Rethinking the Dose-Response Relationship Between Usage and Outcome in an Online Intervention for Depression: Randomized Controlled Trial
Rethinking the Dose-Response Relationship Between Usage and Outcome in an Online Intervention for Depression: Randomized Controlled Trial
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DOI：
10.2196/jmir.2771
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发表时间：
2013-10-01
影响因子：
7.4
通讯作者：
Glozier, Nick
中科院分区：
文献类型：
--
作者：
Donkin, Liesje;Hickie, Ian B.;Glozier, Nick
背景资料：现在有大量的证据表明，基于网络的干预可以有效地改变行为，并成功地治疗心理障碍。然而，对使用对干预结果的影响的兴趣只是最近才发展起来的。到目前为止，持续或完成干预一直是最常见的使用指标，但这并不能充分描述用户的在线行为。分析使用的替代措施及其与结果的关系可能有助于了解多少干预用户可能需要获得临床显着benefit from the program.Objective：本研究的目的是确定哪些使用指标，如果有的话，与在线抑郁症治疗试验的结果相关。心血管风险电子沙发抑郁结果（CREDO）是一项随机对照试验，评估基于认知行为疗法和人际关系疗法的无指导网络计划（E-couch）对抑郁症和心血管疾病患者的影响。总共有280名参与者在试验的积极臂开始了该计划，在12个模块包含文本和活动的页面交付。使用数据（例如，登录次数、完成的模块、在线花费的时间和完成的活动）由程序界面自动捕获。我们估计这些和复合指标的临床显着改善抑郁症评分的患者健康问卷（PHQ-9）的= 5 points.Results的结果：在所有的，214/280（76.4%）参与者提供的结果数据在12周期间结束时，并被纳入分析。其中，94名（43.9%）参与者获得了临床显著改善。参与者平均登录程序18.7次（SD 8.3），大多数（62.1%，133/214）完成所有12个模块。每次登录的平均在线时间为17.3分钟（SD 10.5）。参与者平均完成了该计划中18项活动中的9项。在多变量回归模型中，只有每次登录完成的活动数量与临床显着结局相关（OR 2.82，95%CI 1.05-7.59）。最终模型预测结果的方差为7.4%。曲线估计表明，显着的对数（P= 0.009）和线性（P= 0.002）之间的关系存在的活动完成每次登录和临床显着的changes.Conclusions：只有一个客观的使用措施是独立的，与更好的结果，基于Web的干预已知的有效性。在回归的最后一步中保留的4个使用指标几乎没有造成结果差异。与低水平使用者相比，中等水平使用者似乎几乎没有额外获益，这表明使用与结局之间线性关系的假设可能过于简单，需要探索进一步的模型和变量以充分理解这种关系。
Background: There is now substantial evidence that Web-based interventions can be effective at changing behavior and successfully treating psychological disorders. However, interest in the impact of usage on intervention outcomes has only been developed recently. To date, persistence with or completion of the intervention has been the most commonly reported metric of use, but this does not adequately describe user behavior online. Analysis of alternative measures of usage and their relationship to outcome may help to understand how much of the intervention users may need to obtain a clinically significant benefit from the program.Objective: The objective of this study was to determine which usage metrics, if any, are associated with outcome in an online depression treatment trial.Methods: Cardiovascular Risk E-couch Depression Outcome (CREDO) is a randomized controlled trial evaluating an unguided Web-based program (E-couch) based on cognitive behavioral therapy and interpersonal therapy for people with depression and cardiovascular disease. In all, 280 participants in the active arm of the trial commenced the program, delivered in 12 modules containing pages of text and activities. Usage data (eg, number of log-ins, modules completed, time spent online, and activities completed) were captured automatically by the program interface. We estimated the association of these and composite metrics with the outcome of a clinically significant improvement in depression score on the Patient Health Questionnaire (PHQ-9) of = 5 points.Results: In all, 214/280 (76.4%) participants provided outcome data at the end of the 12-week period and were included in the analysis. Of these, 94 (43.9%) participants obtained clinically significant improvement. Participants logged into the program an average of 18.7 times (SD 8.3) with most (62.1%, 133/214) completing all 12 modules. Average time spent online per log-in was 17.3 minutes (SD 10.5). Participants completed an average of 9 of 18 activities available within the program. In a multivariate regression model, only the number of activities completed per log-in was associated with a clinically significant outcome (OR 2.82, 95% CI 1.05-7.59). The final model predicted 7.4% of variance in outcome. Curve estimates indicated that significant logarithmic (P=.009) and linear (P=.002) relationships existed between activities completed per log-in and clinically significant change.Conclusions: Only one objective measure of usage was independently associated with better outcome of a Web-based intervention of known effectiveness. The 4 usage metrics retained in the final step of the regression accounted for little outcome variance. Medium level users appeared to have little additional benefit compared to low users indicating that assumptions of a linear relationship between use and outcome may be too simplistic and further models and variables need to be explored to adequately understand the relationship.