Khan Kareem, Hollis Chris, Murphy Tara, Hall Charlotte L
NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.
NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, United Kingdom.
Front Psychiatry. 2022 Jul 15;13:928487. doi: 10.3389/fpsyt.2022.928487. eCollection 2022.
The rapid expansion of access to and engagement with digital technology over the past 15 years has transformed the potential for remote delivery of evidence-based digital health interventions (DHIs). Digital and remote behavioral interventions have the potential to address current gaps in the provision of evidence-based therapies in healthcare services. As the lack of access to behavioral treatments for people with tic disorders is a pressing issue across the world, there is great potential for DHIs to close this treatment gap. Here, we present a critical synthesis of the recent key advances in the field of digitally delivered, remote therapy for tics, outlining the research evidence for the clinical and cost-effectiveness and acceptability of digital or remotely delivered therapy. We found five trials aimed at reducing tic severity in children and young people and one trial for adults. The evidence supports the clinical utility of DHIs to deliver tic therapies, which shows promise in being clinically efficacious compared to an active control. Furthermore, DHIs in trials show good adherence and engagement and are acceptable to patients. The role of human support (including therapists and parents for young people) is likely to be important to encourage adherence. DHIs, where the main therapeutic content is delivered web-based chapters, are likely to reduce clinical time, and maintain intervention fidelity, but further research is required to understand cost-effectiveness. Despite utilizing randomized controlled trials, only two trials were sufficiently powered to address efficacy and only one trial explored contextual factors that may influence engagement. Moreover, only one trial followed patients for >12 months, thus further long-term follow-ups are required. Specifically, we note that despite an emerging evidence base, DHIs for tics are yet to be routinely implemented in healthcare provision in any country. Drawing on the existing evidence, we conclude by proposing a stepped care model, in which digital therapy is implemented as a widely accessible first-line treatment using a purely online or therapist-supported approach.
在过去15年里，数字技术的获取和使用迅速扩展，改变了远程提供循证数字健康干预措施（DHI）的可能性。数字和远程行为干预措施有潜力弥补当前医疗服务中循证治疗提供方面的差距。由于抽动障碍患者难以获得行为治疗是全球范围内的一个紧迫问题，DHI在缩小这一治疗差距方面具有巨大潜力。在此，我们对数字交付的抽动症远程治疗领域最近的关键进展进行了批判性综述，概述了数字或远程治疗的临床、成本效益及可接受性的研究证据。我们发现了五项旨在降低儿童和青少年抽动严重程度的试验以及一项针对成人的试验。证据支持DHI在提供抽动症治疗方面的临床效用，与积极对照相比，显示出临床疗效的前景。此外，试验中的DHI显示出良好的依从性和参与度，且患者可接受。人力支持（包括治疗师和青少年的父母）的作用对于鼓励依从性可能很重要。主要治疗内容通过基于网络的章节提供的DHI可能会减少临床时间，并保持干预的保真度，但需要进一步研究以了解成本效益。尽管采用了随机对照试验，但只有两项试验有足够效力来解决疗效问题，只有一项试验探讨了可能影响参与度的背景因素。此外，只有一项试验对患者进行了超过12个月的随访，因此需要进一步进行长期随访。具体而言，我们注意到，尽管有新的证据基础，但抽动症的DHI在任何国家的医疗服务中都尚未得到常规实施。基于现有证据，我们通过提出一种阶梯式护理模式来得出结论，在该模式中，数字疗法作为一种广泛可用的一线治疗方法，采用纯在线或治疗师支持的方法来实施。
