School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
InsideOut Institute for Eating Disorders, Boden Institute, University of Sydney, Sydney, New South Wales, Australia.
Int J Eat Disord. 2019 Oct;52(10):1077-1094. doi: 10.1002/eat.23131. Epub 2019 Jul 22.
Despite the existence of reviews which document the effectiveness of online therapies, there is little consensus regarding the exact components of online treatment delivery that are most effective in maintaining user engagement and reducing eating disorder (ED) symptomology. The current review and meta-analysis aimed to determine which components of web-based, ED self-help interventions are associated with lower attrition and improved therapeutic outcome.
A systematic search of electronic databases (PsycINFO, Medline, Web of Science, Scopus) was conducted for published studies of web-based interventions for EDs and a meta-analysis of the final included studies was performed. Each intervention was coded across four dimensions, including the multimedia channels employed (e.g., text, audio, videos), degree of user interactivity (e.g., online self-monitoring, skills exercises), level of automated feedback (e.g., reminders, personalized feedback), and technological device through which the program was accessed (e.g., smartphone, computer).
A final 23 papers were included. The results of meta-regressions indicated that higher scores on the multimedia subscale were associated with greater ED symptom improvement in treatment groups. Conversely, a higher degree of feedback in the treatment group was associated with a group difference in ED psychopathology favoring the control group. Other intervention components were not associated with treatment outcome or dropout.
The results are discussed in relation to limitations of the scale used to quantify digital intervention features, as well as the limited diversity and technological sophistication of available ED digital interventions. Such findings indicate the importance of understanding the digital components, which differentiate online therapeutic programs.
尽管已有综述记录了在线疗法的有效性，但对于维持用户参与度和减少饮食失调（ED）症状最有效的在线治疗交付的确切组成部分，仍缺乏共识。本综述和荟萃分析旨在确定基于网络的 ED 自助干预措施的哪些组成部分与降低退出率和改善治疗效果相关。
对电子数据库（PsycINFO、Medline、Web of Science、Scopus）进行了系统搜索，以查找 ED 的基于网络的干预措施的已发表研究，并对最终纳入的研究进行了荟萃分析。对每个干预措施进行了四个维度的编码，包括使用的多媒体渠道（例如，文本、音频、视频）、用户交互程度（例如，在线自我监测、技能练习）、自动化反馈程度（例如，提醒、个性化反馈）以及访问程序的技术设备（例如，智能手机、计算机）。
最终纳入了 23 篇论文。荟萃回归的结果表明，治疗组中多媒体子量表的得分越高，ED 症状改善越大。相反，治疗组中更高程度的反馈与 ED 精神病理学的组间差异有利于对照组。其他干预措施与治疗结果或退出无关。
结果与用于量化数字干预措施特征的量表的局限性以及现有 ED 数字干预措施的多样性和技术复杂性有限有关。这些发现表明，理解区分在线治疗方案的数字组件非常重要。
