Alief's English Presentation

7/28/2019 Alief's English Presentation

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ALIEF AL AMINNIM: 01.208.5590

A Behavioral Weight-LossIntervention in Persons w

Serious Mental Illness


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BACKGROUNDOverweight and obesity are epidemic amon

persons with serious mental illness, yet weightrials systematically exclude this vulnerablepopulation.

TUJUAN to determine the effectiveness of an 18-mon

tailored behavioral weight-loss intervention inwith serious mental illness.

INTRODUCTION


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STUDY OVERSIGHT

Institutional review boards at Johns Hopkins Uni-versity and Sheppard Pratt Health Sindependent data and safety monitoring board approved the protocol for the Randof Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE )

SETTING AND STUDY POPULATION

We placed the trial in outpatient psychiatric rehabilitation programs, settings that ppoten-tially unrealized opportunities to deliver lifestyle interventions

overweight or obese adults (18 years of age) who attended 1 of 10 community prehabilitation pro-grams in central Maryland or their affiliated out-patient mental he

Kriteria eksklusi

We excluded persons with:

a medical contraindication to weight loss,

a cardiovascular event within the previous 6 months,

an inability to walk, or an active alcohol-use or

substance-use disorder

METHODS


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STUDY PERIODS January 2009 to February2011

Group studi Intervention

The conceptual framework of the intervention incorporated soccognitive and behavioral self-management theories and was cwith psychiatric rehabilitation principles of skill building and envsupports

Control Participants in the control group received standard nutrition and

activity information at base-line. Health classes were offered quwith content unrelated to weight (e.g., cancer screening).


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Data Collection

Data collectors visited the rehabilitation programs t

determine study eligibility, to collect baseline data, perform follow-up assessments at 6, 12, and 18 monHeight was measured at study entry. At each visit, wwas measured.

Measurements of blood pressure, waist circumferenfasting blood chemical levels were obtained at bas

and at 6 and 18 months. Information on sociodemographic characteristics an

medications were obtained from participant self-repand program records; psychiatric diagnoses wereabstracted from program records.


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Done with intention-to-treat Primary Outcome :

BMI changes

Persentage of weight change

chi-square test Sensitivity analysis

Statistical Analysis


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BASELINECHARACTERISTIC

The mean age was 45.3 years; 49.8% ofthe participants were men, and 38.1%

were black (Table 1). More than half theparticipants lived in supported housing,and almost 80% were unable to work. Atotal of 58.1% of the participants hadschizophrenia or a schizoaffectivedisorder, 22.0% had bipolar disorder, and12.0% had major depression. The meannumber of psychotropic medications was3.1. On average, there were 29participants per study site (range, 18 to45). Follow-up weights were ob-tainedfrom 279 participants, out of 280 for whomdata were not censored at 18 months. Atfollow-up visits, 93.3% of the participantshad their weight measured within the

data-collection windows.


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Figure 2.Mean Weight Change, AccordinStudy Group.

As compared with group, the mean loss in the intervenincreased progrethe 18-month study


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Table 2. Weight-Loss Outcomes at 6, 12, and 18 Months.

Among participants in the inte63.9% had a weight at 18 monor lower than their baselin

compared with 49.2% of thosgroup. The percentage of plost at least 5% of their basel37.8% in the intervention groupwith 22.7% in the control groupthe net difference in changparticipants in the interventcompared with those in the was 1.1 (95% CI, 1.8 to 0.5)


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INTERVENTION PARTICIPATION

The median numbe

attended sessions wafirst 6 months and 31 through 18. Attendagroup exercise contributed most tonumber of contacts.


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ADVERSE EFFECT


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In overweight and obese adults with serious mental illnwere participating in psychiatric rehabilitation programbehavioral weight-loss intervention incorporating weigmanagement counseling and group exercise significareduced participant weight over a period of 18 month

despite sub-stantial challenges, persons with serious m

illness are able to lose weight with a tailored in-tervent Incorporating lifestyle interventions into rehabilitation

programs or placing such programs in other mental hesettings would require financial and organizational res

DISCUSSION


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enrolled a diverse population of patients with mental illnesses from multiple community-baseprograms

throughout the trial, we attained high follow-ufor outcome data

the interven-tion was offered over a period of months, in contrast to the short-term interventiprevious randomized trials of behavioral weighinterventions in this population

STUDY STRENGTHS


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attendance at the intervention sessions and rehabilitaprograms decreased

the trial was not deSigned or powered to determine theffects of weight reduction on cardiovascular risk factthis population

the trial was not designed to influence the prescribingmedication

efforts to provide healthy meal options were availableparticipants in the rehabilitation programs

STUDY WEAKNESS


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Conclusion over-weight and obese adults with serious mental illn

make substantial lifestyle changes despite the myriachallenges they face.

Suggestion

Given the epidemic of obesity and weight-relatdisease among persons with serious mental illnesfindings support implementation of targeted beweight-loss interventions in this high-risk populatio


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CRITICAL APPRAISAL

Journal identityPositive:

Penulis come from Welch Center for PrevenEpidemiology, and Clinical Research, JohnHopkins University

Published by n engl j med 368;17 nejm.org 25, 2013


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CRITICAL APPRAISAL

TitlesA Behavioral Weight-Loss Intervention Persons with Serious Mental Illness

Positive: Clearly shows that variables that were investigated

Bold written with a capital letter at the beginning of the word There is no abbreviation

Less than 12 words

Negative: -


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MethodsPositive:

Participant of study is clear, followed by the inclusiexclusion criteria

inter-group interventions are clear

Analysis tools mentionedclearly measurable outcomes are clear

Negative: -


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ResultsPositive

Tables are presented in accordance with thinternational journal writing format (withoutvertical and horizontal lines in a) with no ser

number and table title and description of thcontents of the table

The values of the statistics written

Negative : -


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DiscussionPositive

There is a comparison test of previous research an

There are disadvantages and advantages of thementioned research results that have been achiev

There is an emphasis if the results of the research w

applied There are suggestions for future research

Negative -


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PICO ANALYSIS

PATIENT Adult patients with serious mental disorders excess b

weight or obesity from 10 community rehabilitation pof outpatient psychiatry at central Maryland and af

INTERVENTION

Behavioral weight loss through lifestyle in adult patieserious mental disorders excess body weight or obes


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ANALISIS PICO

COMPARATION Persentase penurunan berat badan pada 6, 12, dan

bulan antara kelompok kontrol dan kelompok interv

OUTCOME

Intervensi perilaku penurunan berat badan secara s

mengurangi berat badan selama periode 18 bulan orang dewasa dengan kelebihan berat badan danobesitas dengan penyakit mental serius

Validitas Uji


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VALID EVIDENCE

QUESTIONS

Is the allocation of patients in the study

randomized?

yaIs patient observation done quite long and

complete?

ya.

Are all patients in the randomized, analyzed? ya

Whether patients and physicians remain blind in

doing therapy, apart from the therapy being

tested?

NO

Is the treatment and control groups equally? NO. BUT ALMOST SIMILA144 in intervention group

in control group

Validitas Uji


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APLIKASIAPPLICABILITY

Is there a difference in our patients when

compared with that found in previousstudies so that the results can not be

applied to our patients?

NO

Whether such therapy may be applied to

our patients?

ya

Does the patient have a potentialbeneficial or detrimental treatment or

when the program implemented?

Profitable. Behavioral weiginterventions can significabody weight over a periodmonths in adults with overobesity with serious menta

APPLICABILITY OF TEST


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WEIGHT LOSS FROM BASELINE AT 18 MONTHSFOLLOW UP

THE IMPORTANCE OF STU

WEIGHT LOSS

Total(+) (-)

Intervention 88 49 137

Control 70 72 142

Total 158 121 279


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EBM for RCT RRR = -0.303 (95% CI: -0.605

Weight loss from baseline inintervention group was 30.3the control group

ARR = -0.149 (95% CI: -0.26 tARR = -0.149 means absolutderived from behavioral intweight loss is a 14.9% increaweight loss from baseline.

NNT = -7 (-4 to -30)The number of patients whotreated (for the duration of order to increase the weigh

baseline in obese adult patmental disorders are 7 peop

All 95%CI does not include indicating that the RRR, ARRmeaningful.


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WEIGHT LOSS 5% FROM BASELINE AT 18MONTHS FOLLOW UP

THE IMPORTANCE OF STU

WEIGHT LOSS

Total(+) (-)

Intervention 52 85 137

Control 32 110 142

Total 52 85 137


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EBM for RCT RRR = -0.684 (95% CI: -1.445 t

Weight loss in the interve5% from baseline was 68the control group

ARR = -0.154 (95% CI: -0.258 t

ARR = -0.154 means absadvantage derived frominterventions for weight increase in the weight lothe baseline.

NNT = -7 (-4 to -22)

The number of patients treated (for the durationorder to increase the 5%from baseline in obese awith mental disorders ar

All 95% CI does not include tindicating that the RRR, ARRmeaningful


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1 Clinical study is valid

2Clinical study is applica

3Clinical study is importa

CONCLUSIONS

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