Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT
dc.contributor.author | Taylor, Adrian | |
dc.contributor.author | Taylor, RS | |
dc.contributor.author | Ingram, Wendy | |
dc.contributor.author | Anokye, N | |
dc.contributor.author | Dean, S | |
dc.contributor.author | Jolly, K | |
dc.contributor.author | Mutrie, N | |
dc.contributor.author | Lambert, J | |
dc.contributor.author | Yardley, L | |
dc.contributor.author | Greaves, C | |
dc.contributor.author | King, J | |
dc.contributor.author | McAdam, C | |
dc.contributor.author | Steele, M | |
dc.contributor.author | Price, L | |
dc.contributor.author | Streeter, Adam | |
dc.contributor.author | Charles, N | |
dc.contributor.author | Terry, R | |
dc.contributor.author | Webb, D | |
dc.contributor.author | Campbell, J | |
dc.contributor.author | Hughes, L | |
dc.contributor.author | Ainsworth, B | |
dc.contributor.author | Jones, Ben | |
dc.contributor.author | Jane, B | |
dc.contributor.author | Erwin, J | |
dc.contributor.author | Little, P | |
dc.contributor.author | Woolf, A | |
dc.contributor.author | Cavanagh, C | |
dc.date.accessioned | 2020-11-27T11:18:10Z | |
dc.date.available | 2020-11-27T11:18:10Z | |
dc.date.issued | 2020-11 | |
dc.identifier.issn | 1366-5278 | |
dc.identifier.issn | 2046-4924 | |
dc.identifier.uri | http://hdl.handle.net/10026.1/16686 | |
dc.description.abstract |
<jats:sec id="abs1-1"> <jats:title>Background</jats:title> <jats:p>There is modest evidence that exercise referral schemes increase physical activity in inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of exercise referral schemes on long-term physical activity.</jats:p> </jats:sec> <jats:sec id="abs1-2"> <jats:title>Objectives</jats:title> <jats:p>To determine if adding the e-coachER intervention to exercise referral schemes is more clinically effective and cost-effective in increasing physical activity after 1 year than usual exercise referral schemes.</jats:p> </jats:sec> <jats:sec id="abs1-3"> <jats:title>Design</jats:title> <jats:p>A pragmatic, multicentre, two-arm randomised controlled trial, with a mixed-methods process evaluation and health economic analysis. Participants were allocated in a 1 : 1 ratio to either exercise referral schemes plus e-coachER (intervention) or exercise referral schemes alone (control).</jats:p> </jats:sec> <jats:sec id="abs1-4"> <jats:title>Setting</jats:title> <jats:p>Patients were referred to exercise referral schemes in Plymouth, Birmingham and Glasgow.</jats:p> </jats:sec> <jats:sec id="abs1-5"> <jats:title>Participants</jats:title> <jats:p>There were 450 participants aged 16–74 years, with a body mass index of 30–40 kg/m<jats:sup>2</jats:sup>, with hypertension, prediabetes, type 2 diabetes, lower limb osteoarthritis or a current/recent history of treatment for depression, who were also inactive, contactable via e-mail and internet users.</jats:p> </jats:sec> <jats:sec id="abs1-6"> <jats:title>Intervention</jats:title> <jats:p>e-coachER was designed to augment exercise referral schemes. Participants received a pedometer and fridge magnet with physical activity recording sheets, and a user guide to access the web-based support in the form of seven ‘steps to health’. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in the importance of physical activity, competence, autonomy in physical activity choices and relatedness. All participants were referred to a standard exercise referral scheme.</jats:p> </jats:sec> <jats:sec id="abs1-7"> <jats:title>Primary outcome measure</jats:title> <jats:p>Minutes of moderate and vigorous physical activity in ≥ 10-minute bouts measured by an accelerometer over 1 week at 12 months, worn ≥ 16 hours per day for ≥ 4 days including ≥ 1 weekend day.</jats:p> </jats:sec> <jats:sec id="abs1-8"> <jats:title>Secondary outcomes</jats:title> <jats:p>Other accelerometer-derived physical activity measures, self-reported physical activity, exercise referral scheme attendance and EuroQol-5 Dimensions, five-level version, and Hospital Anxiety and Depression Scale scores were collected at 4 and 12 months post randomisation.</jats:p> </jats:sec> <jats:sec id="abs1-9"> <jats:title>Results</jats:title> <jats:p>Participants had a mean body mass index of 32.6 (standard deviation) 4.4 kg/m<jats:sup>2</jats:sup>, were referred primarily for weight loss and were mostly confident self-rated information technology users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (<jats:italic>n</jats:italic> = 108) compared with the control group (<jats:italic>n</jats:italic> = 124); 11.8 weekly minutes of moderate and vigorous physical activity (95% confidence interval –2.1 to 26.0 minutes; <jats:italic>p</jats:italic> = 0.10). Sixty-four per cent of intervention participants logged on at least once; they gave generally positive feedback on the web-based support. The intervention had no effect on other physical activity outcomes, exercise referral scheme attendance (78% in the control group vs. 75% in the intervention group) or EuroQol-5 Dimensions, five-level version, or Hospital Anxiety and Depression Scale scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months, but not at 12 months. At 12 months, the intervention group incurred an additional mean cost of £439 (95% confidence interval –£182 to £1060) compared with the control group, but generated more quality-adjusted life-years (mean 0.026, 95% confidence interval 0.013 to 0.040), with an incremental cost-effectiveness ratio of an additional £16,885 per quality-adjusted life-year.</jats:p> </jats:sec> <jats:sec id="abs1-10"> <jats:title>Limitations</jats:title> <jats:p>A significant proportion (46%) of participants were not included in the primary analysis because of study withdrawal and insufficient device wear-time, so the results must be interpreted with caution. The regression model fit for the primary outcome was poor because of the considerable proportion of participants [142/243 (58%)] who recorded no instances of ≥ 10-minute bouts of moderate and vigorous physical activity at 12 months post randomisation.</jats:p> </jats:sec> <jats:sec id="abs1-11"> <jats:title>Future work</jats:title> <jats:p>The design and rigorous evaluation of cost-effective and scalable ways to increase exercise referral scheme uptake and maintenance of moderate and vigorous physical activity are needed among patients with chronic conditions.</jats:p> </jats:sec> <jats:sec id="abs1-12"> <jats:title>Conclusions</jats:title> <jats:p>Adding e-coachER to usual exercise referral schemes had only a weak indicative effect on long-term rigorously defined, objectively assessed moderate and vigorous physical activity. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000 per quality-adjusted life-year. The intervention did improve some process outcomes as specified in our logic model.</jats:p> </jats:sec> <jats:sec id="abs1-13"> <jats:title>Trial registration</jats:title> <jats:p>Current Controlled Trials ISRCTN15644451.</jats:p> </jats:sec> <jats:sec id="abs1-14"> <jats:title>Funding</jats:title> <jats:p>This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in <jats:italic>Health Technology Assessment</jats:italic>; Vol. 24, No. 63. See the NIHR Journals Library website for further project information.</jats:p> </jats:sec> | |
dc.format.extent | 1-106 | |
dc.format.medium | ||
dc.language | en | |
dc.language.iso | en | |
dc.publisher | National Institute for Health Research | |
dc.subject | ACCELEROMETER | |
dc.subject | COST-EFFECTIVENESS | |
dc.subject | DEPRESSION | |
dc.subject | DIABETES | |
dc.subject | E-HEALTH | |
dc.subject | EXERCISE | |
dc.subject | HYPERTENSION | |
dc.subject | OBESITY | |
dc.subject | OSTEOARTHRITIS | |
dc.subject | PRIMARY CARE | |
dc.subject | Accelerometry | |
dc.subject | Adolescent | |
dc.subject | Adult | |
dc.subject | Aged | |
dc.subject | Chronic Disease | |
dc.subject | Cost-Benefit Analysis | |
dc.subject | Exercise | |
dc.subject | Female | |
dc.subject | Humans | |
dc.subject | Male | |
dc.subject | Mental Health | |
dc.subject | Mentoring | |
dc.subject | Middle Aged | |
dc.subject | Quality of Life | |
dc.subject | Referral and Consultation | |
dc.subject | Sedentary Behavior | |
dc.subject | Self Report | |
dc.subject | Telemedicine | |
dc.subject | Time Factors | |
dc.subject | Weight Reduction Programs | |
dc.subject | Young Adult | |
dc.title | Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER RCT | |
dc.type | journal-article | |
dc.type | Journal Article | |
dc.type | Multicenter Study | |
dc.type | Randomized Controlled Trial | |
dc.type | Research Support, Non-U.S. Gov't | |
plymouth.author-url | https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000595488100001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008 | |
plymouth.issue | 63 | |
plymouth.volume | 24 | |
plymouth.publication-status | Published online | |
plymouth.journal | Health Technology Assessment | |
dc.identifier.doi | 10.3310/hta24630 | |
plymouth.organisational-group | /Plymouth | |
plymouth.organisational-group | /Plymouth/Faculty of Health | |
plymouth.organisational-group | /Plymouth/Faculty of Health/Peninsula Dental School | |
plymouth.organisational-group | /Plymouth/Faculty of Health/Peninsula Medical School | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA | |
plymouth.organisational-group | /Plymouth/REF 2021 Researchers by UoA/UoA03 Allied Health Professions, Dentistry, Nursing and Pharmacy | |
plymouth.organisational-group | /Plymouth/Research Groups | |
plymouth.organisational-group | /Plymouth/Research Groups/FoH - Community and Primary Care | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Health and Community | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED) | |
plymouth.organisational-group | /Plymouth/Research Groups/Institute of Translational and Stratified Medicine (ITSMED)/CCT&PS | |
plymouth.organisational-group | /Plymouth/Research Groups/Plymouth Institute of Health and Care Research (PIHR) | |
plymouth.organisational-group | /Plymouth/Users by role | |
plymouth.organisational-group | /Plymouth/Users by role/Academics | |
plymouth.organisational-group | /Plymouth/Users by role/Researchers in ResearchFish submission | |
dc.publisher.place | England | |
dcterms.dateAccepted | 2019-11-25 | |
dc.rights.embargodate | 2020-12-3 | |
dc.identifier.eissn | 2046-4924 | |
dc.rights.embargoperiod | Not known | |
rioxxterms.funder | National Institute for Health Research | |
rioxxterms.identifier.project | A multi-centred RCT of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculo-skeletal and mental health conditions. | |
rioxxterms.versionofrecord | 10.3310/hta24630 | |
rioxxterms.licenseref.uri | http://www.rioxx.net/licenses/all-rights-reserved | |
rioxxterms.licenseref.startdate | 2020-11 | |
rioxxterms.type | Journal Article/Review | |
plymouth.funder | A multi-centred RCT of an augmented exercise referral scheme using web-based behavioural support in individuals with metabolic, musculo-skeletal and mental health conditions.::National Institute for Health Research |