Background

Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC.

Method

Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' g (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy.

Results

A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy (g = 0.38; 95% CI, 0.15 to 0.61; I² = 0) and combined disease-related outcomes (g = −0.13; 95% CI, −0.25 to −0.01; I² = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies.

Conclusion

The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.

中文翻译：

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数字健康干预对患有慢性疾病的青年的疗效：荟萃分析

背景

数字健康干预措施可能会为患有慢性疾病 (CC) 和合并心理健康症状的青少年提供服务。我们旨在全面评估基于互联网和移动设备的干预措施 (IMIs) 对患有 CC 的儿童和青少年的不同心理和疾病相关结果的疗效。

方法

通过在 CENTRAL、Embase、MEDLINE/PubMed 和 PsycINFO 中进行系统搜索来确定研究，并在符合条件的研究和其他评论的参考列表中进行搜索作为补充。我们纳入的研究是随机对照试验 (RCT)，比较 IMI 与控制条件在改善患有 CC 的青年（平均年龄 ≤ 18 岁）的心理和疾病相关结果方面的功效。研究选择、数据提取和偏倚风险评估由两名评审员独立进行。在随机效应模型中进行荟萃分析，并计算 Hedges' g（具有 95% 置信区间）作为效应量测量。主要结果是合并的心理健康症状（即抑郁、焦虑和压力），以及生活质量和自我效能。

结果

该荟萃分析共纳入 19 项随机对照试验（2410 名患者）。IMI 与自我效能感（g  = 0.38；95% CI，0.15 至 0.61；I ²  = 0）和综合疾病相关结果（g  = -0.13；95% CI，-0.25 至 -0.01 ；I ²  = 21)。对其他结果的荟萃分析不显着，由于缺乏研究，一些预先计划的分析不可行。

结论

现有的关于 IMI 改善 CC 青少年心理和健康相关结果的证据是有限的。我们的研究结果指出了一个相当小的好处和有限的功效。未来的研究需要全面评估 IMI 扩展协作护理的潜力，并确定有助于改善以用户为中心的干预措施和更好的治疗结果的因素。