TY - JOUR
T1 - Use of a smartphone-based mobile app for weight management in obese minority stroke survivors
T2 - Pilot randomized controlled trial with open blinded end point
AU - Ifejika, Nneka L.
AU - Bhadane, Minal
AU - Cai, Chunyan C.
AU - Noser, Elizabeth A.
AU - Grotta, James C.
AU - Savitz, Sean I.
N1 - Funding Information:
NLI has received a University of Texas Southwestern Medical Center and Texas Health Resources Clinical Scholar Award (#4). NLI’s and CCC’s previous work at the Center for Clinical and Translational Sciences at the McGovern Medical School at University of Texas Health Science Center at Houston was funded by US National Institutes of Health (NIH)/National Center for Advancing Translational Sciences Clinical and Translational Award UL1 TR000371 and KL2 TR000370. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the NIH. NLI received the NIH/National Institute of Neurological Disorders and Stroke Diversity Supplement to P50 NS 044227, the University of Texas Specialized Program of Translational Research in Acute Stroke.
Funding Information:
NLI has received a University of Texas Southwestern Medical Center and Texas Health Resources Clinical Scholar Award (#4). NLI?s and CCC?s previous work at the Center for Clinical and Translational Sciences at the McGovern Medical School at University of Texas Health Science Center at Houston was funded by US National Institutes of Health (NIH)/National Center for Advancing Translational Sciences Clinical and Translational Award UL1 TR000371 and KL2 TR000370. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the NIH. NLI received the NIH/National Institute of Neurological Disorders and Stroke Diversity Supplement to P50 NS 044227, the University of Texas Specialized Program of Translational Research in Acute Stroke.
Publisher Copyright:
©Nneka L Ifejika, Minal Bhadane, Chunyan C Cai, Elizabeth A Noser, James C Grotta, Sean I Savitz.
PY - 2020/4
Y1 - 2020/4
N2 - Background: Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective: Our objective was to determine the feasibility and preliminary treatment effects of a smartphone-based weight loss intervention versus food journals to monitor dietary patterns in minority stroke patients. Methods: Swipe out Stroke was a pilot prospective randomized controlled trial with open blinded end point. Minority stroke patients and their caregivers were screened for participation using cluster enrollment. We used adaptive randomization for assignment to a behavior intervention with (1) smartphone-based self-monitoring or (2) food journal self-monitoring. The smartphone group used Lose it! to record meals and communicate with us. Reminder messages (first 30 days), weekly summaries plus reminder messages on missed days (days 31-90), and weekly summaries only (days 91-180) were sent via push notifications. The food journal group used paper diaries. Both groups received 4 in-person visits (baseline and 30, 90, and 180 days), culturally competent counseling, and educational materials. The primary outcome was reduced total body weight. Results: We enrolled 36 stroke patients (n=23, 64% African American; n=13, 36% Hispanic), 17 in the smartphone group, and 19 in the food journal group. Mean age was 54 (SD 9) years; mean body mass index was 35.7 (SD 5.7) kg/m2; education, employment status, and family history of stroke or obesity did not differ between the groups. Baseline rates of depression (Patient Health Questionnaire-9 [PHQ-9] score median 5.5, IQR 3.0-9.5), cognitive impairment (Montreal Cognitive Assessment score median 23.5, IQR 21-26), and inability to ambulate (5/36, 14% with modified Rankin Scale score 3) were similar. In total, 25 (69%) stroke survivors completed Swipe out Stroke (13/17 in the smartphone group, 12/19 in the food journal group); 1 participant in the smartphone group died. Median weight change at 180 days was 5.7 lb (IQR –2.4 to 8.0) in the smartphone group versus 6.4 lb (IQR –2.2 to 12.5; P=.77) in the food journal group. Depression was significantly lower at 30 days in the smartphone group than in the food journal group (PHQ-9 score 2 vs 8; P=.03). Clinically relevant depression rates remained in the zero to minimal range for the smartphone group compared with mild to moderate range in the food journal group at day 90 (PHQ-9 score 3.5 vs 4.5; P=.39) and day 180 (PHQ-9 score 3 vs 6; P=.12). Conclusions: In a population of obese minority stroke survivors, the use of a smartphone did not lead to a significant difference in weight change compared with keeping a food journal. The presence of baseline depression (19/36, 53%) was a confounding variable, which improved with app engagement. Future studies that include treatment of poststroke depression may positively influence intervention efficacy.
AB - Background: Minorities have an increased incidence of early-onset, obesity-related cerebrovascular disease. Unfortunately, effective weight management in this vulnerable population has significant barriers. Objective: Our objective was to determine the feasibility and preliminary treatment effects of a smartphone-based weight loss intervention versus food journals to monitor dietary patterns in minority stroke patients. Methods: Swipe out Stroke was a pilot prospective randomized controlled trial with open blinded end point. Minority stroke patients and their caregivers were screened for participation using cluster enrollment. We used adaptive randomization for assignment to a behavior intervention with (1) smartphone-based self-monitoring or (2) food journal self-monitoring. The smartphone group used Lose it! to record meals and communicate with us. Reminder messages (first 30 days), weekly summaries plus reminder messages on missed days (days 31-90), and weekly summaries only (days 91-180) were sent via push notifications. The food journal group used paper diaries. Both groups received 4 in-person visits (baseline and 30, 90, and 180 days), culturally competent counseling, and educational materials. The primary outcome was reduced total body weight. Results: We enrolled 36 stroke patients (n=23, 64% African American; n=13, 36% Hispanic), 17 in the smartphone group, and 19 in the food journal group. Mean age was 54 (SD 9) years; mean body mass index was 35.7 (SD 5.7) kg/m2; education, employment status, and family history of stroke or obesity did not differ between the groups. Baseline rates of depression (Patient Health Questionnaire-9 [PHQ-9] score median 5.5, IQR 3.0-9.5), cognitive impairment (Montreal Cognitive Assessment score median 23.5, IQR 21-26), and inability to ambulate (5/36, 14% with modified Rankin Scale score 3) were similar. In total, 25 (69%) stroke survivors completed Swipe out Stroke (13/17 in the smartphone group, 12/19 in the food journal group); 1 participant in the smartphone group died. Median weight change at 180 days was 5.7 lb (IQR –2.4 to 8.0) in the smartphone group versus 6.4 lb (IQR –2.2 to 12.5; P=.77) in the food journal group. Depression was significantly lower at 30 days in the smartphone group than in the food journal group (PHQ-9 score 2 vs 8; P=.03). Clinically relevant depression rates remained in the zero to minimal range for the smartphone group compared with mild to moderate range in the food journal group at day 90 (PHQ-9 score 3.5 vs 4.5; P=.39) and day 180 (PHQ-9 score 3 vs 6; P=.12). Conclusions: In a population of obese minority stroke survivors, the use of a smartphone did not lead to a significant difference in weight change compared with keeping a food journal. The presence of baseline depression (19/36, 53%) was a confounding variable, which improved with app engagement. Future studies that include treatment of poststroke depression may positively influence intervention efficacy.
KW - Cognitive dysfunction
KW - Minority groups
KW - Obesity
KW - Outcome assessment, health care
KW - Smartphone
KW - Stroke
KW - Telemedicine
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UR - http://www.scopus.com/inward/citedby.url?scp=85083777308&partnerID=8YFLogxK
U2 - 10.2196/17816
DO - 10.2196/17816
M3 - Article
C2 - 32319963
AN - SCOPUS:85083777308
SN - 2291-5222
VL - 8
JO - JMIR mHealth and uHealth
JF - JMIR mHealth and uHealth
IS - 4
M1 - e17816
ER -