Protocol for a randomized controlled trial of a specialized health coaching intervention to prevent excessive gestational weight gain and postpartum weight retention in women: the HIPP study

BackgroundPregnancy is a time of significant physiological and physical change for women. In particular, it is a time at which many women are at risk of gaining excessive weight. We describe the rationale and methods of the Health in Pregnancy and Post-birth (HIPP) Study, a study which aims primarily to determine the effectiveness of a specialized health coaching (HC) intervention during pregnancy, compared to education alone, in preventing excessive gestational weight gain and postpartum weight retention 12 months post birth. A secondary aim of this study is to evaluate the mechanisms by which our HC intervention impacts on weight management both during pregnancy and post birth.Methods/DesignThe randomized controlled trial will be conducted with 220 women who have a BMI &gt; 18.5 (American IOM cut-off for normal weight), are 18 years of age or older, English speaking, no history of disordered eating or diabetes and are less than 18 weeks gestation at recruitment. Women will be randomly allocated to either a specialized HC intervention group or an Education Alone group. Our specialized HC intervention has two components: (1) one-on-one sessions with a Health Coach, and (2) two by two hour educational group sessions led by a Health Coach. Women in the Education Alone group will receive two by two hour educational group sessions with no HC components. Body Mass Index, waist circumference, and psychological factors including motivation, readiness to change, symptoms of depression and anxiety, and body dissatisfaction will be assessed at baseline (14-16 weeks gestation), and again at follow-up: 32 weeks gestation, 6 weeks, 6 months and 12 months postpartum.DiscussionOur study responds to the urgent need to design effective interventions in pregnancy to prevent excessive gestational weight gain and postpartum weight retention. Our pregnancy HC intervention is novel and innovative and has been designed to be easily adopted by health professionals who work with pregnant women, such as obstetricians, midwives, allied health professionals and health psychologists. <br /

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Will I or Won’t I? Secondary School Students’ Aspirations for University Study: Final Report

Report for the 'Schools Access Monash' program committee

Will I or Won’t I? Secondary School Students’ Aspirations for University Study: Final Report

Report for the 'Schools Access Monash' program committee

Fostering patient uptake of recommended health services and self-management strategies for musculoskeletal conditions: a Delphi study of clinician attributes

Introduction: Successful management of musculoskeletal conditions depends on active patient engagement and uptake of recommended health services and self-management strategies. Clinicians have a strong influence on patient uptake behaviours. Both clinicians and educators need to recognise the clinician's influence on patient uptake as a specific clinical skillset to be professionally developed. To inform professional development strategies this study explored priority clinician attributes that underpin the clinical skillset of fostering patient uptake. Methods: A three-round Delphi process engaged relevant stakeholders including a professional panel (clinicians, health managers, education providers) and a patient panel. Panel members deliberated and reached consensus regarding key attributes required by allied health clinicians who manage patients with musculoskeletal disorders to optimize patient uptake behaviours. In the final round, panel members rated the importance of each attribute on a numerical rating scale. Results: Overall 12 attributes were finalised. Both the professional and the patient panel provided a high rating of importance for all finalised attributes with ‘patient centred communication’ rated the highest importance (median scores 9.5–10/10) and ‘contemporary electronics and media’ rated the lowest (median scores 6–7/10). Conclusions: There appears to be agreement on a basic inventory of clinician attributes which positively influence patient uptake when managing musculoskeletal conditions. Professional development and training programs for clinicians managing musculoskeletal conditions may need to consider discipline relevant aspects of these attributes to advance the development of clinicians in this aspect of professional practice to attain better patient outcomes

Telephone coaching to enhance a home-based physical activity program for knee osteoarthritis : a randomized clinical trial

Objective. To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA). Methods. A total of 168 inactive adults ages ≥50 years with knee pain on a numeric rating scale ≥4 (NRS; range 0–10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n=84) or PT-only (n=84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT+coaching participants also received 6–12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0–68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data. Results. A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) 20.4, 1.3]) and in WOMAC function (1.8 [95% CI ‒1.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT+coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes. Conclusion. The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program

Telephone coaching to enhance physiotherapy-prescribed physical activity for knee osteoarthritis : a randomised controlled trial

Clinical and general health guidelines recommend physical activity (PA) and exercise for osteoarthritis (OA). Among people with OA, PA levels are low, there is a global underutilisation of exercise, and benefits are generally not sustained due to suboptimal adherence that declines over time. Telephone delivered health coaching can be used in chronic disease management to improve adherence to treatment recommendations and to facilitate health behaviour change