Building an Evidence Base for Weight Loss Strategies Among Those With Chronic SCI-The GLB-SCI+

Study Overview
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Brief Summary
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This study's overarching aim is to follow a systematic approach that incorporates community-based participatory research (CBPR) to develop a multi-component weight loss intervention that may yield significant effects for a chronic SCI sample. The approach is to obtain data on the 3 unique strategies (prepackaged/portion-controlled meals; enhanced self-monitoring; the GLB-SCI) to inform design of an empirically supported and consumer-validated multicomponent intervention program, that combines the best of the 3 approaches into one unique intervention, the GLB SCI+. Based on the investigators' prior experience with adapting and delivering the GLB AIM (a lifestyle intervention previously adapted for those with impaired mobility), interim findings, existing literature, and consumer feedback, they hypothesize that these 3 unique strategies may confer individualized benefits to people with SCI given their complex disability-related barriers to weight loss.

Official Title
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Building an Evidence Base for Weight Loss Strategies Among Those With Chronic SCI-The GLB-SCI+

Conditions
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Spinal Cord Injuries, Obesity, Weight Loss, Diet Modification

Intervention / Treatment
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* Behavioral: Portion-Controlled Meals
* Behavioral: Enhanced Self-Monitoring
* Behavioral: GLB-SCI
* Behavioral: GLB-SCI+


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Over 18 years old Have had a spinal cord injury for at least 1 year Overweight as evidenced by BMI > 25 Must have sufficient upper arm mobility to engage in exercise Must have access to the internet Must be able to obtain physician signed clearance to participate in a weight management intervention Exclusion Criteria: Cognitive impairment which substantially impairs autonomy (e.g. mental retardation) Medical issues for which exercise is contraindicated such as uncontrolled hypertension or coronary heart disease, Pregnancy Not fluent in English Presence of grade 3 or 4 pressure ulcer Previously diagnosed eating disorder

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Portion-Controlled Meals<br>Participants will receive prepackaged food, delivered biweekly to their home over the course of 13 weeks, with costs covered by the grant. Depending on their calorie goals, participants will drink and eat a mix of shakes and entrees each day, plus up to five fruits and vegetables. HMR entrees and shakes are formulated to provide recommended levels of macronutrients, vitamins, sodium, fat, cholesterol and fiber and fortified to meet at least 100% of the recommended daily allowance for essential vitamins and minerals. | Behavioral: Portion-Controlled Meals<br>* Participants will receive portion-controlled meals with the aim of encouraging weight loss and healthier eating.<br>|
| Experimental: Enhanced Self-Monitoring<br>Participants will be encouraged to self-monitor 4 specific behaviors daily: 1) measuring their food; 2) measuring their physical activity; 3) recording their food, drink, and physical activity; and 4) monitoring their weight. To achieve this aim, participants will attend a single group-based educational session at baseline during which they will be provided the self-monitoring equipment (scale and Garmin vivofit) and receive training about how to use the Lilypad scale and smartphone food tracking app. | Behavioral: Enhanced Self-Monitoring<br>* Participants will be encouraged to track their physical activity, food intake, and weight using technology that will be provided as part of the study.<br>|
| Experimental: GLB-SCI<br>The content and delivery format of the developed GLB SCI lifestyle intervention program is subject to change based on guidance of the SCI Consumer Group. Therefore, this section provides a general description of the GLB AIM (lifestyle intervention program adapted for impaired mobility). The content of the GLB AIM core meetings include a mix of in-person (4) and telephone (9) sessions. The initial meeting is conducted in person, with one in-person sessions delivered each month, and the intervening weeks delivered by telephone. To achieve weight loss, participants will be encouraged to follow daily calorie and fat gram goals to achieve a .5 to 1 pound weight loss over the 13 weeks. Participants will also be encouraged to gradually increase their physical activity to ultimately achieve 150 weekly minutes. | Behavioral: GLB-SCI<br>* Participants will take part in a lifestyle intervention program (tailored for spinal cord injury needs) that encourages steady weight loss through increased physical activity and healthier diet patterns.<br>|
| Experimental: GLB-SCI+<br>The final multicomponent GLB SCI+ will include combining specific intervention strategies identified from the previous 3 interventions as effective and usable. If all 3 strategies yield evidence in support of being included, the combined intervention would encompass (1) providing prepackaged foods for a specified period of time to facilitate greater initial weight loss, (2) encouraging enhanced self-monitoring of food, physical activity, and weight using devices and apps along with social support, and (3) delivering the further adapted GLB SCI in a group-based format to teach skills helpful in making lifestyle changes. | Behavioral: GLB-SCI+<br>* Participants will receive a combination of the prior interventions studied, with the goal of showing that a multi-component intervention will be the most effective in encouraging weight loss among participants with a spinal cord injury.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in weight | Change in weight (pounds) will be measured after each 13-week intervention. | Approximately every 13 weeks through study completion, expected to be 3 years. | 
| Change in physical activity level | Change in self-reported physical activity (minutes per week) will be measured after each 13-week intervention to assess whether the intervention effectively encouraged greater levels of physical activity. | Approximately every 13 weeks through study completion, expected to be 3 years. | 
| Self-efficacy | Self-efficacy will be measured through changes in the Self-Rated Abilities for Health Practices Scale from baseline to post-intervention. The questionnaire contains 28 items that are on a 5-point scale. It was designed to measure a person's perception of his/her own ability to practice healthy behaviors and has 4 sub-scales with 7 items each: Exercise, Nutrition, Responsible Health Practice, and Psychological Well Being. Ratings for each subscale are summed to yield subscale scores and subscale scores are summed to obtain a total score. Higher scores indicate greater confidence in one's ability to perform health practices and total scores range from 0-112. | Approximately every 13 weeks through study completion, expected to be 3 years. | 
| Function/Quality of Life | Changes in self-reported levels of function and quality of life will be assessed through the LIFE-H survey, given before and after each intervention. The Assessment of Life Habits (LIFE-H) assesses a person's self-reported difficulty with and need for assistance performing tasks associated with activities of daily living (ADL) and social roles. The version used for this study covers 6 ADL categories: nutrition, fitness, personal care, communication, residence, mobility and 6 social role categories: responsibility, interpersonal relations, community, education, employment, recreation. Scoring is based on respondent rating of level of accomplishment (No difficulty to Not accomplished) combined with the type of assistance (if any) used to perform these tasks. Scores range from 9 to 0, with higher scores indicating less difficulty. | Approximately every 13 weeks through study completion, expected to be 3 years. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in waist circumference | Participants will have their waist circumference measured before and after each intervention to assess the level of change, if any. | Approximately every 13 weeks through study completion, expected to be 3 years. | 
| Change in blood pressure (systolic and diastolic) | Participants will have their blood pressure measured before and after each intervention to assess the level of change, if any. | Approximately every 13 weeks through study completion, expected to be 3 years. | 
| Change in hemoglobin A1c level | Participants will have their hemoglobin A1c measured before and after each intervention assess the level of change, if any. | Approximately every 13 weeks through study completion, expected to be 3 years. | 
| Change in motivation for weight-loss | Participants will have their levels of motivation assessed before and after each intervention with the Treatment Self-Regulation Questionnaire. The 18-item Treatment Self-Regulation Questionnaire is derived from self-determination theory and yields 2 subscales: autonomous regulation (or intrinsic motivation) and controlled regulation (or extrinsic motivation). Responses are provided on a 7-point Likert type scale ranging from 1 'not at all true' to 7 'very true,' and includes the option of not applicable. Autonomous Regulation scores are obtained by averaging questions 3, 4, 9, 13, 17, 18 and Controlled Regulation scores are obtained by averaging questions 1, 2, 5, 6, 7, 8, 10, 11, 12, 14, 15, 16. Higher scores indicate higher levels of motivation. Higher scores indicate higher levels of each type of regulation. | Approximately every 13 weeks through study completion, expected to be 3 years. |