Lurbe I Puerto Katia, Bruzzi Matthieu, Rives-Lange Claire, Poghosyan Tigran, Bretault Marion, Chatellier Gilles, Vilfaillot Aurelie, Chevallier Jean-Marc, Czernichow Sebastien, Carette Claire
Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.
Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France.
JMIR Form Res. 2023 Mar 28;7:e26077. doi: 10.2196/26077.
Despite bariatric surgery showing significant weight loss trajectories for many patients, a substantial proportion regain weight after the first year following surgery. The addition of telemedicine to standard care could support patients with engaging in a more active lifestyle and thus improve clinical outcomes.
Our aim was to evaluate a telemedicine intervention program dedicated to the promotion of physical activity including digital devices, teleconsultation, and telemonitoring the first 6 months following bariatric surgery.
This study employed a mixed methods design based on an open-label randomized controlled trial. Patients were included during the first week after bariatric surgery; then, they were randomized into 2 intervention groups: The TelePhys group received a monthly telemedicine consultation focusing on physical activity coaching, while the TeleDiet group received a monthly telemedicine consultation involving diet coaching. Data were collected using a watch pedometer and body weight scale, both of which were connected wirelessly. The primary outcome was the difference between the 2 groups in the mean numbers of steps at the first and sixth postoperative months. Weight change was also evaluated, and focus groups and interviews were conducted to enrich the results and capture perceptions of the telemedicine provided.
Among the 90 patients (mean age 40.6, SD 10.4 years; 73/90, 81% women; 62/90, 69% gastric bypass), 70 completed the study until the sixth month (n=38 TelePhys; n=32 TeleDiet), and 18 participants agreed to be interviewed (n=8 Telephys; n=10 TeleDiet). An increase in the mean number of steps between the first and sixth months was found in both groups, but this change was significant only in the TeleDiet group (P=.01). No difference was found when comparing both intervention groups. Interviewed participants reported having appreciated the teleconsultations, as the individualized tailored counseling helped them to make better choices about behaviors that could increase their likelihood of a daily life in better health. Weight loss followed by social factors (such as social support) were identified as the main facilitators to physical activity. Family responsibilities, professional constraints as well as poor urban policies promoting physical activity, and lack of accessibility to sport infrastructure were their major barriers to postoperative lifestyle adherence.
Our study did not show any difference in mobility recovery after bariatric surgery related to a telemedicine intervention dedicated to physical activity. The early postoperative timing for our intervention may explain the null findings. eHealth interventions aiming to change behaviors and carried out by clinicians require support from structured public health policies that tackle patients' obesogenic environment in order to be efficient in their struggle against sedentary lifestyle-related pathologies. Further research will need to focus on long-term interventions.
ClinicalTrials.gov NCT02716480, https://clinicaltrials.gov/ct2/show/NCT02716480.
尽管减肥手术使许多患者的体重显著下降，但相当一部分患者在术后第一年体重会反弹。在标准护理中加入远程医疗可以帮助患者保持更积极的生活方式，从而改善临床结果。
我们旨在评估一个远程医疗干预项目，该项目致力于在减肥手术后的前6个月促进身体活动，包括使用数字设备、远程会诊和远程监测。
本研究采用基于开放标签随机对照试验的混合方法设计。患者在减肥手术后的第一周被纳入研究；然后，他们被随机分为2个干预组：远程物理组每月接受一次专注于身体活动指导的远程医疗会诊，而远程饮食组每月接受一次涉及饮食指导的远程医疗会诊。数据通过无线连接的手表计步器和体重秤收集。主要结局是两组术后第一个月和第六个月平均步数的差异。还评估了体重变化，并进行了焦点小组讨论和访谈，以丰富结果并了解对所提供远程医疗的看法。
在90例患者中（平均年龄40.6岁，标准差10.4岁；73/90，81%为女性；62/90，69%为胃旁路手术患者），70例完成了为期6个月的研究（远程物理组n = 38；远程饮食组n = 32），18名参与者同意接受访谈（远程物理组n = 8；远程饮食组n = 10）。两组在第一个月和第六个月之间的平均步数均有所增加，但这种变化仅在远程饮食组中显著（P = 0.01）。比较两个干预组时未发现差异。接受访谈的参与者表示赞赏远程会诊，因为个性化的定制咨询帮助他们在可能改善健康的日常生活行为方面做出更好的选择。体重减轻以及社会因素（如社会支持）被确定为身体活动的主要促进因素。家庭责任、职业限制以及促进身体活动的城市政策不完善和缺乏体育基础设施是他们术后坚持生活方式的主要障碍。
我们的研究未显示减肥手术后与致力于身体活动的远程医疗干预相关的活动恢复有任何差异。我们干预的术后早期时机可能解释了这一阴性结果。旨在改变行为并由临床医生实施的电子健康干预需要结构化公共卫生政策的支持，这些政策应对患者的致肥胖环境，以便在与久坐生活方式相关疾病的斗争中发挥有效作用。进一步的研究需要关注长期干预。
ClinicalTrials.gov NCT02716480，https://clinicaltrials.gov/ct2/show/NCT02716480
