School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
Centre for Research On Exercise, Physical Activity and Health, The University of Queensland, Brisbane, Australia.
BMC Health Serv Res. 2024 Aug 15;24(1):935. doi: 10.1186/s12913-024-11383-4.
Diet and exercise are important components of treatment for complex chronic conditions, however access to allied health support is limited. When available, support is often siloed and fragmented. Digital health incorporating patient choice may help to align health care services with preferences and goals. This study evaluated the implementation of a ubiquitously accessible patient-centred digital health diet and exercise service.
U-DECIDE was a single-centre, 26-week randomised controlled trial set in kidney and liver disease clinics in a tertiary hospital in Brisbane, Australia. Participants were adults with a complex chronic condition referred for dietetic consultation with at least one feature of the metabolic syndrome. All participants received a dietary consultation, an activity monitor and usual care. Intervention participants were offered one text message per week and access to additional digital health options (increased text message frequency, nutrition app, exercise app, group-based diet and/or exercise video consultations). The primary outcome of feasibility was determined by safety (study-related serious adverse events: SRSAEs), recruitment (≥ 50% eligible patients), retention (≥ 70%), exposure uptake (≥ 75% of intervention group had greater access to health professional contact than comparator) and video consultation adherence (≥ 80% attendance). Secondary outcomes included process evaluation metrics and clinical outcomes.
Of 67 participants (intervention n = 33, comparator n = 34), 37 (55%) were men, median (IQR) age was 51 (41-58) years. The most chosen digital health options were the nutrition app (n = 29, 88%) and exercise video consultations (n = 26, 79%). Only one participant chose no additional digital health options. The intervention group had no SRSAEs. The study exceeded targets for recruitment (52%), retention (81%) and exposure uptake (94%). Video consultation adherence was 42%. Engagement across digital health options was inconsistent.
Digital health options incorporating patient choice were feasible and can be offered to people with complex chronic disease as a service model option.
Australia and New Zealand Trials Register: Trial Registration Number: ACTRN12620001282976. Registered 27th November 2020.
饮食和运动是治疗复杂慢性疾病的重要组成部分，然而获得联合健康支持的机会有限。在有支持的情况下，支持往往是孤立和分散的。纳入患者选择的数字健康可能有助于使医疗服务与偏好和目标保持一致。本研究评估了普遍可及的以患者为中心的数字健康饮食和运动服务的实施情况。
U-DECIDE 是一项单中心、26 周的随机对照试验，在澳大利亚布里斯班的一家三级医院的肾脏和肝脏疾病诊所进行。参与者为患有复杂慢性疾病并接受饮食咨询的成年人，至少有代谢综合征的一个特征。所有参与者均接受饮食咨询、活动监测和常规护理。干预组参与者每周接受一条短信，并可获得额外的数字健康选择（增加短信频率、营养应用程序、运动应用程序、基于小组的饮食和/或运动视频咨询）。可行性的主要结果是通过安全性（与研究相关的严重不良事件：SRSAEs）、招募（≥50%符合条件的患者）、保留（≥70%）、暴露率（干预组≥75%的人比对照组有更多的机会与卫生专业人员联系）和视频咨询依从性（≥80%的出勤率）来确定。次要结果包括过程评估指标和临床结果。
在 67 名参与者中（干预组 n=33，对照组 n=34），37 名（55%）为男性，中位（IQR）年龄为 51（41-58）岁。最受欢迎的数字健康选择是营养应用程序（n=29，88%）和运动视频咨询（n=26，79%）。只有一名参与者选择不使用任何其他数字健康选择。干预组无严重不良事件。该研究超过了招募（52%）、保留（81%）和暴露率（94%）的目标。视频咨询的依从性为 42%。对数字健康选择的参与程度不一致。
纳入患者选择的数字健康选项是可行的，可以作为一种服务模式选择提供给患有复杂慢性疾病的患者。
澳大利亚和新西兰临床试验注册处：临床试验注册编号：ACTRN12620001282976。注册于 2020 年 11 月 27 日。
