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Gandy M, Woldhuis T, Wu W, Youssef M, Bisby MA, Dear BF, Heriseanu AI, Scott AJ. Cognitive behavioral interventions for depression and anxiety in adults with neurological disorders: a systematic review and meta-analysis. Psychol Med 2024:1-14. [PMID: 39320459 DOI: 10.1017/s0033291724001995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
We examined the efficacy of cognitive and behavioral interventions for improving symptoms of depression and anxiety in adults with neurological disorders. A pre-registered systematic search of Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Embase, and Neurobite was performed from inception to May 2024. Randomized controlled trials (RCTs) which examined the efficacy of cognitive and behavioral interventions in treating depression and/or anxiety among adults with neurological disorders were included. Estimates were pooled using a random-effects meta-analysis. Subgroup analyses and meta-regression were performed on categorical and continuous moderators, respectively. Main outcomes were pre- and post-intervention depression and anxiety symptom scores, as reported using standardized measures. Fifty-four RCTs involving 5372 participants with 11 neurological disorders (including multiple sclerosis, epilepsy, stroke) were included. The overall effect of interventions yielded significant improvements in both depression (57 arms, Hedges' g = 0.45, 95% confidence interval [CI] 0.35-0.54) and anxiety symptoms (29 arms, g = 0.38, 95% CI 0.29-0.48), compared to controls. Efficacy was greater in studies which employed a minimum baseline symptom severity inclusion criterion for both outcomes, and greater in trials using inactive controls for depression only. There was also evidence of differential efficacy of interventions across the neurological disorder types and the outcome measure used. Risk of bias, intervention delivery mode, intervention tailoring for neurological disorders, sample size, and study year did not moderate effects. Cognitive and behavioral interventions yield small-to-moderate improvements in symptoms of both depression and anxiety in adults with a range of neurological disorders.
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Affiliation(s)
- Milena Gandy
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Thomas Woldhuis
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Wendy Wu
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Marette Youssef
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | | | - Amelia J Scott
- School of Psychological Sciences, Macquarie University, Sydney, Australia
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Klooster IT, Kip H, van Gemert-Pijnen L, Crutzen R, Kelders S. A systematic review on eHealth technology personalization approaches. iScience 2024; 27:110771. [PMID: 39290843 PMCID: PMC11406103 DOI: 10.1016/j.isci.2024.110771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/05/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.
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Affiliation(s)
- Iris Ten Klooster
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Department of Research, Stichting Transfore, Deventer, the Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Saskia Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
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Meyer B, Betz LT, Brückner K, Holtkamp M. Enhancing quality of life in epilepsy with a digital intervention (emyna): Results of the ELAINE randomized controlled trial. Epilepsia Open 2024. [PMID: 39167060 DOI: 10.1002/epi4.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/23/2024] [Accepted: 06/17/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE Despite the availability of pharmacological treatment for seizures, people with epilepsy (PwE) commonly experience impairments in quality of life (QoL). Given the limited access to psychosocial treatments for PwE, digital interventions could bridge treatment gaps and help improve QoL. The objective of this study was to examine the effectiveness of emyna, a fully automated digital intervention based on cognitive behavioral therapy (CBT) techniques, in improving health-related QoL among PwE who reported impairments in QoL. A previous trial showed that emyna was effective in improving depressive symptoms among PwE with a comorbid depressive disorder, but its effects on QoL among PwE without comorbid depression remain unknown. METHODS A pragmatic randomized controlled trial was conducted with N = 438 PwE (mean age = 37.5, 70.3% women, physician-verified diagnoses) who were assigned to the intervention group (n = 216), which used emyna alongside treatment as usual (TAU), or the control group (n = 222), which received TAU only. QoL and secondary outcomes such as general self-efficacy, medication adherence, general distress, and epilepsy-related work and social adjustment were assessed at baseline, 3 months, and 6 months. The primary outcome was QoL assessed with the Quality of Life in Epilepsy [QOLIE-31] total score at 3 months post-randomization. RESULTS Findings from the intent-to-treat analyses showed that after 3 months, participants in the intervention group experienced significant and clinically relevant improvements in health-related QoL compared to the control group (baseline-adjusted group difference = 4.5; 95% CI = [2.0, 6.9], p < 0.001; Cohen's d = 0.32). Effects on secondary outcomes did not reach statistical significance. SIGNIFICANCE This study extends previous research by demonstrating that emyna facilitates improvements in QoL in a diverse group of PwE treated in routine care settings. This CBT-based digital intervention therefore presents a convenient and cost-effective addition to healthcare providers' treatment repertoire. PLAIN LANGUAGE SUMMARY In our study, we tested a digital program called emyna, which conveys cognitive behavioral therapy (CBT) techniques to help improve the quality of life for people living with epilepsy. We found that those who used emyna alongside their usual treatments felt better about their quality of life compared to those who did not use the program. Emyna offers a new, convenient way for people with epilepsy to manage their condition, which can be used alongside currently available treatments.
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Affiliation(s)
- Björn Meyer
- Research & Development Department, GAIA Group, Hamburg, Germany
| | - Linda T Betz
- Research & Development Department, GAIA Group, Hamburg, Germany
| | - Katja Brückner
- Department of Neurology and Epileptology, Epilepsy Center Hamburg, Evangelical Hospital Alsterdorf, Hamburg, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Gandy M, Coleman H, Cutler H, Jones MP, Karin E, Kwan P, Nikpour A, Parratt K, Rayner G, Titov N, Todd L, Seil E, Winton‐Brown T, Wu W, Dear BF. Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial. Epilepsia Open 2024; 9:808-818. [PMID: 38345357 PMCID: PMC10984311 DOI: 10.1002/epi4.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Mental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out-of-pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost-effectiveness, and long-term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy. METHOD Approximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10-week internet-delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment-as-usual waiting-list control group. Participants will complete online questionnaires at pre-, post-treatment, and 3- and 12-month follow-up and consent to have their data linked to their medical records to capture healthcare system resource use and costs. ANALYSIS Primary outcome measures will be symptoms of depression and anxiety. A cost-utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia. SIGNIFICANCE The results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer-reviewed publication(s). ANZCTR TRIAL REGISTRATION NUMBER ACTRN12623001327673. PLAIN LANGUAGE SUMMARY This study seeks to find out if a 10-week online psychological treatment can improve the mental health and well-being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.
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Affiliation(s)
- Milena Gandy
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Honor Coleman
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Henry Cutler
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Michael P. Jones
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eyal Karin
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Armin Nikpour
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kaitlyn Parratt
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The Epilepsy Society of AustraliaSouth AustraliaAustralia
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Nickolai Titov
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
| | - Lisa Todd
- Epilepsy Action AustraliaSydneyNew South WalesAustralia
| | - Elizabeth Seil
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Toby Winton‐Brown
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Wendy Wu
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Blake F. Dear
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
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Choudhary N, Kumar A, Sharma V, Kaur K, Singh Kharbanda P, Baishya J, Kumar D, Sharma A, Chakravarty K. Effectiveness of CBT for reducing depression and anxiety in people with epilepsy: A systematic review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 151:109608. [PMID: 38183927 DOI: 10.1016/j.yebeh.2023.109608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/18/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Patients with epilepsy suffer from depression and anxiety that reduces quality of life. Cognitive behavioral therapy (CBT) among various non pharmacological treatment recommended for depression and anxiety. Since there are several articles reporting CBT treatment for depression in patients with epilepsy, we conduct a meta-analysis to evaluate the effectiveness of CBT for adult patients with epilepsy. METHODS Four electronic databases PubMed, Scopus, Embase, and the Cochrane library searched for relevant studies. A detailed "RISK of bias" assessment has been done for included studies. Funnel plot was used for assessing publication Bias. R Software- RStudio 2022 was used to calculate standard mean difference (SMD). The study has been registered in PROSPERO (CRD42023447655). RESULTS Eventually, a Total 13 studies involving 1222 patients met the eligibility criteria. There was decline in the Patient Health Questionnaire (PHQ) [SMD = -0.42, 95 % CI = -0.63 to -0.22], Neurologic Disorder Depression Inventory-Epilepsy (NDDI-E) [SMD = -0.53, 95 % CI = -0.75 to -0.31], Beck depression Inventory (BDI) [SMD = -0.69, 95 % CI = -1.08 to -0.30], Hospital Anxiety and Depression Scale-Depression (HADS-D) [SMD = -0.73 , 95 % CI = -0.94 to -0.52] and Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A) [SMD = -0.66, 95 % CI = -0.87 to -0.45] score of the CBT group than that of the control group at post-intervention. The results showed that the improvement in QOLIE-31 score of the CBT group than that of the control group [SMD = 0.67, 95 % CI = 1.33] at post-intervention. CONCLUSION The result of our study showed that Cognitive behavioral therapy is a superior therapy for treating anxiety and depression in epilepsy patients. CBT was effective in improving Quality of life in patients with epilepsy. However, the sample size varied across the trials, additional high-quality studies are needed in the future.
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Affiliation(s)
- Neetu Choudhary
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaishali Sharma
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirandeep Kaur
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Jitupam Baishya
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Devender Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akhilesh Sharma
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalesh Chakravarty
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Johnson E, Corrick S, Isley S, Vandermeer B, Dolgoy N, Bates J, Godfrey E, Soltys C, Muir C, Vohra S, Tandon P. Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs. PLOS DIGITAL HEALTH 2024; 3:e0000435. [PMID: 38261600 PMCID: PMC10805319 DOI: 10.1371/journal.pdig.0000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
This review summarizes the effectiveness of scalable mind-body internet and mobile-based interventions (IMIs) on depression and anxiety symptoms in adults living with chronic physical conditions. Six databases (MEDLINE, PsycINFO, SCOPUS, EMBASE, CINAHL, and CENTRAL) were searched for randomized controlled trials published from database inception to March 2023. Mind-body IMIs included cognitive behavioral therapy, breathwork, meditation, mindfulness, yoga or Tai-chi. To focus on interventions with a greater potential for scale, the intervention delivery needed to be online with no or limited facilitation by study personnel. The primary outcome was mean change scores for anxiety and depression (Hedges' g). In subgroup analyses, random-effects models were used to calculate pooled effect size estimates based on personnel support level, intervention techniques, chronic physical condition, and survey type. Meta-regression was conducted on age and intervention length. Fifty-six studies met inclusion criteria (sample size 7691, mean age of participants 43 years, 58% female): 30% (n = 17) neurological conditions, 12% (n = 7) cardiovascular conditions, 11% cancer (n = 6), 43% other chronic physical conditions (n = 24), and 4% (n = 2) multiple chronic conditions. Mind-body IMIs demonstrated statistically significant pooled reductions in depression (SMD = -0.33 [-0.40, -0.26], p<0.001) and anxiety (SMD = -0.26 [-0.36, -0.17], p<0.001). Heterogeneity was moderate. Scalable mind-body IMIs hold promise as interventions for managing anxiety and depression symptoms in adults with chronic physical conditions without differences seen with age or intervention length. While modest, the effect sizes are comparable to those seen with pharmacological therapy. The field would benefit from detailed reporting of participant demographics including those related to technological proficiency, as well as further evaluation of non-CBT interventions. Registration: The study is registered with PROSPERO ID #CRD42022375606.
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Affiliation(s)
- Emily Johnson
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
| | - Shaina Corrick
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
| | - Serena Isley
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
| | - Ben Vandermeer
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Naomi Dolgoy
- Faculty of Rehabilitation Science, Edmonton, Alberta
| | - Jack Bates
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Elana Godfrey
- Faculty of Science, University of Toronto, Toronto, Ontario
| | - Cassidy Soltys
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Conall Muir
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Sunita Vohra
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
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Shih YH, Wang JY, Chou PH, Lin KH. The effects of treatment via telemedicine interventions for patients with depression on depressive symptoms and quality of life: a systematic review and meta-ranalysis. Ann Med 2023; 55:1092-1101. [PMID: 36920229 PMCID: PMC10026747 DOI: 10.1080/07853890.2023.2187078] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Aim: The aim of this systematic review and meta-analysis was to identify, evaluate, and synthesize the evidence from studies that have investigated the treatment effect via telemedicine interventions on depressive symptoms, quality of life, and work and social functioning in patients with depression.Methods: Six electronic databases (MEDLINE [1916-2021], PubMED [1950-2021], PsycINFO [1971-2021], Scopus [2004-2021], Embase [1972-2021], and CINAHL [1937-2021]) were systematically searched in March 2021. Reference lists of identified articles were hand searched. Randomized controlled trials were included if they investigated the treatment effects via telemedicine interventions in patients who had a depression diagnosis. Quality assessment was evaluated using the critical appraisal checklists developed by the Joanna Briggs Institute.Results: Seventeen (17) trials (n = 2,394) met eligibility criteria and were included in the analysis. Eleven (11) randomized controlled trials shared common outcome measures, allowing meta-analysis. The results provided evidence that treatment via telemedicine interventions were beneficial for depressive symptoms (standardized mean difference= -0.44; 95% CI= -0.64 to -0.25; p < .001) and quality of life (standardized mean difference= 0.25, 95% CI -0.01 to 0.49, p = .04) in patients of depression. There were insufficient data for meta-analysis of work and social functioning.Conclusion: This study showed the positive effects of treatment via telemedicine interventions on depressive symptoms and quality of life in patients with depression and supported the idea for clinical practice to establish a well-organized telepsychiatry system.KEY MESSAGESTelemedicine is effective at reducing symptoms of depression.Telemedicine can improve quality of life in persons with depression.
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Affiliation(s)
- Yin-Hwa Shih
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Kuan-Han Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Kutzinski M, Krause N, Riemann-Lorenz K, Meyer B, Heesen C. Acceptability of a digital health application to empower persons with multiple sclerosis with moderate to severe disability: single-arm prospective pilot study. BMC Neurol 2023; 23:382. [PMID: 37872471 PMCID: PMC10591383 DOI: 10.1186/s12883-023-03434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Many persons with multiple sclerosis (pwMS) desire to learn how health behaviour changes (e.g., dietary adjustments, physical activity, improvements in stress management) might help them manage their disease. Previous research has shown that certain health behaviour changes can improve quality of life (QoL), fatigue and other MS outcomes. Digital health applications may be well suited to deliver relevant health behavioural interventions because of their accessibility and flexibility. The digital health application "levidex" was designed to facilitate health behaviour change by offering evidence-based patient information and cognitive-behavioural therapy techniques to pwMS. By doing so, levidex aims to improve QoL and MS symptoms such as fatigue and mental health. OBJECTIVES A previous study reported on the development of levidex; this non-randomised pilot study examined the feasibility (practicability and acceptability) of levidex in pwMS with moderate to severe disability. Furthermore, the intervention's impact on empowerment, stress management, and relevant health behaviours (e.g., dietary behaviour, physical activity) was explored. METHODS levidex was originally developed for newly diagnosed pwMS in the first year after diagnosis and eventually modified to offer access to pwMS with moderate to severe disability. Participants (n = 43) with an Expanded Disability Status Scale between 3.5 and 7.5 and a disease duration of more than one year were eligible to participate. The intervention was used over a period of six months with measurement time points at baseline, month 3 and month 6. RESULTS Out of 38 participants who completed the six-month intervention period, 18 (47.4%) completed all 16 modules and 9 (23.7%) reached modules 13-16, the long-term maintenance part of levidex. Participants rated levidex positively in terms of practicability and acceptability and had only few points of criticism such as to include more physical exercise routine suggestions suitable for participants with severe impairment. Data on secondary endpoints showed no significant changes. CONCLUSION This pilot study provided evidence for the practicability and acceptability of levidex, a digital health application designed to facilitate health behaviour change in pwMS with moderate to severe disability. Adequately powered randomised controlled studies with longer follow-up periods are needed to clarify the benefit of levidex in pwMS with moderate to severe disability. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00032667 (14/09/2023); Retrospectively registered.
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Affiliation(s)
- Max Kutzinski
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Nicole Krause
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Björn Meyer
- Research and Development Department, GAIA Group, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Morello K, Schäfer SK, Kunzler AM, Priesterroth LS, Tüscher O, Kubiak T. Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis. Front Digit Health 2023; 5:1253390. [PMID: 37927578 PMCID: PMC10623449 DOI: 10.3389/fdgth.2023.1253390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective. Objectives To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations. Methods The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators). Results Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies. Conclusions We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].
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Affiliation(s)
- Karolina Morello
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
| | - Sarah K Schäfer
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Clinical Psychology, Psychotherapy and Diagnostics, Technische Universität Braunschweig, Brunswick, Germany
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Oliver Tüscher
- Leibniz Institute for Resilience Research (LIR) Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Molecular Biology (IMB), Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University Mainz, Mainz, Germany
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Wang M, Chen H, Yang F, Xu X, Li J. Effects of digital psychotherapy for depression and anxiety: A systematic review and bayesian network meta-analysis. J Affect Disord 2023; 338:569-580. [PMID: 37392941 DOI: 10.1016/j.jad.2023.06.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of digital psychotherapies for depression and anxiety. We conducted a systematic review and network meta-analyses (NMA) to make comparisons of digital psychotherapies. METHODS A bayesian NMA was conducted in this study. The databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and CINAL were searched for all eligible randomized controlled trials (RCTs) published from Jan 1, 2012 to Oct 1, 2022. We used the Cochrane Collaboration's Risk of bias tool for quality assessment. The primary outcomes were set as a standardized mean difference model in efficacy to describe continuous outcomes. We used STATA and WinBUGS to conduct a bayesian network meta-analysis of all interventions based on a random-effects model. This study was registered with PROSPERO, number CRD42022374558. RESULTS From the retrieved 16,750 publications, we included 72 RCTs (13,096 participants) with the overall medium quality and above. In terms of depression scale, cognitive behavioral therapy (CBT) was more effective than TAU (SMDs 0.53) and NT (SMDs 0.98). In terms of anxiety scale, CBT (SMDs 0.68; SMDs 0.72) and exercise therapy (ERT) (SMDs 1.01; SMDs 1.05) were more effective than TAU and NT. LIMITATIONS Uneven quality of literature, simple network, and subjective judgment. CONCLUSION Based on NMA results, we suggest that CBT, which is the most commonly used digital technology, should be preferred among digital psychotherapy for relieving depression and anxiety symptoms. Digital exercise therapy is an effective strategy to relieve some anxiety problems in the context of COVID-19.
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Affiliation(s)
- Min Wang
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Haoran Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Fengchun Yang
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Xiaowei Xu
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Jiao Li
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China.
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11
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Lecce F, Smith CR, Burbach FR. Digital mental health interventions for people with epilepsy: a systematic review. Seizure 2023; 107:91-103. [PMID: 37001253 DOI: 10.1016/j.seizure.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Although mental health difficulties are common in people with epilepsy, their assessment and treatment are rarely incorporated into routine medical care, with detrimental effects on quality of life. Several barriers to access traditional face to face interventions have been identified, including travel restriction and shortage of appropriately trained mental health clinicians. Digital mental health interventions offer the potential to improve access to mental health treatment. The main aim of the present study is to systematically review the empirical literature to identify what digital mental health interventions for adults, children and young people with epilepsy are currently available, as well as exploring if these interventions are effective in improving mental health and wellbeing. METHODS Searches were conducted using the MEDLINE, PsycINFO, Web of Science and Embase. The reference lists of papers collected were examined in order to identify any further relevant articles cited in peer-reviewed journals. A total of 1490 papers were identified; of these 11 were included in this review. The protocol was registered in the PROSPERO database (CRD42022318658) and the PRISMA 2020 statement was followed. RESULTS Seven digital interventions were identified. All interventions were based predominantly on CBT and mindfulness techniques and showed promising results in reducing symptoms of depression, with some studies also reporting encouraging results in reducing anxiety and improving satisfaction with life and the quality of life of adults and children and young people with epilepsy. CONCLUSIONS In summary, digital mental health interventions for people with epilepsy seem to be effective and have the potential to improve access to psychological interventions and reach underserved clinical populations. However, further well-powered and methodological rigorous studies are needed to confirm the effect of such interventions for people with epilepsy.
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12
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León-Salas B, González-Hernández Y, Infante-Ventura D, de Armas-Castellano A, García-García J, García-Hernández M, Carmona-Rodríguez M, Olazarán J, Dobato JL, Rodríguez-Rodríguez L, Trujillo-Martín MM. Telemedicine for neurological diseases: A systematic review and meta-analysis. Eur J Neurol 2023; 30:241-254. [PMID: 36256522 DOI: 10.1111/ene.15599] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to systematically review the effectiveness and safety of telemedicine combined with usual care (in-person visits) compared to usual care for the therapeutic management and follow-up assessment of neurological diseases. METHODS The electronic databases MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials were searched (June 2021). Randomized controlled trials (RCTs) on patients of any age with neurological diseases were considered. Two reviewers screened and abstracted data in duplicate and independently and assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials (RoB 2). When possible, pooled effect estimates were calculated. RESULTS Of a total of 3018 records initially retrieved, 25 RCTs (n = 2335) were included: 11 (n = 804) on stroke, four (n = 520) on Parkinson's disease, three (n = 110) on multiple sclerosis, two (n = 320) on epilepsy, one (n = 63) on dementia, one (n = 23) on spina bifida, one (n = 40) on migraine, one (n = 22) on cerebral palsy and one (n = 433) on brain damage. Types of telemedicine assessed were online visits (11 studies), tele-rehabilitation (seven studies), telephone calls (three), smartphone apps (two) and online computer software (two). The evidence was quite limited except for stroke. Compared to usual care alone, telemedicine plus usual care was found to improve depressive symptoms, functional status, motor function, executive function, generic quality of life, healthcare utilization and healthy lifestyle in patients in post-stroke follow-up. CONCLUSIONS Well-designed and executed RCTs are needed to confirm our findings on stroke and to have more scientific evidence available for the other neurological diseases.
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Affiliation(s)
- Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Diego Infante-Ventura
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Aythami de Armas-Castellano
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Javier García-García
- Quality and Patient Safety Unit, Nuestra Señora de Candelaria University Hospital, Tenerife, Spain
| | - Miguel García-Hernández
- Teaching Unit of Family and Community Medicine 'La Laguna-Tenerife Norte', Primary Care Management of Tenerife, Canary Islands Health Service (SCS), Tenerife, Spain
| | - Montserrat Carmona-Rodríguez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.,Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Olazarán
- Neurology Service, Gregorio Marañón University Hospital, Madrid, Spain
| | - José Luis Dobato
- Neurology Service, Alcorcón Foundation University Hospital, Madrid, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - María M Trujillo-Martín
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.,Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
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13
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Li D, Song Y, Zhang S, Qiu J, Zhang R, Wu J, Wu Z, Wei J, Xiang X, Zhang Y, Yu L, Wang H, Niu P, Fan C, Li X. Cognitive behavior therapy for depression in people with epilepsy: A systematic review and meta-analysis. Epilepsy Behav 2023; 138:109056. [PMID: 36571868 DOI: 10.1016/j.yebeh.2022.109056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is the recommended treatment for depression in patients with epilepsy (PWE). However, there are no studies that calculate the effect size of CBT on depression and quality of life (QoL) in PWE. METHODS We searched seven electronic databases (PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials, Ovid Medline, and PsycINFO). We included 13 studies examining CBT for depression in PWE and calculated its effect size. RESULTS A total of 13 studies met the criteria. After treatment, CBT improves depression in PWE (g = 0.36, 95%CI: 0.18 to 0.54, I2 = 50%), and the efficacy maintains during follow-up (g = 0.47, 95%CI: 0.04 to 0.89, I2 = 80%). Subgroup analysis has shown that individual CBT (g = 0.47, 95%CI: 0.20 to 0.73, I2 = 0%) had a greater effect size than group CBT (g = 0.30, 95%CI: 0.07 to 0.53, I2 = 62%) in the treatment of depression. Likewise, CBT has a positive effect on the QoL improvement of PWE (g = 0.34, 95%CI: 0.11 to 0.57, I2 = 64%). In controlling seizures, CBT did not differ from the control group (g = -0.06, 95%CI: -0.32 to 0.19, I2 = 0%). CONCLUSIONS Cognitive behavioral therapy interventions were effective in improving depression and QoL in PWE, but not effective in controlling seizures. The efficacy of CBT interventions targeting seizure control seems to be uncertain.
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Affiliation(s)
- Dongxu Li
- Research Center for Translational Medicine, the Second Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China; Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Yuqi Song
- Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, China
| | - Shuyu Zhang
- School of Psychology, The Australian National University, Canberra, ACT 2601, Australia
| | - Juan Qiu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Rui Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Jiayi Wu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Ziyan Wu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Junwen Wei
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Xuefeng Xiang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Yue Zhang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Liangdong Yu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Honghan Wang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Ping Niu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Chuan Fan
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Xiaoming Li
- Research Center for Translational Medicine, the Second Hospital of Anhui Medical University, Hefei, China; Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China.
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14
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Krause N, Riemann-Lorenz K, Rahn AC, Pöttgen J, Köpke S, Meyer B, Thale F, Temmes H, van de Loo M, Gold SM, Heesen C. 'That would have been the perfect thing after diagnosis': development of a digital lifestyle management application in multiple sclerosis. Ther Adv Neurol Disord 2022; 15:17562864221118729. [PMID: 36092248 PMCID: PMC9459469 DOI: 10.1177/17562864221118729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background A multiple sclerosis (MS) diagnosis urges decision-making on immunotherapies, while persons with MS (PwMS) need to develop a coping concept in parallel. At this stage, PwMS ask how they themselves may contribute to controlling the disease. Evidence suggests that maintaining a healthy lifestyle (e.g. physical activity and stress management) is a key factor for healthy aging and preserving activity, while data on MS are complex. Objectives Following the Medical Research Council framework, this study aimed to develop and investigate the feasibility of a new digital health application that conveys evidence-based patient information about lifestyle factors in MS and engages PwMS in relevant behaviour change techniques. Methods Based on a digital health application promoting lifestyle management in breast cancer survivors, an MS-specific adaptation ('levidex') was developed. Feasibility was tested with 15 PwMS and eight MS experts. Subsequently, a six-week pilot study with eight PwMS was conducted. All participants provided feedback on practicability and acceptability via a questionnaire and took part in a semi-structured telephone interview. Levidex was revised after each test phase. Results The final levidex tool includes 16 modules, 177 references and several other functions. Feasibility results showed that PwMS and MS experts perceived levidex as understandable (14 out of 15; 6 out of 8), trustworthy (15 out of 15; 8 out of 8), and relevant (10 out of 15; 8 out of 8). Interviews revealed potential for improvement regarding the length and complexity of some content. Piloting of the revised version confirmed good feasibility and high acceptance. Most participants felt inspired to initiate (7 out of 8) or had already implemented (5 out of 8) lifestyle changes after working with levidex. Conclusion Results suggest that levidex is feasible and well-accepted by PwMS and MS experts. It might be a useful tool to support PwMS in adapting to their diagnosis and initiating health-promoting lifestyle changes.
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Affiliation(s)
- Nicole Krause
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf,
Martinistraße 52, 20246 Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Nursing Research Unit, Institute for Social
Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Department of Neurology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of
Medicine, University of Cologne and University Hospital Cologne, Cologne,
Germany
| | - Björn Meyer
- Research and Development Department, GAIA
Group, Hamburg, Germany
| | - Frithjof Thale
- Research and Development Department, GAIA
Group, Hamburg, Germany
| | - Herbert Temmes
- German Multiple Sclerosis Society, Federal
Association, Hannover, Germany
| | - Markus van de Loo
- German Multiple Sclerosis Society, Federal
Association, Hannover, Germany
| | - Stefan M. Gold
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Charité–Universitätsmedizin Berlin, Klinik für
Psychiatrie und Psychotherapie und Med. Klinik m.S. Psychosomatik, Berlin,
Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple
Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg,
Germany
- Department of Neurology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Moshe I, Terhorst Y, Paganini S, Schlicker S, Pulkki-Råback L, Baumeister H, Sander LB, Ebert DD. Predictors of Dropout in a Digital Intervention for the Prevention and Treatment of Depression in Patients With Chronic Back Pain: Secondary Analysis of Two Randomized Controlled Trials. J Med Internet Res 2022; 24:e38261. [PMID: 36040780 PMCID: PMC9472049 DOI: 10.2196/38261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/03/2022] [Accepted: 07/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Depression is a common comorbid condition in individuals with chronic back pain (CBP), leading to poorer treatment outcomes and increased medical complications. Digital interventions have demonstrated efficacy in the prevention and treatment of depression; however, high dropout rates are a major challenge, particularly in clinical settings. Objective This study aims to identify the predictors of dropout in a digital intervention for the treatment and prevention of depression in patients with comorbid CBP. We assessed which participant characteristics may be associated with dropout and whether intervention usage data could help improve the identification of individuals at risk of dropout early on in treatment. Methods Data were collected from 2 large-scale randomized controlled trials in which 253 patients with a diagnosis of CBP and major depressive disorder or subclinical depressive symptoms received a digital intervention for depression. In the first analysis, participants’ baseline characteristics were examined as potential predictors of dropout. In the second analysis, we assessed the extent to which dropout could be predicted from a combination of participants’ baseline characteristics and intervention usage variables following the completion of the first module. Dropout was defined as completing <6 modules. Analyses were conducted using logistic regression. Results From participants’ baseline characteristics, lower level of education (odds ratio [OR] 3.33, 95% CI 1.51-7.32) and both lower and higher age (a quadratic effect; age: OR 0.62, 95% CI 0.47-0.82, and age2: OR 1.55, 95% CI 1.18-2.04) were significantly associated with a higher risk of dropout. In the analysis that aimed to predict dropout following completion of the first module, lower and higher age (age: OR 0.60, 95% CI 0.42-0.85; age2: OR 1.59, 95% CI 1.13-2.23), medium versus high social support (OR 3.03, 95% CI 1.25-7.33), and a higher number of days to module completion (OR 1.05, 95% CI 1.02-1.08) predicted a higher risk of dropout, whereas a self-reported negative event in the previous week was associated with a lower risk of dropout (OR 0.24, 95% CI 0.08-0.69). A model that combined baseline characteristics and intervention usage data generated the most accurate predictions (area under the receiver operating curve [AUC]=0.72) and was significantly more accurate than models based on baseline characteristics only (AUC=0.70) or intervention usage data only (AUC=0.61). We found no significant influence of pain, disability, or depression severity on dropout. Conclusions Dropout can be predicted by participant baseline variables, and the inclusion of intervention usage variables may improve the prediction of dropout early on in treatment. Being able to identify individuals at high risk of dropout from digital health interventions could provide intervention developers and supporting clinicians with the ability to intervene early and prevent dropout from occurring.
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Affiliation(s)
- Isaac Moshe
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sarah Paganini
- Department of Sport Psychology, Institute of Sports and Sport Science, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Sandra Schlicker
- Clinic for Psychiatry and Psychotherapy, Rhein-Erft-Kreis, Germany
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Daniel Ebert
- Department for Sport and Health Sciences, Chair for Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
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16
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Burbach F, Lecce F, Allen VM, Porter CM. A conversational virtual avatar-led cognitive behavioural therapy app intervention for improving the quality of life and mental health of people with epilepsy: protocol for a randomised control trial. (Preprint). JMIR Res Protoc 2022; 11:e40261. [DOI: 10.2196/40261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
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17
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White V, Linardon J, Stone JE, Holmes-Truscott E, Olive L, Mikocka-Walus A, Hendrieckx C, Evans S, Speight J. Online psychological interventions to reduce symptoms of depression, anxiety, and general distress in those with chronic health conditions: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2022; 52:548-573. [PMID: 32674747 DOI: 10.1017/s0033291720002251] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition. METHOD We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses. RESULTS In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22-0.39), anxiety g = 0.19 (95% CI 0.12-0.27), and distress g = 0.36 (95% CI 0.23-0.49). CONCLUSION Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.
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Affiliation(s)
- V White
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J Linardon
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria3168, Australia
| | - E Holmes-Truscott
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
| | - L Olive
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - A Mikocka-Walus
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - C Hendrieckx
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
| | - S Evans
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J Speight
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
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18
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Mula M, Brodie MJ, de Toffol B, Guekht A, Hecimovic H, Kanemoto K, Kanner AM, Teixeira AL, Wilson SJ. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia 2021; 63:316-334. [PMID: 34866176 DOI: 10.1111/epi.17140] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022]
Abstract
The aim of this document is to provide evidence-based recommendations for the medical treatment of depression in adults with epilepsy. The working group consisted of members of an ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Psychiatry, ILAE Executive and the International Bureau for Epilepsy (IBE) representatives. The development of these recommendations is based on a systematic review of studies on the treatment of depression in adults with epilepsy, and a formal adaptation process of existing guidelines and recommendations of treatment of depression outside epilepsy using the ADAPTE process. The systematic review identified 11 studies on drug treatments (788 participants, class of evidence III and IV); 13 studies on psychological treatments (998 participants, class of evidence II, III and IV); and 2 studies comparing sertraline with cognitive behavioral therapy (CBT; 155 participants, class of evidence I and IV). The ADAPTE process identified the World Federation of Societies of Biological Psychiatry guidelines for the biological treatment of unipolar depression as the starting point for the adaptation process. This document focuses on first-line drug treatment, inadequate response to first-line antidepressant treatment, and duration of such treatment and augmentation strategies within the broader context of electroconvulsive therapy, psychological, and other treatments. For mild depressive episodes, psychological interventions are first-line treatments, and where medication is used, selective serotonin reuptake inhibitors (SSRIs) are first-choice medications (Level B). SSRIs remain the first-choice medications (Level B) for moderate to severe depressive episodes; however, in patients who are partially or non-responding to first-line treatment, switching to venlafaxine appears legitimate (Level C). Antidepressant treatment should be maintained for at least 6 months following remission from a first depressive episode but it should be prolonged to 9 months in patients with a history of previous episodes and should continue even longer in severe depression or in cases of residual symptomatology until such symptoms have subsided.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospital NHS Foundation Trust, London, UK
| | | | - Bertrand de Toffol
- Department of Neurology and Clinical Neurophysiology, CHU Bretonneau, INSERM U 1253 ibrain, Université de Tours, Tours, France
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Pirogov Russian National Research Medical University, Moscow, Russia
| | - Hrvoje Hecimovic
- Neuro Center, Zagreb, Croatia.,Department of Biomedicine, University North, Varaždin, Croatia
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagoya, Japan
| | - Andres M Kanner
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Antonio L Teixeira
- Instituto de Ensino e Pesquisa, Santa Casa BH Belo Horizonte, Belo Horizonte, Brasil.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne and Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
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19
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Meyer B, Utter GL, Hillman C. A Personalized, Interactive, Cognitive Behavioral Therapy-Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study. JMIR Ment Health 2021; 8:e31173. [PMID: 34623309 PMCID: PMC8538017 DOI: 10.2196/31173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Opioid use disorder (OUD) is characterized by the inability to control opioid use despite attempts to stop use and negative consequences to oneself and others. The burden of opioid misuse and OUD is a national crisis in the United States with substantial public health, social, and economic implications. Although medication-assisted treatment (MAT) has demonstrated efficacy in the management of OUD, access to effective counseling and psychosocial support is a limiting factor and a significant problem for many patients and physicians. Digital therapeutics are an innovative class of interventions that help prevent, manage, or treat diseases by delivering therapy using software programs. These applications can circumvent barriers to uptake, improve treatment adherence, and enable broad delivery of evidence-based management strategies to meet service gaps. However, few digital therapeutics specifically targeting OUD are available, and additional options are needed. OBJECTIVE To this end, we describe the development of the novel digital therapeutic MODIA. METHODS MODIA was developed by an international, multidisciplinary team that aims to provide effective, accessible, and sustainable management for patients with OUD. Although MODIA is aligned with principles of cognitive behavioral therapy, it was not designed to present any 1 specific treatment and uses a broad range of evidence-based behavior change techniques drawn from cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and motivational interviewing. RESULTS MODIA uses proprietary software that dynamically tailors content to the users' responses. The MODIA program comprises 24 modules or "chats" that patients are instructed to work through independently. Patient responses dictate subsequent content, creating a "simulated dialogue" experience between the patient and program. MODIA also includes brief motivational text messages that are sent regularly to prompt patients to use the program and help them transfer therapeutic techniques into their daily routines. Thus, MODIA offers individuals with OUD a custom-tailored, interactive digital psychotherapy intervention that maximizes the personal relevance and emotional impact of the interaction. CONCLUSIONS As part of a clinician-supervised MAT program, MODIA will allow more patients to begin psychotherapy concurrently with opioid maintenance treatment. We expect access to MODIA will improve the OUD management experience and provide sustainable positive outcomes for patients.
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Holtdirk F, Mehnert A, Weiss M, Mayer J, Meyer B, Bröde P, Claus M, Watzl C. Results of the Optimune trial: A randomized controlled trial evaluating a novel Internet intervention for breast cancer survivors. PLoS One 2021; 16:e0251276. [PMID: 33961667 PMCID: PMC8104369 DOI: 10.1371/journal.pone.0251276] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/20/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION After the acute treatment phase, breast cancer patients often experience low quality of life and impaired mental health, which could potentially be improved by offering cognitive behavioural therapy (CBT) and addressing exercise and dietary habits. However, CBT and other behavioural interventions are rarely available beyond the acute treatment phase. Internet-based interventions could bridge such treatment gaps, given their flexibility and scalability. In this randomized controlled trial (RCT), we investigated the effects of such an intervention ("Optimune") over three months. METHODS This RCT included 363 female breast cancer survivors (age range = 30-70), recruited from the community, who had completed the active treatment phase. Inclusion criteria were: breast cancer diagnosis less than 5 years ago and acute treatment completion at least 1 month ago. Participants were randomly assigned to (1) an intervention group (n = 181), in which they received care as usual (CAU) plus 12-month access to Optimune immediately after randomization, or (2) a control group (n = 182), in which they received CAU and Optimune after a delay of 3 months. Primary endpoints were quality of life (QoL), physical activity, and dietary habits at three months. We hypothesized that intervention group participants would report better QoL, more physical activity, and improved dietary habits after 3 months. RESULTS Intention-to-treat (ITT) analyses revealed significant effects on QoL (d = 0.27, 95% CI: 0.07-0.48) and dietary habits (d = 0.36, 95% CI: 0.15-0.56), but the effect on physical exercise was not significant (d = 0.30; 95% CI: 0.10-0.51). DISCUSSION These findings suggest the effectiveness of Optimune, a new CBT-based Internet intervention for breast cancer survivors, in facilitating improvements in quality of life and dietary habits. Efforts to disseminate this intervention more broadly may be warranted. TRIAL REGISTRATION ClinicalTrials.gov, NCT03643640. Registered August 23rd 2018, https://clinicaltrials.gov/ct2/show/NCT03643640.
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Affiliation(s)
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology University Hospital of Leipzig, Leipzig, Germany
| | - Mario Weiss
- Research Department, Gaia Group, Hamburg, Germany
| | | | - Björn Meyer
- Research Department, Gaia Group, Hamburg, Germany
| | - Peter Bröde
- Leibniz Research Centre (IfADo), Technical University of Dortmund, Dortmund, Germany
| | - Maren Claus
- Leibniz Research Centre (IfADo), Technical University of Dortmund, Dortmund, Germany
| | - Carsten Watzl
- Leibniz Research Centre (IfADo), Technical University of Dortmund, Dortmund, Germany
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21
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Gandy M, Modi AC, Wagner JL, LaFrance WC, Reuber M, Tang V, Valente KD, Goldstein LH, Donald KA, Rayner G, Michaelis R. Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force. Epilepsia Open 2021; 6:127-139. [PMID: 33681656 PMCID: PMC7918327 DOI: 10.1002/epi4.12455] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Objectives The Psychology Task Force of the Medical Therapies Commission of the International League Against Epilepsy (ILAE) has been charged with taking steps to improve global mental health care for people with epilepsy. This study aimed to inform the direction and priorities of the Task Force by examining epilepsy healthcare providers' current practical experiences, barriers, and unmet needs around addressing depression and anxiety in their patients. Methods A voluntary 27-item online survey was distributed via ILAE chapters and networks. It assessed practices in the areas of screening, referral, management, and psychological care for depression and anxiety. A total of 445 participants, from 67 countries (68% high income), commenced the survey, with 87% completing all components. Most respondents (80%) were either neurologists or epileptologists. Results Less than half of respondents felt adequately resourced to manage depression and anxiety. There was a lack of consensus about which health professionals were responsible for screening and management of these comorbidities. About a third only assessed for depression and anxiety following spontaneous report and lack of time was a common barrier (>50%). Routine referrals to psychiatrists (>55%) and psychologists (>41%) were common, but approximately one third relied on watchful waiting. A lack of both trained mental health specialists (>55%) and standardized procedures (>38%) was common barriers to referral practices. The majority (>75%) of respondents' patients identified with depression or anxiety had previously accessed psychotropic medications or psychological treatments. However, multiple barriers to psychological treatments were endorsed, including accessibility difficulties (52%). Significance The findings suggest that while the importance of managing depression and anxiety in patients with epilepsy is being recognized, there are ongoing barriers to effective mental health care. Key future directions include the need for updated protocols in this area and the integration of mental health professionals within epilepsy settings.
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Affiliation(s)
- Milena Gandy
- The eCentreClinicDepartment of PsychologyFaculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyAustralia
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical PsychologyCincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOHUSA
| | - Janelle L. Wagner
- College of NursingMedical University of South CarolinaCharlestonSCUSA
| | - W. Curt LaFrance
- Departments of Psychiatry and NeurologyRhode Island HospitalBrown UniversityProvidenceRIUSA
| | - Markus Reuber
- Academic Neurology UnitRoyal Hallamshire HospitalUniversity of SheffieldSheffieldUK
| | - Venus Tang
- Department of Clinical PsychologyPrince of Wales Hospital, Hospital AuthoritySha TinHong Kong
- Division of NeurosurgeryDepartment of SurgeryFaculty of MedicineChinese University of Hong KongShatinHong Kong
| | - Kette D. Valente
- Department of PsychiatryFaculty of MedicineUniversity of Sao Paulo (HCFMUSP)Sao PauloBrazil
| | - Laura H. Goldstein
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Kirsten A. Donald
- Division of Developmental PaediatricsDepartment of Paediatrics and Child HealthRed Cross War Memorial Children’s Hospital and the Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Rosa Michaelis
- Department of NeurologyGemeinschaftskrankenhaus HerdeckeUniversity of Witten/HerdeckeHerdeckeGermany
- Department of NeurologyUniversity Hospital Knappschaftskrankenhaus BochumRuhr‐University BochumBochumGermany
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22
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Domingues RB, Mantese CE, Aquino EDS, Fantini FGMM, Prado GFD, Nitrini R. Telemedicine in neurology: current evidence. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:818-826. [PMID: 33295422 DOI: 10.1590/0004-282x20200131] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. OBJECTIVE This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. METHODS A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. RESULTS Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. CONCLUSION Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.
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Affiliation(s)
- Renan Barros Domingues
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Santa Casa de Misericórdia de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Carlos Eduardo Mantese
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Hospital Mãe de Deus, Porto Alegre RS, Brazil
| | - Emanuelle da Silva Aquino
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Gilmar Fernandes do Prado
- Diretoria Executiva, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.,Diretoria Científica, Academia Brasileira de Neurologia, São Paulo SP, Brazil
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23
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Tailby C, Collins AJ, Vaughan DN, Abbott DF, O'Shea M, Helmstaedter C, Jackson GD. Teleneuropsychology in the time of COVID-19: The experience of The Australian Epilepsy Project. Seizure 2020; 83:89-97. [PMID: 33120327 PMCID: PMC7561524 DOI: 10.1016/j.seizure.2020.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Traditional neuropsychological testing carries elevated COVID-19 risk for both examinee and examiner. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during the pandemic. METHODS The AEP includes adults (age 18-60) with a first unprovoked seizure, new diagnosis of epilepsy or drug resistant focal epilepsy. Shortly after launching the study, COVID-related restrictions necessitated adaptation to teleNP, including delivery of verbal tasks via videoconference; visual stimulus delivery via document camera; use of web-hosted, computerised assessment; substitution of oral versions for written tests; online delivery of questionnaires; and discontinuation of telehealth incompatible tasks. RESULTS To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9 %) have been invalidated, for a variety of reasons (technical, procedural, environmental). Data confirm typical patterns of epilepsy-related deficits (p < .05) affecting processing speed, executive function, language and memory. Questionnaire responses indicate elevated rates of patients at high risk of mood (34 %) and anxiety disorder (38 %). CONCLUSION Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers an opportunity to expand the reach and breadth of neuropsychological services.
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Affiliation(s)
- Chris Tailby
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Australia.
| | - Alana J Collins
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Neurology, Austin Health, Heidelberg, Australia
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Marie O'Shea
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, Australia; School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | | | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Neurology, Austin Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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24
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Bernard-Willis Y, Oliveira ED, Lakhan SE. An Overview of Digital Health in the Transition of Pediatric to Adult Epilepsy Care. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractChildren with epilepsy often have impairments in cognitive and behavioral functioning which may hinder socio-occupational well-being as they reach adulthood. Adolescents with epilepsy have the added worry of health problems while starting the transition from family-centered pediatric care into largely autonomous adult care. If this transition is not appropriately planned and resourced, it may result in medical mistrust, nonadherence, and worsening biopsychosocial health as an adult. In recent years, there has been increased availability of digital health solutions that may be used during this stark change in care and treating teams. The digital health landscape includes a wide variety of technologies meant to address challenges faced by patients, caregivers, medical professionals, and health care systems. These technologies include mobile health products and wearable devices (e.g., seizure monitors and trackers, smartphone passive data collection), digital therapeutics (e.g., cognitive/behavioral health management; digital speech–language therapy), telehealth services (e.g., teleneurology visits), and health information technology (e.g., electronic medical records with patient portals). Such digital health solutions may empower patients in their journey toward optimal brain health during the vulnerable period of pediatric to adult care transition. Further research is needed to validate and measure their impact on clinical outcomes, health economics, and quality of life.
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Affiliation(s)
| | - Emily De Oliveira
- Department of Speech-Language Pathology, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States
| | - Shaheen E Lakhan
- Department of Biosciences, Global Neuroscience Initiative Foundation, Boston, Massachusetts, United States
- College of Science, Virginia Tech, Blacksburg, Virginia, United States
- Division of Neurology, Cambridge Health Alliance, Cambridge, Massachusetts, United States
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25
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Michaelis R, Tang V, Nevitt SJ, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Gandy M, Bresnahan R, Valente K, Donald KA, Reuber M. Psychological treatments for people with epilepsy. Cochrane Database Syst Rev 2020; 8:CD012081. [PMID: 35653266 PMCID: PMC8409429 DOI: 10.1002/14651858.cd012081.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Given the significant impact epilepsy may have on the health-related quality of life (HRQOL) of individuals with epilepsy and their families, there is increasing clinical interest in evidence-based psychological treatments, aimed at enhancing psychological and seizure-related outcomes for this group. This is an updated version of the original Cochrane Review published in Issue 10, 2017. OBJECTIVES To assess the impact of psychological treatments for people with epilepsy on HRQOL outcomes. SEARCH METHODS For this update, we searched the following databases on 12 August 2019, without language restrictions: Cochrane Register of Studies (CRS Web), which includes randomized or quasi-randomized controlled trials from the Specialized Registers of Cochrane Review Groups including Epilepsy, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid, 1946 to 09 August 2019), and PsycINFO (EBSCOhost, 1887 onwards), and from PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). We screened the references from included studies and relevant reviews, and contacted researchers in the field for unpublished studies. SELECTION CRITERIA We considered randomized controlled trials (RCTs) and quasi-RCTs for this review. HRQOL was the main outcome. For the operational definition of 'psychological treatments', we included a broad range of skills-based psychological treatments and education-only interventions designed to improve HRQOL, seizure frequency and severity, as well as psychiatric and behavioral health comorbidities for adults and children with epilepsy. These psychological treatments were compared to treatment as usual (TAU), an active control group (such as social support group), or antidepressant pharmacotherapy. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 36 completed RCTs, with a total of 3526 participants. Of these studies, 27 investigated skills-based psychological interventions. The remaining nine studies were education-only interventions. Six studies investigated interventions for children and adolescents, three studies investigated interventions for adolescents and adults, and the remaining studies investigated interventions for adults. Based on satisfactory clinical and methodological homogeneity, we pooled data from 11 studies (643 participants) that used the Quality of Life in Epilepsy-31 (QOLIE-31) or other QOLIE inventories (such as QOLIE-89 or QOLIE-31-P) convertible to QOLIE-31. We found significant mean changes for the QOLIE-31 total score and six subscales (emotional well-being, energy and fatigue, overall QoL, seizure worry, medication effects, and cognitive functioning). The mean changes in the QOLIE-31 total score (mean improvement of 5.23 points, 95% CI 3.02 to 7.44; P < 0.001), and the overall QoL score (mean improvement of 5.95 points, 95% CI 3.05 to 8.85; P < 0.001) exceeded the threshold of minimally important change (MIC: total score: 4.73 points; QoL score: 5.22 points), indicating a clinically meaningful postintervention improvement in HRQOL. We downgraded the certainty of the evidence provided by the meta-analysis due to serious risks of bias in some of the included studies. Consequently, these results provided moderate-certainty evidence that psychological treatments for adults with epilepsy may enhance overall HRQOL. AUTHORS' CONCLUSIONS Implications for practice: Skills-based psychological interventions improve HRQOL in adults and adolescents with epilepsy. Adjunctive use of skills-based psychological treatments for adults and adolescents with epilepsy may provide additional benefits in HRQOL when these are incorporated into patient-centered management. We judge the evidence to be of moderate certainty. IMPLICATIONS FOR RESEARCH Investigators should strictly adhere to the CONSORT guidelines to improve the quality of reporting on their interventions. A thorough description of intervention protocols is necessary to ensure reproducibility. When examining the effectiveness of psychological treatments for people with epilepsy, the use of standardized HRQOL inventories, such as the Quality of Life in Epilepsy Inventories (QOLIE-31, QOLIE-31-P, and QOLIE-89) would increase comparability. Unfortunately, there is a critical gap in pediatric RCTs and RCTs including people with epilepsy and intellectual disabilities. Finally, in order to increase the overall quality of RCT study designs, adequate randomization with allocation concealment and blinded outcome assessment should be pursued. As attrition is often high in research that requires active participation, an intention-to-treat analysis should be carried out. Treatment fidelity and treatment competence should also be assessed. These important dimensions, which are related to 'Risk of bias' assessment, should always be reported.
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Affiliation(s)
- Rosa Michaelis
- Department of Neurology Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
| | - Venus Tang
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hospital Authority, Hong Kong
- Department of Clinical Psychology, Prince of Wales Hospital, Hospital Authority, Hong Kong
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Janelle L Wagner
- College of Nursing, Medical University of South Carolina, Charleston, USA
| | - Avani C Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA
| | - William Curt LaFrance
- Departments of Psychiatry and Neurology, Brown University, Providence, Rhode Island, USA
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Milena Gandy
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Rebecca Bresnahan
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kette Valente
- Faculty of Medicine, University of São Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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A feasibility trial of an internet-delivered psychological intervention to manage mental health and functional outcomes in neurological disorders. J Psychosom Res 2020; 136:110173. [PMID: 32623193 DOI: 10.1016/j.jpsychores.2020.110173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Mental health and cognitive difficulties are highly prevalent across neurological disorders and significantly contribute to poorer patient outcomes. Unfortunately, access to effective psychological services for these comorbidities are limited. To determine whether a novel transdiagnostic internet-delivered psychological intervention, the Wellbeing Neuro Course, was feasible, acceptable and efficacious a single-group feasibility open trial was employed. METHODS The Wellbeing Neuro Course, targets mental health and cognitive difficulties, across a variety of neurological disorders. It is comprised of six online lessons, based on Cognitive Behavioural Therapy and Compensatory Cognitive Rehabilitation, delivered over 10 weeks and provided with weekly support from a mental health professional via email and telephone. 105 adults with diagnoses of either epilepsy, multiple sclerosis, Parkinson's disease and/or acquired brain injury, underwent the intervention. RESULTS The intervention was found to be highly acceptable with high intervention completion and levels of satisfaction (>95%). There was evidence of clinically significant improvements in primary outcomes (within-group Cohen's d; average reductions) of depression (d = 0.93; avg. reduction ≥36%), anxiety (ds = 0.66, avg. reduction ≥36%), and disability (ds ≥ 0.49; avg. reduction ≥23%) at post-intervention, maintained at 3-month follow-up. For secondary outcomes there were significant improvements in fatigue severity and perceived cognitive difficulties of attention, planning and prospective memory. Findings were achieved with minimal clinician time, highlighting its public health potential. CONCLUSION This open trial provides preliminary evidence the Wellbeing Neuro Course is acceptable and reduces symptoms of depression, anxiety and disability in neurological disorders. Future controlled trials of the intervention are now needed. TRIAL REGISTRATION ACTRN12617000581369.
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27
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Wang Y, Hou D, Wu X, Qiu L, Chen H, Xin J, Yan Z, Sun M. An intensive education program for caregivers ameliorates anxiety, depression, and quality of life in patients with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis who underwent cortico-amygdalohippocampectomy. Braz J Med Biol Res 2020; 53:e9000. [PMID: 32696820 PMCID: PMC7372948 DOI: 10.1590/1414-431x20209000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022] Open
Abstract
This study aimed to investigate the effect of a caregiver intensive education
program (CIEP) on anxiety, depression, and quality of life (QOL) in patients
with drug-resistant temporal lobe epilepsy and mesial temporal sclerosis
(TLE-MTS) who underwent cortico-amygdalohippocampectomy (CAH). Ninety patients
with drug-resistant TLE-MTS who underwent CAH and their caregivers were
recruited and randomly allocated to the CIEP group or control group as 1:1
ratio. Caregivers received the CIEP program or routine guidance/education
(control group). Anxiety/depression and QOL in patients at month (M)0, M1, M3,
and M6 were assessed by the Hospital Anxiety and Depression Scale (HADS) scale
and the QOL in Epilepsy Inventory-31 (QOLIE-31), respectively. Treatment
efficacy at M6 was assessed by Engel classification. The HADS-anxiety score at
M3 (P=0.049) and M6 (P=0.028), HADS-anxiety score change (M6-M0) (P=0.001),
percentage of anxiety patients at M6 (P=0.025), and anxiety severity at M6
(P=0.011) were all decreased in the CIEP group compared with the control group.
The HADS-depression score at M6 (P=0.033) and HADS-depression score change
(M6-M0) (P=0.022) were reduced, while percentage of depression patients at M6
(P=0.099) and depression severity at M6 (P=0.553) showed no difference in the
CIEP group compared with the control group. The QOLIE-31 score at M6 (P=0.043)
and QOLIE-31 score change (M6-M0) (P=0.010) were both elevated in the CIEP group
compared with the control group. In conclusion, CIEP for caregivers contributed
to the recovery of anxiety and depression as well as the improvement of QOL in
patients with drug-resistant TLE-MTS who underwent CAH.
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Affiliation(s)
- Yuena Wang
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongyu Hou
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaohua Wu
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lili Qiu
- Department of Endocrinology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Chen
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxia Xin
- Department of Neurosurgery, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhirong Yan
- Department of Orthopedics, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Meiling Sun
- Department of Nursing, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
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Holtdirk F, Mehnert A, Weiss M, Meyer B, Watzl C. Protocol for the Optimune trial: a randomized controlled trial evaluating a novel Internet intervention for breast cancer survivors. Trials 2020; 21:117. [PMID: 31996235 PMCID: PMC6990478 DOI: 10.1186/s13063-019-3987-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/11/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Depression and fatigue are common in breast cancer survivors, and their presence is associated with personal suffering and worse prognosis. While many women receive short-term psychological support in the acute treatment phase, this is rarely available in subsequent phases. Internet interventions for breast cancer survivors could provide additional psychological support, as they are easily accessible and may be effective. However, no trial has yet examined the effectiveness of an Internet intervention that provides cognitive behavioural therapy techniques plus lifestyle advice for this population. This trial aims to test whether Optimune, a novel Internet intervention we developed for that purpose, leads to improvements in quality of life and relevant lifestyle habits over the course of 3 to 6 months. METHODS This randomized controlled trial (RCT) will include 360 female breast cancer survivors who have completed the active tumour eradication phase. Participants will be recruited from various settings, including web-based advertisements and Internet forums in German-speaking countries. The main inclusion criteria are a breast cancer diagnosis less than 5 years ago and completion of acute treatment at least 1 month ago, as verified by discharge letter from an oncology treatment centre. Participants will be randomly assigned to either (1) a control group, in which they receive care as usual (CAU) and are given access to Optimune after a delay of 3 months (CAU/wait list control), or (2) a treatment group that may also use CAU and will receive 12-month access to Optimune immediately after randomization. The three primary endpoints are quality of life, physical activity and diet quality, assessed with the World Health Organization Quality of Life Questionnaire, the International Physical Activity Questionnaire and the Food Quality Questionnaire, at 3 months post-baseline; secondary outcomes include cancer-related fatigue, emotional stress, depression, anxiety, fear of progression, insomnia, usefulness of the programme and negative treatment effects. Online assessments are conducted at baseline (T0), 3 months (T1) and 6 months (T2). DISCUSSION Results of this RCT are expected to extend the body of knowledge with regard to the effectiveness of CBT-based Internet interventions for female breast cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov, NCT03643640. Registered on 23 August 2018.
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Affiliation(s)
- Franziska Holtdirk
- Research Department, Gaia Group, Hans-Henny-Jahnn Weg 53, 22085, Hamburg, Germany.
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, Section Psychosocial Oncology, University Hospital of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Mario Weiss
- Research Department, Gaia Group, Hans-Henny-Jahnn Weg 53, 22085, Hamburg, Germany
| | - Björn Meyer
- Research Department, Gaia Group, Hans-Henny-Jahnn Weg 53, 22085, Hamburg, Germany
| | - Carsten Watzl
- Technical University of Dortmund, Leibniz Research Centre (IfADo), Ardeystraße 67, 44139, Dortmund, Germany
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Margolis SA, Gonzalez JS, Faria C, Kenney L, Grant AC, Nakhutina L. Anxiety disorders in predominantly African American and Caribbean American adults with intractable epilepsy: The role of perceived epilepsy stigma. Epilepsy Behav 2019; 99:106450. [PMID: 31419635 DOI: 10.1016/j.yebeh.2019.106450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anxiety disproportionately affects people with epilepsy (PWE) and leads to poor outcomes. Yet, risk factors are not well understood especially among underserved groups. This cross-sectional study aimed to identify epilepsy-specific predictors of anxiety disorders in predominantly African American and Caribbean American PWE. MATERIALS AND METHODS The prevalence of anxiety disorders was established via diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)). We identified the extent to which aspects of seizure burden (seizure frequency, seizure severity, convulsive vs. nonconvulsive seizures), seizure worry, and perceived epilepsy stigma were associated with anxiety disorder diagnosis. Finally, logistic regression assessed the overall and independent contributions of significant risk factors. RESULTS There were 60 participants (62% women, 52% African American, 27% Caribbean American, 20% Hispanic/Latino) with an average of 2 seizures per month. Nearly half of the sample (43%) had ≥1 anxiety disorder, with 62% of affected individuals qualifying for agoraphobia. Those with anxiety disorders tended to have convulsive seizures (p = 0.037) and endorsed greater seizure worry (p = 0.012), more general symptoms of anxiety (p = 0.005), and worse perceived epilepsy stigma (p = 0.003). Logistic regression accounted for 28% to 37.6% of the variance in anxiety disorder diagnostic status and correctly classified 73% of cases; however, only perceived epilepsy stigma made a unique contribution. CONCLUSIONS Anxiety disorders were prevalent in these predominantly African American and Caribbean American PWE. Epilepsy-specific risk factors included convulsive seizures, seizure worry, and perceived epilepsy stigma. Interventions aimed at treating anxiety disorders in diverse PWE may especially benefit from targeting stigma beliefs.
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Affiliation(s)
- Seth A Margolis
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA.
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Caylin Faria
- Bridgewater State University, 131 Summer St., Bridgewater, MA 02324, USA
| | - Lauren Kenney
- Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Arthur C Grant
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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Noble AJ, Marson AG, Blower SL. Psychological interventions for epilepsy: How good are trialists at assessing their implementation fidelity, what are the barriers, and what are journals doing to encourage it? A mixed methods study. Epilepsy Behav 2019; 97:174-181. [PMID: 31252275 DOI: 10.1016/j.yebeh.2019.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/28/2019] [Accepted: 05/28/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Psychological interventions hold promise for the epilepsy population and continue to be trialed to determine their efficacy. Such interventions present opportunities for variance in delivery. Therefore, to accurately interpret a trial's estimate of effect, information on implementation fidelity (IF) is required. We present a novel 3-part study. Part 1 systematically rated trials for the extent to which they reported assessing whether the intervention was delivered as intended (adherence) and with what sort of skill (competence). Part 2 identified barriers to reporting and assessing on fidelity perceived by trialists. Part 3 determined what journals publishing epilepsy trials are doing to support IFs reporting. METHODS Articles for 50 randomized controlled trials (RCTs)/quasi-RCTs of psychological interventions identified by Cochrane searches were rated using the Psychotherapy Outcome Study Methodology Rating Form's fidelity items. The 45 corresponding authors for the 50 trials were invited to complete the 'Barriers to Treatment Integrity Implementation Survey'. 'Instructions to Authors' for the 17 journals publishing the trials were reviewed for endorsement of popular reporting guidelines which refer to fidelity (Consolidated Standards of Reporting Trials (CONSORT) statement or Journal Article Reporting Standards [JARS]) and asked how they enforced compliance. RESULTS Part 1: 15 (30%) trials reported assessing for adherence, but only 2 (4.3%) gave the result. Four (8.5%) reported assessing for competence, 1 (2.1%) gave the result. Part 2: 22 trialists - mostly chief investigators - responded. They identified 'lack of theory and specific guidelines on treatment integrity procedures', 'time, cost, and labor demands', and 'lack of editorial requirement' as "strong barriers". Part 3: Most (15, 88.2%) journals endorsed CONSORT or JARS, but only 5 enforced compliance. CONCLUSIONS Most trials of psychological interventions for epilepsy are not reported in a transparent way when it comes to IF. The barriers' trialists identify for this do not appear insurmountable. Addressing them could ultimately help the field to better understand how best to support the population with epilepsy.
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Affiliation(s)
- Adam J Noble
- Health Services Research, University of Liverpool, Liverpool, UK.
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Sarah L Blower
- Department of Health Sciences, University of York, York, UK
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