A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics.
A randomized controlled trial comparing a manual and computer version of CALM in VA community-based outpatient clinics.
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DOI：
10.1016/j.jadr.2021.100202
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发表时间：
2021-12
影响因子：
--
通讯作者：
Lindsay J
中科院分区：
文献类型：
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作者：
Cucciare MA;Marchant K;Abraham T;Ecker A;Han X;White P;Craske MG;Lindsay J
这项研究比较了定制的协调焦虑学习和管理 (VA CALM) 协议的计算机版本和手动版本，以了解提供者对 CBT 和患者结果的忠诚度。这项研究是一项整群随机对照试验。提供者 (N = 32) 被随机分配通过计算机或手动提供 VA CALM。招募了由研究提供者治疗的退伍军人患者 (N = 135)。主要结果是 CBT 保真度，通过对录音会话进行评级来衡量。次要结局是在基线、三个月和六个月随访时评估的退伍军人一般（BSI-18 GSI、SF-12）和特定疾病（GAD-7、PCL-5、PHQ-9）结局。我们发现条件之间的平均保真度评分存在较大差异 (d = 0.88)，但在统计上不显着。与手册相比，通过计算机接受 VA CALM 的广泛性焦虑症参与者在 3 次（-5.88；95% CI=-11.37，-0.39）和 6 个月（-5.25；95% CI=-10.29，-0.22）随访（d = 0.37 至 0.55）时报告 GAD-7 分数较低。计算机和手动条件下的参与者报告较低的 PHQ-9（分别为 -3.11；95% CI=-5.51、-0.71；-4.06；95% CI=-7.22、-0.90）和 BSI-18 GSI（0.78；95% CI=0.68,0.90；0.71；95% CI=0.58， 0.87）从基线到六个月随访的得分。我们没有发现 SF-12 或 PCL-5 分数随时间或条件之间的统计显着差异。这项研究不足以测试主要结果。特定疾病亚组分析中的小样本量可能会限制研究结果的普遍性。事实证明，这两种方式在 VA CALM 保真度方面都没有优势。与手册相比，VA CALM 的计算机版本可能会给患有 GAD 的退伍军人带来一定的好处。
This study compared a computer and manual version of a tailored Coordinated Anxiety Learning and Management (VA CALM) protocol on provider fidelity to CBT and patient outcomes. This study was a cluster randomized controlled trial. Providers (N = 32) were randomized to deliver VA CALM by computer or manual. Veteran patients (N = 135), treated by study providers, were recruited. The primary outcome was CBT fidelity, measured by rating audiotaped sessions. Secondary outcomes were Veterans’ general (BSI-18 GSI, SF-12) and disorder-specific (GAD-7, PCL-5, PHQ-9) outcomes assessed at baseline, three and six month follow-up. We found a large (d = 0.88) but not statistically significant difference in mean fidelity rating scores between conditions. Compared with the manual, participants with generalized anxiety disorder receiving VA CALM by computer reported lower GAD-7 scores at three (−5.88; 95% CI=−11.37, −0.39) and six month (−5.25; 95% CI=−10.29, −0.22) follow-ups (d = 0.37 to 0.55). Participants in the computer and manual conditions reported lower PHQ-9 (−3.11; 95% CI=−5.51, −0.71; −4.06; 95% CI=−7.22, −0.90, respectively) and BSI-18 GSI (0.78; 95% CI=0.68,0.90; 0.71; 95% CI=0.58, 0.87, respectively) scores from baseline to six month follow-up. We did not find statistically significant differences over time or between conditions on SF-12 or PCL-5 scores. This study was underpowered to test the primary outcome. Small samples sizes in the disorder-specific subgroup analysis may limit the generalizability of findings. Neither modality proved to be superior on VA CALM fidelity. The computer version of VA CALM, compared to the manual, may provide modest benefit to Veterans with GAD.