Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial

Christinelli, Heloá Costa Borim; Westphal, Greice; Costa, Maria Antonia Ramos; Okawa, Rogério Toshiro Passos; Nardo Junior, Nelson; Fernandes, Carlos Alexandre Molena

doi:10.1590/0034-7167-2021-0059

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (Suppl 2) • 2022 • https://doi.org/10.1590/0034-7167-2021-0059 copy

Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial

Intervención multiprofesional y teleenfermería en el tratamiento de obesos en la pandemia de Covid-19: ensayo clínico pragmático

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the effects of a multiprofessional remote intervention and telenursing in the treatment of obesity.

Methods:

pragmatic clinical trial of intervention, conducted with obese adults. The multiprofessional remote intervention with a nurse occurred for 16 weeks through a messaging application. The application analyzed body composition, hemodynamic and laboratory variables, comparing the results obtained with the group that participated in face-to-face multiprofessional intervention without a nurse. The study investigated the effects of the intervention comparing the intervention groups and the moments through the ANOVA test for repeated measures.

Results:

Group 1 obtained significance in the variables: percentage of body fat (p = 0.008); blood glucose (p = 0.014); insulin (p = 0.001); abdominal and waist circumference; and HDL cholesterol (p = 0.000).

Conclusions:

the effects of multiprofessional remote intervention and telenursing significantly decreased the risk variables for metabolic syndrome in the treatment of obesity.

Descriptors:
Obesity Management; Telenursing; Telemonitoring; Patient Care Team; Primary Health Care

Vary	PMTO - G1 (n = 22)			PMTO - G2 (n = 25)			Comparison between groups (p)
Vary	Initial values	Values after intervention	Time effect (p)	Initial values	Values after intervention	Time effect (p)	Comparison between groups (p)
Age (years)	39.55±7.60	39.55±7.60	_	41.48±5.07	41.48±5.07	_	_
Body mass (kg)	101.16±22.46	99.03±23.32	0.064	108.69±19.29	103.47±18.15	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	0.046^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.
Height (m)	1.60.3±0.67	1.60.3±0.67	__	1.63±0.09	1.63±0.09	_	_
BMI (kg/m2)	39.19±7.34	38.31±7.55	0.069	40.84±5.83	39.14±6.06	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	0.180
Lean body mass (kg)	47.65±8.59^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference. .^†	47.53±8.23	0.708	53.18±8.79^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference. .^†	51.99±8.14	*0.001^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	0.020^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.
Body fat %	50.10±4.86	48.45±4.65	0.008^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.	47.28±6.21	46.19±7.63	0.119	0.092
Neck circ. (cm)	37.08±3.22	36.66±3.03	0.237	39.37±4.64	38.55±4.50	0.011^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.	0.416
Abdominal circ. (cm)	110.80±15.27^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference. .^†	101.35±12.29	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	122.38±14.89^* * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference. .^†	115.41±16.29	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**
Waist circ. (cm)	114.23±15.67	97.79±12.73	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	110.41±12.79	105.06±13.24	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	*0.000^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**
Waist-hip ratio	124.35±13.22	122.79±14.71	0.228	125.04±13.06	121.50±14.21	*0.001^ * Pre = G1 × G2; †Pre = G1 × G2 - Bonferroni post-hoc; BMI - Body Mass Index; % - percentage; cm - centimeters; circ - circumference.**	0.208

Vary	PMTO - G1 (n = 22)			PMTO - G2 (n = 25)			Comparison between groups (p)
Vary	Initial values	Values after intervention	Time effect (p)	Initial values	Values after intervention	Time effect (p)	Comparison between groups (p)
SBP mmHg	123.61±10.39	120.08±14.99	0.165	123.08±88	119.32±7.45	0.019^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	0.733
DBP mmHg	87.09±8.41^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein. .^†	85.95±7.93^§.\|\|	0.470	78.12±6.50^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein. .^†	75.56±5.86^c.d	0.136	0.543
SPO₂	96.64±1.87^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein. .^†	97.45±0.74	0.053	95.24±2.11^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein. .^†	96.44±1.56	0.002^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	0.021^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.
HR bpm	77.32±9.04	81.68±11.86^§.\|\|	0.086	80.44±10.34	70.68±9.45^§.\|\|	0.000^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	0.000^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.
Blood glucose (mg / dl)	103.82±35.30	92.91±25.12	0.014^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	93.04±10.41	94.96±12.27	0.319	0.001^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.
Insulin	18.50±8.82	12.41±5.29	0.001^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	22.05±9.65	17.97±10.08	0.024^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	0.350
US-CRP	6.51±4.14	6.63±4.39	0.894	9.25±10.52	9.77±10.83	0.787	0.928
Total cholesterol	199.09±32.73	217.05±37.18^§.\|\|	0.021^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	185.32±26.97	182.48±33.86^§.\|\|	0.604	0.023^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.
HDL	48.73±9.74	67.77±14.67^§.\|\|	0.000^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	46.24±12.33	42.60±9.47^§.\|\|	0.010^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	0.000^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.
LDL	126±26.58^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein. .^†	120.45±30.78	0.414	109.86±26.43^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein. .^†	114.77±30.67	0.290	0.192
Triglycerides	122.82±37.08	124.32±44.70	0.898	152.48±69.75	125.44±52.90	0.033^* * Pre = G1 × G2; †Pre = G1 × G2 § Post = G1 × G2; \|\| Post = G2 × G1 - Bonferroni post-hoc; SBP - systolic blood pressure; DBP - diastolic blood pressure; mmHg - millimeter of mercury; SPO2 - oxygen saturation; HR - heart rate; bpm: beats per minute; mg/dl - milligrams per deciliter; us-CRP - ultra-sensitive C-reactive protein; HDL - high density lipoprotein; LDL - low density lipoprotein.	0.118
Glycated Hemoglobin	5.55±0.85	5.53±0.78	0.826	5.47±0.64	5.35±0.41	0.154	0.390

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[1] Corresponding author: Heloá Costa Borim Christinelli E-mail: heloa.borim@hotmail.com