{"id":15470,"date":"2017-01-01T00:00:00","date_gmt":"2018-12-03T18:26:35","guid":{"rendered":"https:\/\/aprifel-pp.mentalworks.biz\/fr\/resume-scientifique\/randomised-controlled-trial-and-economic-analysis-of-an-internet-based\/"},"modified":"2018-12-03T19:26:35","modified_gmt":"2018-12-03T18:26:35","slug":"randomised-controlled-trial-and-economic-analysis-of-an-internet-based","status":"publish","type":"resume","link":"https:\/\/aprifel-pp.mentalworks.biz\/fr\/resume-scientifique\/randomised-controlled-trial-and-economic-analysis-of-an-internet-based\/","title":{"rendered":"Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)."},"content":{"rendered":"

BACKGROUND<\/strong>
\nBehavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.<\/p>\n

OBJECTIVES<\/strong>
\nTo estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.<\/p>\n

DESIGN<\/strong>
\nIndividually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.<\/p>\n

SETTING<\/strong>
\nPrimary care general practices in the UK.<\/p>\n

PARTICIPANTS<\/strong>
\nPatients with a body mass index of ≥ 30 kg\/m(2) (or ≥ 28 kg\/m(2) with risk factors) identified from general practice records, recruited by postal invitation.<\/p>\n

INTERVENTIONS<\/strong>
\nPositive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).<\/p>\n

MAIN OUTCOME MEASURES<\/strong>
\nThe primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.<\/p>\n

RESULTS<\/strong>
\nA total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control, n = 227; POWeR+F, n = 221; POWeR+R, n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg; p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg; p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51; p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74; p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64\/136); POWeR+F, 37.2% (51\/137); POWeR+R, 26.7% (40\/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI -£129 to £195) for POWeR+F and -£25 (95% CI -£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.<\/p>\n

STUDY LIMITATIONS<\/strong>
\nMaintenance of weight loss after 1 year is unknown.<\/p>\n

FUTURE WORK<\/strong>
\nIdentifying strategies for longer-term engagement, impact in community settings and increasing physical activity.<\/p>\n

CONCLUSION<\/strong>
\nClinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.<\/p>\n

TRIAL REGISTRATION<\/strong>
\nCurrent Controlled Trials ISRCTN21244703.<\/p>\n

FUNDING<\/strong>
\nThis 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. 21, No. 4. See the NIHR Journals Library website for further project information.<\/p>\n","protected":false},"template":"","mots_cles":[],"class_list":["post-15470","resume","type-resume","status-publish","hentry"],"acf":{"adresse":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK.","annee":"2017","mois":"1","numero":"21:4","page":"1-62","auteurs":[{"ID":15453,"post_author":"0","post_date":"2018-12-03 19:26:18","post_date_gmt":"2018-12-03 18:26:18","post_content":"","post_title":"Barrie M Margetts","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"barrie-m-margetts","to_ping":"","pinged":"","post_modified":"2018-12-03 19:26:18","post_modified_gmt":"2018-12-03 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