Efficacy of Standard Versus Enhanced Features in a Web-Based Commercial Weight-Loss Program for Obese Adults,Part 2: Randomized Controlled Trial

Background

Commercial Web-based weight-loss programs are becoming more popular and increasingly refined through the addition of enhanced features, yet few randomized controlled trials (RCTs) have independently and rigorously evaluated the efficacy of these commercial programs or additional features.

Objective

To determine whether overweight and obese adults randomized to an online weight-loss program with additional support features (enhanced) experienced a greater reduction in body mass index (BMI) and increased usage of program features after 12 and 24 weeks compared to those randomized to a standard online version (basic).

Methods

An assessor-blinded RCT comparing 301 adults (male: n=125, 41.5%; mean age: 41.9 years, SD 10.2; mean BMI: 32.2 kg/m², SD 3.9) who were recruited and enrolled offline, and randomly allocated to basic or enhanced versions of a commercially available Web-based weight-loss program for 24 weeks.

Results

Retention at 24 weeks was greater in the enhanced group versus the basic group (basic 68.5%, enhanced 81.0%; P=.01). In the intention-to-treat analysis of covariance with imputation using last observation carried forward, after 24 weeks both intervention groups had reductions in key outcomes with no difference between groups: BMI (basic mean –1.1 kg/m², SD 1.5; enhanced mean –1.3 kg/m², SD 2.0; P=.29), weight (basic mean –3.3 kg, SD 4.7; enhanced mean –4.0 kg, SD 6.2; P=.27), waist circumference (basic mean –3.1 cm, SD 4.6; enhanced mean –4.0 cm, SD 6.2; P=.15), and waist-to-height ratio (basic mean –0.02, SD 0.03; enhanced mean –0.02, SD 0.04, P=.21). The enhanced group logged in more often at both 12 and 24 weeks, respectively (enhanced 12-week mean 34.1, SD 28.1 and 24-week mean 43.1, SD 34.0 vs basic 12-week mean 24.6, SD 25.5 and 24-week mean 31.8, SD 33.9; P=.002).

Conclusions

The addition of personalized e-feedback in the enhanced program provided limited additional benefits compared to a standard commercial Web-based weight-loss program. However, it does support greater retention in the program and greater usage, which was related to weight loss. Further research is required to develop and examine Web-based features that may enhance engagement and outcomes and identify optimal usage patterns to enhance weight loss using Web-based programs.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR) trial number: ACTRN12610000197033; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/6HoOMGb8j).     

Home monitoring for heart failure management

With a prevalence of 5.8 million in the United States alone, heart failure (HF) is a common syndrome associated with substantial morbidity, mortality, and healthcare expenditures. Close to 1 million HF hospitalizations occur annually in the United States, with the majority of these resulting from worsening congestion in patients previously diagnosed with HF. An estimated $37.2 billion is spent each year on HF in the United States. These statistics emphasize the need to develop and implement more effective strategies to assess, monitor, and treat HF. It has also become increasingly apparent that interventions geared toward identifying and monitoring subclinical congestion would be of value in the home management of chronic HF. Earlier identification and treatment of congestion together with improved care coordination, management of comorbid conditions, and enhanced patient self-management may help to prevent hospitalizations in patients with chronic HF. Such home monitoring extends from the promotion of self-care and home visitations to telemedicine and remote monitoring of external or implantable devices. This paper discusses the challenges in monitoring patients with HF, reviews clinical trials testing different monitoring strategies in HF, and highlights ongoing investigations into the optimal approaches to home monitoring for HF.     

远程医疗系统建设中的组网设计

结合多年远程医疗系统建设和使用的经验,从远程医疗活动实际需要入手,根据远程医疗过程中数据传输、视音频交互等应用的通信要求,结合不同通信方式的特点,提供了几种远程医疗系统组网方案,供远程医疗系统建设和使用者参考。     

克拉玛依市M-1-N远程医学架构模式的构建

对国内众多远程医学平台进行分析研究后,结合新疆克拉玛依地理位置特点,需要建设一种开放架构模式的远程医学平台系统,让国内众多M家知名医院和N家医疗资源欠发达地区医院加入到平台中,形成一个M-1-N覆盖区域较广的远程医学网络,使接入平台中的知名医院可接受任何一家或多家医院开展远程医学业务,实现国内优质医疗资源共享,解决国内医疗资源分布不均衡这一现实问题,真正意义上解决看病难问题.     

基于B/5架构的远程医学电子病历浏览器设计

为克服传统远程会诊资料上传及会诊模式,采取远程B/S架构浏览器模式,远程专家无论何时何地登录远程医学平台,都可以便捷地浏览患者资料,及时做出诊断和治疗方案.目的是设计一种兼容性好、成本低廉的远程医学病历浏览器,改变传统的上传模式,简化会诊方配备繁多的会诊设备,实现快速便捷会诊.     

远程医疗在老干部保健工作中的应用与设计

随着网络通信技术的飞速发展,远程医疗服务在各个医院得到越来越多的应用。目的：为了提升老干部的医疗保健服务水平,解决老干部传统就医方法的不便,医院运行了远程医疗系统。方法：采用B/S架构设计,利用最先进的h264编码技术和rtmp流媒体传输协议,使用中间件技术将软件和硬件视频会议设备相结合,搭建一个整合各个医疗信息的管理平台。结果：系统为更多行动不便、长期卧床老干部的日常诊疗和医疗保健实现了“家中诊疗、实时监控、即时指导、保健咨询”。结论：远程医疗系统可为行动不便的老干部带来更加便捷的医疗保健服务。     

苏州市区域影像平台成效分析与评价

苏州市区域影像工程是苏州市区域卫生信息化的重点工程,介绍了苏州远程医疗影像的平台建设情况,通过对平台运行数据的分析,探讨其运行效果,总结和评价建设成果,指出建设过程中遇到的难点,并展望未来。     

武警部队远程医学网络平台的拓展与实现

依托武警部队己建成的广域网,构建远程医学网络平台,将武警部队远程医学网延伸到基层中队,重点对设计与实施过程中的网络架构、技术特点等问题进行了阐述。     

Analyzing the ingredients of a telephone counseling intervention for traumatic brain injury

Abstract

Purpose: To develop reliable coding for five treatment ingredients hypothesized to be “active” in a scheduled telephone intervention (STI) for traumatic brain injury (TBI); to examine factors associated with delivery of ingredients over the first year post-injury. Method: Operational definitions of directive and non-directive action planning; TBI education; reinforcement; and reframing, were refined until kappa >0.80 across multiple coders. Codes were assigned for presence/absence of ingredients in 253 recorded calls delivered to 49 participants in a randomized controlled trial on effects of STI versus usual care. Using multivariate analyses, we tested hypotheses about effects of TBI severity, time and other factors on delivery of ingredients. Results: Longitudinal analyses revealed that TBI education decreased over time, as expected. Non-directive action planning increased over time, according to hypotheses; unexpectedly, directive action planning did not concurrently decline. Reinforcement and reframing both increased over time, with reframing also increasing with TBI severity. Therapist differences were pronounced, despite extensive supervision designed to promote uniform treatment delivery. Conclusions: Reliable operational definitions of therapist behavior for each ingredient were achieved, but at the sacrifice of sensitivity in the coding scheme. Behavioral operational definitions of ingredients may be useful for treatment specification, for therapist training and supervision, and for testing hypotheses about the strength of specific components within the “black box” of rehabilitation.

• Implications for Rehabilitation

• Operationally defining active ingredients of rehabilitation can allow measurement of adherence to specified treatment protocols, and can facilitate the study of the relationship between delivery of specific ingredients and resulting outcomes.

• In this study, there were strong differences in delivery of ingredients by different clinicians despite frequent joint supervision and a shared treatment philosophy. Defining active ingredients in advance may help focus training and supervision on specific clinician behaviors that convey key ingredients of treatment.

• Complex treatments such as counseling, where the therapist’s behavior is partly determined by the client’s behavior and vice versa, are particularly challenging to define operationally since the opportunity to deliver certain ingredients varies with the problems the client presents and the way they are presented.