Katherine D Hoerster1,2,3, Lamont Tanksley2, Tracy Simpson2,3,4, Brian E Saelens3,5, Jürgen Unützer3, Marissa Black6, Preston Greene1, Nadiyah Sulayman1, Gayle Reiber7,8, Karin Nelson1,9,10. 1. Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA. 2. Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA. 3. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. 4. Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA. 5. Seattle Children's Research Institute, Seattle, WA, USA. 6. Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA. 7. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA. 8. Health Services Research Center of Innovation, Salt Lake City, UT, USA. 9. General Internal Medicine Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA. 10. Department of Medicine, University of Washington, Seattle, WA, USA.
Abstract
PURPOSE: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. DESIGN: Single-arm pre-post pilot to iteratively develop MOVE!+UP (2015-2018). SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = "Development" and cohort 5 [n = 8] = "Final" MOVE!+UP). INTERVENTION: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. MEASURES: To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. ANALYSIS: Baseline to 16-week paired t tests and template analysis. RESULTS: Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight (M = -14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD (M = -17.9 [SD = 12.2]) improvements, P < .05. CONCLUSIONS: The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.
PURPOSE: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. DESIGN: Single-arm pre-post pilot to iteratively develop MOVE!+UP (2015-2018). SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = "Development" and cohort 5 [n = 8] = "Final" MOVE!+UP). INTERVENTION: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. MEASURES: To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. ANALYSIS: Baseline to 16-week paired t tests and template analysis. RESULTS: Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight (M = -14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD (M = -17.9 [SD = 12.2]) improvements, P < .05. CONCLUSIONS: The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.
Entities:
Keywords:
PTSD; health disparities; mental health; physical activity; weight management
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