Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction).
<h4>Background</h4> <p>Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.</p> <h4>Objectives</h4> <p>To estimate the clinical effectiveness and cost-eff...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
National Institute for Health Research
2017
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| _version_ | 1797058174183800832 |
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| author | Little, P Stuart, B Hobbs, F Kelly, J Smith, E Bradbury, K Hughes, S Smith, P Moore, M Lean, M Margetts, B Byrne, C Griffin, S Davoudianfar, M Hooper, J Yao, G Zhu, S Raftery, J Yardley, L |
| author_facet | Little, P Stuart, B Hobbs, F Kelly, J Smith, E Bradbury, K Hughes, S Smith, P Moore, M Lean, M Margetts, B Byrne, C Griffin, S Davoudianfar, M Hooper, J Yao, G Zhu, S Raftery, J Yardley, L |
| author_sort | Little, P |
| collection | OXFORD |
| description | <h4>Background</h4> <p>Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.</p> <h4>Objectives</h4> <p>To 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> <h4>Design</h4> <p>Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.</p> <h4>Setting</h4> <p>Primary care general practices in the UK.</p> <h4>Participants</h4> <p>Patients with a body mass index of ≥ 30 kg/m2 (or ≥ 28 kg/m2 with risk factors) identified from general practice records, recruited by postal invitation</p> <h4>Interventions</h4> <p>Positive 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> <h4>Main outcome measures </h4> <p>The 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> <h4>Results</h4> <p>A 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> <h4>Study limitations</h4> <p>Maintenance of weight loss after 1 year is unknown.</p> <h4>Future work:</h4> <p>Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity.</p> <h4>Conclusion</h4> <p>Clinically 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> |
| first_indexed | 2024-03-06T19:46:50Z |
| format | Journal article |
| id | oxford-uuid:229651b8-adeb-43a6-ace1-ab4bbffe5c7e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:46:50Z |
| publishDate | 2017 |
| publisher | National Institute for Health Research |
| record_format | dspace |
| spelling | oxford-uuid:229651b8-adeb-43a6-ace1-ab4bbffe5c7e2022-03-26T11:39:38ZRandomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction).Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:229651b8-adeb-43a6-ace1-ab4bbffe5c7eEnglishSymplectic Elements at OxfordNational Institute for Health Research2017Little, PStuart, BHobbs, FKelly, JSmith, EBradbury, KHughes, SSmith, PMoore, MLean, MMargetts, BByrne, CGriffin, SDavoudianfar, MHooper, JYao, GZhu, SRaftery, JYardley, L <h4>Background</h4> <p>Behavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.</p> <h4>Objectives</h4> <p>To 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> <h4>Design</h4> <p>Individually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.</p> <h4>Setting</h4> <p>Primary care general practices in the UK.</p> <h4>Participants</h4> <p>Patients with a body mass index of ≥ 30 kg/m2 (or ≥ 28 kg/m2 with risk factors) identified from general practice records, recruited by postal invitation</p> <h4>Interventions</h4> <p>Positive 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> <h4>Main outcome measures </h4> <p>The 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> <h4>Results</h4> <p>A 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> <h4>Study limitations</h4> <p>Maintenance of weight loss after 1 year is unknown.</p> <h4>Future work:</h4> <p>Identifying strategies for longer-term engagement, impact in community settings and increasing physical activity.</p> <h4>Conclusion</h4> <p>Clinically 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> |
| spellingShingle | Little, P Stuart, B Hobbs, F Kelly, J Smith, E Bradbury, K Hughes, S Smith, P Moore, M Lean, M Margetts, B Byrne, C Griffin, S Davoudianfar, M Hooper, J Yao, G Zhu, S Raftery, J Yardley, L Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). |
| title | Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). |
| title_full | Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). |
| title_fullStr | Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). |
| title_full_unstemmed | Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). |
| title_short | Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). |
| title_sort | randomised controlled trial and economic analysis of an internet based weight management programme power positive online weight reduction |
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