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Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial

Research output: Contribution to journalArticle

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Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions : the e-coachER Randomised Controlled Trial. / Taylor, Adrian H; Taylor, Rod S.; Ingram, Wendy M; Anokye, Nana; Dean, Sarah G; Jolly, Kate; Mutrie, Nanette; Lambert, Jeffrey D; Yardley, Lucy; Greaves, Colin J; King, Jennie; McAdam, Chloe; Steele, Mary; Price, Lisa; Streeter, Adam; Charles, Nigel; Terry, Rohini ; Webb, Doug P S; Campbell, John; Hughes, Lucy; Ainsworth, Ben; Jane, Ben; Jones, Ben; Erwin, Josephine; Little, Paul; Woolf, Antony; Cavanagh, Chris.

In: Health Technology Assessment, 27.11.2019.

Research output: Contribution to journalArticle

Harvard

Taylor, AH, Taylor, RS, Ingram, WM, Anokye, N, Dean, SG, Jolly, K, Mutrie, N, Lambert, JD, Yardley, L, Greaves, CJ, King, J, McAdam, C, Steele, M, Price, L, Streeter, A, Charles, N, Terry, R, Webb, DPS, Campbell, J, Hughes, L, Ainsworth, B, Jane, B, Jones, B, Erwin, J, Little, P, Woolf, A & Cavanagh, C 2019, 'Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial', Health Technology Assessment.

APA

Taylor, A. H., Taylor, R. S., Ingram, W. M., Anokye, N., Dean, S. G., Jolly, K., ... Cavanagh, C. (Accepted/In press). Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial. Health Technology Assessment.

Vancouver

Taylor AH, Taylor RS, Ingram WM, Anokye N, Dean SG, Jolly K et al. Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial. Health Technology Assessment. 2019 Nov 27.

Author

Taylor, Adrian H ; Taylor, Rod S. ; Ingram, Wendy M ; Anokye, Nana ; Dean, Sarah G ; Jolly, Kate ; Mutrie, Nanette ; Lambert, Jeffrey D ; Yardley, Lucy ; Greaves, Colin J ; King, Jennie ; McAdam, Chloe ; Steele, Mary ; Price, Lisa ; Streeter, Adam ; Charles, Nigel ; Terry, Rohini ; Webb, Doug P S ; Campbell, John ; Hughes, Lucy ; Ainsworth, Ben ; Jane, Ben ; Jones, Ben ; Erwin, Josephine ; Little, Paul ; Woolf, Antony ; Cavanagh, Chris. / Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions : the e-coachER Randomised Controlled Trial. In: Health Technology Assessment. 2019.

Bibtex

@article{c6dbbf4f212a45a6be49716afd25be1f,
title = "Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions: the e-coachER Randomised Controlled Trial",
abstract = "Background: There is modest evidence that exercise referral schemes (ERS) increase physical activity (PA) of inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of ERS on long-term PA. Objectives: To determine if adding the e-coachER intervention to ERS is more effective and cost-effective in increasing PA after one year, compared to usual ERS. Design: Pragmatic, multicentre 2 arm randomised trial, with mixed methods process evaluation and health economic analysis. Participants were allocated 1:1 to either ERS plus e-coachER (intervention) or ERS alone (control). Setting: Patients referred to ERS in Plymouth, Birmingham and Glasgow. Participants: N = 450, aged 16-74 years, with BMI 30-40, hypertension, pre-diabetes, type 2 diabetes, lower limb osteoarthritis, or a current/recent history of treatment for depression; inactive; contactable via email; and an internet user. Intervention: e-coachER was designed to augment ERS. Participants received a pedometer and fridge magnet with PA recording sheets, and a User Guide to access the web-based support in the form of 7 Steps to Health. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in importance for doing PA, competence, autonomy in PA choices and relatedness. All participants were referred to a standard ERS programme. Primary outcome measure: Minutes of moderate and vigorous PA (MVPA) in ≥10 min bouts measured by accelerometer over one week at 12 months, worn ≥16 hours per day for ≥4 days including ≥1 weekend day. Secondary outcomes: Other accelerometer-derived PA measures, self-reported PA, ERS attendance, EQ-5D-5L and HADS were collected at 4 and 12 months.Results: Participants had a BMI mean (SD) of 32.6 (4.4), were primarily referred for weight loss, and were mostly confident self-rated IT users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (N=108) compared with the control group (N=124); 11.9 weekly minutes MVPA, 95{\%} CI -2.1 to 26.0; p = 0.10. 64{\%} of intervention participants logged on at least once with generally positive feedback on the web-based support. The intervention had no effect on other PA outcomes, ERS attendance (78{\%} v 75{\%} in control and intervention, respectively), EQ-5D-5L or HADS scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months but not at 12 months. At 12 months, compared to control, the intervention group incurred an additional mean cost of £439 (95{\%} CI £-182, £1060) but generated more mean quality adjusted life years (QALYs); (0.026, 95{\%} CI 0.013, 0.040) with an incremental cost effectiveness ratio of additional £16,885 per QALY. Limitations: A significant proportion (46{\%}) of participants were not included in the primary analysis, due to study withdrawal, and insufficient device wear time and the results must be interpreted with caution. The regression model fit for the primary outcome was poor, because of the considerable proportion of participants (142/243 (58{\%})) who recorded zero minutes of ≥10 minute bouted MVPA at 12 months. Future work:The design and rigorous evaluation of cost-effective and scalable ways to increase ERS uptake and maintenance of MVPA are needed among patients with chronic conditions.Conclusion: Adding e-coachER to usual ERS had only a weak indicative effect on long-term rigorously defined, objectively assessed MVPA. The provision of the e-coachER support package led to an additional cost and has a 63{\%} probability of being cost-effective based on the UK threshold of £30,000/QALY. The intervention did improve some process outcomes as specified in our Logic Model. Study registration: ISRCTN15644451Funding details: NIHR HTA 13/25/20",
keywords = "Accelerometer, behaviour change, body mass index, cost-benefit analysis, depression, Diabetes Mellitus, Type 2, e-health, exercise, Goal setting, adult, Humans, hypertension, Mediation, obesity, Osteoarthritis, Pedometer, primary health care, process evaluation, Qualitative, quality of life, quality-adjusted life years, self-determination theory, self-monitoring",
author = "Taylor, {Adrian H} and Taylor, {Rod S.} and Ingram, {Wendy M} and Nana Anokye and Dean, {Sarah G} and Kate Jolly and Nanette Mutrie and Lambert, {Jeffrey D} and Lucy Yardley and Greaves, {Colin J} and Jennie King and Chloe McAdam and Mary Steele and Lisa Price and Adam Streeter and Nigel Charles and Rohini Terry and Webb, {Doug P S} and John Campbell and Lucy Hughes and Ben Ainsworth and Ben Jane and Ben Jones and Josephine Erwin and Paul Little and Antony Woolf and Chris Cavanagh",
year = "2019",
month = "11",
day = "27",
language = "English",
journal = "Health Technology Assessment",
issn = "1366-5278",
publisher = "NIHR Journals Library",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Adding web-based behavioural support to exercise referral schemes for inactive adults with chronic health conditions

T2 - the e-coachER Randomised Controlled Trial

AU - Taylor, Adrian H

AU - Taylor, Rod S.

AU - Ingram, Wendy M

AU - Anokye, Nana

AU - Dean, Sarah G

AU - Jolly, Kate

AU - Mutrie, Nanette

AU - Lambert, Jeffrey D

AU - Yardley, Lucy

AU - Greaves, Colin J

AU - King, Jennie

AU - McAdam, Chloe

AU - Steele, Mary

AU - Price, Lisa

AU - Streeter, Adam

AU - Charles, Nigel

AU - Terry, Rohini

AU - Webb, Doug P S

AU - Campbell, John

AU - Hughes, Lucy

AU - Ainsworth, Ben

AU - Jane, Ben

AU - Jones, Ben

AU - Erwin, Josephine

AU - Little, Paul

AU - Woolf, Antony

AU - Cavanagh, Chris

PY - 2019/11/27

Y1 - 2019/11/27

N2 - Background: There is modest evidence that exercise referral schemes (ERS) increase physical activity (PA) of inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of ERS on long-term PA. Objectives: To determine if adding the e-coachER intervention to ERS is more effective and cost-effective in increasing PA after one year, compared to usual ERS. Design: Pragmatic, multicentre 2 arm randomised trial, with mixed methods process evaluation and health economic analysis. Participants were allocated 1:1 to either ERS plus e-coachER (intervention) or ERS alone (control). Setting: Patients referred to ERS in Plymouth, Birmingham and Glasgow. Participants: N = 450, aged 16-74 years, with BMI 30-40, hypertension, pre-diabetes, type 2 diabetes, lower limb osteoarthritis, or a current/recent history of treatment for depression; inactive; contactable via email; and an internet user. Intervention: e-coachER was designed to augment ERS. Participants received a pedometer and fridge magnet with PA recording sheets, and a User Guide to access the web-based support in the form of 7 Steps to Health. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in importance for doing PA, competence, autonomy in PA choices and relatedness. All participants were referred to a standard ERS programme. Primary outcome measure: Minutes of moderate and vigorous PA (MVPA) in ≥10 min bouts measured by accelerometer over one week at 12 months, worn ≥16 hours per day for ≥4 days including ≥1 weekend day. Secondary outcomes: Other accelerometer-derived PA measures, self-reported PA, ERS attendance, EQ-5D-5L and HADS were collected at 4 and 12 months.Results: Participants had a BMI mean (SD) of 32.6 (4.4), were primarily referred for weight loss, and were mostly confident self-rated IT users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (N=108) compared with the control group (N=124); 11.9 weekly minutes MVPA, 95% CI -2.1 to 26.0; p = 0.10. 64% of intervention participants logged on at least once with generally positive feedback on the web-based support. The intervention had no effect on other PA outcomes, ERS attendance (78% v 75% in control and intervention, respectively), EQ-5D-5L or HADS scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months but not at 12 months. At 12 months, compared to control, the intervention group incurred an additional mean cost of £439 (95% CI £-182, £1060) but generated more mean quality adjusted life years (QALYs); (0.026, 95% CI 0.013, 0.040) with an incremental cost effectiveness ratio of additional £16,885 per QALY. Limitations: A significant proportion (46%) of participants were not included in the primary analysis, due to study withdrawal, and insufficient device wear time and the results must be interpreted with caution. The regression model fit for the primary outcome was poor, because of the considerable proportion of participants (142/243 (58%)) who recorded zero minutes of ≥10 minute bouted MVPA at 12 months. Future work:The design and rigorous evaluation of cost-effective and scalable ways to increase ERS uptake and maintenance of MVPA are needed among patients with chronic conditions.Conclusion: Adding e-coachER to usual ERS had only a weak indicative effect on long-term rigorously defined, objectively assessed MVPA. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000/QALY. The intervention did improve some process outcomes as specified in our Logic Model. Study registration: ISRCTN15644451Funding details: NIHR HTA 13/25/20

AB - Background: There is modest evidence that exercise referral schemes (ERS) increase physical activity (PA) of inactive individuals with chronic health conditions. There is a need to identify additional ways to improve the effects of ERS on long-term PA. Objectives: To determine if adding the e-coachER intervention to ERS is more effective and cost-effective in increasing PA after one year, compared to usual ERS. Design: Pragmatic, multicentre 2 arm randomised trial, with mixed methods process evaluation and health economic analysis. Participants were allocated 1:1 to either ERS plus e-coachER (intervention) or ERS alone (control). Setting: Patients referred to ERS in Plymouth, Birmingham and Glasgow. Participants: N = 450, aged 16-74 years, with BMI 30-40, hypertension, pre-diabetes, type 2 diabetes, lower limb osteoarthritis, or a current/recent history of treatment for depression; inactive; contactable via email; and an internet user. Intervention: e-coachER was designed to augment ERS. Participants received a pedometer and fridge magnet with PA recording sheets, and a User Guide to access the web-based support in the form of 7 Steps to Health. e-coachER aimed to build the use of behavioural skills (e.g. self-monitoring) while strengthening favourable beliefs in importance for doing PA, competence, autonomy in PA choices and relatedness. All participants were referred to a standard ERS programme. Primary outcome measure: Minutes of moderate and vigorous PA (MVPA) in ≥10 min bouts measured by accelerometer over one week at 12 months, worn ≥16 hours per day for ≥4 days including ≥1 weekend day. Secondary outcomes: Other accelerometer-derived PA measures, self-reported PA, ERS attendance, EQ-5D-5L and HADS were collected at 4 and 12 months.Results: Participants had a BMI mean (SD) of 32.6 (4.4), were primarily referred for weight loss, and were mostly confident self-rated IT users. Primary outcome analysis involving those with usable data showed a weak indicative effect in favour of the intervention group (N=108) compared with the control group (N=124); 11.9 weekly minutes MVPA, 95% CI -2.1 to 26.0; p = 0.10. 64% of intervention participants logged on at least once with generally positive feedback on the web-based support. The intervention had no effect on other PA outcomes, ERS attendance (78% v 75% in control and intervention, respectively), EQ-5D-5L or HADS scores, but did enhance a number of process outcomes (i.e. confidence, importance and competence) compared with the control group at 4 months but not at 12 months. At 12 months, compared to control, the intervention group incurred an additional mean cost of £439 (95% CI £-182, £1060) but generated more mean quality adjusted life years (QALYs); (0.026, 95% CI 0.013, 0.040) with an incremental cost effectiveness ratio of additional £16,885 per QALY. Limitations: A significant proportion (46%) of participants were not included in the primary analysis, due to study withdrawal, and insufficient device wear time and the results must be interpreted with caution. The regression model fit for the primary outcome was poor, because of the considerable proportion of participants (142/243 (58%)) who recorded zero minutes of ≥10 minute bouted MVPA at 12 months. Future work:The design and rigorous evaluation of cost-effective and scalable ways to increase ERS uptake and maintenance of MVPA are needed among patients with chronic conditions.Conclusion: Adding e-coachER to usual ERS had only a weak indicative effect on long-term rigorously defined, objectively assessed MVPA. The provision of the e-coachER support package led to an additional cost and has a 63% probability of being cost-effective based on the UK threshold of £30,000/QALY. The intervention did improve some process outcomes as specified in our Logic Model. Study registration: ISRCTN15644451Funding details: NIHR HTA 13/25/20

KW - Accelerometer

KW - behaviour change

KW - body mass index

KW - cost-benefit analysis

KW - depression

KW - Diabetes Mellitus, Type 2

KW - e-health

KW - exercise

KW - Goal setting

KW - adult

KW - Humans

KW - hypertension

KW - Mediation

KW - obesity

KW - Osteoarthritis

KW - Pedometer

KW - primary health care

KW - process evaluation

KW - Qualitative

KW - quality of life

KW - quality-adjusted life years

KW - self-determination theory

KW - self-monitoring

M3 - Article

JO - Health Technology Assessment

JF - Health Technology Assessment

SN - 1366-5278

ER -