Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis
Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis
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DOI：
10.1111/acps.12275
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发表时间：
2014-09-01
影响因子：
6.7
通讯作者：
Churchill, R.
中科院分区：
文献类型：
--
作者：
Furukawa, T. A.;Noma, H.;Churchill, R.
目的：在心理治疗试验中采用了各种控制条件，但越来越多的人怀疑它们可能导致不同的效应量估计。本研究旨在探讨控制条件包括等候名单（WL），无治疗（NT）和心理安慰剂（PP）之间的差异。我们全面检索了所有比较认知行为疗法（CBT）与各种对照条件在抑郁症急性期治疗中的随机对照试验（RCT），结果：共纳入49篇随机对照试验，共2730名受试者，比较了WL、NT、PP和CBT。该证据网络是一致的，CBT的效应量估计值根据控制条件而存在实质性差异。NT相对于WL的缓解比值比为2.9（95% CI：1.3-5.7），具有统计学显著性。然而，证据的质量，包括出版偏见，是不够理想的，没有预先计划的敏感性分析限制高质量的研究可以进行，而显着差异的结果并没有坚持在事后的敏感性分析，试图调整出版bias.Conclusion：有可能是重要的差异，目前在心理治疗试验中使用的控制条件。
Objective: Various control conditions have been employed in psychotherapy trials, but there is growing suspicion that they may lead to different effect size estimates. The present study aims to examine the differences among control conditions including waiting list (WL), no treatment (NT) and psychological placebo (PP).Method: We comprehensively searched for all randomized controlled trials (RCTs) comparing cognitive-behaviour therapies (CBT) against various control conditions in the acute phase treatment of depression, and applied network meta-analysis (NMA) to combine all direct and indirect comparisons among the treatment and control arms.Results: We identified 49 RCTs (2730 participants) comparing WL, NT, PP and CBT. This network of evidence was consistent, and the effect size estimates for CBT were substantively different depending on the control condition. The odds ratio of response for NT over WL was statistically significant at 2.9 (95% CI: 1.3-5.7). However, the quality of evidence, including publication bias, was less than ideal and none of the preplanned sensitivity analyses limiting to high-quality studies could be conducted, while findings of significant differences did not persist in post hoc sensitivity analyses trying to adjust for publication bias.Conclusion: There may be important differences in control conditions currently used in psychotherapy trials.