L'éducation thérapeutique réduit les risques de nouvelles maladies

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A clinical trial proves the efficacy of a disease management program in the reduction of comorbidities in patients taking psychotropic drugs.

A US randomized controlled trial of Green and colleagues, published in the American Journal of Psychiatry in 2015, evaluates the efficacy of a therapeutic education program for six months on weight loss and reduced risk of diabetes of patients on antipsychotic drugs. The results show a decrease in hospitalizations and improved fasting blood sugar for the group receiving the intervention compared to the control group at the end of the program, then 6 months.

The Study Rationale

People suffering from chronic mental illness have a high risk of contracting other diseases, especially those of metabolic origin such as obesity and diabetes type 2. These comorbidities cause premature mortality in these patients. The causes are multiple and often combined:

– Adverse effects of antipsychotic drugs,

– Limited access to medical services,

– Bad nutrition,

– Hyperglycemia,

– Physical inactivity,

– Smoking,

– Substance addiction.

A targeted therapeutic education program could improve the health of patients and reduce their risk of metabolic and cardiovascular diseases. The use of psycho-behavioral techniques to regulate body weight and education for self-management of the disease may be more useful for these people.

The Question

Three months aqua-they improve aerobic capacity, functional ability and perceived physical health of patients with rheumatoid arthritis?

The Protocol

The randomized controlled Bilberg and colleagues, published in the journal Rheumatology in 2005, compared the effectiveness of a water aerobics program on endurance, functional capacity and perceived physical health to a control group without intervention. The study examined 47 patients with rheumatoid arthritis, aged 20-65 years. The study included patients whose disease was diagnosed between one and five years prior to study participation. Drug treatment should be stabilized during the three months prior to surgery.

Patients were randomly placed either in the group benefiting from the aerobics program or in the control group following routine care. The evaluations were performed by physiotherapists who did not know the group of belonging patients. The researchers measured the quality of life (SF-36), aerobic capacity (submaximal endurance test on a cycle ergometer), muscular endurance (test of the chair and isometric endurance test of the shoulder) and flexibility. Patients were evaluated at the beginning and end of the intervention and at 6 months follow-up.

The tested Non-Pharmacological Intervention (NPI)

The objective of the overall change in response to health behaviors named STRIDE was to reduce body weight between 4.5 and 6.8 kilos in 6 months. Intervention patients learned behavioral self-management and problem solving techniques. It promoted social support and ownership of the program. He was asked participants to practice more than 25 minutes of moderate physical activity daily. The calorie intakes were reduced through a customized diet plan. The operation was overseen by a mental health counselor and nutritionist.

The sessions were conducted in groups and lasted 2 hours per week. Patients had to keep a diary of foods, beverages, fruit portions, vegetables and dairy products low in fat consumed. They also had to note the time of daily exercise and sleep duration. health professionals examined the participants’ files to help them evaluate and modify their goals and their time.

At the end of the six months of intervention, the objective was to keep the weight reaches about 6 months of follow-up. During this period, patients were contacting monthly advise them by phone.

Main Results

The results show that the STRIDE intervention helped patients lose an average of 4.4 kg more than patients in the control group at 6 months. However, this difference does not exist six less after the program.

The fasting glucose level is reduced by 5.9 mg / dL in the group STRIDE and increases of 3.5 mg / dL in the control group at one year. Patients STRIDE group had fewer medical admissions compared to the control group over a period of one year, or 6.7% against 18.8% of hospitalizations respectively. However, there was no difference in the number of hospitalizations for psychiatric reason between the two groups.

What it means for Patients

The therapeutic education program STRIDE reduced body weight after six months in patients treated with antipsychotic drugs. Six months after the program, the researchers found a continuation of benefits on blood sugar fasting and half of hospitalizations for reasons other than mental.

What it means for Healthcare Professionals

The therapeutic education program STRIDE six months allows a weight loss of 4.4 kg on average in patients taking antipsychotics. Six months after the program, the researchers found a continuation of benefits on blood sugar fasting and hospitalizations for non-psychiatric reasons halved. Their risk of cardiovascular and metabolic comorbidity is thus reduced.

What it means for Researchers

Patients treated with antipsychotics can significantly lose weight and improve their fasting blood sugar by following an integrated program change health behaviors named STRIDE. These techniques are especially borrowed from cognitive behavioral therapy. The characterization of the NIE is essential in any clinical trial.

What it means for Policymakers

The therapeutic education program STRIDE reduced body weight after six months of antipsychotic in patients. Six months after the program, the researchers found a continuation of benefits on blood sugar fasting and a halving of the number of hospitalizations for reasons other than mental.

The reference

Green CA, Yarborough BJH, Leo MC, Yarborough MT, Stumbo SP, Janoff SL, Perrin NA, Nichols GA, Stevens VJ (2015). The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial. American Journal of Psychiatry, 172, 71-81.

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To reference this Blog en Sante © article.

Ninot G (2016). A disease management program reduces the risk of new diseases. Blog en Sante, A75.

© Copyright 2016 Grégory Ninot. All rights reserved.