User Engagement, Acceptability, and Clinical Markers in a Digital Health Program for Nonalcoholic Fatty Liver Disease: Prospective, Single-Arm Feasibility Study

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the world. Common comorbidities are central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome. Cardiovascular disease is the most common cause of death among people with NAFLD, and lifestyle changes can improve health outcomes.

OBJECTIVE

This study aims to explore the acceptability of a digital health program in terms of engagement, retention, and user satisfaction in addition to exploring changes in clinical outcomes, such as weight, cardiometabolic risk factors, and health-related quality of life.

METHODS

We conducted a prospective, open-label, single-arm, 12-week study including 38 individuals with either a BMI >30, metabolic syndrome, or type 2 diabetes mellitus and NAFLD screened by FibroScan. An NAFLD-specific digital health program focused on disease education, lowering carbohydrates in the diet, food logging, increasing activity level, reducing stress, and healthy lifestyle coaching was offered to participants. The coach provided weekly feedback on food logs and other in-app activities and opportunities for participants to ask questions. The coaching was active throughout the 12-week intervention period. The primary outcome was feasibility and acceptability of the 12-week program, assessed through patient engagement, retention, and satisfaction with the program. Secondary outcomes included changes in weight, liver fat, body composition, and other cardiometabolic clinical parameters at baseline and 12 weeks.

RESULTS

In total, 38 individuals were included in the study (median age 59.5, IQR 46.3-68.8 years; n=23, 61% female). Overall, 34 (89%) participants completed the program and 29 (76%) were active during the 12-week program period. The median satisfaction score was 6.3 (IQR 5.8-6.7) of 7. Mean weight loss was 3.5 (SD 3.7) kg (P<.001) or 3.2% (SD 3.4%), with a 2.2 (SD 2.7) kg reduction in fat mass (P<.001). Relative liver fat reduction was 19.4% (SD 23.9%). Systolic blood pressure was reduced by 6.0 (SD 13.5) mmHg (P=.009). The median reduction was 0.14 (IQR 0-0.47) mmol/L for triglyceride levels (P=.003), 3.2 (IQR 0.0-5.4) µU/ml for serum insulin (s-insulin) levels (P=.003), and 0.5 (IQR -0.7 to 3.8) mmol/mol for hemoglobin A1c (HbA1c) levels (P=.03). Participants who were highly engaged (ie, who used the app at least 5 days per week) had greater weight loss and liver fat reduction.

CONCLUSIONS

The 12-week-long digital health program was feasible for individuals with NAFLD, receiving high user engagement, retention, and satisfaction. Improved liver-specific and cardiometabolic health was observed, and more engaged participants showed greater improvements. This digital health program could provide a new tool to improve health outcomes in people with NAFLD.

TRIAL REGISTRATION

Clinicaltrials.gov NCT05426382; https://clinicaltrials.gov/study/NCT05426382.

Digital health program improves quality of life in rheumatoid arthritis: a retrospective analysis of real-world data

OBJECTIVES

Sidekick Health launched a 16-week digital support programme for people with rheumatoid arthritis in 2021. The objective of this retrospective analysis was to understand whether quality of life (QoL; sleep quality, energy and stress levels) improved for users engaged with the programme in a real-world setting.

METHODS

This analysis included 635 users who engaged with the programme after the first week, out of 1541 who enrolled. Users self-reported QoL up to four times per week on their phones. Survival bias was investigated by comparing pre-post QoL scores of the full analysis set (all users) and the complete case set (programme completers). Users were divided into highly-engaged and less-engaged groups based on the weekly average number of in-app activities by iterative K-means clustering. Mixed models for repeated measures were used to estimate changes in QoL for highly-versus less-engaged groups.

RESULTS

Both the full analysis set and the complete case set had significant pre-post improvements in energy and stress; this suggested that survival bias did not have a substantial effect on these real-world data. Both the highly- and less-engaged groups experienced significant longitudinal improvements in all QoL outcomes. Highly-engaged users achieved better scores in energy, stress, and sleep than less-engaged users. Moreover, a significant time-group interaction for sleep showed that highly-engaged users not only had better sleep scores, but also experienced larger improvements over time than less-engaged users.

CONCLUSIONS

These findings demonstrate that a 16-week digital support programme improves self-reported QoL measures, supporting the 2021 EULAR recommendations to incorporate digital healthcare into routine practice. Noteworthy is the study's relevance in the context of the increasing importance of patient empowerment in managing chronic diseases.