A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study.
A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study.
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DOI：
10.2196/34889
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发表时间：
2022-02-21
影响因子：
2.2
通讯作者：
Cheng AL
中科院分区：
文献类型：
--
作者：
Leo AJ;Schuelke MJ;Hunt DM;Metzler JP;Miller JP;Areán PA;Armbrecht MA;Cheng AL
抑郁和焦虑的症状通常与慢性肌肉骨骼疼痛共存，当这种情况发生时，标准的骨科治疗效果较差。然而，心理健康干预还不是标准骨科治疗的常规部分，部分原因是与访问相关的障碍。数字化心理健康干预是一种潜在的可扩展资源，可以切实可行地纳入骨科护理。本研究的主要目的是评估在门诊整形外科环境中向患有抑郁和/或焦虑症状的患者引入数字心理健康干预（Wysa）的可行性。次要目的是对干预措施进行初步有效性分析。在这项单组、前瞻性队列研究中，参与者包括成年患者（18岁及以上），这些患者在一个三级医疗学术中心接受非外科骨科专家评估肌肉骨骼疾病，并自我报告抑郁和/或焦虑症状（患者报告结局测量信息系统[PROMIS]抑郁和/或焦虑评分≥55）。在参与者与骨科医生会面后，研究协调员立即进行面对面登记。参与者可以使用一个名为Wysa的移动的应用程序2个月，这是一个成熟的多组件数字心理健康干预，使用聊天机器人技术和基于文本的人类顾问访问，以提供认知行为治疗，正念训练和睡眠工具等功能。在这项研究中，Wysa Access还包括专门为慢性疼痛用户开发的基于行为激活的新功能。主要可行性结局包括研究招募率、留存率和Wysa参与率（定义为在研究期间至少使用一次Wysa治疗工具）。次要有效性结局是2个月随访时高和低Wysa使用者之间平均纵向PROMIS精神和身体健康评分变化的组间差异，由中位数划分定义。招募率为29.3%（61/208），留存率为84%（51/61），参与率为72%（44/61）。与低使用者相比，高使用者在2个月随访时报告PROMIS焦虑评分改善更大（组间差异为-4.2分，95%CI为-8.1至-0.2; P= 0.04）。PROMIS抑郁（-3.2分，95% CI-7.5至1.2; P= 0.15）和疼痛干扰评分（-2.3分，95% CI-6.3至1.7; P= 0.26）的组间差异有利于高使用者，但不符合统计学显著性。两组之间PROMIS身体功能评分的改善相当。在骨科护理的背景下提供数字心理健康干预是可行的，并且有可能在临床上有意义的程度上改善心理健康和疼痛相关的损害。参与者的参与率超过了行业标准，并发现了改善征聘和留住工作的更多机会。进一步的试点研究，随后是一个明确的，随机对照试验是必要的。ClinicalTrials.gov NCT 04640090; https://clinicaltrials.gov/ct2/show/NCT04640090
Symptoms of depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. However, mental health intervention is not yet a routine part of standard orthopedic treatment, in part because of access-related barriers. Digital mental health intervention is a potential scalable resource that could be feasibly incorporated into orthopedic care. This study’s primary purpose was to assess the feasibility of introducing a digital mental health intervention (Wysa) in an outpatient orthopedic setting to patients with coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a nonsurgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression and/or Anxiety score ≥55). Face-to-face enrollment was performed by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided 2 months of access to a mobile app called Wysa, which is an established, multicomponent digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation–based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engagement with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at 2-month follow-up between high and low Wysa users, defined by a median split. The recruitment rate was 29.3% (61/208), retention rate was 84% (51/61), and engagement rate was 72% (44/61). Compared to low users, high users reported greater improvement in PROMIS Anxiety scores (between-group difference −4.2 points, 95% CI −8.1 to −0.2; P=.04) at the 2-month follow-up. Between-group differences in PROMIS Depression (−3.2 points, 95% CI −7.5 to 1.2; P=.15) and Pain Interference scores (−2.3 points, 95% CI −6.3 to 1.7; P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function scores were comparable between groups. Delivery of a digital mental health intervention within the context of orthopedic care is feasible and has the potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. ClinicalTrials.gov NCT04640090; https://clinicaltrials.gov/ct2/show/NCT04640090
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