Online psychosocial intervention for persons with spinal cord injury: A meta-analysis

Background Delivery of psychosocial interventions via the Internet has the potential to overcome barriers and increase access; however, effectiveness is yet to be established among those with spinal cord injury (SCI). Methods The objective of this meta-analysis is to evaluate the efficacy of Internet-based psychosocial interventions on the symptoms of anxiety, depression, and pain amongst those with SCI. The databases Medline, PsycInfo, and EMBASE were used to locate studies published between 1990 and December 2020. A study was included if (1) the study involved the application of an online psychosocial intervention; (2) adults with SCI; and (3) reported outcomes on depression and/or anxiety. From each study, participant characteristics and study details were extracted. A standardized mean difference (SMD) ± standard error and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed-effects model. Results The search yielded 920 studies, of which five were included in the final meta-analysis; It was revealed that Internet-based psychosocial interventions had a small effect on reducing overall anxiety (SMD: 0.42 ± 0.09, p < 0.001) and depression (SMD: 0.41 ± 0.09, p < 0.001) symptoms at the end of the study period. Online psychosocial interventions also had a moderate effect in maintaining reduction of anxiety (SMD: 0.50 ± 0.1, p < 0.001) and depressive (SMD: 0.64 ± 0.10, p < 0.001) symptoms at 3-month follow-up. Conclusion The results of this meta-analysis provide evidence for the use of internet-based psychosocial interventions to manage anxiety and depression symptoms among those with spinal cord injuries.

[1]  N. Titov,et al.  Guided internet-delivered cognitive-behaviour therapy for persons with spinal cord injury: a feasibility trial , 2020, Spinal Cord.

[2]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, International Coaching Psychology Review.

[3]  C. Blake,et al.  An internet‐delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial , 2019, European journal of pain.

[4]  N. Titov,et al.  Preference trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support. , 2019, Journal of anxiety disorders.

[5]  C. Fekete,et al.  Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships , 2019, PloS one.

[6]  S. Mehta,et al.  Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis , 2018, Journal of Behavioral Medicine.

[7]  N. Titov,et al.  The Pain Course: exploring the feasibility of an internet-delivered pain management programme for adults with spinal cord injury , 2018, Spinal Cord.

[8]  J. Hearn,et al.  Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial , 2018, Spinal Cord.

[9]  N. Titov,et al.  Randomized controlled trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support. , 2017, Journal of anxiety disorders.

[10]  M. Hernán,et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions , 2016, British Medical Journal.

[11]  Nils Lindefors,et al.  Guided internet-based treatments in psychiatry / , 2016 .

[12]  D. Dorstyn,et al.  Anxiety prevalence following spinal cord injury: a meta-analysis , 2016, Spinal Cord.

[13]  G. Andersson,et al.  Internet interventions for chronic pain including headache: A systematic review , 2016, Internet interventions.

[14]  P. New,et al.  A randomised control trial of an Internet-based cognitive behaviour treatment for mood disorder in adults with chronic spinal cord injury , 2015, Spinal Cord.

[15]  J. Hayden,et al.  Therapist-supported internet cognitive—behavioural therapy for anxiety disorders in adults , 2015, BJPsych Advances.

[16]  Frédéric Dumont,et al.  Spinal Cord Injury Community Survey: Understanding the Needs of Canadians with SCI. , 2014, Topics in spinal cord injury rehabilitation.

[17]  D M Caldwell,et al.  Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta‐analysis , 2014, Acta psychiatrica Scandinavica.

[18]  Maroeska M Rovers,et al.  Internet-Based Cognitive Behavioral Therapy for Patients With Chronic Somatic Conditions: A Meta-Analytic Review , 2014, Journal of medical Internet research.

[19]  Sang-Jun Han,et al.  A Meta-Analysis on the Effectiveness of Smart-Learning , 2014 .

[20]  Gerhard Andersson,et al.  Advantages and limitations of Internet‐based interventions for common mental disorders , 2014, World psychiatry : official journal of the World Psychiatric Association.

[21]  K. Kypri,et al.  Exploratory randomized controlled trial evaluating the impact of a waiting list control design , 2013, BMC Medical Research Methodology.

[22]  M. Post,et al.  Validity of the mental health subscale of the SF-36 in persons with spinal cord injury , 2012, Spinal Cord.

[23]  P. Cuijpers,et al.  Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions , 2011, Journal of medical Internet research.

[24]  Denise G Tate,et al.  Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. , 2011, Archives of physical medicine and rehabilitation.

[25]  J. Mathias,et al.  Efficacy of cognitive behavior therapy for the management of psychological outcomes following spinal cord injury A meta-analysis , 2011, Journal of health psychology.

[26]  Kevin T. Hansen,et al.  An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. , 2011, Rehabilitation psychology.

[27]  Michele Tarsilla.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[28]  Filip Smit,et al.  Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. , 2008, The American journal of psychiatry.

[29]  Bethlyn Houlihan,et al.  Computer and internet use by persons after traumatic spinal cord injury. , 2008, Archives of physical medicine and rehabilitation.

[30]  H. Jim,et al.  Psychosocial Interventions for Anxiety and Depression in Adult Cancer Patients: Achievements and Challenges , 2008, CA: a cancer journal for clinicians.

[31]  J. Myers,et al.  Cardiovascular disease in spinal cord injury: an overview of prevalence, risk, evaluation, and management. , 2007, American journal of physical medicine & rehabilitation.

[32]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[33]  B. Kemp,et al.  Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators. , 2000, Archives of physical medicine and rehabilitation.

[34]  P. Kennedy,et al.  Anxiety and depression after spinal cord injury: a longitudinal analysis. , 2000, Archives of physical medicine and rehabilitation.

[35]  G. Scivoletto,et al.  Psychological investigation of spinal cord injury patients , 1997, Spinal Cord.

[36]  A. Craig,et al.  Anxiety and depression over the first year of spinal cord injury: a longitudinal study , 1993, Paraplegia.

[37]  S. Charlifue,et al.  Behavioral and demographic predictors of suicide after traumatic spinal cord injury. , 1991, Archives of physical medicine and rehabilitation.

[38]  G. Andersson,et al.  ICBT for Depression , 2016 .

[39]  W. Nielson,et al.  Depression and activity patterns of spinal cord injured persons living in the community. , 1987, Archives of physical medicine and rehabilitation.