背景:基于Web的干预措施已成为治疗健康问题的创新选择,比如肥胖.本系统评价和网络荟萃分析的目的是分析基于网络的行为治疗对超重和肥胖成人的有效性。基于网络的干预和比较干预(传统的体重控制程序)根据以下反馈特征进行分类:频率,个性化,和提供者(人与机器)。
方法:从最初的1789项研究来看,这次审查包括15个。进行了网络荟萃分析,以分析基于网络的程序与传统干预的功效,考虑直接和间接比较。主要结果是基线和治疗后的体重减轻平均差(kg)。对异质性和一致性假设进行了网络荟萃分析。
结果:网络荟萃分析显示了不同治疗方案之间的比较。主要结果是,基于Web的密集接触程序比等待列表更有效(平均差异-1.86kg;95%置信区间:-3.61,-0.12)。此外,与其他基于网络的选择和自助传统干预措施相比,基于网络的密集接触计划更有效。然而,唯一显著的比较是基于网络的密集接触程序与基于网络的引导自助程序(平均差异-4.31kg;95%置信区间:-5,22,-3,41)。根据获得的结果,基于Web的密集接触程序是最有效的治疗选择,在网络荟萃分析提供的排名中排名第一,概率为98.5%。
结论:基于网络的密集接触干预措施在排名中排名第一,证明了频繁的相关性,个性化,和专业反馈及其与超重和肥胖患者预后更好的关联。这些结果提供了相关信息,为超重和肥胖患者设计更有效的治疗方法,以一种特别适合当前情况的新格式。
自1975年以来,全球超重和肥胖的人数增加了两倍。肥胖已经成为公共健康的严重问题。出于这个原因,迫切需要为超重和肥胖人群设计创新的治疗方法。这项系统评价和网络荟萃分析评估了创新干预措施的有效性,具体的基于网络的超重和肥胖计划,将它们与传统行为治疗和等待名单组进行比较。基于网络的行为治疗和传统的行为治疗都根据三个反馈特征进行分类:个性化,频率,和提供者(人与机器)。文献表明,在传统干预措施中,频繁的反馈是预后良好的指标。这项研究的结果表明,对于基于网络的干预措施,医疗保健专业人员提供的密集和个性化反馈是导致更好预后的治疗选择.第二种和第三种选择是基于网络的指导自助计划和传统的自助计划。这些干预措施赋予参与者权力,提供更多的自我效能感。基于Web的最小接触程序,基于网络的自助程序和等待列表是最后的选择。只有网络荟萃分析才能提供可用治疗方案的准确排名,本研究中使用的统计技术。
BACKGROUND: Web-based delivered interventions have become an innovative option to treat health problems, like obesity. The aim of this systematic
review and network meta-analysis was to analyze the effectiveness of web-based behavioral treatments for adults with overweight and obesity. Web-based interventions and comparison interventions (traditional weight control programs) were classified according to the following feedback characteristics: frequency, personalization, and provider (human versus machine).
METHODS: From the initial 1789 studies, 15 were included in this
review. A network meta-analysis was conducted to analyze the efficacy of web-based programs with traditional interventions, considering direct and indirect comparisons. The main outcome was the weight loss mean difference (kg) between baseline and post-treatment. Heterogeneity and consistency assumptions were validated to conduct the network meta-analysis.
RESULTS: Network meta-analysis showed comparisons between different treatment options. The main results were that Intensive Contact Web-based programs were more effective than wait-list (Mean Difference - 1.86 kg; 95% Confidence Interval: - 3.61, - 0.12). Moreover, Intensive Contact Web-based programs were more effective than the other web-based options and self-help traditional interventions. However, the only significant comparison was Intensive Contact Web-based programs versus Guided Self-Help Web-based programs (Mean Difference - 4.31 kg; 95% Confidence Interval: - 5,22, - 3,41). Intensive Contact Web-based programs were the most effective treatment option according the obtained results, achieving the first place in the ranking provided by the network meta-analysis with 98.5% of probabilities.
CONCLUSIONS: Intensive Contact Web-based interventions have obtained the first position in the ranking, proving the relevance of frequent, personalized, and professional feedback and their association with a better prognosis for people with overweight and obesity. These results provide relevant information to design more effective treatments for people with overweight and obesity, in a new format especially appropriate for the current situation.
The number of people with overweight and obesity has tripled worldwide since 1975. Obesity has become a serious problem for public health. For that reason, the design of innovative treatments for people with overweight and obesity is an urgent need. This systematic
review and network meta-analysis assesses the effectiveness of innovative interventions, concretely web-based programs for overweight and obesity, comparing them with traditional behavioral treatments and wait-list groups. Both web-based and traditional behavioral treatments were classified according to three feedback characteristics: personalization, frequency, and provider (human versus machine). The literature has suggested that a frequent feedback is an indicator of good prognosis in traditional interventions. The results of this study showed that for web-based interventions, an intensive and personalized feedback provided by a healthcare professional was the treatment option that led to a better prognosis. The second and third option were web-based guided self-hep programs and traditional self-help programs. These interventions empowered the participants, providing more sense of self-efficacy. Web-based minimal-contact programs, web-based self-help programs and wait-list were the last options. An accurate ranking of available treatment options only can be provided by a network meta-analysis, the statistic technique used in this study.