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"As du Coeur" study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease.

ABSTRACT: Physical activity programs (PAP) in patients with cardiovascular disease require evidence of cost-utility. To assess improvement in health-related quality of life (QoL) and reduction of health care consumption of patients following PAP, a randomized trial was used. Patients from a health insurance company who had experienced coronary artery disease or moderate heart failure were invited to participate (N?=?1891). Positive responders (N?=?50) were randomly assigned to a progressively autonomous physical activity (PAPA) program or to a standard supervised physical activity (SPA) program. The SPA group had two supervised sessions per week over 5?months. PAPA group had one session per week and support to aid habit formation (written tips, exercise program, phone call). To measure health-related quality of life EQ-5D utility score were used, before intervention, 6?months (T6) and 1 year later. Health care costs were provided from reimbursement databases. Mobility, usual activities and discomfort improved significantly in both group (T6). One year later, EQ-5D utility score was improved in the PAPA group only. Total health care consumption in the intervention group decreased, from a mean of 4097 euros per year before intervention to 2877 euros per year after (p?=?0.05), compared to a health care consumption of 4087 euros and 4180 euros per year, in the total population of patients (N?=?1891) from the health insurance company. The incremental cost effectiveness ratio was 10,928 euros per QALYs. A physical activity program is cost-effective in providing a better quality of life and reducing health care consumption in cardiovascular patients. ISRCTN77313697 , retrospectively registered on 20 November 2015.

SUBMITTER: Bailly L

PROVIDER: S-EPMC6284296 | biostudies-other | 2018 Dec

REPOSITORIES: biostudies-other

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"As du Coeur" study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease.

Bailly Laurent L Mossé Philippe P Diagana Stéphane S Fournier Marion M d'Arripe-Longueville Fabienne F Diagana Odile O Gal Jocelyn J Grebet Jean J Moncada Mario M Domerego Jean-Jacques JJ Radel Rémi R Fabre Roxane R Fuch Alain A Pradier Christian C

BMC cardiovascular disorders 20181206 1

<h4>Background</h4>Physical activity programs (PAP) in patients with cardiovascular disease require evidence of cost-utility. To assess improvement in health-related quality of life (QoL) and reduction of health care consumption of patients following PAP, a randomized trial was used.<h4>Methods</h4>Patients from a health insurance company who had experienced coronary artery disease or moderate heart failure were invited to participate (N = 1891). Positive responders (N = 50) were randomly assign ...[more]

PMID: 30522438

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Project description:Background and objectivesWe conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention.MethodsHOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months.ResultsA total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP.DiscussionThis study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect.Trial registration informationClinicalTrials.gov (NCT02394509).Classification of evidenceThis study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.

Project description:BACKGROUND: This study evaluated the effectiveness of the contextualized EBP training program for Filipino physical therapists in terms of knowledge, skills, attitudes and behavior. METHODS: A randomized controlled trial was designed to assess the effectiveness of the EBP training program. Fifty four physical therapists were randomly allocated to the EBP group (intervention) and waitlist (control) group. The EBP group had a one day face-to-face training with an online support, whilst the control was waitlisted. There were three measurement points which were pre, post, and three months post intervention for knowledge, skills and attitudes. Activity diaries were used to measure behavior. The diaries were collected after three months. Data analysis was by intention to treat in EBP domains of knowledge, skills and attitudes. RESULTS: Fifty-four physical therapists were included in the study. Fifty two (52) completed the post training assessment and 26 completed the 3 months post training assessment for EBP knowledge, skills and attitudes. There were significant improvements in these domains in the EBP group from pre to post training and over a period of three months (p < 0.05) compared with the waitlist control group. Thirty seven (37) physical therapists completed their activity diaries over three months. Behavior significantly improved in the EBP group in terms of EBP behaviors (formulating PICO, searching, appraising and applying the evidence) when faced with both new/unique and usual case scenarios (p < 0.05). More physical therapists in the waitlist control group significantly performed non-EBP behaviors (asking doctors and reading textbooks) when faced with new/unique cases compared with the EBP group (p < 0.05). No differences were noted between groups regarding non-EBP behaviors (asking colleagues and doctors and reading textbooks) particularly when faced with usual cases. CONCLUSION: The contextually designed EBP training program for Filipino physical therapists was effective in improving knowledge, skills and attitudes to EBP from pre to post training. Improvements were also observed at three months post training in knowledge, skills, attitudes and behavior to EBP. This model of training can be modified as needed based on the needs of the local context. Findings need to be interpreted with caution due to study limitations. CURRENT CONTROLLED TRIALS: ISRCTN74485061 (Registration date: February 9, 2011).

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"As du Coeur" study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease.

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"As du Coeur" study: a randomized controlled trial on quality of life impact and cost effectiveness of a physical activity program in patients with cardiovascular disease.

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