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| ID | Type | Description | Link |
|---|---|---|---|
| R21HS023963 | U.S. AHRQ Grant/Contract | View source |
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The goal of this study is to facilitate the dissemination and implementation of patient centered outcomes research using mHealth technology to improve self-management of adverse symptoms in persons living with HIV/AIDS (PLWH). Symptom management in PLWH is especially important because the US HIV epidemic continues to exact a huge toll, especially among Agency for Healthcare Research and Quality (AHRQ) priority populations including racial, ethnic, and sexual minorities and low-income persons. The incorporation of HIV symptom management strategies into patients' lives through the use of mHealth technologies has the potential to advance the effective dissemination and implementation of patient centered outcomes research findings.
HIV has changed from an acute illness to a chronic disease. The success of HIV medications and treatments has significantly altered the course of the disease. While AIDS-related illnesses are no longer the primary threat, a new set of HIV-associated complications have emerged, resulting in a chronic disease that for many will span several decades of life. The ability to self-manage adverse symptoms of HIV illness has been shown to improve patient-centered outcomes. In response to this need, a team at University of California, San Francisco (UCSF) developed a paper-based symptom management manual with self-management strategies for 21 common HIV/AIDS adverse symptoms (PCOR evidence). The efficacy of the manual was demonstrated in a 775-person randomized controlled trial (RCT) over three months at 12 sites. However, subsequent use of these strategies has been very limited; mHealth offers an ideal platform for the implementation and dissemination of evidence-based strategies for HIV symptom management. Due to the high incidence of HIV among racial and ethnic minority populations, it is appropriate to develop mHealth tools tailored to the needs of these populations. mHealth technology has the potential to address many of the healthcare needs of persons living with HIV/AIDS (PLWH) including symptom management. In response to these current issues, this study seeks to inform the development and testing of a mHealth application that will incorporate findings from PCOR studies to improve the outcomes of PLWH. To improve outcomes for those most in need, study activities are focused on communities with the greatest burden of HIV in the US, including racial and ethnic minorities and those of low socioeconomic status.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| mVIP group | Experimental | This group will receive targeted symptom strategies via a Health Management App developed from the UCSF symptom management manual based on the symptoms that they report. This is the intervention app group. |
|
| Attention Control Group | Placebo Comparator | This group will received an app without symptom strategies, pre-loaded on their smartphones. This is the control app group. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Health Management App with symptom strategies | Device | The mVIP group will receive a Health Management App with symptom strategies. A mobile app which includes symptom strategies from the UCSF symptom management manual. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Symptom Status From Baseline to Week 12 | Change in Symptom Status calculates the difference in symptom scores between the intervention and control groups at baseline versus follow-up after 12 weeks. Symptom scores were determined using the Revised Sign and Symptom Check-List for HIV (SSC-HIVrev), where participants who reported experiencing any one of the 13 symptoms in the past 7 days were asked how much it bothered them (a little bit, somewhat, quite a bit, or very much). Instances where the symptom did not bother the individual were coded as "0" whereas instances where the symptom bothered the individual any amount were recoded as "1". The overall difference between groups at baseline and after 12 weeks ("difference of differences") falls within a range of -1 to 1, where lower numbers indicate the symptom bothered the person less, while higher numbers indicate it bothered them more. With the Difference Between Groups, a more negative score (closer to -1) represents a better outcome. | Baseline and 12 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Quality of Life -- RAND-36 | 36-Item Short Form Survey (RAND-36) is a widely-used 36-item tool to measure health-related quality of life, where each item in the scale is scored as 0, 25, 50, 75, or 100. Scoring is a two-step process. First, precoded numeric values are recoded per the scoring key so that all items are scored so that a high score defines a more favorable health state. In addition, each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively. Scores represent the percentage of total possible score achieved. In step 2, items in the same scale are averaged together to create the 8 scale scores, where a lower score may indicate a better outcome for some of the scales, while it may indicate a better outcome for others. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Rebecca Schnall, PhD, MPH, RN-BC, FAAN | Columbia University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Columbia University School for Nursing | New York | New York | 10032 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | mVIP Group | This group will receive targeted symptom strategies from the University of California, San Francisco (UCSF) symptom management manual based on the symptoms that they report. Health Management App with symptom strategies: The mVIP group will receive a Health Management App with symptom strategies. A mobile app which includes symptom strategies from the UCSF symptom management manual. |
| FG001 | Attention Control Group | This group will have the Health Management App without symptom strategies pre-loaded on their smartphones. Health Management App without symptom strategies: The attention control group will receive the Health Management App preloaded on their smartphones without symptoms strategies |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | mVIP Group | This group will receive targeted symptom strategies from the UCSF symptom management manual based on the symptoms that they report. Health Management App with symptom strategies: The mVIP group will receive a Health Management App with symptom strategies. A mobile app which includes symptom strategies from the UCSF symptom management manual. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Change in Symptom Status From Baseline to Week 12 | Change in Symptom Status calculates the difference in symptom scores between the intervention and control groups at baseline versus follow-up after 12 weeks. Symptom scores were determined using the Revised Sign and Symptom Check-List for HIV (SSC-HIVrev), where participants who reported experiencing any one of the 13 symptoms in the past 7 days were asked how much it bothered them (a little bit, somewhat, quite a bit, or very much). Instances where the symptom did not bother the individual were coded as "0" whereas instances where the symptom bothered the individual any amount were recoded as "1". The overall difference between groups at baseline and after 12 weeks ("difference of differences") falls within a range of -1 to 1, where lower numbers indicate the symptom bothered the person less, while higher numbers indicate it bothered them more. With the Difference Between Groups, a more negative score (closer to -1) represents a better outcome. | Posted | Mean | Standard Error | score on a scale | Baseline and 12 weeks |
|
Study duration, 12 weeks
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | mVIP Group | This group will receive targeted symptom strategies from the UCSF symptom management manual based on the symptoms that they report. Health Management App with symptom strategies: The mVIP group will receive a Health Management App with symptom strategies. A mobile app which includes symptom strategies from the UCSF symptom management manual. |
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Participants wanted reminders and login information sent via text instead of email. Both groups wanted summary reports of symptoms. Self-care strategy videos did not have sound. Generalizability is limited due to smartphone/tablet requirement.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Rebecca Schnall | Columbia University | 212-342-6886 | rb897@cumc.columbia.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 17, 2018 | Sep 7, 2018 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D000163 | Acquired Immunodeficiency Syndrome |
| ID | Term |
|---|---|
| D015658 | HIV Infections |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D007239 | Infections |
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| Control App | Device | The attention control group will receive an app which asked them about their symptoms but did not provide symptoms strategies |
|
| Baseline and 12 weeks |
| Patient-Reported Outcomes Measurement Information System (PROMIS)-29 | The PROMIS-29 includes seven health related quality of life domains on a 5-point scale from a score of 1 to 5 and the pain domain has two subdomains (interference and intensity) where pain intensity is assessed using a single 11-point numeric rating scale anchored between no pain (0) and worse imaginable pain (10). Raw scores are transformed using the T-score metric based on the item response theory calibrations in which scores have a mean of 50 and standard deviation of 10 for the general population in the US. T-scores can be estimated using the scoring tables listed in the PROMIS manuals. A higher PROMIS T-score implies more of the concept being measured; for instance, a higher PROMIS score on physical function indicates better functioning, whereas a higher score on depression indicates a greater severity of depression. | 12 weeks |
| Engagement With Healthcare Provider | Engagement with Health Care Provide scale is a 13-item scale in which subjects rate their interactions with their health care providers on a four-point scale with 1=always true and 4=never true in which a lower score indicates a better outcome. The scores are then collated to an aggregate score where the minimum value = 13 and the maximum value = 52. A low score indicates greater provider engagement, where as higher scores indicate lower provider engagement (less favorable outcome). The difference in scores at baseline and follow-up at three months was calculated within both the intervention and control groups, and the difference was then taken between the resulting means of those scores. | Baseline and 12 weeks |
| Medication Adherence | Medication adherence was calculated by two scales: the Center for Adherence Support Evaluation (CASE) Adherence Index and the Visual Analogue Scale (VAS). The CASE Adherence Index consists of the composite scores of three questions evaluating self-reported measures of adherence. The minimum score on this scale is 3 while the maximum score on this scale is 16, with higher scores indicating better outcome. Scores greater than 10 indicate "good adherence," while scores less than or equal to 10 indicate poor adherence. The VAS asks subjects to indicate a point on a line that shows their best guess about how much of each drug they have taken from a scale of 0% to 100% in which 0% means they have taken no drug, 50% means they have taken half their drugs, and 100% means they have taken every single dose. Consequently, a higher score (100%) indicates | 12 weeks |
| Health-IT Usability Evaluation Scale (Health-ITUES) | Health Information Technology Usability Evaluation Scale (Health-ITUES) was used to measure usability. Health-ITUES consists of 20 items rated on a 5-point Likert scale from strongly disagree (score of 1) to strongly agree (score of 5) measuring actual usage, intention to use, satisfaction, perceived usefulness, perceived ease of use, perceived performance speed, learnability, competency, flexibility/customizability, memorability, error prevention, information needs, and other outcomes. A higher score (5) indicates higher usability. Overall score was calculated as the mean score from the score for quality of life, perceived usefulness, perceived ease of use, and user control. | 12 weeks |
| BG001 |
| Attention Control Group |
This group will have the Health Management App without symptom strategies pre-loaded on their smartphones. Health Management App without symptom strategies: The attention control group will receive the Health Management App preloaded on their smartphones without symptoms strategies |
| BG002 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Education | Count of Participants | Participants |
|
| Annual income | Count of Participants | Participants |
|
| Employment | Count of Participants | Participants |
|
| Antiretroviral therapy (ART) Use | Count of Participants | Participants |
|
| Virologically suppressed | Count of Participants | Participants |
|
| Ever diagnosed with AIDS | Count of Participants | Participants |
|
| Cluster of Differentiation 4 (CD4) count greater than 500 | Count of Participants | Participants |
|
| Possible alcohol use disorder | Count of Participants | Participants |
|
| Substance use weekly or more often | Count of Participants | Participants |
|
| Intervention |
Participants in the intervention group received self-care strategies for symptoms which they reported experiencing in the past seven days. Three self-care strategies were delivered for each reported symptom, along with short (3-27sec) videos to illustrate the strategy. At the end of the app session, participants were able to view a summary of their strategies. |
| OG001 | Control | Participants in the control group were asked the same questions about symptoms experienced in the last seven days (as dictated by the Revised Sign and Symptom Check-List for HIV -- SSC-HIVrev), though they were not given any self-care or symptom management strategies. |
| OG002 | Difference Between Groups | This represents the calculated difference between the average score changes from baseline to follow-up (12 weeks) among control and intervention group participants (described in the first two columns). |
|
|
|
| Secondary | Change in Quality of Life -- RAND-36 | 36-Item Short Form Survey (RAND-36) is a widely-used 36-item tool to measure health-related quality of life, where each item in the scale is scored as 0, 25, 50, 75, or 100. Scoring is a two-step process. First, precoded numeric values are recoded per the scoring key so that all items are scored so that a high score defines a more favorable health state. In addition, each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively. Scores represent the percentage of total possible score achieved. In step 2, items in the same scale are averaged together to create the 8 scale scores, where a lower score may indicate a better outcome for some of the scales, while it may indicate a better outcome for others. | Posted | Mean | Standard Deviation | score on a scale | Baseline and 12 weeks |
|
|
|
|
| Secondary | Patient-Reported Outcomes Measurement Information System (PROMIS)-29 | The PROMIS-29 includes seven health related quality of life domains on a 5-point scale from a score of 1 to 5 and the pain domain has two subdomains (interference and intensity) where pain intensity is assessed using a single 11-point numeric rating scale anchored between no pain (0) and worse imaginable pain (10). Raw scores are transformed using the T-score metric based on the item response theory calibrations in which scores have a mean of 50 and standard deviation of 10 for the general population in the US. T-scores can be estimated using the scoring tables listed in the PROMIS manuals. A higher PROMIS T-score implies more of the concept being measured; for instance, a higher PROMIS score on physical function indicates better functioning, whereas a higher score on depression indicates a greater severity of depression. | Posted | Mean | Standard Deviation | T-score | 12 weeks |
|
|
|
|
| Secondary | Engagement With Healthcare Provider | Engagement with Health Care Provide scale is a 13-item scale in which subjects rate their interactions with their health care providers on a four-point scale with 1=always true and 4=never true in which a lower score indicates a better outcome. The scores are then collated to an aggregate score where the minimum value = 13 and the maximum value = 52. A low score indicates greater provider engagement, where as higher scores indicate lower provider engagement (less favorable outcome). The difference in scores at baseline and follow-up at three months was calculated within both the intervention and control groups, and the difference was then taken between the resulting means of those scores. | Posted | Mean | Standard Deviation | score on a scale | Baseline and 12 weeks |
|
|
|
|
| Secondary | Medication Adherence | Medication adherence was calculated by two scales: the Center for Adherence Support Evaluation (CASE) Adherence Index and the Visual Analogue Scale (VAS). The CASE Adherence Index consists of the composite scores of three questions evaluating self-reported measures of adherence. The minimum score on this scale is 3 while the maximum score on this scale is 16, with higher scores indicating better outcome. Scores greater than 10 indicate "good adherence," while scores less than or equal to 10 indicate poor adherence. The VAS asks subjects to indicate a point on a line that shows their best guess about how much of each drug they have taken from a scale of 0% to 100% in which 0% means they have taken no drug, 50% means they have taken half their drugs, and 100% means they have taken every single dose. Consequently, a higher score (100%) indicates | Posted | Mean | Standard Deviation | score on a scale | 12 weeks |
|
|
|
|
| Secondary | Health-IT Usability Evaluation Scale (Health-ITUES) | Health Information Technology Usability Evaluation Scale (Health-ITUES) was used to measure usability. Health-ITUES consists of 20 items rated on a 5-point Likert scale from strongly disagree (score of 1) to strongly agree (score of 5) measuring actual usage, intention to use, satisfaction, perceived usefulness, perceived ease of use, perceived performance speed, learnability, competency, flexibility/customizability, memorability, error prevention, information needs, and other outcomes. A higher score (5) indicates higher usability. Overall score was calculated as the mean score from the score for quality of life, perceived usefulness, perceived ease of use, and user control. | Posted | Mean | Standard Deviation | score on a scale | 12 weeks |
|
|
|
|
| 0 |
| 40 |
| 0 |
| 40 |
| 0 |
| 40 |
| EG001 | Attention Control Group | This group will have the Health Management App without symptom strategies pre-loaded on their smartphones. Health Management App without symptom strategies: The attention control group will receive the Health Management App preloaded on their smartphones without symptoms strategies | 0 | 40 | 0 | 40 | 0 | 40 |
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| D015229 |
| Sexually Transmitted Diseases, Viral |
| D012749 | Sexually Transmitted Diseases |
| D016180 | Lentivirus Infections |
| D012192 | Retroviridae Infections |
| D012327 | RNA Virus Infections |
| D014777 | Virus Diseases |
| D012897 | Slow Virus Diseases |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D007153 | Immunologic Deficiency Syndromes |
| D007154 | Immune System Diseases |
| Role limitations due to emotional problems scale |
|
| Energy/fatigue scale |
|
| Emotional well-being scale |
|
| Social functioning scale |
|
| Pain scale |
|
| General health scale |
|
| Physical health summary scale |
|
| Mental health summary scale |
|
| Role limitations due to physical health scale | Mixed Models Analysis | [Not specified] | 0.458 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Median Difference (Final Values) | 7.47 | Standard Error of the Mean | 10.02 | 2-Sided | [Not specified] | Superiority | [Not specified] |
| Role limitations due to emotional problems scale | Mixed Models Analysis | [Not specified] | 0.725 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 3.50 | Standard Error of the Mean | 9.91 | 2-Sided | [Not specified] | Superiority | [Not specified] |
| Energy/fatigue scale | Mixed Models Analysis | [Not specified] | 0.807 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -1.00 | Standard Error of the Mean | 4.09 | 2-Sided | [Not specified] | Superiority | [Not specified] | [Not specified] |
| Emotional well-being scale | Mixed Models Analysis | 0.693 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 1.48 | Standard Error of the Mean | 3.73 | 2-Sided | Superiority |
| Social functioning scale | Mixed Models Analysis | 0.128 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -8.93 | Standard Error of the Mean | 5.80 | 2-Sided | Superiority |
| Pain scale | Mixed Models Analysis | 0.007 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -14.33 | Standard Error of the Mean | 5.18 | 2-Sided | Superiority |
| General health scale | Mixed Models Analysis | 0.960 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -0.20 | Standard Error of the Mean | 3.93 | 2-Sided | Superiority |
| Physical health summary scale | Mixed Models Analysis | 0.836 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -0.93 | Standard Error of the Mean | 4.47 | 2-Sided | Superiority |
| Mental health summary scale | Mixed Models Analysis | 0.822 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -0.81 | Standard Error of the Mean | 3.60 | 2-Sided | Superiority |
| Depression |
|
| Fatigue |
|
| Sleep Disturbance |
|
| Satisfaction with participation in social roles |
|
| Pain interference |
|
Anxiety
| Mixed Models Analysis |
| 0.312 |
Model controlled for age, sex, race, education, and CD4 count ; a=0.05 |
| Mean Difference (Final Values) |
| 1.71 |
| Standard Error of the Mean |
| 1.68 |
| 2-Sided |
| Superiority |
| Depression | Mixed Models Analysis | 0.841 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -0.36 | Standard Error of the Mean | 1.81 | 2-Sided | Superiority |
| Fatigue | Mixed Models Analysis | 0.848 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 0.40 | Standard Error of the Mean | 2.07 | 2-Sided | Superiority |
| Sleep Disturbance | Mixed Models Analysis | 0.208 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 2.58 | Standard Error of the Mean | 2.03 | 2-Sided | Superiority |
| Satisfaction with participation in social roles | Mixed Models Analysis | 0.754 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 0.72 | Standard Error of the Mean | 2.29 | 2-Sided | Superiority |
| Pain interference | Mixed Models Analysis | 0.454 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 1.25 | Standard Error of the Mean | 1.66 | 2-Sided | Superiority |
Visual analogue scale
| Mixed Models Analysis |
| 0.338 |
Model controlled for age, sex, race, education, and CD4 count ; a=0.05 |
| Mean Difference (Final Values) |
| -4.88 |
| Standard Error of the Mean |
| 5.06 |
| 2-Sided |
| Superiority |
| Perceived usefulness |
|
| Perceived ease of use |
|
| User control |
|
Quality of life
| Mixed Models Analysis |
| 0.166 |
Model controlled for age, sex, race, education, and CD4 count ; a=0.05 |
| Mean Difference (Final Values) |
| -0.28 |
| Standard Error of the Mean |
| 0.20 |
| 2-Sided |
| Superiority |
| Perceived usefulness | Mixed Models Analysis | 0.899 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | 0.03 | Standard Error of the Mean | 0.26 | 2-Sided | Superiority |
| Perceived ease of use | Mixed Models Analysis | 0.803 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -0.07 | Standard Error of the Mean | 0.26 | 2-Sided | Superiority |
| User Control | Mixed Models Analysis | 0.480 | Model controlled for age, sex, race, education, and CD4 count ; a=0.05 | Mean Difference (Final Values) | -0.20 | Standard Error of the Mean | 0.28 | 2-Sided | Superiority |