Jiaxi Lin

Internetbasierte kognitiv-behaviorale Behandlungs­ansätze: State of the Art und Einsatzmöglichkeiten in der Rehabilitation

Internet-based health interventions (IHIs) provide a way to treat people via the Internet. The spectrum is wide, comprising interventions for mental disorders and somatic diseases as well as health and risk behavior change interventions. Numerous international studies have demonstrated the efficacy of IHIs for the aforementioned areas. Through the resource-saving applications IHIs are cost-efficient, not least suggesting their usefulness for medical rehabilitation. The present overview starts with a description of IHIs with a differentiation of technical-formal and thematic aspects. In doing so, the focus lies primarily on cognitive-behavioral treatment approaches, as the best scientifically investigated IHIs to date. An overview of the empirical evidence of IHIs is given, followed by a discussion of the implementation possibilities in medical rehabilitation.

Internetbasierte kognitiv-behaviorale Behandlungsansätze:

Internet-based health interventions (IHIs) provide a way to treat people via the Internet. The spectrum is wide, comprising interventions for mental disorders and somatic diseases as well as health and risk behavior change interventions. Numerous international studies have demonstrated the efficacy of IHIs for the aforementioned areas. Through the resource-saving applications IHIs are cost-efficient, not least suggesting their usefulness for medical rehabilitation. The present overview starts with a description of IHIs with a differentiation of technical-formal and thematic aspects. In doing so, the focus lies primarily on cognitive-behavioral treatment approaches, as the best scientifically investigated IHIs to date. An overview of the empirical evidence of IHIs is given, followed by a discussion of the implementation possibilities in medical rehabilitation.

Impact of an Acceptance Facilitating Intervention on Patients' Acceptance of Internet-based Pain Interventions: A Randomized Controlled Trial.

Objective:Results from clinical trials indicate that Internet-based psychological pain interventions are effective in treating chronic pain. However, little is known about patients’ acceptance of these programs and how to positively influence patients’ intention to engage in them. Therefore, the present study aimed (1) to assess patients’ acceptance of Internet-based interventions, and (2) to examine whether patients’ acceptance can be increased by an acceptance facilitating intervention. Methods:A total of 104 patients with chronic pain from 2 pain units were randomly allocated to an intervention group (IG) and a no-intervention control group (CG). The IG was shown a short informational video about Internet-based psychological pain interventions before receiving a questionnaire on patients’ acceptance of Internet-based psychological pain interventions and predictors of acceptance (performance expectancy, effort expectancy, social influence, facilitating conditions, Internet usage, and Internet anxiety). The CG filled out the questionnaire immediately. Patients’ acceptance was measured with a 4-item scale (sum score ranging from 4 to 20). Results:Baseline acceptance of Internet-based interventions was reported as low (sum-score:4-9) by 53.8%, moderate (10 to 15) by 42.3%, and high (16 to 20) by 3.9% of the patients with chronic pain in the CG. The IG showed a significantly higher acceptance (M=12.17, SD=4.22) than the CG (M=8.94, SD=3.71) with a standardized mean difference of d=0.81 (95% CI, 0.41, 1.21). All predictor variables were significantly improved in the IG compared with the CG, except for Internet usage. Conclusions:Patients with chronic pain display a relatively low acceptance of Internet-based psychological pain interventions, which can be substantially increased by a short informational video.

Wirksamkeit web-basierter psychologischer Interventionen zur Gewichtsreduktion – ein systematisches Review

Weight reduction is a core objective in the rehabilitation of somatic diseases. This systematic review aims to investigate the effectiveness of web-based psychological interventions for weight loss.Included were randomized controlled trials comparing web-based psychological interventions for weight loss with waiting list or usual care. Outcomes were body mass index (BMI), weight and waist circumference. Effect sizes were analyzed in random-effects meta-analyses.The search identified 5 trials. Subjects of the intervention group reduced their BMI (weighted mean difference--WMD = -0.49 [95%--CI: -0.95; -0.03]), weight (WMD = -1.32 [-2.59; -0.06]) and waist circumference (WMD = -2.35 [-3.18; -1.52]) significantly more than controls.Web-based psychological interventions are effective weight loss interventions. However, the effects are small and their clinical importance is limited.

Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial

Introduction Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare. Methods and analysis In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months. Ethics and dissemination All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences. Trial registration number DRKS00009272; Pre-results.

Internet- und mobilebasierte Ansätze

Technology-based approaches for psychosocial diagnostics and interventions provide an attractive opportunity to optimize medical rehabilitation. Based on an Internet- and mobile-based assessment of existing functional health impairments, appropriate planning, implementation of corresponding courses of action as well as outcome assessment can take place. This can be implemented in the form of Internet- and mobile-based interventions (IMI).The present article provides an overview of the basic knowledge of IMI and their evidence base both in general and in particular for their use in medical rehabilitation. Important aspects of internet and mobile-based psycho-social diagnostics are discussed subsequently. Finally, an outlook for the use of Internet- and mobile-based diagnostics and interventions in medical rehabilitation is given.ZusammenfassungTechnologiebasierte Ansätze zur psychosozialen Diagnostik und Intervention stellen eine attraktive Möglichkeit zur Optimierung der medizinischen Rehabilitation dar. Auf Basis einer internet- und mobilebasierten Erfassung bestehender Einschränkungen der funktionalen Gesundheit kann eine bedarfsgerechte Planung, Durchführung und Ergebnismessung entsprechender Maßnahmen erfolgen, die u. a. in Form von internet- und mobilebasierten Interventionen (IMI) zur Verbesserung der entsprechenden Einschränkung umgesetzt werden können.Der vorliegende Beitrag bietet einen Überblick zu Grundlagen von IMI und deren Evidenzlage sowohl im Allgemeinen als auch im Besonderen für den Einsatz in der medizinischen Rehabilitation. Die Einbindung einer internet- und mobilebasierten psychosozialen Erst- und Verlaufsdiagnostik in diesen Prozess wird diskutiert. Abschließend erfolgt ein Ausblick für den Einsatz internet- und mobilebasierter Diagnostik und Interventionen in der medizinischen Rehabilitation.AbstractTechnology-based approaches for psychosocial diagnostics and interventions provide an attractive opportunity to optimize medical rehabilitation. Based on an Internet- and mobile-based assessment of existing functional health impairments, appropriate planning, implementation of corresponding courses of action as well as outcome assessment can take place. This can be implemented in the form of Internet- and mobile-based interventions (IMI).The present article provides an overview of the basic knowledge of IMI and their evidence base both in general and in particular for their use in medical rehabilitation. Important aspects of internet and mobile-based psycho-social diagnostics are discussed subsequently. Finally, an outlook for the use of Internet- and mobile-based diagnostics and interventions in medical rehabilitation is given.

Internet- und Mobilebasierte Interventionen in der Psychotherapie

Zusammenfassung Strukturelle Versorgungslücken und niedrige Inanspruchnahmeraten therapiebedürftiger Menschen beschränken eine bedarfsgerechte psychotherapeutische Versorgung. Internet- und Mobilebasierte Interventionen (IMIs) können als ort- und zeitunabhängige Angebote dazu beitragen, die psychotherapeutische Versorgung zu verbessern. Der vorliegende Beitrag gibt einen Überblick zum Gegenstandsbereich, der Evidenzbasierung sowie den Implementierungsmöglichkeiten von IMIs.

Psychological flexibility mediates the effect of an online-based acceptance and commitment therapy for chronic pain: an investigation of change processes

Abstract One way to improve treatment effects of chronic pain is to identify and improve control over mechanisms of therapeutic change. One treatment approach that includes a specific proposed mechanism is acceptance and commitment therapy (ACT) with its focus on increasing psychological flexibility (PF). The aim of the present study was to examine the role of PF as a mechanism of change in ACT. This is based on mediation analyses of data from a previously reported randomized controlled trial, evaluating the effectiveness of an ACT-based online intervention for chronic pain (ACTonPain). We performed secondary analyses on pretreatment, posttreatment, and follow-up data from 302 adults, receiving a guided (n = 100) or unguided (n = 101) version of ACTonPain, or allocated to the waitlist control group (n = 101). Structural equation modelling and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment through pretreatment and posttreatment changes in the latent construct reflecting PF. The latent construct consisted of data from the Chronic Pain Acceptance Questionnaire and the Acceptance and Action Questionnaire. The outcomes were pretreatment to follow-up changes in pain interference, anxiety, depression, pain, and mental and physical health. Structural equation modelling analyses revealed that changes in PF significantly mediated pretreatment to follow-up changes in all outcomes in the intervention groups compared with waitlist (standardized estimates ranged from I0.16I to I0.69I). Global model fit yielded modest but acceptable results. Findings are consistent with the theoretical framework behind ACT and contribute to growing evidence, supporting a focus on PF to optimize treatment effects.

Internet- und mobilebasierte Intervention bei psychischen Störungen

Internet- und mobilebasierte Interventionen (IMI) für psychische Störungen sind meist Selbsthilfeprogramme, deren Einsatzmöglichkeiten von Prävention, über die Behandlung bis zur Nachsorge reichen. Die Wirksamkeit von IMI wurde in zahlreichen Studien belegt, auch im direkten Vergleich zu Psychotherapien im klassischen Setting. Der folgende Beitrag gibt einen Überblick über den Gegenstandsbereich, die Evidenzlage und das Nutzungspotenzial sowie die Implementierungsmöglichkeiten und -hindernisse von IMI.

A Web-Based Acceptance-Facilitating Intervention for Identifying Patients’ Acceptance, Uptake, and Adherence of Internet- and Mobile-Based Pain Interventions: Randomized Controlled Trial

Background Internet- and mobile-based interventions are effective for the treatment of chronic pain. However, little is known about patients’ willingness to engage with these types of interventions and how the uptake of such interventions can be improved. Objective The aim of this study was to identify people’s acceptance, uptake, and adherence (primary outcomes) with regard to an internet- and mobile-based intervention for chronic pain and the influence of an information video as an acceptance-facilitating intervention (AFI). Methods In this randomized controlled trial with a parallel design, we invited 489 individuals with chronic pain to participate in a Web-based survey assessing the acceptance of internet- and mobile-based interventions with the offer to receive an unguided internet- and mobile-based intervention for chronic pain after completion. Two versions of the Web-based survey (with and without AFI) were randomly sent to two groups: one with AFI (n=245) and one without AFI (n=244). Participants who completed the Web-based survey with or without AFI entered the intervention group or the control group, respectively. In the survey, the individuals’ acceptance of pain interventions, measured with a 4-item scale (sum score ranging from 4 to 20), predictors of acceptance, sociodemographic and pain-related variables, and physical and emotional functioning were assessed. Uptake rates (log in to the intervention) and adherence (number of completed modules) to the intervention was assessed 4 months after intervention access. To examine which factors influence acceptance, uptake rate, and adherence in the internet- and mobile-based interventions, we conducted additional exploratory subgroup analyses. Results In total, 57 (intervention group) and 58 (control group) participants in each group completed the survey and were included in the analyses. The groups did not differ with regard to acceptance, uptake rate, or adherence (P=.64, P=.56, P=.75, respectively). Most participants reported moderate (68/115, 59.1%) to high (36/115, 31.3%) acceptance, with 9.6% (11/115) showing low acceptance (intervention group: mean 13.91, SD 3.47; control group: mean 13.61, SD 3.50). Further, 67% (38/57, intervention group) and 62% (36/58, control group) had logged into the intervention. In both groups, an average of 1.04 (SD 1.51) and 1.14 (SD 1.90) modules were completed, respectively. Conclusions The informational video was not effective with regard to acceptance, uptake rate, or adherence. Despite the high acceptance, the uptake rate was only moderate and adherence was remarkably low. This study shows that acceptance can be much higher in a sample participating in an internet- and mobile-based intervention efficacy trial than in the target population in routine health care settings. Thus, future research should focus not only on acceptance and uptake facilitating interventions but also on ways to influence adherence. Further research should be conducted within routine health care settings with more representative samples of the target population. Trial Registration German Clinical Trial Registration DRKS00006183; http://www.drks.de/drks_web/navigate.do ?navigationId=trial.HTML&TRIAL_ID=DRKS00006183 (Archived by WebCite at http://www.webcitation.org/70ebHDhne)