 months (95% CI: 8 - 89). Similarly, this was associated with a clinically, higher average step number of 5256 steps/week increase over a year (95% CI: 660 - 9852). Among the most sedentary subgroup, walking less than 5000 steps/day at baseline, an 8868 steps/week (95% CI [2988 - 14700]) increase was observed in the prescription group. CONCLUSION Prescribing physical activity did not significantly modify total weekly energy expenditure, but slightly increased moderate-intensity activity duration and step counts, particularly among the most sedentary participants. Prescribing personalised physical activity goals encourages sedentary patients to engage in physical activity. TRIAL REGISTRATION The PEPPER trial is registered in the US National Institutes of Health Clinical Trials Registry under number NCT02317003 (15/12/2014).
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Affiliation(s)
- William Bellanger
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Matthieu Peurois
- Department of General Practice, University of Angers, 49000, Angers, France.
- University of Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER,, SFR ICAT, 49000, Angers, France.
| | - Laurent Connan
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Nastassia Navasiolava
- University of Angers, CHU Angers, CRC, INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, 49000, Angers, France
| | - David Missud
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Thibaut Py
- Department of General Practice, University of Angers, 49000, Angers, France
| | - Cyril Bègue
- Department of General Practice, University of Angers, 49000, Angers, France
- University of Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER,, SFR ICAT, 49000, Angers, France
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Zhao X, Liu X, Wu X, Fu P, Zhang X, Zhou M, Hao Y, Xu B, Yan L, Xiao J, Li X, Lv L, Yang H, Liu Z, Yang C, Wang X, Liao J, Jiang X, Zhang B, Li J. Associations between changes of smartphone pedometer-assessed step counts and levels of obesity-related breast cancer biomarkers in non-cancer women: A population-based observational study. J Sports Sci 2023; 41:937-946. [PMID: 37598352 DOI: 10.1080/02640414.2023.2249754] [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: 10/16/2022] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
While a higher level of physical activity (PA) is inversely associated with a higher breast cancer (BC) risk, the health benefits of daily steps on obesity-related BC biomarkers remain unclear. We aimed to understand the associations of changes in step counts with levels of five obesity-related BC biomarkers during a two-year follow-up. In total, 144 non-cancer women (47.96 ± 5.72) were observed on both 2019 and 2021. A structured questionnaire, daily steps and fasting blood samples were collected before (t0, 2019) and after (t1, 2021). Levels of biomarkers (IGF-binding proteins 3, adiponectin, soluble leptin receptor, C-reactive protein, and resistin) were assayed by ELISA. Participants were divided into persistent low steps, decreasing steps, increasing steps, and persistent high steps. Associations of categories on proposed biomarkers were estimated using linear regression models, with persistent low steps as reference. Associations between time-varying step counts with biomarkers were quantified using mixed linear models. Compared with persistent low steps, increasing steps is associated with a reduction in C-reactive protein level (β=-0.74, 95%CI=-1.23--0.26, P-value = 2.98 × 10-3). An inverse association between time-varying step counts with C-reactive protein level was identified, consistent across different obesity types and baseline step level categories. No association with daily step counts was observed for other proteins.
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Affiliation(s)
- Xunying Zhao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohua Liu
- Department of Maternal and Child Health, Chengdu Shuangliu District Maternal and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Xueyao Wu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Fu
- Department of Maternal and Child Health, Chengdu Shuangliu District Maternal and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Xiaofan Zhang
- Department of Scientific Research & Management, The Second People's Hospital of Guiyang, Guiyang, China
| | - Min Zhou
- Department of Maternal and Child Health, Chengdu Shuangliu District Maternal and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Yu Hao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bin Xu
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lanping Yan
- Department of Maternal and Child Health, Chengdu Shuangliu District Maternal and Child Health Care Hospital, Chengdu, Sichuan, China
| | - Jinyu Xiao
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingyue Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liang Lv
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huifang Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmi Liu
- Department of Maternal, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaqiang Liao
- Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xia Jiang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ben Zhang
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Occupational and Environmental Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, Institute of Systems Epidemiology, and West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Sarkodie SK, Wason JMS, Grayling MJ. A hybrid approach to comparing parallel-group and stepped-wedge cluster-randomized trials with a continuous primary outcome when there is uncertainty in the intra-cluster correlation. Clin Trials 2023; 20:59-70. [PMID: 36086822 PMCID: PMC9940131 DOI: 10.1177/17407745221123507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS To evaluate how uncertainty in the intra-cluster correlation impacts whether a parallel-group or stepped-wedge cluster-randomized trial design is more efficient in terms of the required sample size, in the case of cross-sectional stepped-wedge cluster-randomized trials and continuous outcome data. METHODS We motivate our work by reviewing how the intra-cluster correlation and standard deviation were justified in 54 health technology assessment reports on cluster-randomized trials. To enable uncertainty at the design stage to be incorporated into the design specification, we then describe how sample size calculation can be performed for cluster- randomized trials in the 'hybrid' framework, which places priors on design parameters and controls the expected power in place of the conventional frequentist power. Comparison of the parallel-group and stepped-wedge cluster-randomized trial designs is conducted by placing Beta and truncated Normal priors on the intra-cluster correlation, and a Gamma prior on the standard deviation. RESULTS Many Health Technology Assessment reports did not adhere to the Consolidated Standards of Reporting Trials guideline of indicating the uncertainty around the assumed intra-cluster correlation, while others did not justify the assumed intra-cluster correlation or standard deviation. Even for a prior intra-cluster correlation distribution with a small mode, moderate prior densities on high intra-cluster correlation values can lead to a stepped-wedge cluster-randomized trial being more efficient because of the degree to which a stepped-wedge cluster-randomized trial is more efficient for high intra-cluster correlations. With careful specification of the priors, the designs in the hybrid framework can become more robust to, for example, an unexpectedly large value of the outcome variance. CONCLUSION When there is difficulty obtaining a reliable value for the intra-cluster correlation to assume at the design stage, the proposed methodology offers an appealing approach to sample size calculation. Often, uncertainty in the intra-cluster correlation will mean a stepped-wedge cluster-randomized trial is more efficient than a parallel-group cluster-randomized trial design.
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Affiliation(s)
- Samuel K Sarkodie
- Samuel K Sarkodie, Population Health
Sciences Institute, Newcastle University, 4th Floor Ridley Building 1, Queen
Victoria Road, Newcastle upon Tyne NE1 7RU, UK.
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Assayag E, Wiener R, Gelman E, Abulafia A, Wasser LM, Hanhart J, Zadok D, Weill Y. The Physical Activity Level of Ophthalmologists at Work: A Pedometer-Based Study. Workplace Health Saf 2023; 71:6-12. [PMID: 35673758 DOI: 10.1177/21650799221099039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ophthalmology practice entails many hours of physical inactivity, a potential long-term health hazard. This study aims to perform a pedometer-based evaluation of the physical activity (PA) levels of ophthalmologists at work. METHODS This is a prospective observational study. Ophthalmologists from a single tertiary medical center were monitored with electronic pedometers during six morning sessions in the ophthalmology clinics. Working hours and the number of patients seen per clinic session were retrieved. The age and body mass index (BMI) of participants were documented. Step number per working hour (SPH) was calculated for all participants. Comparisons between males and females, practicing ophthalmologists (attendings) and ophthalmology residents (residents), and sub-specialties were performed. Correlations between SPH and age, BMI, and patients seen per clinic session were computed. FINDINGS Pedometer readings for a total of 673 working hours were analyzed for 24 ophthalmologists, 17% female, 17 attendings, mean age 44.2 years (standard deviation (SD = 9.8). The average number of SPH for all participants was 359.7 (SD = 166.7). The mean PA level of residents was significantly higher than that of attendings (410.17 SPH vs. 338.95 SPH, respectively, p = .019). Oculoplastic surgeons demonstrated significantly higher step counts per hour than cornea specialists (439.90 SPH vs. 245.55 SPH, respectively, p = .002). A negative correlation was observed between SPH and the number of patients seen per clinic session (ρ = -0.274, p = .001). CONCLUSIONS/APPLICATIONS TO PRACTICE Low number of SPH for ophthalmologists in this study indicates ophthalmology to be a highly sedentary medical occupation. PA levels of ophthalmologists in the workplace may indicate a personal health care challenge.
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Affiliation(s)
- Elishai Assayag
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Rony Wiener
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Evgeny Gelman
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Adi Abulafia
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Lauren M Wasser
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Joel Hanhart
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - David Zadok
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yishay Weill
- Department of Ophthalmology, Shaare Zedek Medical Center, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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McNamara R, Davy K, Niranjan V, O'Regan A. Recruitment and characteristics of participants in trials of physical activity for adults aged 45 years and above in general practice: a systematic review. Fam Pract 2022; 40:387-397. [PMID: 36472583 PMCID: PMC10047612 DOI: 10.1093/fampra/cmac128] [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] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND General practice is well situated to promote physical activity (PA), but with PA levels declining after 45 years of age, often those who are most likely to benefit from interventions tend to be the least likely recruited to participate in research. AIMS AND RATIONALE The aim of this study was to investigate recruitment and reporting of participant demographics in PA trials for adults aged 45 years and above. Specific objectives were: (i) to examine the reporting of demographics of participants; (ii) to investigate the strategies used to recruit these participants; and, (iii) to examine the efficiency of recruitment strategies. METHODS Seven databases were searched, including: PubMed, CINAHL, the Cochrane Library Register of Controlled Trials, Embase, Scopus, PsycINFO, and Web of Science. Only randomized control trials involving adults 45 years old or older recruited through primary care were included. The PRISMA framework for systematic review was followed, which involved 2 researchers independently conducting title, abstract, and full article screening. Tools for data extraction and synthesis were adapted from previous work on inclusivity in recruitment. RESULTS The searches retrieved 3,491 studies of which 12 were included for review. Sample size of the studies ranged from 31 to 1,366, with a total of 6,042 participants of which 57% were female. Of 101 participating practices, 1 was reported as rural. Reporting of recruitment lacked detail-only 6 studies outlined how practices were recruited. 11/12 studies involved a database or chart review to identify participants that met the inclusion criteria, followed by a letter of invitation sent to those people. The studies with higher recruitment efficiency ratios each employed more than 1 recruitment strategy, e.g. opportunistic invitations and telephone calls. CONCLUSION This systematic review has presented deficits in the reporting of both demographics and recruitment. Future research should aim for a standardized approach to reporting.
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Affiliation(s)
- Richard McNamara
- University of Limerick, Health Research Institute, School of Medicine, Limerick, Ireland
| | - Kimberly Davy
- University of Limerick, Health Research Institute, School of Medicine, Limerick, Ireland
| | - Vikram Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Andrew O'Regan
- University of Limerick, Health Research Institute, School of Medicine, Limerick, Ireland
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Patnode CD, Redmond N, Iacocca MO, Henninger M. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:375-388. [PMID: 35881116 DOI: 10.1001/jama.2022.7408] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation. DATA SOURCES MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022. STUDY SELECTION Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating and random effects meta-analysis. MAIN OUTCOMES AND MEASURES CVD events, CVD risk factors, diet and physical activity measures, and harms. RESULTS One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups. CONCLUSIONS AND RELEVANCE Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Barrett S, Begg S, O’Halloran P, Doran CM, Kingsley M. Physical activity telephone coaching intervention for insufficiently physically active ambulatory hospital patients: Economic evaluation of the Healthy 4U-2 randomised controlled trial. PLoS One 2022; 17:e0270211. [PMID: 35737687 PMCID: PMC9223391 DOI: 10.1371/journal.pone.0270211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
The Healthy 4U-2 randomised controlled trial demonstrated that a physical activity (PA) telephone coaching intervention was effective for improving objectively-measured PA and health-related outcomes. The current study reports on an economic evaluation performed alongside the trial to determine whether this effective intervention is also cost-effective from a healthcare funder perspective. Participants (N = 120) were insufficiently physically active adults recruited from an ambulatory care clinic in a public hospital in regional Australia. The primary outcome was change in moderate-to-vigorous physical activity (MVPA) measured using accelerometers. Changes in quality-adjusted life-years (QALYs) were derived from the 12-Item Short Form Health Survey Questionnaire (SF-12). Incremental cost-effectiveness ratios (ICERs) were calculated for each outcome. Uncertainty of cost-effectiveness results were estimated using non-parametric bootstrapping techniques and sensitivity analyses. The mean intervention cost was $132 per person. The control group incurred higher overall costs compared to intervention ($2,465 vs. $1,743, respectively). Relative to control, the intervention resulted in incremental improvements in MVPA and QALYs and was deemed cost-effective. Probabilistic sensitivity analysis indicated that compared to control, the intervention would be cost-effective for improving MVPA and QALYs at very low willingness to pay thresholds. Sensitivity analyses indicated that results were robust to varied assumptions. This study shows that PA telephone coaching was a low-cost strategy for increasing MVPA and QALYs in insufficiently active ambulatory hospital patients. Findings of health benefits and overall cost-savings are uncommon and PA telephone coaching offers a potentially cost-effective investment to produce important public health outcomes.
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Affiliation(s)
- Stephen Barrett
- Health Promotion Department, Bendigo Health Care Group, Bendigo, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Paul O’Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Christopher M. Doran
- Centre for Resilience and Wellbeing, Central Queensland University, Queensland, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Department of Exercise Sciences, University of Auckland, Newmarket, New Zealand
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Current practice in the measurement and interpretation of intervention adherence in randomised controlled trials: A systematic review. Contemp Clin Trials 2022; 118:106788. [PMID: 35562000 DOI: 10.1016/j.cct.2022.106788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ideally all participants in a randomised controlled trial (RCT) should fully receive their allocated intervention; however, this rarely occurs in practice. Intervention adherence affects Type II error so influences the interpretation of trial results and subsequent implementation. We aimed to describe current practice in the definition, measurement, and reporting of intervention adherence in non-pharmacological RCTs, and how this data is incorporated into a trial's interpretation and conclusions. METHODS We conducted a systematic review of phase III RCTs published between January 2018 and June 2020 in the National Institute for Health Research Journals Library for the Health Technology Assessment, Programme Grants for Applied Research, and Public Health Research funding streams. RESULTS Of 237 reports published, 76 met the eligibility criteria and were included. Most RCTs (n = 68, 89.5%) reported adherence, though use of terminology varied widely; nearly three quarters of these (n = 49, 72.1%) conducted a sensitivity analysis. Adherence measures varied between intervention types: behavioural change (n = 10, 43.5%), psychological therapy (n = 5, 83.3%) and physiotherapy/rehabilitation (n = 8, 66.7%) interventions predominately measured adherence based on session attendance. Whereas medical device and surgical interventions (n = 17, 73.9%) primarily record the number of participants receiving the allocated intervention, a third (n = 33, 67.3%) of studies reported a difference in findings between primary and sensitivity analyses. CONCLUSIONS Although most trials report elements of adherence, terminology was inconsistent, and there was no systematic approach to its measurement, analyses, interpretation, or reporting. Given the importance of adherence within clinical trials, there is a pressing need for a standardised approach or framework.
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Carbonneau E, Dumas A, Brodeur-Doucet A, Fontaine-Bisson B. A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes. Nutrients 2022; 14:nu14061151. [PMID: 35334807 PMCID: PMC8951613 DOI: 10.3390/nu14061151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m2. This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.
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Affiliation(s)
- Elise Carbonneau
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Centre NUTRISS—Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec, QC G1V 0A6, Canada
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
- Correspondence:
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | | | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
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15
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Statistical analysis of publicly funded cluster randomised controlled trials: a review of the National Institute for Health Research Journals Library. Trials 2022; 23:115. [PMID: 35120567 PMCID: PMC8817506 DOI: 10.1186/s13063-022-06025-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In cluster randomised controlled trials (cRCTs), groups of individuals (rather than individuals) are randomised to minimise the risk of contamination and/or efficiently use limited resources or solve logistic and administrative problems. A major concern in the primary analysis of cRCT is the use of appropriate statistical methods to account for correlation among outcomes from a particular group/cluster. This review aimed to investigate the statistical methods used in practice for analysing the primary outcomes in publicly funded cluster randomised controlled trials, adherence to the CONSORT (Consolidated Standards of Reporting Trials) reporting guidelines for cRCTs and the recruitment abilities of the cluster trials design. METHODS We manually searched the United Kingdom's National Institute for Health Research (NIHR) online Journals Library, from 1 January 1997 to 15 July 2021 chronologically for reports of cRCTs. Information on the statistical methods used in the primary analyses was extracted. One reviewer conducted the search and extraction while the two other independent reviewers supervised and validated 25% of the total trials reviewed. RESULTS A total of 1942 reports, published online in the NIHR Journals Library were screened for eligibility, 118 reports of cRCTs met the initial inclusion criteria, of these 79 reports containing the results of 86 trials with 100 primary outcomes analysed were finally included. Two primary outcomes were analysed at the cluster-level using a generalized linear model. At the individual-level, the generalized linear mixed model was the most used statistical method (80%, 80/100), followed by regression with robust standard errors (7%) then generalized estimating equations (6%). Ninety-five percent (95/100) of the primary outcomes in the trials were analysed with appropriate statistical methods that accounted for clustering while 5% were not. The mean observed intracluster correlation coefficient (ICC) was 0.06 (SD, 0.12; range, - 0.02 to 0.63), and the median value was 0.02 (IQR, 0.001-0.060), although 42% of the observed ICCs for the analysed primary outcomes were not reported. CONCLUSIONS In practice, most of the publicly funded cluster trials adjusted for clustering using appropriate statistical method(s), with most of the primary analyses done at the individual level using generalized linear mixed models. However, the inadequate analysis and poor reporting of cluster trials published in the UK is still happening in recent times, despite the availability of the CONSORT reporting guidelines for cluster trials published over a decade ago.
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Johansson JF, Lam N, Ozer S, Hall J, Morton S, English C, Fitzsimons CF, Lawton R, Forster A, Clarke D. Systematic review of process evaluations of interventions in trials investigating sedentary behaviour in adults. BMJ Open 2022; 12:e053945. [PMID: 35105631 PMCID: PMC8804646 DOI: 10.1136/bmjopen-2021-053945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To systematically review and synthesise findings from process evaluations of interventions in trials which measured sedentary behaviour as an outcome in adults to explore: (1) how intervention content, implementation, mechanisms of impact and context influence outcomes and (2) how these interventions are experienced from different perspectives (participants, carers, staff). DESIGN Systematic review and narrative synthesis underpinned by the Medical Research Council process evaluation framework. DATA SOURCES Databases searches were conducted in March 2019 then updated in May 2020 and October 2021 in: CINAHL, SPORTDiscus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, AMED; EMBASE, PsycINFO, MEDLINE, Web of Science and ProQuest Dissertations & Theses. ELIGIBILITY CRITERIA We included: Process evaluations of trials including interventions where sedentary behaviour was measured as an outcome in adults aged 16 or over from clinical or non-clinical populations. We excluded studies if interventions were delivered in educational or workplace settings, or if they were laboratory studies focused on immediate effects of breaking sitting. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted and coded data into a framework and assessed the quality of studies using the Mixed Methods Appraisal Tool. We synthesised findings using a narrative approach. RESULTS 17 process evaluations were included. Five interventions focused on reducing sedentary behaviour or sitting time, 12 aimed to increase physical activity or promote healthier lifestyles. Process evaluations indicated changes in sedentary behaviour outcomes were shaped by numerous factors including: barriers (eg, staffing difficulties and scheduling problems) and facilitators (eg, allowing for flexibility) to intervention delivery; contextual factors (eg, usual lifestyle and religious events) and individual factors (eg, pain, tiredness, illness, age and individual preferences). DISCUSSION Intervention requires careful consideration of different factors that could influence changes in sedentary behaviour outcomes to ensure that interventions can be tailored to suit different individuals and groups. PROSPERO REGISTRATION NUMBER CRD42018087403.
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Affiliation(s)
- Jessica Faye Johansson
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - Jennifer Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
- Faculty of Life Sciences and Health Studies, University of Bradford, Bradford, UK
| | - Sarah Morton
- Geriatric Medicine, The University of Edinburgh Centre for Clinical Brain Sciences, Edinburgh, UK
| | - Coralie English
- Faculty of Health and Medicine, The University of Newcastle School of Health Sciences, Callaghan, New South Wales, Australia
| | - Claire F Fitzsimons
- Institute of Sport, Physical Education and Health Sciences, University of Edinburgh Physical Activity for Health Research Centre, Edinburgh, UK
| | - Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
- Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds Institute of Health Sciences, Leeds, UK
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford, UK
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Lavelle G, Norris M, Flemming J, Harper J, Bradley J, Johnston H, Fortune J, Stennett A, Kilbride C, Ryan JM. Validity and Acceptability of Wearable Devices for Monitoring Step-Count and Activity Minutes Among People With Multiple Sclerosis. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:737384. [PMID: 36188762 PMCID: PMC9397948 DOI: 10.3389/fresc.2021.737384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Multiple wearable devices that purport to measure physical activity are widely available to consumers. While they may support increases in physical activity among people with multiple sclerosis (MS) by providing feedback on their performance, there is little information about the validity and acceptability of these devices. Providing devices that are perceived as inaccurate and difficult to use may have negative consequences for people with MS, rather than supporting participation in physical activity. The aim of this study was, therefore, to assess the validity and acceptability of commercially available devices for monitoring step-count and activity time among people with MS. Nineteen ambulatory adults with MS [mean (SD) age 52.1 (11.9) years] participated in the study. Step-count was assessed using five commercially available devices (Fitbit Alta, Fitbit Zip, Garmin Vivofit 4, Yamax Digi Walker SW200, and Letscom monitor) and an activPAL3μ while completing nine everyday activities. Step-count was also manually counted. Time in light activity, moderate-to-vigorous activity, and total activity were measured during activities using an Actigraph GT3X accelerometer. Of the 19 participants who completed the validity study, fifteen of these people also wore the five commercially available devices for three consecutive days each, and participated in a semi-structured interview regarding their perception of the acceptability of the monitors. Mean percentage error for step-count ranged from 12.1% for the Yamax SW200 to −112.3% for the Letscom. Mean step-count as manually determined differed to mean step-count measured by the Fitbit Alta (p = 0.002), Garmin vivofit 4 (p < 0.001), Letscom (p < 0.001) and the research standard device, the activPAL3μ (p < 0.001). However, 95% limits of agreement were smallest for the activPAL3μ and largest for the Fitbit Alta. Median percentage error for activity minutes was 52.9% for the Letscom and 100% for the Garmin Vivofit 4 and Fitbit Alta compared to minutes in total activity. Three inductive themes were generated from participant accounts: Interaction with device; The way the device looks and feels; Functionality. In conclusion, commercially available devices demonstrated poor criterion validity when measuring step-count and activity time in people with MS. This negatively affected the acceptability of devices, with perceived inaccuracies causing distrust and frustration. Additional considerations when designing devices for people with MS include an appropriately sized and lit display and ease of attaching and charging devices.
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Affiliation(s)
- Grace Lavelle
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Meriel Norris
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
- *Correspondence: Meriel Norris
| | - Julie Flemming
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Jamie Harper
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Joan Bradley
- The Hillingdon Hospitals, NHS Foundation Trust, Uxbridge, United Kingdom
| | - Helen Johnston
- The Hillingdon Hospitals, NHS Foundation Trust, Uxbridge, United Kingdom
| | - Jennifer Fortune
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrea Stennett
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
- Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, United Kingdom
| | - Cherry Kilbride
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Jennifer M. Ryan
- College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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O'Regan A, Pollock M, D'Sa S, Niranjan V. ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients. BMJ Open Sport Exerc Med 2021; 7:e001050. [PMID: 34150320 PMCID: PMC8174512 DOI: 10.1136/bmjsem-2021-001050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Exercise prescribing can help patients to overcome physical inactivity, but its use in general practice is limited. The purpose of this narrative review was to investigate contemporaneous experiences of general practitioners and patients with exercise prescribing. METHOD PubMed, Scopus, Science Direct and Cochrane reviews were reviewed using the terms 'exercise prescription', 'exercise prescribing', 'family practice', 'general practice', 'adults' and 'physical activity prescribing'. RESULTS After screening by title, abstract and full paper, 23 studies were selected for inclusion. Qualitative, quantitative and mixed-methods studies revealed key experiences of general practitioners and patients. Barriers identified included: physician characteristics, patients' physical and psychosocial factors, systems and cultural failures, as well as ambiguity around exercise prescribing. We present a synthesis of the key strategies to overcome these using an ABC approach: A: assessment of physical activity: involves asking about physical activity, barriers and risks to undertaking an exercise prescription; B: brief intervention: advice, written prescription detailing frequency, intensity, timing and type of exercise; and C: continued support: providing ongoing monitoring, accountability and progression of the prescription. Multiple supports were identified: user-friendly resources, workshops for doctors, guidelines for specific illnesses and multimorbidity, electronic devices, health system support and collaboration with other healthcare and exercise professionals. DISCUSSION This review has identified levers for facilitating exercise prescribing and adherence to it. The findings have been presented in an ABC format as a guide and support for general practitioners to prescribe exercise.
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Affiliation(s)
- Andrew O'Regan
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Saskia D'Sa
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University College Dublin, Dublin, Ireland
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Mattli R, Farcher R, Syleouni ME, Wieser S, Probst-Hensch N, Schmidt-Trucksäss A, Schwenkglenks M. Physical Activity Interventions for Primary Prevention in Adults: A Systematic Review of Randomized Controlled Trial-Based Economic Evaluations. Sports Med 2021; 50:731-750. [PMID: 31755043 DOI: 10.1007/s40279-019-01233-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Physical inactivity is a worldwide pandemic associated with major chronic diseases. Given limited resources, policy makers are in need of physical activity interventions that provide best value for money. OBJECTIVE To summarize evidence from RCT-based economic evaluations of primary prevention physical activity interventions in adult populations outside the workplace setting. DESIGN Systematic review of health economic evaluations. Incremental cost-effectiveness ratios (ICERs) in US$ per MET-hour gained were estimated on the basis of mean differences in intervention costs and standardized effects between intervention and control groups. DATA SOURCES Identification of relevant studies via systematic searches in electronic databases (MEDLINE, Embase and NHSEED). ELIGIBILITY CRITERIA Cost-effectiveness analyses in which all data (except unit costs) came from one RCT investigating physical activity interventions for primary prevention or health promotion in an adult population in high-income countries. RESULTS In twelve eligible studies, 22 interventions were investigated. Interventions were based on advice, goal setting and follow-up support, exercise classes, financial incentives or teaching on behavioral change. The ICER varied widely among the interventions and four interventions showed an ICER below the applied benchmark of US$0.44 to US$0.63 per MET-hour gained. These four interventions were based on individualized advice via print or web. CONCLUSION We found evidence from RCTs indicating cost-effectiveness of some physical activity interventions for primary prevention in adults. However, the majority of interventions assessed would not be cost-effective according to the benchmark applied. Furthermore, our study showed that trial-based evidence on cost-effectiveness of physical activity interventions is scarce. Therefore, we recommend that future studies investigating the efficacy or effectiveness of such interventions consider costs as an additional outcome and assess cost-effectiveness.
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Affiliation(s)
- Renato Mattli
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland. .,Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland.
| | - Renato Farcher
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland
| | - Maria-Eleni Syleouni
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Mittlere Allee 18, 4052, Basel, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
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20
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Taylor A, Taylor RS, Ingram W, Dean SG, Jolly K, Mutrie N, Lambert J, Yardley L, Streeter A, Greaves C, McAdam C, Price L, Anokye NK, Campbell J. Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial. Br J Sports Med 2020; 55:444-450. [PMID: 33247001 PMCID: PMC8020080 DOI: 10.1136/bjsports-2020-103121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 01/07/2023]
Abstract
Objective To determine whether adding web-based support (e-coachER) to an exercise referral scheme (ERS) increases objectively assessed physical activity (PA). Design Multicentre trial with participants randomised to usual ERS alone (control) or usual ERS plus e-coachER (intervention). Setting Primary care and ERS in three UK sites from 2015 to 2018. Participants 450 inactive ERS referees with chronic health conditions. Interventions Participants received a pedometer, PA recording sheets and a user guide for the web-based support. e-coachER interactively encouraged the use of the ERS and other PA options. Main outcome measures Primary and key secondary outcomes were: objective moderate-to-vigorous PA (MVPA) minutes (in ≥10 min bouts and without bouts), respectively, after 12 months. Secondary outcomes were: other accelerometer-derived and self-reported PA measures, ERS attendance, EQ-5D-5L, Hospital Anxiety and Depression Scale and beliefs about PA. All outcomes were collected at baseline, 4 and 12 months. Primary analysis was an intention to treat comparison between intervention and control arms at 12-month follow-up. Results There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: −2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: −26.8 to 54.2; p=0.51) for 232 participants with usable data. There was no difference in the primary or secondary PA outcomes at 4 or 12 months. Conclusion Augmenting ERS referrals with web-based behavioural support had only a weak, non-significant effect on MVPA. Trial registration number ISRCTN15644451.
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Affiliation(s)
- Adrian Taylor
- Peninsula School of Medicine, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Rod S Taylor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,Health Statistics, University of Exeter Medical School, Exeter, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, Devon, UK
| | | | - Kate Jolly
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK
| | - Jeff Lambert
- Department of Health, University of Bath, Bath, Somerset, UK
| | - Lucy Yardley
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.,School of Psychological Sciences, University of Bristol, Bristol, UK
| | - Adam Streeter
- Medical Statistics, University of Plymouth, Plymouth, Devon, UK
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,University of Exeter Medical School, Exeter, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK
| | - Lisa Price
- School of Sport and Health Sciences, University of Exeter, Exeter, Devon, UK
| | - Nana Kwame Anokye
- Department of Clinical Sciences, Brunel University, Uxbridge, Middlesex, UK
| | - John Campbell
- University of Exeter Medical School, Exeter, Devon, UK
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21
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Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean S, Jolly K, Mutrie N, Lambert J, Yardley L, Greaves C, King J, McAdam C, Steele M, Price L, Streeter A, Charles N, Terry R, Webb D, Campbell J, Hughes L, Ainsworth B, Jones B, Jane B, Erwin J, Little P, Woolf A, Cavanagh C. Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT. Health Technol Assess 2020; 24:1-106. [PMID: 33243368 PMCID: PMC7750864 DOI: 10.3310/hta24630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity. OBJECTIVES To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes. DESIGN A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control). SETTING Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow. PARTICIPANTS There were 450 participants aged 16-74 years, with a body mass index of 30-40 kg/m2, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users. INTERVENTION e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven 'steps to health'. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme. PRIMARY OUTCOME MEASURE Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day. SECONDARY OUTCOMES Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation. RESULTS Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m2, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (n = 108) compared with the control group (n = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval -2.1 to 26.0 minutes; p = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval -£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year. LIMITATIONS A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation. FUTURE WORK The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions. CONCLUSIONS Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model. TRIAL REGISTRATION Current Controlled Trials ISRCTN15644451. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adrian H Taylor
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Rod S Taylor
- University of Exeter Medical School, University of Exeter, Exeter, UK
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Wendy M Ingram
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Nana Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Sarah Dean
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Jeffrey Lambert
- University of Exeter Medical School, University of Exeter, Exeter, UK
- Department for Health, University of Bath, Bath, UK
| | - Lucy Yardley
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Colin Greaves
- University of Exeter Medical School, University of Exeter, Exeter, UK
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Jennie King
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mary Steele
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Lisa Price
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Adam Streeter
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | | | - Rohini Terry
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Douglas Webb
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lucy Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ben Ainsworth
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Ben Jones
- Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Ben Jane
- School of Sport, Health and Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Jo Erwin
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Paul Little
- Centre for Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Anthony Woolf
- Bone and Joint Research Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
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22
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Dombrowski SU, McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, Calveley E, Elders A, Glennie N, Gray CM, Harris FM, Hapca A, Jones C, Kee F, McKinley MC, Skinner R, Tod M, Hoddinott P. Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
In 2016, 26% of UK men were estimated to be obese. Systematic reviews suggest that few men engage in formal weight loss interventions that support weight reduction and improve health.
Objective
To co-produce, with patient and public involvement, an acceptable and feasible randomised controlled trial design to test a men-only weight management intervention.
Design
This was a two-phase feasibility study. Phase 1 was the development of intervention components, study procedures and materials including a discrete choice experiment with survey questions. Phase 2 was an individually randomised three-arm feasibility trial over 12 months. Qualitative interviews were conducted at 3 and 12 months.
Setting
The setting was two sites in Scotland that had disadvantaged urban and rural areas and differed in employment levels and ethnic groups.
Participants
In phase 1, 1045 men with obesity were recruited by Ipsos MORI (London, UK; www.ipsos.com/ipsos-mori/en-uk) to represent the UK population. In phase 2, 105 men with obesity were recruited in the community or through general practice obesity registers. Qualitative interviews were conducted with 50 men at 3 months and with 33 men at 12 months.
Interventions
The trial arms were narrative short message service (SMS) for 12 months (SMS only), financial endowment incentive informed by loss aversion and linked to achievement of weight loss targets plus narrative SMS for 12 months (SMS + I), and waiting list control group for 12 months followed by 3 months of an alternative SMS style developed based on feedback from men who had received the narrative SMS (control).
Main outcome measures
The main outcome measures were acceptability and feasibility of recruitment, retention, engagement, intervention components and trial procedures. Outcomes were assessed by examining procedural, quantitative and qualitative data at 3, 6 and 12 months.
Results
The most acceptable incentive strategy, based on the discrete choice experiment results, was to verify weight loss of 5% at 3 months, verify weight loss of 10% at 6 months and maintain weight loss of 10% at 12 months. Overall, 105 men with obesity from across the socioeconomic spectrum were successfully recruited to target, 59% of whom lived in more disadvantaged areas. Retention at 12 months was acceptable (74%) and was higher among individuals from disadvantaged areas. Narrative SMS were acceptable to many men, with a minority reporting negative reactions. Incentives were acceptable but were not the primary motivation for behaviour change. Twelve men in the incentive arm (33%) secured at least some money and three (8%) secured the full amount. Both intervention arms lost some weight, with greater weight loss in the arm that received SMS and incentives. The alternative SMS based on men’s feedback received no strong negative reactions.
Limitations
Fewer participants from the SMS + I arm (64%) completed the study at 12 months than did those in the SMS-only (79%) and control (83%) arms. The reasons for this difference were complex.
Conclusions
The men-only weight management intervention consisting of narrative SMS and financial incentives was acceptable and feasible, meeting the progression criteria for a full trial. Tailoring of SMS may improve acceptability and retention.
Future work
Minor refinements to the intervention components based on the study findings will be made prior to testing in a multisite definitive randomised controlled trial.
Trial registration
ClinicalTrials.gov NCT03040518.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stephan U Dombrowski
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Matthew McDonald
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Mark Grindle
- Division of Rural Health and Wellbeing, University of the Highlands and Islands, Inverness, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Eileen Calveley
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Nicola Glennie
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Cindy M Gray
- Institute of Health & Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Fiona M Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Dundee, UK
| | - Frank Kee
- Centre for Public Health, Institute of Clinical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Rebecca Skinner
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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23
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van der Veen W, Taxis K, Wouters H, Vermeulen H, Bates DW, van den Bemt PMLA. Factors associated with workarounds in barcode-assisted medication administration in hospitals. J Clin Nurs 2020; 29:2239-2250. [PMID: 32043705 PMCID: PMC7328795 DOI: 10.1111/jocn.15217] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/11/2020] [Accepted: 02/03/2020] [Indexed: 01/25/2023]
Abstract
Aims and objectives To identify that workarounds (defined as “informal temporary practices for handling exceptions to normal procedures or workflow”) by nurses using information technology potentially compromise medication safety. Therefore, we aimed to identify potential risk factors associated with workarounds performed by nurses in Barcode‐assisted Medication Administration in hospitals. Background Medication errors occur during the prescribing, distribution and administration of medication. Errors could harm patients and be a tragedy for both nurses and medical doctors involved. Interventions to prevent errors have been developed, including those based on information technology. To cope with shortcomings in information technology‐based interventions as Barcode‐assisted Medication Administration, nurses perform workarounds. Identification of workarounds in information technology is essential to implement better‐designed software and processes which fit the nurse workflow. Design We used the data from our previous prospective observational study, performed in four general hospitals in the Netherlands using Barcode techniques, to administer medication to inpatients. Methods Data were collected from 2014–2016. The disguised observation was used to gather information on potential risk factors and workarounds. The outcome was a medication administration with one or more workarounds. Logistic mixed models were used to determine the association between potential risk factors and workarounds. The STROBE checklist was used for reporting our data. Results We included 5,793 medication administrations among 1,230 patients given by 272 nurses. In 3,633 (62.7%) of the administrations, one or more workarounds were observed. In the multivariate analysis, factors significantly associated with workarounds were the medication round at 02 p.m.–06 p.m. (adjusted odds ratio [OR]: 1.60, 95% CI: 1.05–2.45) and 06 p.m.–10 p.m. (adjusted OR: 3.60, 95% CI: 2.11–6.14) versus the morning shift 06 a.m.–10 a.m., the workdays Monday (adjusted OR: 2.59, 95% CI: 1.51–4.44), Wednesday (adjusted OR: 1.92, 95% CI: 1.2–3.07) and Saturday (adjusted OR: 2.24, 95% CI: 1.31–3.84) versus Sunday, the route of medication, nonoral (adjusted OR: 1.28, 95% CI: 1.05–1.57) versus the oral route of drug administration, the Anatomic Therapeutic Chemical classification‐coded medication “other” (consisting of the irregularly used Anatomic Therapeutic Chemical classes [D, G, H, L, P, V, Y, Z]) (adjusted OR: 1.49, 95% CI: 1.05–2.11) versus Anatomic Therapeutic Chemical class A (alimentary tract and metabolism), and the patient–nurse ratio ≥6–1 (adjusted OR: 5.61, 95% CI: 2.9–10.83) versus ≤5–1. Conclusions We identified several potential risk factors associated with workarounds performed by nurses that could be used to target future improvement efforts in Barcode‐assisted Medication Administration. Relevance to clinical practice Nurses administering medication in hospitals using Barcode‐assisted Medication Administration frequently perform workarounds, which may compromise medication safety. In particular, nurse workload and the patient–nurse ratio could be the focus for improvement measures as these are the most clearly modifiable factors identified in this study.
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Affiliation(s)
- Willem van der Veen
- Unit PharmacoTherapy, Epidemiology & Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Katja Taxis
- Unit PharmacoTherapy, Epidemiology & Economics, Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Hans Wouters
- General Practitioners Research Institute, University of Groningen, Groningen, The Netherlands
| | - Hester Vermeulen
- Department of IQ Healthcare, Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - David W Bates
- Harvard Medical School and Brigham and Woman's Hospital, Boston, MA, USA
| | - Patricia M L A van den Bemt
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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24
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Harris T, Limb ES, Hosking F, Carey I, DeWilde S, Furness C, Wahlich C, Ahmad S, Kerry S, Whincup P, Victor C, Ussher M, Iliffe S, Ekelund U, Fox-Rushby J, Ibison J, Cook DG. Effect of pedometer-based walking interventions on long-term health outcomes: Prospective 4-year follow-up of two randomised controlled trials using routine primary care data. PLoS Med 2019; 16:e1002836. [PMID: 31237875 PMCID: PMC6592516 DOI: 10.1371/journal.pmed.1002836] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Data are lacking from physical activity (PA) trials with long-term follow-up of both objectively measured PA levels and robust health outcomes. Two primary care 12-week pedometer-based walking interventions in adults and older adults (PACE-UP and PACE-Lift) found sustained objectively measured PA increases at 3 and 4 years, respectively. We aimed to evaluate trial intervention effects on long-term health outcomes relevant to walking interventions, using routine primary care data. METHODS AND FINDINGS Randomisation was from October 2012 to November 2013 for PACE-UP participants from seven general (family) practices and October 2011 to October 2012 for PACE-Lift participants from three practices. We downloaded primary care data, masked to intervention or control status, for 1,001 PACE-UP participants aged 45-75 years, 36% (361) male, and 296 PACE-Lift participants, aged 60-75 years, 46% (138) male, who gave written informed consent, for 4-year periods following randomisation. The following new events were counted for all participants, including those with preexisting diseases (apart from diabetes, for which existing cases were excluded): nonfatal cardiovascular, total cardiovascular (including fatal), incident diabetes, depression, fractures, and falls. Intervention effects on time to first event post-randomisation were modelled using Cox regression for all outcomes, except for falls, which used negative binomial regression to allow for multiple events, adjusting for age, sex, and study. Absolute risk reductions (ARRs) and numbers needed to treat (NNTs) were estimated. Data were downloaded for 1,297 (98%) of 1,321 trial participants. Event rates were low (<20 per group) for outcomes, apart from fractures and falls. Cox hazard ratios for time to first event post-randomisation for interventions versus controls were nonfatal cardiovascular 0.24 (95% confidence interval [CI] 0.07-0.77, p = 0.02), total cardiovascular 0.34 (95% CI 0.12-0.91, p = 0.03), diabetes 0.75 (95% CI 0.42-1.36, p = 0.34), depression 0.98 (95% CI 0.46-2.07, p = 0.96), and fractures 0.56 (95% CI 0.35-0.90, p = 0.02). Negative binomial incident rate ratio for falls was 1.07 (95% CI 0.78-1.46, p = 0.67). ARR and NNT for cardiovascular events were nonfatal 1.7% (95% CI 0.5%-2.1%), NNT = 59 (95% CI 48-194); total 1.6% (95% CI 0.2%-2.2%), NNT = 61 (95% CI 46-472); and for fractures 3.6% (95% CI 0.8%-5.4%), NNT = 28 (95% CI 19-125). Main limitations were that event rates were low and only events recorded in primary care records were counted; however, any underrecording would not have differed by intervention status and so should not have led to bias. CONCLUSIONS Routine primary care data used to assess long-term trial outcomes demonstrated significantly fewer new cardiovascular events and fractures in intervention participants at 4 years. No statistically significant differences between intervention and control groups were demonstrated for other events. Short-term primary care pedometer-based walking interventions can produce long-term health benefits and should be more widely used to help address the public health inactivity challenge. TRIAL REGISTRATIONS PACE-UP isrctn.com ISRCTN98538934; PACE-Lift isrctn.com ISRCTN42122561.
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Affiliation(s)
- Tess Harris
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Elizabeth S. Limb
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Fay Hosking
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Iain Carey
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Steve DeWilde
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Cheryl Furness
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Charlotte Wahlich
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Shaleen Ahmad
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary’s University of London, London, United Kingdom
| | - Peter Whincup
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
| | - Christina Victor
- Gerontology and Health Services Research Unit, Brunel University, London, United Kingdom
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
- Institute for Social Marketing and Public Health, University of Stirling, Stirling, Scotland, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Ulf Ekelund
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Julia Fox-Rushby
- Department of Population Science, King’s College London, London, United Kingdom
| | - Judith Ibison
- Institute of Medical and Biomedical Education, St George’s University of London, Tooting, London, United Kingdom
| | - Derek G. Cook
- Population Health Research Institute, St George’s University of London, Tooting, London, United Kingdom
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