Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care.

Lucy Yardley,Lisa J Ware,Chris D Byrne,Katherine J Bradbury,Mike Ej Lean,Richard Fd Hobbs,Janet L Peacock,Mark A Mullee,Sarah Williams,Emily R Smith,Paul Little,Emily J Arden-Close,Michael V Moore,Barrie M Margetts

doi:10.1186/1479-5868-11-67

Abstract

BackgroundThere is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial.MethodsThis was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures.ResultsAll randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients.ConclusionsThis study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context.Trial registrationCurrent Controlled Trials ISRCTN31685626.

Highlights

There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity
Given the high levels of morbidity associated with obesity, there is a demand for health professionals in primary care to provide weight management interventions for their obese patients
As this was a feasibility trial to inform the design of a subsequent full trial, our target sample size was around 50 patients per group, which would allow us to estimate: the likely relationship between level of nurse support and change outcome; the variability and the variability of change in outcomes in this population; and any further issues of feasibility or acceptability of the intervention and/or trial procedures

Summary

Introduction

There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial. Given the high levels of morbidity associated with obesity, there is a demand for health professionals in primary care to provide weight management interventions for their obese patients. Automated web-based programmes to support weight management might offer a potential solution [5,6]. Given the high cost of intensive, personal support, it is vital to try to determine the optimal combination of web-based and personal support [7]

Methods

Results

Conclusion