umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Quality of life and cost-effectiveness of a 3-year trial of lifestyle intervention in primary health care
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
Departement of Social medicine and Public Health and centre for Health Care Science Örebro County Council.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.ORCID-id: 0000-0002-1633-2179
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
Visa övriga samt affilieringar
2010 (Engelska)Ingår i: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 170, nr 16, s. 1470-1479Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Lifestyle interventions reduce cardiovascular risk and diabetes but reports on long term effects on quality of life (QOL) and health care utilization are rare. The aim was to investigate the impact of a primary health care based lifestyle intervention program on QOL and cost-effectiveness over 3 years.

Methods: 151 men and women, age 18-65 yr, at moderate-to-high risk for cardiovascular disease, were randomly assigned to either lifestyle intervention with standard care or standard care alone. Intervention consisted of supervised exercise sessions and diet counseling for 3 months, followed by regular group meetings during 3years. Change in QOL was measured with EuroQol (EQ-5D, EQ VAS), the 36-item Short Form Health Survey (SF-36), and the SF-6D.  The health economic evaluation was performed from a societal view and a treatment perspective. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY) and savings in health care were considered. Cost-effectiveness was also described using the Net Monetary Benefit Method.

Results: Significant differences between groups over the 3-yr period were shown in EQ VAS, SF-6D and SF-36 physical component summary but not in EQ-5D or SF-36 mental component summary. There was a net saving of 47 USD per participant. Costs per gained QALY, savings not counted, were 1,668 – 4,813 USD. Probabilities of cost-effectiveness were 89 – 100 %, when 50 000 USD was used as stakeholder’s threshold of willingness to pay for a gained QALY.

Conclusion: Lifestyle intervention in primary care improves QOL and is highly cost-effective in relation to standard care.

Ort, förlag, år, upplaga, sidor
Chicago: American Medical Association , 2010. Vol. 170, nr 16, s. 1470-1479
Nyckelord [en]
randomized controlled trial, physical activity, body mass, women, prescription, utilities, exercise, efficacy, program, Sweden
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
sjukgymnastik
Identifikatorer
URN: urn:nbn:se:umu:diva-32764DOI: 10.1001/archinternmed.2010.301ISI: 000281764100009OAI: oai:DiVA.org:umu-32764DiVA, id: diva2:305702
Tillgänglig från: 2010-03-25 Skapad: 2010-03-25 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. A 3-year lifestyle intervention in primary health care: effects on physical activity, cardiovascular risk factors, quality of life and cost-effectiveness
Öppna denna publikation i ny flik eller fönster >>A 3-year lifestyle intervention in primary health care: effects on physical activity, cardiovascular risk factors, quality of life and cost-effectiveness
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: A sedentary lifestyle diminishes quality of life (QOL) and contributes to increasing prevalence of obesity, diabetes and cardiovascular diseases (CVD), and thus increases the economic burden on health care and society. Expensive and tightly controlled lifestyle interventions reduce cardiovascular risk and onset of diabetes. Transferring these findings to the primary care setting is of clinical importance. The primary aim of this thesis was to apply a lifestyle intervention program in the primary care setting among individuals with moderate-to-high risk for CVD, and evaluate the effects on physical activity, cardiovascular risk factor levels and QOL. A secondary aim was to investigate the cost-effectiveness.

Methods: A randomized controlled trial with one intervention group (n=75) and one control group (n=76) with follow-up at 3, 12, 24 and 36 months was used. Patients with the diagnosis obesity, hypertension, dyslipidemia, type 2 diabetes or any combination thereof (mean age 54 yr, 57% female) were recruited from a primary health centre in northern Sweden. The three-month intervention period consisted of group-based supervised exercise sessions and diet counselling, followed by regular, but sparse, group meetings with a behavioural approach during three years. Clinical measurements included anthropometrics, aerobic fitness, blood pressure and metabolic traits. Questionnaires on self-reported physical activity, stages of change for physical activity, and QOL were used. In a cost-utility analysis the costs, gained quality-adjusted life years (QALY), and savings in health care were considered. Probability of cost-effectiveness was described using Net Monetary Benefit Method.

Results: Overall, the lifestyle intervention generated beneficial improvements in anthropometrics, blood pressure, aerobic fitness and activity level, and QOL, compared to the control group which only received one information meeting.  At 36 months, intention-to-treat analyses showed that lifestyle modification reduced waist circumference (–2.2 cm), waist-hip ratio (–0.02), systolic blood pressure (–5.1 mmHg), and diastolic blood pressure (–1.6 mmHg) and significantly improved aerobic fitness (5%).  BMI, lipid or glucose values did not differ between groups. Progression to active stages of change for physical activity and increases in time spent exercising and total physical activity were reported. Both physical and mental dimensions of QOL were improved during the study period, but after 3 years differences persisted mainly in physical dimensions. Cost per gained QALY was low, 1668-4813 USD (savings not counted). Visits to family physicians significantly decreased and there was a net saving of 47 USD per participant. Probabilities of cost-effectiveness were 89-100% when 50 000 USD was used as threshold of willingness to pay for a gained QALY.

Conclusions: A group-based lifestyle intervention program in a primary health care setting favourably influences cardiovascular risk-factor profiles, increases physical activity level, and improves several dimensions of QOL in high-risk individuals, at least up to 3 years. The intervention method was highly cost-effective in relation to standard care. The results emphasize the advantage of an intervention that combines supervised exercise with regular follow-ups for reaching long term effects.  The study high-lights the feasibility of lifestyle interventions in the primary care setting and the importance of health care professionals supporting change in lifestyle.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå university, 2010. s. 117
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1333
Nyckelord
lifestyle intervention, primary health care, physical activity, cardiovascular risk factors, quality of life, cost-effectivenesss
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
sjukgymnastik
Identifikatorer
urn:nbn:se:umu:diva-32765 (URN)978-91-7264-953-8 (ISBN)
Disputation
2010-04-16, Aulan, konferenscenter, Sunderby sjukhus, Luleå, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2010-03-26 Skapad: 2010-03-25 Senast uppdaterad: 2010-09-27Bibliografiskt granskad

Open Access i DiVA

fulltext(550 kB)505 nedladdningar
Filinformation
Filnamn FULLTEXT02.pdfFilstorlek 550 kBChecksumma SHA-512
53508ef337ca323c943bd4b408fcc4e121ee63c14eecfe1eba11fd4c3179ad496b05378eb80e9caea3bd1e977bffd80f4596c5db57e53569909b4006c05e6806
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltext

Personposter BETA

Eriksson, Kerstin MargaretaLindholm, LarsMalmgren-Olsson, Eva-BrittEliasson, Mats

Sök vidare i DiVA

Av författaren/redaktören
Eriksson, Kerstin MargaretaLindholm, LarsMalmgren-Olsson, Eva-BrittEliasson, Mats
Av organisationen
SjukgymnastikEpidemiologi och global hälsaMedicin
I samma tidskrift
Archives of Internal Medicine
Sjukgymnastik

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 530 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
urn-nbn

Altmetricpoäng

doi
urn-nbn
Totalt: 407 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf