Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials

Autor: Daniela N Schulz, Gerhard Andersson, Håvar Brendryen, Anne H. Berman, Nicolas Bertholet, Adriana Mira, Brian Suffoletto, Reinout W. Wiers, Brigitte Boon, Heleen Riper, Christopher Sundström, Elizabeth Murray, David Daniel Ebert, Eirini Karyotaki, John A. Cunningham, Paul K. Wallace, Adriaan W. Hoogendoorn, Marloes G. Postel, Leif Boß, Gallus Bischof, Kristina Sinadinovic, Johannes H. Smit, Hein de Vries, Anders Blædel Gottlieb Hansen, Reid K. Hester, Matthijs Blankers, Nikolaos Boumparis, Zarnie Khadjesari, Jeannet Kramer, Pim Cuijpers
Přispěvatelé: Clinical Psychology, APH - Global Health, APH - Mental Health, Clinical, Neuro- & Developmental Psychology, Adult Psychiatry, Psychiatry, APH - Methodology, Health promotion, RS: CAPHRI - R6 - Promoting Health & Personalised Care, Ontwikkelingspsychologie (Psychologie, FMG), Psychology, Health & Technology
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Data Analysis
Male
BASE-LINE
Adult
Alcohol Drinking/epidemiology
Alcohol Drinking/psychology
Alcohol Drinking/therapy
Alcoholism/epidemiology
Alcoholism/psychology
Alcoholism/therapy
Female
Humans
Internet
Randomized Controlled Trials as Topic/methods
Therapy
Computer-Assisted/methods
Treatment Outcome
ALCOHOL-CONSUMPTION
Treatment outcome
General Practice
Psychological intervention
Social Sciences
SUBSTANCE USE DISORDERS
law.invention
Mathematical and Statistical Techniques
0302 clinical medicine
Randomized controlled trial
law
Medicine and Health Sciences
Psychology
Public and Occupational Health
030212 general & internal medicine
Computer Networks
ddc:158
Randomized Controlled Trials as Topic
RISK
Alcohol Consumption
Organic Compounds
Statistics
PRIMARY-CARE
General Medicine
Metaanalysis
Alcoholism
Chemistry
Meta-analysis
Physical Sciences
Number needed to treat
Medicine
Alcohol consumption
Research Article
Computer and Information Sciences
medicine.medical_specialty
Drug Research and Development
Alcohol Drinking
Substance-Related Disorders
SELF-HELP
Addiction
Philosophische Fakultät und Fachbereich Theologie
Research and Analysis Methods
03 medical and health sciences
SDG 3 - Good Health and Well-being
Internal medicine
Mental Health and Psychiatry
medicine
Clinical Trials
PROBLEM DRINKERS
Statistical Methods
Primary Care
Nutrition
Pharmacology
Behavior
Ethanol
FEEDBACK
business.industry
Organic Chemistry
Chemical Compounds
Biology and Life Sciences
Health sciences
Patient data
Odds ratio
PARTICIPANT DATA
Randomized Controlled Trials
Diet
Health Care
Allmänmedicin
MISUSE
Alcohols
Therapy
Computer-Assisted
Clinical Medicine
business
Mathematics
030217 neurology & neurosurgery
Zdroj: PLoS Medicine, Vol 15, Iss 12, p e1002714 (2018)
PLoS Medicine, 15(12):e1002714, 1-26. Nature Publishing Group
Riper, H, Hoogendoorn, A, Cuijpers, P, Karyotaki, E, Boumparis, N, Mira, A, Andersson, G, Berman, A, Bertholet, N, Bischof, G, Blankers, M, Boon, B, Boß, L, Brendryen, H, Cunningham, J, Ebert, D D, Hansen, A, Hester, R, Khadjesari, Z, Kramer, J, Murray, E, Postel, M, Schulz, D, Sinadinovic, K, Suffoletto, B, Sundström, C, de Vries, H, Wallace, P, Wiers, R W & Smit, J H 2018, ' Effectiveness and treatment moderators of internet interventions for adult problem drinking : An individual patient data meta-analysis of 19 randomised controlled trials. ', PLoS Medicine, vol. 15, no. 12, e1002714 . https://doi.org/10.1371/journal.pmed.1002714
Riper, H, Hoogendoorn, A, Cuijpers, P, Karyotaki, E, Boumparis, N, Mira, A, Andersson, G, Berman, A, Bertholet, N, Bischof, G, Blankers, M, Boon, B, Boß, L, Brendryen, H, Cunningham, J, Ebert, D D, Hansen, A, Hester, R, Khadjesari, Z, Kramer, J, Murray, E, Postel, M, Schulz, D, Sinadinovic, K, Suffoletto, B, Sundström, C, de Vries, H, Wallace, P, Wiers, R W & Smit, J H 2018, ' Effectiveness and treatment moderators of internet interventions for adult problem drinking : An individual patient data meta-analysis of 19 randomised controlled trials. ' PLOS Medicine, vol 15, no. 12 . DOI: 10.1371/journal.pmed.1002714
Riper, H, Hoogendoorn, A, Cuijpers, P, Karyotaki, E, Boumparis, N, Mira, A, Andersson, G, Berman, A H, Bertholet, N, Bischof, G, Blankers, M, Boon, B, Boß, L, Brendryen, H, Cunningham, J, Ebert, D, Hansen, A, Hester, R, Khadjesari, Z, Kramer, J, Murray, E, Postel, M, Schulz, D, Sinadinovic, K, Suffoletto, B, Sundström, C, de Vries, H, Wallace, P, Wiers, R W & Smit, J H 2018, ' Effectiveness and treatment moderators of internet interventions for adult problem drinking : An individual patient data meta-analysis of 19 randomised controlled trials ', PLoS Medicine, vol. 15, no. 12, e1002714, pp. 1-26 . https://doi.org/10.1371/journal.pmed.1002714
Riper, H, Hoogendoorn, A, Cuijpers, P, Karyotaki, E, Boumparis, N, Mira, A, Andersson, G, Berman, A H, Bertholet, N, Bischof, G, Blankers, M, Boon, B, Boß, L, Brendryen, H V, Cunningham, J, Ebert, D, Hansen, A, Hester, R, Khadjesari, Z, Kramer, J, Murray, E, Postel, M, Schulz, D, Sinadinovic, K, Suffoletto, B, Sundström, C, de Vries, H, Wallace, P, Wiers, R W & Smit, J H 2018, ' Effectiveness and treatment moderators of internet interventions for adult problem drinking : An individual patient data meta-analysis of 19 randomised controlled trials ', PLoS Medicine, vol. 15, no. 12, pp. e1002714 . https://doi.org/10.1371/journal.pmed.1002714, https://doi.org/10.1371/journal.pmed.1002714
PLoS medicine, 15(12). Public Library of Science
PLoS Medicine, 15(12). Public Library of Science
PLoS medicine, vol. 15, no. 12, pp. e1002714
PLOS Medicine, 15(12):1002714. Public Library of Science
PLoS Medicine, 15(12):e1002714. Public Library of Science
PLoS Medicine
Zaguán. Repositorio Digital de la Universidad de Zaragoza
instname
ISSN: 1549-1277
1549-1676
DOI: 10.1371/journal.pmed.1002714
Popis: Background Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs). Methods and findings Systematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data. The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention, and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis. We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants. Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI −7.57 to −2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63–2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06–6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21–2.27, p = 0.002). Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: −6.78 SUs, 95% CI −12.11 to −1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22–4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29–0.93, p = 0.029). The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: −9.27 SUs, 95% CI −13.97 to −4.57, p < 0.001; TR: OR = 3.74, 95% CI 2.13–6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses. Conclusion To our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.
In this meta-analysis using individual patient data from 19 randomised controlled trials, Heleen Riper and colleagues investigate which internet-based interventions for decreasing problem drinking work best and how participant and intervention characteristics moderate the effectiveness of these interventions.
Author summary Why was this study done? Global estimations continue to show increasing morbidity, mortality, and social harm caused by all types of problem drinking. Face-to-face brief interventions for problem drinking are effective but rarely used. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking. What did the researchers do and find? We conducted a one-stage individual patient data meta-analysis (IPDMA). This is, to our knowledge, the first study to identify moderators at the participant, intervention, and study design levels that are associated with treatment outcomes in internet-based interventions for adult problem drinking. Our IPDMA included 14,198 adults at baseline from 19 randomised controlled trials who exhibited various profiles of problem drinking. We obtained posttreatment data for 8,095 participants. Our results show that internet-based alcohol interventions in both community and healthcare populations are effective in reducing mean weekly alcohol consumption and in achieving adherence to low-risk drinking limits. We did not find differences in impact related to drinking profiles, meaning that people exceeding risk limits to a smaller or a larger degree benefited from the interventions, as did binge-only drinkers. Human-guided interventions showed a stronger impact on treatment outcome than fully automated ones, but waitlist design controls may inflate outcomes. What do these findings mean? The health gains of internet-based alcohol interventions could be substantial, because such programmes can reach high numbers of problem drinkers by virtue of their swift entry procedures and their easy scalability. Future research should seek to identify categories of people for whom such interventions work best, to analyse how the interventions work and to determine what delivery contexts are most favourable. It should explore which patient populations could benefit most from referral to unguided forms and which would be more amenable to guidance by GPs or other professionals.
Databáze: OpenAIRE
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