{"id":18878,"date":"2016-10-01T00:00:00","date_gmt":"2018-12-03T19:13:54","guid":{"rendered":"https:\/\/aprifel-pp.mentalworks.biz\/fr\/resume-scientifique\/an-internet-based-intervention-with-brief-nurse-support-to\/"},"modified":"2018-12-03T20:13:54","modified_gmt":"2018-12-03T19:13:54","slug":"an-internet-based-intervention-with-brief-nurse-support-to","status":"publish","type":"resume","link":"https:\/\/aprifel-pp.mentalworks.biz\/fr\/resume-scientifique\/an-internet-based-intervention-with-brief-nurse-support-to\/","title":{"rendered":"An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial."},"content":{"rendered":"<p style=\"text-align:justify\"><strong>BACKGROUND<\/strong><br \/>\nThe obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care.<\/p>\n<p style=\"text-align:justify\"><strong>METHODS<\/strong><br \/>\nWe did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg\/m(2) or more (or &ge;28 kg\/m(2) with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+-a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703.<\/p>\n<p style=\"text-align:justify\"><strong>FINDINGS<\/strong><br \/>\nBetween Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104&middot;38 kg [SD 21&middot;11; n=279], 6 months 101&middot;91 kg [19&middot;35; n=136], 12 months 101&middot;74 kg [19&middot;57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1&middot;5 kg (95% CI 0&middot;6-2&middot;4; p=0&middot;001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1&middot;3 kg (0&middot;34-2&middot;2; p=0&middot;007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1&middot;56, 0&middot;96-2&middot;51; p=0&middot;070) and 32% of patients in the POWeR+R group (1&middot;82, 1&middot;31-2&middot;74; p=0&middot;004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was &pound;18 (95% CI -129 to 195) for POWeR+F and -&pound;25 (-268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of &pound;100 per kg lost was 88% and 98%, respectively. No adverse events were reported.<\/p>\n<p style=\"text-align:justify\"><strong>INTERPRETATION<\/strong><br \/>\nWeight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year.<\/p>\n<p style=\"text-align:justify\"><strong>FUNDING<\/strong><br \/>\nHealth Technology Assessment Programme of the National Institute for Health Research.<\/p>\n","protected":false},"template":"","mots_cles":[],"class_list":["post-18878","resume","type-resume","status-publish","hentry"],"acf":{"adresse":"Primary Care and Population Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK. p.little@soton.ac.uk","annee":"2016","mois":"10","numero":"4:10","page":"821-8","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 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18:26:19","post_content":"","post_title":"Paul Little","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"paul-little","to_ping":"","pinged":"","post_modified":"2018-12-03 19:26:19","post_modified_gmt":"2018-12-03 18:26:19","post_content_filtered":"","post_parent":0,"guid":"https:\/\/aprifel-pp.mentalworks.biz\/fr\/auteur\/paul-little\/","menu_order":0,"post_type":"auteur_resume","post_mime_type":"","comment_count":"0","filter":"raw"},{"ID":15455,"post_author":"0","post_date":"2018-12-03 19:26:20","post_date_gmt":"2018-12-03 18:26:20","post_content":"","post_title":"Beth Stuart","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"beth-stuart","to_ping":"","pinged":"","post_modified":"2018-12-03 19:26:20","post_modified_gmt":"2018-12-03 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