Acierno Ron, Knapp Rebecca, Tuerk Peter, Gilmore Amanda K, Lejuez Carl, Ruggiero Kenneth, Muzzy Wendy, Egede Leonard, Hernandez-Tejada Melba A, Foa Edna B
Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; College of Nursing, Medical University of South Carolina, Charleston, SC, USA.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Behav Res Ther. 2017 Feb;89:57-65. doi: 10.1016/j.brat.2016.11.009. Epub 2016 Nov 22.
This is the first randomized controlled trial to evaluate non-inferiority of Prolonged Exposure (PE) delivered via home-based telehealth (HBT) compared to standard in-person (IP) PE. One-hundred thirty two Veterans recruited from a Southeastern Veterans Affairs Medical Center and affiliated University who met criteria for posttraumatic stress disorder (PTSD) were randomized to receive PE via HBT or PE via IP. Results indicated that PE-HBT was non-inferior to PE-IP in terms of reducing PTSD scores at post-treatment, 3 and 6 month follow-up. However, non-inferiority hypotheses for depression were only supported at 6 month follow-up. HBT has great potential to reduce patient burden associated with receiving treatment in terms of travel time, travel cost, lost work, and stigma without sacrificing efficacy. These findings indicate that telehealth treatment delivered directly into patients' homes may dramatically increase the reach of this evidence-based therapy for PTSD without diminishing effectiveness.
这是第一项随机对照试验，旨在评估通过家庭远程医疗（HBT）提供的延长暴露疗法（PE）与标准面对面（IP）PE相比的非劣效性。从东南部退伍军人事务医疗中心和附属大学招募的132名符合创伤后应激障碍（PTSD）标准的退伍军人被随机分配接受通过HBT的PE或通过IP的PE。结果表明，在治疗后、3个月和6个月随访时，PE-HBT在降低PTSD评分方面不劣于PE-IP。然而，抑郁症的非劣效性假设仅在6个月随访时得到支持。HBT在不牺牲疗效的情况下，在旅行时间、旅行成本、工作损失和耻辱感方面，有很大潜力减轻患者接受治疗的负担。这些发现表明，直接在患者家中提供的远程医疗治疗可能会显著扩大这种基于证据的PTSD疗法的覆盖范围，而不会降低有效性。
