背景:失眠是一种普遍存在的健康状况,社会,和经济影响。失眠的认知行为疗法(CBTI)被推荐为一线治疗。由于亲自交付的CBTI(ipCBTI)的可访问性有限,电子交付的电子健康CBTI(eCBTI),从电话和视频会议提供的干预到完全自动化的基于网络的程序和移动应用程序,已经成为一种选择。然而,eCBTI与ipCBTI相比的相对疗效尚未最终确定.
目的:本研究旨在通过基于直接比较2种交付方式的随机对照试验的系统评价和等效性荟萃分析,来测试eCBTI和ipCBTI的可比性。
方法:对多个数据库进行了全面搜索,从而鉴定和分析了ipCBTI和eCBTI的15种独特的随机头对头比较。提取有关睡眠和非睡眠结果的数据,并根据先前建议的最小重要差异得出的预定等效裕度,对其进行常规荟萃分析方法和等效性测试。进行了补充贝叶斯分析以确定可用证据的强度。
结果:荟萃分析包括15项研究,共1083名参与者。传统的比较通常有利于ipCBTI。然而,效果大小很小,对于大多数睡眠和非睡眠结局,两种分娩方式在统计学上具有统计学意义(P<0.05)。其他组内分析显示,这两种形式在失眠严重程度、睡眠质量和疲劳等次要结局方面均有统计学上的显着改善(P<0.05)。焦虑,和抑郁症。异质性分析强调了治疗持续时间和辍学率作为治疗疗效差异的潜在调节因素的作用。
结论:发现eCBTI和ipCBTI在治疗大多数检查结果的失眠方面具有统计学意义。表明eCBTI是ipCBTI的临床相关替代品。这支持扩展eCBTI作为增加有效失眠治疗的可及性的可行选择。尽管如此,需要进一步的研究来解决所指出的局限性,包括一些研究中偏倚的高风险以及治疗持续时间和退出率对疗效的潜在影响.
背景:PROSPEROCRD42023390811;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=390811。
BACKGROUND: Insomnia is a prevalent condition with significant health, societal, and economic impacts. Cognitive behavioral therapy for insomnia (CBTI) is recommended as the first-line treatment. With limited accessibility to in-person-delivered CBTI (ipCBTI), electronically delivered eHealth CBTI (eCBTI), ranging from telephone- and videoconference-delivered interventions to fully automated web-based programs and mobile apps, has emerged as an alternative. However, the relative efficacy of eCBTI compared to ipCBTI has not been conclusively determined.
OBJECTIVE: This study aims to test the comparability of eCBTI and ipCBTI through a systematic review and meta-analysis of equivalence based on randomized controlled trials directly comparing the 2 delivery formats.
METHODS: A comprehensive search across multiple databases was conducted, leading to the identification and analysis of 15 unique randomized head-to-head comparisons of ipCBTI and eCBTI. Data on sleep and nonsleep outcomes were extracted and subjected to both conventional meta-analytical methods and equivalence testing based on predetermined equivalence margins derived from previously suggested minimal important differences. Supplementary Bayesian analyses were conducted to determine the strength of the available evidence.
RESULTS: The meta-analysis included 15 studies with a total of 1083 participants. Conventional comparisons generally favored ipCBTI. However, the effect sizes were small, and the 2 delivery formats were statistically significantly equivalent (P<.05) for most sleep and nonsleep outcomes. Additional within-group analyses showed that both formats led to statistically significant improvements (P<.05) in insomnia severity; sleep quality; and secondary outcomes such as fatigue, anxiety, and depression. Heterogeneity analyses highlighted the role of treatment duration and dropout rates as potential moderators of the differences in treatment efficacy.
CONCLUSIONS: eCBTI and ipCBTI were found to be statistically significantly equivalent for treating insomnia for most examined outcomes, indicating eCBTI as a clinically relevant alternative to ipCBTI. This supports the expansion of eCBTI as a viable option to increase accessibility to effective insomnia treatment. Nonetheless, further research is needed to address the limitations noted, including the high risk of bias in some studies and the potential impact of treatment duration and dropout rates on efficacy.
BACKGROUND: PROSPERO CRD42023390811; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=390811.