Toivonen Kirsti I, Zernicke Kristin, Carlson Linda E
Department of Psychology, University of Calgary, Calgary, AB, Canada.
Shared Mental Health Care, Alberta Health Services, Sheldon M. Shumir Health Centre, Calgary, AB, Canada.
J Med Internet Res. 2017 Aug 31;19(8):e303. doi: 10.2196/jmir.7487.
Mindfulness-based interventions (MBIs) are becoming increasingly popular for helping people with physical health conditions. Expanding from traditional face-to-face program delivery, there is growing interest in Web-based application of MBIs, though Web-based MBIs for people with physical health conditions specifically have not been thoroughly reviewed to date.
The objective of this paper was to review Web-based MBIs for people with physical health conditions and to examine all outcomes reported (eg, efficacy or effectiveness for physical changes or psychological changes; feasibility).
Databases PubMed, PsycINFO, Science Direct, CINAHL Plus, and Web of Science were searched. Full-text English papers that described any Web-based MBI, examining any outcome, for people with chronic physical health conditions were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included intervention characteristics, population characteristics, outcomes, and quality indicators. Intervention characteristics (eg, synchronicity and guidance) were examined as potential factors related to study outcomes.
Of 435 publications screened, 19 published papers describing 16 studies were included. They examined Web-based MBIs for people with cancer, chronic pain or fibromyalgia, irritable bowel syndrome (IBS), epilepsy, heart disease, tinnitus, and acquired brain injury. Overall, most studies reported positive effects of Web-based MBIs compared with usual care on a variety of outcomes including pain acceptance, coping measures, and depressive symptoms. There were mixed results regarding the effectiveness of Web-based MBIs compared with active control treatment conditions such as cognitive behavioral therapy. Condition-specific symptoms (eg, cancer-related fatigue and IBS symptoms) targeted by treatment had the largest effect size improvements following MBIs. Results are inconclusive regarding physical variables.
Preliminary evidence suggests that Web-based MBIs may be helpful in alleviating symptom burden that those with physical health conditions can experience, particularly when interventions are tailored for specific symptoms. There was no evidence of differences between synchronous versus asynchronous or facilitated versus self-directed Web-based MBIs. Future investigations of Web-based MBIs should evaluate the effects of program adherence, effects on mindfulness levels, and whether synchronous or asynchronous, or facilitated or self-directed interventions elicit greater improvements.
基于正念的干预措施（MBIs）在帮助患有身体健康问题的人群方面越来越受欢迎。从传统的面对面项目实施方式扩展而来，人们对基于网络的MBIs应用的兴趣日益浓厚，尽管迄今为止，专门针对患有身体健康问题人群的基于网络的MBIs尚未得到全面审查。
本文的目的是审查针对患有身体健康问题人群的基于网络的MBIs，并检查所报告的所有结果（例如，身体变化或心理变化的疗效或有效性；可行性）。
检索了PubMed、PsycINFO、Science Direct、CINAHL Plus和Web of Science数据库。纳入了描述任何基于网络的MBI、检查任何结果、针对患有慢性身体健康问题人群的全文英文论文。随机、非随机、对照和非对照试验均被纳入。提取的数据包括干预特征、人群特征、结果和质量指标。干预特征（例如，同步性和指导）作为与研究结果相关的潜在因素进行了检查。
在筛选的435篇出版物中，纳入了19篇发表的论文，描述了16项研究。这些研究考察了针对癌症、慢性疼痛或纤维肌痛、肠易激综合征（IBS）、癫痫、心脏病、耳鸣和获得性脑损伤患者的基于网络的MBIs。总体而言，与常规护理相比，大多数研究报告了基于网络的MBIs在包括疼痛接受度、应对措施和抑郁症状等各种结果上的积极影响。与积极对照治疗条件（如认知行为疗法）相比，基于网络的MBIs的有效性结果不一。治疗所针对的特定疾病症状（例如，癌症相关疲劳和IBS症状）在MBIs后改善效果的效应量最大。关于身体变量的结果尚无定论。
初步证据表明，基于网络的MBIs可能有助于减轻患有身体健康问题人群可能经历的症状负担，特别是当干预措施针对特定症状进行调整时。没有证据表明同步与异步或有指导与自我指导的基于网络的MBIs之间存在差异。未来对基于网络的MBIs的研究应评估项目依从性的影响、对正念水平的影响，以及同步或异步、有指导或自我指导的干预措施是否能带来更大的改善。
