一项随机对照试验评估了一种基于手册的远程辅导协议，以提高基于网络的抑郁症治疗干预措施的依从性。
A randomized controlled trial evaluating a manualized TeleCoaching protocol for improving adherence to a web-based intervention for the treatment of depression.
机构信息
Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
出版信息
PLoS One. 2013 Aug 21;8(8):e70086. doi: 10.1371/journal.pone.0070086. eCollection 2013.
BACKGROUND
Web-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes.
METHODS
101 patients with MDD, recruited from primary care, were randomized to 12 weeks moodManager+TeleCoach, 12 weeks of self-directed moodManager, or 6 weeks of a waitlist control (WLC). Depressive symptom severity was measured using the PHQ-9.
RESULTS
TeleCoach+moodManager, compared to self-directed moodManager, resulted in significantly greater numbers of login days (p = 0.01), greater time until last use (p = 0.007), greater use of lessons (p = 0.03), greater variety of interactive tools used (p = 0.02), but total instances of tool use did not reach statistical significance. (p = 0.07). TeleCoach+moodManager produced significantly lower PHQ-9 scores relative to WLC at week 6 (p = 0.04), but there were no other significant differences in PHQ-9 scores at weeks 6 or 12 (ps>0.20) across treatment arms. Baseline PHQ-9 scores were no significantly related to adherence to moodManager.
CONCLUSIONS
TeleCoach produced significantly greater adherence to moodManager, relative to self-directed moodManager. TeleCoached moodManager produced greater reductions in depressive symptoms relative to WLC, however, there were no statistically significant differences relative to self-directed moodManager. While greater use was associated with better outcomes, most users in both TeleCoach and self-directed moodManager had dropped out of treatment by week 12. Even with telephone coaching, adherence to web-based interventions for depression remains a challenge. Methods of improving coaching models are discussed.
TRIAL REGISTRATION
Clinicaltrials.gov NCT00719979.
背景
与独立的基于网络的干预相比，基于网络的干预并辅以指导的抑郁症干预通常会产生更大的效果量。这可能是由于指导对依从性的影响。我们评估了一种规范化的电话指导干预（TeleCoach）对改善基于网络的干预（moodManager）依从性的效果，以及依从性与抑郁症状结果之间的关系。
方法
从初级保健中招募了 101 名 MDD 患者，将他们随机分为 12 周的 moodManager+TeleCoach、12 周的自我指导的 moodManager 或 6 周的等待名单对照（WLC）。使用 PHQ-9 评估抑郁症状严重程度。
结果
与自我指导的 moodManager 相比，TeleCoach+moodManager 导致登录天数显著增加（p=0.01），末次使用时间显著延长（p=0.007），课程使用量显著增加（p=0.03），使用的交互工具种类显著增加（p=0.02），但工具使用总次数未达到统计学意义（p=0.07）。TeleCoach+moodManager 与 WLC 相比，在第 6 周时 PHQ-9 评分显著降低（p=0.04），但在第 6 周和第 12 周时，各治疗组之间的 PHQ-9 评分没有其他显著差异（p>0.20）。基线 PHQ-9 评分与 moodManager 的依从性无显著相关性。
结论
与自我指导的 moodManager 相比，TeleCoach 显著提高了 moodManager 的依从性。TeleCoach 联合 moodManager 治疗与 WLC 相比，降低抑郁症状的效果更好，但与自我指导的 moodManager 相比，没有统计学上的显著差异。尽管更多的使用与更好的结果相关，但在 TeleCoach 和自我指导的 moodManager 中，大多数使用者在第 12 周时已经退出治疗。即使有电话指导，对基于网络的抑郁症干预的依从性仍然是一个挑战。讨论了改善指导模型的方法。
试验注册
Clinicaltrials.gov NCT00719979。
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