一项基于任务的体重管理小组计划的随机对照试验与经济学评估
Randomised controlled trial and economic evaluation of a task-based weight management group programme.
作者信息
McRobbie Hayden, Hajek Peter, Peerbux Sarrah, Kahan Brennan C, Eldridge Sandra, Trépel Dominic, Parrott Steve, Griffiths Chris, Snuggs Sarah, Smith Katie Myers
机构信息
Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Health and Lifestyle Research Unit, 2 Stayner's Road, London, E1 4AH, UK.
Pragmatic Clinical Trials Unit, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
出版信息
BMC Public Health. 2019 Apr 2;19(1):365. doi: 10.1186/s12889-019-6679-3.
BACKGROUND
Obesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groups are needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI).
METHODS
In this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N = 221) delivered over eight weekly group sessions or PNI (N = 109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12 months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP.
RESULTS
Participants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (- 4·2 kg vs. - 2·3 kg; difference = - 1·9 kg, 95% CI: -3·7 to - 0·1; P = 0·04) and was more likely to generate a weight loss of at least 5% at 12 months (41% vs. 27%, OR = 14·61 95% CI: 2·32 to 91·96, P = 0·004). With an incremental cost-effectiveness ratio (ICER) of £7742/QALY, WAP would be considered highly cost effective compared to PNI.
CONCLUSIONS
The task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities.
TRIAL REGISTRATION
ISRCTN ISRCTN45820471 . Registered 12/10/2012 (retrospectively registered).
背景
肥胖是全球日益严重的健康威胁，也是导致健康不平等的主要因素。需要有有效、经济且能惠及弱势群体的体重管理项目。我们研究了一种为满足弱势社区客户需求而设计的多模式团体干预措施（体重行动计划；WAP）是否比由执业护士提供的初级保健标准体重管理干预措施（PNI）具有更好的一年期效果。
方法
在这项随机对照试验中，从伦敦的全科诊所招募了330名肥胖成年人，并将其（按2:1）分配到WAP组（N = 221），该组通过八次每周一次的团体课程进行干预，或PNI组（N = 109），该组在八周内接受四次课程。两种干预措施都涵盖饮食、体育活动和自我监测。主要结局是12个月时体重相对于基线的变化。为了表明对英国国家医疗服务体系（NHS）的价值，进行了成本效益分析，估计了与WAP相关的成本和质量调整生命年（QALY）的组间差异。
结果
参与者于2012年9月至2014年1月招募，随访于2015年2月完成。大多数参与者没有带薪工作，60%来自少数民族。每个研究组中88%的参与者至少提供了一项记录的结局，并被纳入主要分析。与PNI相比，WAP总体上体重减轻更多（-4.2千克对-2.3千克；差异=-1.9千克，95%置信区间：-3.7至-0.1；P = 0.04），并且在12个月时更有可能实现至少5%的体重减轻（41%对27%，OR = 14.61，95%置信区间：2.32至91.96，P = 0.004）。WAP的增量成本效益比（ICER）为每QALY 7742英镑，与PNI相比，将被认为具有很高的成本效益。
结论
本研究中评估的基于任务的项目可为一种有效且经济的体重管理方法提供模板，该方法能够惠及弱势社区的客户。
试验注册
ISRCTN ISRCTN45820471。于2012年10月12日注册（追溯注册）。
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