Assessing the Value of eHealth for Bariatric Surgery

Obesity Clinical Trial

— BePATIENT  

Official title:

Assessing the Value of eHealth for Bariatric Surgery

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03394638
• Other study ID #: NL56992.100.16
• Status: Recruiting
• Phase: N/A
• First received: December 6, 2017
• Last updated: January 10, 2018
• Start date: February 21, 2017
• Est. completion date: December 15, 2019

Study information

• Verified date: January 2018
• Source: Catharina Ziekenhuis Eindhoven
• Contact: Dirk Versteegden, MD
• Phone: 003140 239 9850
• Email: dirk.versteegden[@]catharinaziekenhuis.nl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Bariatric surgery is the only treatment with long standing effect of morbid obesity. The key elements to success are the patient-selection, an experienced bariatric team and a completed follow-up program. Follow-up programs can consist of, for example, providing social support in support groups, teaching psychological skills, such as coping with the body change or teaching self-regulation of body weight. Furthermore, follow-up is important for dietary and sports counselling. The experience of the team members and coaching skills are essential in indicating the suitable procedure if necessary and guide the patients through the process. Various studies showed a significant positive effect of a completed follow-up program after bariatric surgery on maintaining weight loss. There is a burden for this on site provided care as organizational and financial resources are not unlimited. Especially as the follow-up period is an obligatory 5 years or if possible life long. Even if this aftercare is provided, not all patients complete the complete program. Various reasons are possible for an increasing no-show-rate, the loss of enthusiasm for onsite visits could be one of them. Analogue to other chronic diseases, the addition of telehealth could be useful. Telehealth is the delivery of health-related services and information via telecommunications technologies. It encompasses preventative, promotive and curative aspects. Examples are exchanging health services or education via videoconference, transmission of medical data for disease management (remote monitoring) and advice on prevention of diseases and promotion of good health by patient monitoring and follow-up. The participation of eHealth has been investigated and considered useful in the treatment of obesity. In a systematic review self-measured blood pressure monitoring was associated with better control of hypertension at least in the first year. Its value in a bariatric tract has not been investigated. It can be hypothesized that self-control by eHealth could enhance clinical outcome as more weight loss and comorbidity reduction. Long-term realistic goals setting, consistent use of routines and self-monitoring has been proven effective for weight loss maintenance. Patients with higher self-control are more certain regarding their abilities, which cause higher commitment and adherence to the program. This eventually leads to more weight loss. For this purpose an online monitoring program was designed for our Obesity Centre (BePATIENT) to provide preoperative information as well as aids in the post-bariatric phase by self-control wireless devices for registration of biometric outcomes, teleconference opportunities and access to additional information. In a prospective trial the implementation in several degrees is evaluated.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 200
• Est. completion date: December 15, 2019
• Est. primary completion date: December 15, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Completed the questionnaire online

2. Having ongoing access to internet

3. Ability to use a model of mobile device (smartphone or tablet) with any version of the Android or iOS platform

4. A body mass index above 40 kg/m2 or above 35 kg/m2 with related comorbidity (hypertension, diabetes type 2, hyperlipidaemia, obstructive sleep apnea syndrome or joint arthritis of lower limbs)

5. A primary gastric sleeve or bypass planned

6. Age of 18 years or more

7. Ability to read and write the Dutch language

8. Signed informed consent

Exclusion Criteria:

1. Patients not meeting the inclusion criteria

Related Conditions & MeSH terms

• Bariatric Surgery
• Obesity
• Telemedicine

Intervention

Other:
• Access to online eLearning module
Patients enrolled in the Online group have access to an online platform called BePatient. Patients are given the ability to access the platform and do eLearnings; watch videos about the operation and recovery; do quizzes, see dietary advices; see news about obesity and our department; read patients' stories. They are also able to chat with other patients.
• Access to measurement devices
Patients in the device group have, in addition to patients in the Online group, access to 4 measuring devices, including: weight scale, oximeter, activity bracelet and blood pressure device. Those devices are connectable to their mobile phones where patients can view their own progress.

Procedure:
• Conventional group
All patients undergo the standard of care which included: the bariatric procedure and several outpatient visits including consultation with their surgeon, obesity nurses, dieticians and (if indicated) psychologists.

Locations

Country	Name	City	State
Netherlands	Catharina Hospital	Eindhoven	Noord Brabant

Sponsors (1)

Lead Sponsor	Collaborator
Catharina Ziekenhuis Eindhoven

Country where clinical trial is conducted

Netherlands, 

References & Publications (15)

[2] Lyons K, Meisner B, Sockalingam S, Cassin S.. Body image after bariatric surgery: A qualitative study. Bariatric Surgical Practice and Patient Care. March 2014, 9(1): 41-49.

Ahrendt AD, Kattelmann KK, Rector TS, Maddox DA. The effectiveness of telemedicine for weight management in the MOVE! Program. J Rural Health. 2014 Winter;30(1):113-9. doi: 10.1111/jrh.12049. Epub 2013 Sep 24. — View Citation

Azar KM, Aurora M, Wang EJ, Muzaffar A, Pressman A, Palaniappan LP. Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men. Transl Behav Med. 2015 Mar;5(1):37-44. doi: 10.1007/s13142-014-0296-6. — View Citation

Bond DS, Thomas JG. Measurement and Intervention on Physical Activity and Sedentary Behaviours in Bariatric Surgery Patients: Emphasis on Mobile Technology. Eur Eat Disord Rev. 2015 Nov;23(6):470-8. doi: 10.1002/erv.2394. Epub 2015 Sep 2. Review. — View Citation

Haggerty AF, Huepenbecker S, Sarwer DB, Spitzer J, Raggio G, Chu CS, Ko E, Allison KC. The use of novel technology-based weight loss interventions for obese women with endometrial hyperplasia and cancer. Gynecol Oncol. 2016 Feb;140(2):239-44. doi: 10.1016/j.ygyno.2015.11.033. Epub 2015 Nov 28. — View Citation

Kim HJ, Madan A, Fenton-Lee D. Does patient compliance with follow-up influence weight loss after gastric bypass surgery? A systematic review and meta-analysis. Obes Surg. 2014 Apr;24(4):647-51. doi: 10.1007/s11695-014-1178-1. Review. — View Citation

Livhits M, Mercado C, Yermilov I, Parikh JA, Dutson E, Mehran A, Ko CY, Shekelle PG, Gibbons MM. Is social support associated with greater weight loss after bariatric surgery?: a systematic review. Obes Rev. 2011 Feb;12(2):142-8. doi: 10.1111/j.1467-789X.2010.00720.x. Review. — View Citation

Luley C, Blaik A, Götz A, Kicherer F, Kropf S, Isermann B, Stumm G, Westphal S. Weight loss by telemonitoring of nutrition and physical activity in patients with metabolic syndrome for 1 year. J Am Coll Nutr. 2014;33(5):363-74. doi: 10.1080/07315724.2013.875437. Epub 2014 Aug 8. — View Citation

McKee H, Ntoumanis N, Smith B. Weight maintenance: self-regulatory factors underpinning success and failure. Psychol Health. 2013;28(10):1207-23. doi: 10.1080/08870446.2013.799162. Epub 2013 Jun 14. — View Citation

Mundi MS, Lorentz PA, Grothe K, Kellogg TA, Collazo-Clavell ML. Feasibility of Smartphone-Based Education Modules and Ecological Momentary Assessment/Intervention in Pre-bariatric Surgery Patients. Obes Surg. 2015 Oct;25(10):1875-81. doi: 10.1007/s11695-015-1617-7. — View Citation

Petasne Nijamkin M, Campa A, Samiri Nijamkin S, Sosa J. Comprehensive behavioral-motivational nutrition education improves depressive symptoms following bariatric surgery: a randomized, controlled trial of obese Hispanic Americans. J Nutr Educ Behav. 2013 Nov-Dec;45(6):620-6. doi: 10.1016/j.jneb.2013.04.264. Epub 2013 Jun 29. — View Citation

Skoyen JA, Rutledge T, Wiese JA, Woods GN. Evaluation of TeleMOVE: a Telehealth Weight Reduction Intervention for Veterans with Obesity. Ann Behav Med. 2015 Aug;49(4):628-33. doi: 10.1007/s12160-015-9690-7. — View Citation

Steinberg DM, Levine EL, Lane I, Askew S, Foley PB, Puleo E, Bennett GG. Adherence to self-monitoring via interactive voice response technology in an eHealth intervention targeting weight gain prevention among Black women: randomized controlled trial. J Med Internet Res. 2014 Apr 29;16(4):e114. doi: 10.2196/jmir.2996. — View Citation

Sysko R, Hildebrandt TB, Kaplan S, Brewer SK, Zitsman JL, Devlin MJ. Predictors and correlates of follow-up visit adherence among adolescents receiving laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2014 Sep-Oct;10(5):914-20. doi: 10.1016/j.soard.2014.03.012. Epub 2014 Mar 28. — View Citation

Uhlig K, Patel K, Ip S, Kitsios GD, Balk EM. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Ann Intern Med. 2013 Aug 6;159(3):185-94. doi: 10.7326/0003-4819-159-3-201308060-00008. Review. — View Citation

* Note: There are 15 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Body Mass Index (BMI)	The BMI in kg/m2 at 2 years postoperatively.	2 years after the operation
Secondary	Quality of Life	Quality of Life assessment using the RAND36-questionnaire. The RAND36 questionnaire consists of 36 questions about health related quality of life. The RAND36 scores are divided in 9 subscales: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health and health change. Scores for each subscale are transformed to a linear 0 - 100 score. A higher score indicates a better quality of life in that domain.	At 1 and 2 years after the operation
Secondary	Evolution of obesity related comorbidities	Status of comorbidities are recorded at 1 and 2 years postoperatively and classified as either: cured (no medication and no complaints), improved (less medication needed and/or less complaints), unchanged (no alterations in medication use and no change in complaints), worsened (more medication needed and/or more complaints) or de novo (development of a comorbidity which was not present at inclusion). The reviewed comorbidities include: hypertension, diabetes mellitus, Arthralgia, obstructive sleep apnea syndrome, dyslipidemia and gastro-esophageal reflux disease.	At 1 and 2 years after the operation
Secondary	Program commitment	A 6-item questionnaire to assess program commitment (Neubert & Cady 2001).	At 1 and 2 years after the operation
Secondary	Technical errors biometric devices	Number of technical issues reported by patients or health care professionals	At 2 years after the operation
Secondary	Length of hospitalization	Length of stay in hospital (days)	At 2 years after the operation
Secondary	Return to work (days)	Number of days patients start working again after operation	At 1 year after the operation.
Secondary	Patients' satisfaction	Satisfactory assessment patients (Numeric Rate Scale 0-10)	At 1 and 2 years after the operation
Secondary	Health care suppliers' satisfaction	Satisfactory assessment health care professional (Numeric Rate Scale 0-10)	At 1 and 2 years after the operation