Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
La Trobe University, Melbourne, Australia.
Int J Nurs Stud. 2023 Oct;146:104570. doi: 10.1016/j.ijnurstu.2023.104570. Epub 2023 Jul 31.
To investigate the efficacy of the Thai Health Improvement Profile intervention for preventing clinically significant weight gain in people with early stage psychosis.
We undertook a randomised controlled trial from 10/2018 to 05/2021. Participants with early stage psychosis (<5 year duration) were recruited using convenience sampling from the caseloads of community psychiatric nurses in Thailand and randomly allocated to either the Thai Health Improvement Profile intervention or treatment as usual group following baseline assessment. Outcome assessors were blind to group allocation, whereas participants were not. Participants in the intervention group received three monthly (five in total) systematic health checks using the Thai Health Improvement Profile tool, which was used to develop a personal health plan in collaboration with a family member/carer. Nurses supported participants to implement the health plan using behaviour change techniques derived from motivational interviewing. The treatment as usual group consisted of medication and psychosocial support, and no additional intervention was provided. The primary outcome was weight gain (defined as a greater or equal to 7 % increase in weight against baseline) within 1 year.
Fifty-three participants were allocated to the intervention and an equal number to the treatment as usual group. Primary outcome data were available for 30 participants in each group at the 12 month follow-up. We undertook an intention to treat analysis with multiple imputation (to handle the missing data) for the primary outcome. The treatment as usual group was found to have higher odds than the Thai Health Improvement Profile intervention group of gaining ≥7 % of baseline body weight (OR = 6.52; 95 % CI: 1.88-22.65, p = 0.004).
The Thai Health Improvement Profile intervention was effective at preventing weight gain in people with early stage psychosis at one year, though attrition was relatively high. The results highlight the need for community mental health nurses to adopt a holistic approach, the potential benefits of conducting regular comprehensive health checks and the importance of involving family members when aiming to improve the physical health of people diagnosed with early stage psychosis. A large definitive multi-site randomised controlled trial of the Thai Health Improvement Profile with a longer follow-up is now justified.
Prospectively registered with the Thai Clinical Trials Registry (reference: TCTR20180305002).
研究泰国健康改善概况干预措施在预防早期精神病患者体重显著增加方面的效果。
我们于 2018 年 10 月至 2021 年 5 月进行了一项随机对照试验。通过便利抽样从泰国社区精神科护士的患者中招募了早期精神病患者（<5 年病程），并在基线评估后将他们随机分配到泰国健康改善概况干预组或常规治疗组。结局评估者对分组情况不知情，而参与者知情。干预组的参与者接受了三次（共五次）使用泰国健康改善概况工具的月度（每月一次）系统健康检查，该工具用于与家庭成员/照顾者合作制定个人健康计划。护士使用源自动机访谈的行为改变技术支持参与者实施健康计划。常规治疗组包括药物治疗和心理社会支持，不提供其他干预措施。主要结局是在 1 年内体重增加（定义为与基线相比体重增加≥7%）。
53 名参与者被分配到干预组，另有 53 名参与者被分配到常规治疗组。在 12 个月的随访中，每组有 30 名参与者提供了主要结局数据。我们进行了意向治疗分析，并采用多重插补（处理缺失数据）进行了主要结局分析。常规治疗组体重增加≥7%基线体重的可能性高于泰国健康改善概况干预组（OR=6.52；95%CI：1.88-22.65，p=0.004）。
泰国健康改善概况干预在预防早期精神病患者体重增加方面在一年内是有效的，尽管失访率相对较高。结果强调了社区精神科护士需要采取整体方法的必要性，定期进行全面健康检查的潜在益处，以及在努力改善早期诊断为精神病患者的身体健康时，让家庭成员参与的重要性。现在有理由进行一项更大规模、更具确定性、多地点的泰国健康改善概况随机对照试验，且随访时间更长。
前瞻性注册于泰国临床试验注册中心（注册号：TCTR20180305002）。
