Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
JMIR Ment Health. 2024 Aug 26;11:e58217. doi: 10.2196/58217.
Insomnia is a prevalent condition with significant health, societal, and economic impacts. Cognitive behavioral therapy for insomnia (CBTI) is recommended as the first-line treatment. With limited accessibility to in-person-delivered CBTI (ipCBTI), electronically delivered eHealth CBTI (eCBTI), ranging from telephone- and videoconference-delivered interventions to fully automated web-based programs and mobile apps, has emerged as an alternative. However, the relative efficacy of eCBTI compared to ipCBTI has not been conclusively determined.
This study aims to test the comparability of eCBTI and ipCBTI through a systematic review and meta-analysis of equivalence based on randomized controlled trials directly comparing the 2 delivery formats.
A comprehensive search across multiple databases was conducted, leading to the identification and analysis of 15 unique randomized head-to-head comparisons of ipCBTI and eCBTI. Data on sleep and nonsleep outcomes were extracted and subjected to both conventional meta-analytical methods and equivalence testing based on predetermined equivalence margins derived from previously suggested minimal important differences. Supplementary Bayesian analyses were conducted to determine the strength of the available evidence.
The meta-analysis included 15 studies with a total of 1083 participants. Conventional comparisons generally favored ipCBTI. However, the effect sizes were small, and the 2 delivery formats were statistically significantly equivalent (P<.05) for most sleep and nonsleep outcomes. Additional within-group analyses showed that both formats led to statistically significant improvements (P<.05) in insomnia severity; sleep quality; and secondary outcomes such as fatigue, anxiety, and depression. Heterogeneity analyses highlighted the role of treatment duration and dropout rates as potential moderators of the differences in treatment efficacy.
eCBTI and ipCBTI were found to be statistically significantly equivalent for treating insomnia for most examined outcomes, indicating eCBTI as a clinically relevant alternative to ipCBTI. This supports the expansion of eCBTI as a viable option to increase accessibility to effective insomnia treatment. Nonetheless, further research is needed to address the limitations noted, including the high risk of bias in some studies and the potential impact of treatment duration and dropout rates on efficacy.
PROSPERO CRD42023390811; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=390811.
失眠是一种普遍存在的病症，对健康、社会和经济都有重大影响。认知行为疗法治疗失眠（CBTI）被推荐为一线治疗方法。由于面对面提供的 CBTI（ipCBTI）的可及性有限，电子提供的 eHealth CBTI（eCBTI），从电话和视频会议提供的干预措施到完全自动化的基于网络的程序和移动应用程序，已经成为一种替代方法。然而，eCBTI 与 ipCBTI 的相对疗效尚未得到明确确定。
本研究旨在通过对直接比较两种交付格式的基于随机对照试验的等效性进行系统评价和荟萃分析，测试 eCBTI 和 ipCBTI 的可比性。
对多个数据库进行全面搜索，确定并分析了 15 项独特的 ipCBTI 和 eCBTI 随机头对头比较。提取睡眠和非睡眠结果数据，并根据先前建议的最小重要差异得出的预定等效范围进行常规荟萃分析和等效性测试。进行补充贝叶斯分析以确定现有证据的强度。
荟萃分析包括 15 项研究，共有 1083 名参与者。常规比较普遍有利于 ipCBTI。然而，效果大小较小，并且两种交付格式在大多数睡眠和非睡眠结果方面在统计学上具有显著等效性（P<.05）。额外的组内分析表明，两种格式都导致失眠严重程度、睡眠质量以及疲劳、焦虑和抑郁等次要结果的统计学显著改善（P<.05）。异质性分析强调了治疗持续时间和辍学率作为治疗效果差异的潜在调节剂的作用。
对于大多数检查结果，发现 eCBTI 和 ipCBTI 在治疗失眠方面在统计学上具有显著等效性，表明 eCBTI 是 ipCBTI 的一种临床相关替代方法。这支持扩大 eCBTI 的使用，作为增加有效失眠治疗可及性的可行选择。然而，需要进一步的研究来解决注意到的局限性，包括一些研究中的高偏倚风险以及治疗持续时间和辍学率对疗效的潜在影响。
PROSPERO CRD42023390811；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=390811.
