Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom.
J Med Internet Res. 2020 Oct 28;22(10):e17049. doi: 10.2196/17049.
There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development.
This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom.
Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls.
A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found.
Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects.
International Prospective Register of Systematic Reviews (PROSPERO) registration CRD42019130184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130184.
迅速开发电子疗法来治疗抑郁、焦虑和压力的能力与对其临床效用的严格评估之间存在脱节。这使得在公共资助的心理健康护理中常规提供的电子疗法在开发过程中可能没有经过适当的严格评估。
本研究旨在对英国国民保健制度（NHS）推荐使用的电子疗法的可接受性和临床有效性的黄金标准证据进行荟萃分析。
系统搜索确定了合适的随机对照试验（RCT）。使用随机效应荟萃分析综合治疗结束时和随访时的抑郁、焦虑和压力结局。使用推荐评估、制定和评价方法学（Grading of Recommendations Assessment, Development, and Evaluation approach）评估每个荟萃分析比较的质量。使用亚组和荟萃回归分析检查治疗效果的调节因素。将电子疗法的辍学率（作为可接受性的代理）与对照组进行比较。
共定性和定量综合了 24 项评估 NHS 推荐的 48 种电子疗法中的 7 种的研究。电子疗法在抑郁、焦虑和压力方面的疗效优于对照组（抑郁：标准化均数差[SMD]0.38，95%置信区间[CI]0.24 至 0.52，N=7075；焦虑和压力：SMD 0.43，95%CI 0.24 至 0.63，n=4863），这些小的效果在随访中得到维持。电子疗法的平均辍学率（31%，SD 17.35）明显高于对照组（17%，SD 13.31）。仅发现治疗效果的有限调节因素。
许多 NHS 推荐的电子疗法尚未经过 RCT 式评估。经过适当评估的电子疗法产生了小但显著、持久、有益的治疗效果。
国际前瞻性系统评价注册库（International Prospective Register of Systematic Reviews，PROSPERO）登记号 CRD42019130184；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130184。
