Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION)

Abstract

Background: Unhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking.

Methods: This multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients' cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures.

Results: General multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were - 0.15 cm (95%CI: - 2.49; 2.19) after six and - 1.03 cm (95%CI: - 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients' readiness to change dietary behaviour.

Conclusion: A multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients.

Trial registration: Dutch Trial Registry, www.trialregister.nl , NTR3765, 21 December 2012.

Keywords: E-health; Health behaviour change; Healthy lifestyle; Metabolic syndrome; Motivational interviewing; Physical activity; Serious mental illness.

Fig. 1

Flow chart of patients in the LION trial

Fig. 2

Somatic outcomes at baseline, six and twelve months per condition. Legend: Estimated marginal means and standard errors for: a) waist circumference, b) BMI and c) metabolic syndrome Z-score for intervention and control groups at baseline, six and twelve months.

Fig. 3

Intervention adherence of patients in the LION trial. Legend: If participants completed at least one lifestyle behaviour screening and constructed a lifestyle plan with lifestyle goals, they were considered a low user when no follow-up reports were completed; a medium user when between one and nine follow-up reports were completed; and a high user when ten or more follow-up reports were completed.