Presentation by
CATCH-IT Health Informatics Journal
Club
Presentation by
Lamia Chowdhury
November 16, 2009
Effectiveness of Active-Online: An
Individually Tailored Physical Activity
Intervention, in a Real-Life Setting:
RCT
Wanne...
Outline
Why this paper
About the Authors
Summary of Study and Findings
Methodological Issues
Validity & Usefulness of Resu...
Why I chose this paper
Randomized ControlledTrial
Attrition
Chronic disease and Inactive lifestyles
Internet surfing and h...
About the Authors
MiriamWanner
Institute of Social and Preventive Medicine, University of Basel,
Switzerland
Swiss Federal...
Publications & CitationsPublications & CitationsPublications & CitationsPublications & Citations
-JMIR
6
• JMIR
• Swiss Jo...
Study Objectives
To evaluate the effectiveness of Active-Online
Web –based, tailored physical activity intervention
Freely...
1. How effective is Active-Online, compared
to a non-tailored website,in increasing self-
reported and objectively measure...
2. Do respondents recruited for the
randomized study differ from spontaneous
users of Active-Online, and does
9
users of A...
3. What is the impact of frequency and
duration of use of Active-Online on changes
in physical activity behaviour?
10
in p...
Originality of the Study
Study claims only one other similar study exists
Spittaels H, et al. (2007) Effectiveness of an o...
Originality of Study
Sternfeld et al. (2009) Improving Diet and PhysicalActivity
withALIVE.AWorksite RandomizedTrial. Amer...
Methods
Participants recruited through ads in
newspapers, magazines, Internet
Active-Online website
Three study groups
Con...
Results
n CG IG SU
Total 688 681 162
Responded to all FU 399 (58%) 289 (42.4%) 59 (36.4%)
14
1. How effective is Active-Online, compared
to a non-tailored website,in increasing self-
reported and objectively measure...
Significant increase in self-reported physical
activity levels between baseline and last FU
for all groups, but no signifi...
2. Do respondents recruited for the
randomized study differ from spontaneous
users of Active-Online, and does
17
users of ...
Yes.
SU have a more pronounced increase in
activity levels.
18
activity levels.
However, these users are not randomized—th...
3. What is the impact of frequency and
duration of use of Active-Online on changes
in physical activity behaviour?
19
in p...
Not clear.
20
Not clear.
Methodological Issues—The Good
Sufficient scientific background for study
Computer-randomized groups
Detailed description ...
Methodological Issues—The Bad
Participant eligibility criteria not explicit
Settings and locations of data collection uncl...
23
Validity and Usefulness of Results
Participants were highly selective—only those with Internet
access and competence
Real-...
Further Research
Integrate web-based interventions in a wider health
promotion context
Primary care setting
Workplace sett...
Summary of Issues
Pitfalls of a real-life setting
Contamination of control group
Attrition
Unequal participant groups
26
U...
Questions for the Authors
Were the three groups following similar exercise routines?
How do you account for contamination ...
28
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Effectiveness of Active-Online, an individually tailored physical activity intervention in a real life setting: RCT

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Effectiveness of Active-Online, an individually tailored physical activity intervention in a real life setting: RCT

  1. 1. Presentation by CATCH-IT Health Informatics Journal Club Presentation by Lamia Chowdhury November 16, 2009
  2. 2. Effectiveness of Active-Online: An Individually Tailored Physical Activity Intervention, in a Real-Life Setting: RCT Wanner M., Martin-Diener E., Braun-Fahrländer C., Bauer G., Martin B.W. (2009) Journal of Medical Internet Research, 11 (3): e23. 2
  3. 3. Outline Why this paper About the Authors Summary of Study and Findings Methodological Issues Validity & Usefulness of ResultsValidity & Usefulness of Results Further Research Questions for theAuthors 3
  4. 4. Why I chose this paper Randomized ControlledTrial Attrition Chronic disease and Inactive lifestyles Internet surfing and health? Public Health 4 Public Health Physicians, trainers Vendors
  5. 5. About the Authors MiriamWanner Institute of Social and Preventive Medicine, University of Basel, Switzerland Swiss Federal Institute of Sport, Magglingen, Switzerland Publications 5 Publications Citations
  6. 6. Publications & CitationsPublications & CitationsPublications & CitationsPublications & Citations -JMIR 6 • JMIR • Swiss Journal for Sports Medicine and Sports Medicine
  7. 7. Study Objectives To evaluate the effectiveness of Active-Online Web –based, tailored physical activity intervention Freely accessible on the Internet Tested for acceptability and feasibility before going live in 2003 7 Aim is to increase physical activity levels in users by offering individually tailored counselling and motivational feedback
  8. 8. 1. How effective is Active-Online, compared to a non-tailored website,in increasing self- reported and objectively measured physical 8 reported and objectively measured physical activity levels when delivered in a real-life setting?
  9. 9. 2. Do respondents recruited for the randomized study differ from spontaneous users of Active-Online, and does 9 users of Active-Online, and does effectiveness differ between these groups?
  10. 10. 3. What is the impact of frequency and duration of use of Active-Online on changes in physical activity behaviour? 10 in physical activity behaviour?
  11. 11. Originality of the Study Study claims only one other similar study exists Spittaels H, et al. (2007) Effectiveness of an online computer-tailored physical activity intervention in a real-life setting. Health Educ Res,22(3):385- 396 Spittaels H, et al. (2007) Evaluation of a website-delivered computer- tailored intervention for increasing physical activity in the general 11 tailored intervention for increasing physical activity in the general population. Prev Med 44(3):209-217. Most other studies investigating the effectiveness of web- based tailored physical activity interventions have been carried out in small populations in controlled settings looked at short term effects
  12. 12. Originality of Study Sternfeld et al. (2009) Improving Diet and PhysicalActivity withALIVE.AWorksite RandomizedTrial. American Journal of Preventive Medicine 36 (6), pp. 475-483 Slootmaker, S. et al. (2009) Feasibility and effectiveness of online physical activity advice based on a personal 12 online physical activity advice based on a personal activity monitor: randomized controlled trial. Journal of Medical Internet research 11 (3), pp. e27
  13. 13. Methods Participants recruited through ads in newspapers, magazines, Internet Active-Online website Three study groups Control (CG), Intervention (IG), Spontaneous Users (SU) 13 Control (CG), Intervention (IG), Spontaneous Users (SU) IG and SU Active-Online CG Static website Follow-up (FU) at 6 weeks, 6 months, 13 months
  14. 14. Results n CG IG SU Total 688 681 162 Responded to all FU 399 (58%) 289 (42.4%) 59 (36.4%) 14
  15. 15. 1. How effective is Active-Online, compared to a non-tailored website,in increasing self- reported and objectively measured physical 15 reported and objectively measured physical activity levels when delivered in a real-life setting?
  16. 16. Significant increase in self-reported physical activity levels between baseline and last FU for all groups, but no significant differences 16 for all groups, but no significant differences between randomized groups.
  17. 17. 2. Do respondents recruited for the randomized study differ from spontaneous users of Active-Online, and does 17 users of Active-Online, and does effectiveness differ between these groups?
  18. 18. Yes. SU have a more pronounced increase in activity levels. 18 activity levels. However, these users are not randomized—they are self-selected and account for only 7.4% of total visits to Active-Online.
  19. 19. 3. What is the impact of frequency and duration of use of Active-Online on changes in physical activity behaviour? 19 in physical activity behaviour?
  20. 20. Not clear. 20 Not clear.
  21. 21. Methodological Issues—The Good Sufficient scientific background for study Computer-randomized groups Detailed description of data collection Specific objectives and questions Clearly defined outcome measures, statistical analyses, 21 Clearly defined outcome measures, statistical analyses, recruitment and follow-up dates, baseline demographics, Power calculation to determine sample size, allowing for attrition Participant flow diagram included, all participants accounted for Acknowledges limited effectiveness of the system
  22. 22. Methodological Issues—The Bad Participant eligibility criteria not explicit Settings and locations of data collection unclear Study not blinded—study personnel could identify participants groups through email addresses Survey and questionnaire sample not provided Trial not registered 22 Trial not registered Justification of spontaneous user-group not clear All groups not equal Admits to contamination of control group Attrition rate >50% Out-dated website design and theoretical framework (transtheoretical model of behaviour change) Validity of time-stamp calculating frequency of use Participants already had high levels of physical activity
  23. 23. 23
  24. 24. Validity and Usefulness of Results Participants were highly selective—only those with Internet access and competence Real-life setting—too many uncontrolled factors Conclusion is nothing new 24 Usefulness to stakeholders Family physicians Trainers Public health officials Vendors
  25. 25. Further Research Integrate web-based interventions in a wider health promotion context Primary care setting Workplace setting 25
  26. 26. Summary of Issues Pitfalls of a real-life setting Contamination of control group Attrition Unequal participant groups 26 Unequal participant groups
  27. 27. Questions for the Authors Were the three groups following similar exercise routines? How do you account for contamination of CG in Internet-based studies? Could CG have accessedActive-Online as SU (using a different email address perhaps)? What were the technical difficulties causing 38 participants to be omitted from the study? 27 Could study results be affected by incentives? What was the point of having SU? How to validate uniqueness of participants? What was the reason for not measuring usage of non-tailored website? Why did the total reported activity of those meeting HEPA at baseline decrease at FU3?
  28. 28. 28 www.cartoonstock.com

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