Lange Alfred, Ruwaard Jeroen
Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands.
J Med Internet Res. 2010 Dec 19;12(5):e58. doi: 10.2196/jmir.1455.
In a recent uncontrolled trial of a new therapist-assisted Web-based treatment of adolescent victims of sexual abuse, the treatment effects were found to be promising. However, the study suffered a large pretreatment withdrawal rate that appeared to emanate from reluctance among the participants to disclose their identity and obtain their parents' consent.
Our objectives were to confirm the effects of the online treatment in a controlled trial and to evaluate measures to reduce pretreatment withdrawal in vulnerable populations including young victims of sexual abuse.
The study was designed as a within-subject baseline-controlled trial. Effects of an 8-week attention-placebo intervention were contrasted with the effects of an 8-week treatment episode. Several measures were taken to reduce pretreatment dropout.
Pretreatment withdrawal was reduced but remained high (82/106, 77%). On the other hand, treatment dropout was low (4 out of 24 participants), and improvement during treatment showed significantly higher effects than during the attention placebo control period (net effect sizes between 0.5 and 1.6).
In treatment of vulnerable young populations, caregivers and researchers will have to come to terms with high pretreatment withdrawal rates. Possible measures may reduce pretreatment withdrawal to some degree. Providing full anonymity is not a viable option since it is incompatible with the professional responsibility of the caregiver and restricts research possibilities.
在最近一项针对性虐待青少年受害者的新型治疗师辅助网络治疗的非对照试验中，发现治疗效果很有前景。然而，该研究的预处理退出率很高，这似乎源于参与者不愿透露自己的身份并获得父母的同意。
我们的目标是在对照试验中确认在线治疗的效果，并评估减少包括性虐待年轻受害者在内的弱势群体预处理退出的措施。
该研究设计为受试者内基线对照试验。将为期8周的注意力安慰剂干预的效果与为期8周的治疗阶段的效果进行对比。采取了多项措施来减少预处理阶段的退出情况。
预处理退出情况有所减少，但仍然很高（106人中的82人，77%）。另一方面，治疗阶段的退出率很低（24名参与者中有4人退出），并且治疗期间的改善效果明显高于注意力安慰剂对照期（净效应大小在0.5至1.6之间）。
在治疗脆弱的年轻人群时，护理人员和研究人员将不得不接受高预处理退出率这一现实。可能的措施可能会在一定程度上降低预处理退出率。提供完全匿名不是一个可行的选择，因为这与护理人员的职业责任不相容，并且会限制研究的可能性。
