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An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial

An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial
An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial
Background: Intensive behavioural counselling is effective for obesity, but resource requirements severely limit widespread implementation in primary care. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention with brief practice nurse support.

Methods: POWeR+ is a 24 session web-based weight management intervention lasting 6 months. Adults with BMI>=30 (or >=28 with additional risk factors) were identified from UK GP records and sent postal invitations. Following online registration with POWeR+, patients were randomly allocated using computer generated random numbers by the website to either: 1) Control. An intervention which had previously demonstrated effectiveness: brief web-based information which minimised pressure to reduce foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing, or 2) POWeR+Face-to-face (POWeR+F) with face-to-face nurse-support (<=7 contacts/6 months), or 3) POWeR+Remote (POWeR+R) with remote nurse-support (<=5 emails or brief phone calls/6 months).

Findings: Weight loss averaged over 12 months (the primary outcome) was documented among 661/818 (81%) participants. Analysis was intention to treat analysis using multiple imputation for missing data. The control group lost nearly 3 Kg (baseline 104.4, 6 months 101.9, 12 months 101.7). Compared with the control group POWeR+F achieved additional weight reduction of 1.5kg averaged over 12 months (95% confidence intervals 0.6 to 2.4, p=0.001) and 1.3kg for POWeR+R (0.34 to 2.2, p=0.007). By 12 months 20.8% of the control group had maintained a clinically important 5% weight reduction, POWeR+F 29.2% (Risk ratio 1.56, 0.96 to 2.51, p=0.070), and POWeR+R 32.4% (1.82, 1.31 to 2.74 ,p=0.004). Health service costs of the intervention were low, and the incremental overall cost per kg weight lost compared to the control group was £0.32 (-53.42 to 232.26) for POWeR+F and -£33.51 (-73.38 to 317.68) for POWeR+R. The probability of being cost-effective at a threshold of £100/Kg lost was 79% and 92% respectively. No adverse events were reported.

Interpretation: Weight loss was maintained for some individuals by promoting novel written materials with occasional brief nurse follow-up. However, more can maintain clinically important and cost-effective weight reduction with a web-based behavioural programme and brief remote follow-up.

This work was funded by the Health Technology Assessment (HTA) Programme of the National Institute for Health Research (NIHR). ISRCTN21244703
2213-8587
821-828
Little, Paul
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Stuart, Beth
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Hobbs, Richard F.D.
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Kelly, Joanne
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Smith, Emily R.
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Bradbury, Katherine J.
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Hughes, Stephanie
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Smith, Peter W.F.
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Moore, Michael V.
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Lean, Mike E.J.
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Margetts, Barrie M.
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Byrne, Christopher D.
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Griffin, Simon
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Davoudianfar, Mina
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Hooper, Julie
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Yao, Guiqing
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Zhu, Shihua
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Raftery, James
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Yardley, Lucy
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Little, Paul
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Stuart, Beth
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Hobbs, Richard F.D.
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Kelly, Joanne
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Smith, Emily R.
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Bradbury, Katherine J.
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Hughes, Stephanie
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Smith, Peter W.F.
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Moore, Michael V.
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Lean, Mike E.J.
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Margetts, Barrie M.
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Byrne, Christopher D.
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Griffin, Simon
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Davoudianfar, Mina
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Hooper, Julie
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Yao, Guiqing
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Zhu, Shihua
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Raftery, James
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Yardley, Lucy
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Little, Paul, Stuart, Beth, Hobbs, Richard F.D., Kelly, Joanne, Smith, Emily R., Bradbury, Katherine J., Hughes, Stephanie, Smith, Peter W.F., Moore, Michael V., Lean, Mike E.J., Margetts, Barrie M., Byrne, Christopher D., Griffin, Simon, Davoudianfar, Mina, Hooper, Julie, Yao, Guiqing, Zhu, Shihua, Raftery, James and Yardley, Lucy (2016) An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial. The Lancet Diabetes & Endocrinology, 4 (10), 821-828. (doi:10.1016/S2213-8587(16)30099-7).

Record type: Article

Abstract

Background: Intensive behavioural counselling is effective for obesity, but resource requirements severely limit widespread implementation in primary care. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention with brief practice nurse support.

Methods: POWeR+ is a 24 session web-based weight management intervention lasting 6 months. Adults with BMI>=30 (or >=28 with additional risk factors) were identified from UK GP records and sent postal invitations. Following online registration with POWeR+, patients were randomly allocated using computer generated random numbers by the website to either: 1) Control. An intervention which had previously demonstrated effectiveness: brief web-based information which minimised pressure to reduce foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing, or 2) POWeR+Face-to-face (POWeR+F) with face-to-face nurse-support (<=7 contacts/6 months), or 3) POWeR+Remote (POWeR+R) with remote nurse-support (<=5 emails or brief phone calls/6 months).

Findings: Weight loss averaged over 12 months (the primary outcome) was documented among 661/818 (81%) participants. Analysis was intention to treat analysis using multiple imputation for missing data. The control group lost nearly 3 Kg (baseline 104.4, 6 months 101.9, 12 months 101.7). Compared with the control group POWeR+F achieved additional weight reduction of 1.5kg averaged over 12 months (95% confidence intervals 0.6 to 2.4, p=0.001) and 1.3kg for POWeR+R (0.34 to 2.2, p=0.007). By 12 months 20.8% of the control group had maintained a clinically important 5% weight reduction, POWeR+F 29.2% (Risk ratio 1.56, 0.96 to 2.51, p=0.070), and POWeR+R 32.4% (1.82, 1.31 to 2.74 ,p=0.004). Health service costs of the intervention were low, and the incremental overall cost per kg weight lost compared to the control group was £0.32 (-53.42 to 232.26) for POWeR+F and -£33.51 (-73.38 to 317.68) for POWeR+R. The probability of being cost-effective at a threshold of £100/Kg lost was 79% and 92% respectively. No adverse events were reported.

Interpretation: Weight loss was maintained for some individuals by promoting novel written materials with occasional brief nurse follow-up. However, more can maintain clinically important and cost-effective weight reduction with a web-based behavioural programme and brief remote follow-up.

This work was funded by the Health Technology Assessment (HTA) Programme of the National Institute for Health Research (NIHR). ISRCTN21244703

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Accepted/In Press date: 17 May 2016
e-pub ahead of print date: 26 July 2016
Published date: October 2016
Organisations: Statistical Sciences Research Institute, Primary Care & Population Sciences

Identifiers

Local EPrints ID: 394693
URI: https://eprints.soton.ac.uk/id/eprint/394693
ISSN: 2213-8587
PURE UUID: 5fbfd586-ca1c-46ff-9c2d-a0f6dda54f49
ORCID for Katherine J. Bradbury: ORCID iD orcid.org/0000-0001-5513-7571
ORCID for Peter W.F. Smith: ORCID iD orcid.org/0000-0003-4423-5410
ORCID for Michael V. Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Christopher D. Byrne: ORCID iD orcid.org/0000-0001-6322-7753
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 23 May 2016 13:10
Last modified: 20 Jul 2019 05:55

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Contributors

Author: Paul Little
Author: Beth Stuart
Author: Richard F.D. Hobbs
Author: Joanne Kelly
Author: Emily R. Smith
Author: Mike E.J. Lean
Author: Simon Griffin
Author: Mina Davoudianfar
Author: Julie Hooper
Author: Guiqing Yao
Author: Shihua Zhu
Author: James Raftery
Author: Lucy Yardley ORCID iD

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