School of Medicine and Public Health, The University of Newcastle, Newcastle NSW, 1 University Drive, Callaghan, NSW, 2308, Australia.
Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.
Int J Behav Nutr Phys Act. 2022 Aug 20;19(1):106. doi: 10.1186/s12966-022-01345-6.
To maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an effective strategy (PACE) to assist schools' implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was "as good as" the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers.
A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers' scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at - 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD).
The posterior estimate for the between group difference at follow-up was - 2.3 minutes (95% credible interval = - 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of - 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school.
It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.
Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).
为了最大限度地发挥其潜在的健康益处，需要大规模实施基于学校的身体活动政策。本文描述了旨在优化一种有效策略（PACE）以协助学校实施身体活动政策的一系列试验中的第三项研究。具体而言，其目的是确定经改编以减少面对面接触的多策略干预措施（适应性 PACE）在增加课堂教师实施的结构化身体活动的每周分钟数方面与原始干预措施（PACE）“一样好”的可能性。
在澳大利亚新南威尔士州的 48 所小学中进行了非劣效性聚类随机对照试验。学校被随机分配接受 PACE 或对交付模式进行改编的模型（适应性 PACE）。基线（2018 年 10 月至 2019 年 2 月）和 12 个月随访（2019 年 10 月至 12 月）评估教师每周计划的身体活动分钟数。根据先前的数据和决策小组的共识，非劣性边界设定为-16.4 分钟。使用贝叶斯框架内的线性混合模型分析来探索两种 PACE 模型之间的非劣效性。从卫生服务提供者的角度进行成本最小化分析，使用澳元（AUD）。
随访时组间差异的后验估计为-2.3 分钟（95%可信区间=-18.02，14.45 分钟）。适应性 PACE 被认为具有非劣效性的可能性估计为 96%（只有 4%的后验样本越过了-16.4 分钟的非劣效性边界）。也就是说，适应性 PACE 学校的教师实施的身体活动分钟数与 PACE 学校的教师实施的身体活动分钟数没有明显差异。PACE 的平均总成本为 25375 澳元（95%不确定性区间=21499 澳元，29106 澳元），适应性 PACE 的平均总成本为 16421 澳元（95%不确定性区间=13974 澳元，19656 澳元）；每所学校估计减少 373 澳元（95%不确定性区间=173 澳元，560 澳元）。
适应性 PACE 极有可能不劣于原始模型。它是一种具有成本效益的替代方案，也可能更适合支持学校身体活动政策的大规模实施。
澳大利亚和新西兰临床试验注册中心（ACTRN12619001229167）进行了回顾性注册。
