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A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities |
Aneni EC, Roberson LL, Maziak W, Agatston AS, Feldman T, Rouseff M, Tran TH, Blumenthal RS, Blaha MJ, Blankstein R, Al-Mallah MH, Budoff MJ, Nasir K |
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CRD summary Internet-based employee cardiovascular wellness and prevention programmes did not show consistent improvement across any of the outcomes assessed. Overall the authors' cautious conclusions are likely to be reliable and further research is required to confirm if these programmes are beneficial in targeted employee populations. Authors' objectives To evaluate the effectiveness of internet-based employee cardiovascular wellness and prevention programmes. Searching PubMed, Web of Science and The Cochrane Library were searched to November 2012 (search terms reported) for eligible studies. References of reviews and identified studies were also checked for eligible studies. Only published studies were considered for inclusion. Study selection Studies which focused on internet-based interventions (required accessing the internet) in employee/working populations and reported cardiovascular outcomes were eligible for inclusion. Reviews, case series and case reports were excluded but all other study designs were considered if the follow-up was longer than six months. Pre-specified outcomes included: weight, physical activity, lipids, dietary changes, blood pressure and smoking cessation. Randomised controlled trials (RCTs) and uncontrolled pre-post studies were included with follow-up duration between six months and two years. The interventions were classified as either internet-based with minimal interaction or multi-component interventions with additional non-internet features. Most were primarily internet-based without significant additional components. Intervention features included a specially designed website and needs assessment via questionnaires or monitoring devices. Two reviewers independently screened studies for inclusion; final decisions were made by consensus. Assessment of study quality Studies were assessed according to Ogilvie's criteria, a two part process. Studies were graded for study design and for a number of methodological items. High-quality studies scored at least four out of six items, and A or B on study design. It was not clear how many reviewers performed the quality assessment. Data extraction Data extraction was not described. Methods of synthesis The included studies were described in text and tables, and appear to have been pooled using narrative synthesis. Modified harvest plots were also presented to illustrate the direction of effect, study quality and study design. Results of the review A total of 29 studies were included (18 randomised controlled studies and 11 pre-post studies). All of the randomised studies were described as high quality while most of the non-randomised studies were of low quality. The results below focus on findings from the high-quality studies; see complete article for full details. All multi-component interventions were found to be effective. Weight related outcomes were reported by 20 studies including actual weight, BMI, waist circumference, skin fold thickness and body fat changes. Among the high-quality studies (15 in total) only seven reported significant improvements in any weight related outcome, and these were generally modest. Blood pressure was reported by seven high-quality studies, two of which reported statistically significant reductions in blood pressure. Blood glucose was reported by one high-quality study with mixed results. Lipid profile outcomes were reported by six high-quality studies, of which three showed significant improvements. Dietary outcomes were reported by nine high-quality studies, of which four reported significant improvements. Outcome measures differed across the studies. Physical activity was reported by nine high-quality studies, of which only one reported significant improvements. Smoking cessation was measured by three low-quality studies, all reported significant intervention effects. Authors' conclusions Overall, internet-based employee cardiovascular wellness and prevention programmes did not show consistent improvement across any of the outcomes assessed. These programmes may be a promising resource for improving cardiovascular wellness among employees, however further research was required to understand their utility and long term impact particularly among special/at-risk populations. CRD commentary The review addressed a clear question and searched a limited range of databases. It was unclear if language restrictions were applied. The review processes were only partially reported. Included studies were tabulated and quality assessed. The use of cut-offs to determine high versus low quality was controversial, but it was clear in the synthesis which studies were contributing the more reliable data. The synthesis appeared to have been narrative, although the use of vote-counting can be misleading. Overall the authors' cautious conclusions are likely to be reliable and further research is required to confirm if these programmes are beneficial in targeted employee populations. Implications of the review for practice and research Practice: No specific recommendations for practice were made. Research: Studies in specific populations were recommended, including high-risk participants with longer follow-up. Bibliographic details Aneni EC, Roberson LL, Maziak W, Agatston AS, Feldman T, Rouseff M, Tran TH, Blumenthal RS, Blaha MJ, Blankstein R, Al-Mallah MH, Budoff MJ, Nasir K. A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities. PLOS ONE 2014; 9(1): e83594 Indexing Status Subject indexing assigned by NLM MeSH Cardiovascular Diseases /prevention & Health Promotion; Humans; Internet; PubMed; Risk Management; Treatment Outcome; Workplace; control AccessionNumber 12014006056 Date bibliographic record published 04/02/2014 Date abstract record published 25/02/2014 Record Status This is a systematic review that meets the criteria for inclusion on DARE. |
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