Context

Rheumatic conditions have a large impact on both patients and society. Many patients experience adjustment problems, such as symptoms of anxiety and depression and sleep problems, contributing to high healthcare costs. Internet-based cognitive-behavioral therapy (iCBT) has shown to support patients with somatic conditions in coping with their disease, with therapist-guided iCBT usually showing larger effects than unguided iCBT. However, the specific relevance of guided iCBT for rheumatic conditions has not been reviewed yet, which could have important implications for implementation.

Objectives

The objective of our review was to give an overview of evaluations of guided iCBT for rheumatic conditions, including physical, psychological, and impact on daily life outcomes.

Methods

This review is registered with PROSPERO with registration number CRD42020154911. The review followed PRISMA guidelines and included an assessment of risk of bias. PubMed, PsycINFO, Embase, Cochrane Library, Web of Science, and Emcare were searched until 5 October 2020. Inclusion criteria were: patients ≥18 years old with a rheumatic condition, randomized controlled trial, accessible full-text English article, original data, inclusion of psychological, and/or physical and/or impact outcomes, and therapist-guided iCBT. Study and sample characteristics, as well as clinical variables were extracted.

Results

A systematic search identified 6089 studies, of which 8 trials were included, comprising of 1707 participants in total. Significant medium to large between-group effects were found for psychological outcomes (depression, anxiety, catastrophizing, self-efficacy) and impact on daily life outcomes (impact on daily life, quality of life), whilst results for physical outcomes (pain intensity, fatigue) were mixed.

Conclusion

Whilst more research is warranted, for instance regarding physical outcomes, cost-effectiveness, safety of the intervention, and moderators of iCBT success, our results show that guided iCBT could be an important addition to medical treatment for rheumatic conditions. Guided iCBT can improve psychological and impact on daily life outcomes in patients with rheumatic conditions, which is promising for iCBT implementation in clinical practice.

中文翻译：

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针对风湿病患者的基于互联网的引导认知行为治疗：系统评价

语境

风湿病对患者和社会都有很大影响。许多患者会遇到调整问题，例如焦虑和抑郁症状以及睡眠问题，从而导致高昂的医疗费用。基于互联网的认知行为疗法 (iCBT) 已显示支持患有躯体疾病的患者应对疾病，治疗师指导的 iCBT 通常比非指导的 iCBT 显示出更大的效果。然而，尚未审查引导 iCBT 对风湿性疾病的具体相关性，这可能对实施具有重要意义。

目标

我们审查的目的是概述引导 iCBT 对风湿性疾病的评估，包括身体、心理和对日常生活结果的影响。

方法

该评论已在 PROSPERO 注册，注册号为 CRD42020154911。该审查遵循 PRISMA 指南，并包括对偏倚风险的评估。检索了 PubMed、PsycINFO、Embase、Cochrane 图书馆、Web of Science 和 Emcare，直至 2020 年 10 月 5 日。纳入标准为：≥18 岁的风湿病患者、随机对照试验、可访问的全文英文文章、原始数据、包括心理和/或身体和/或影响结果，以及治疗师指导的 iCBT。提取研究和样本特征以及临床变量。

结果

系统检索确定了 6089 项研究，其中包括 8 项试验，共包括 1707 名参与者。在心理结果（抑郁、焦虑、灾难性、自我效能感）和对日常生活结果的影响（对日常生活的影响、生活质量）和身体结果（疼痛强度、疲劳）是混合的。

结论

虽然需要进行更多研究，例如关于身体结果、成本效益、干预的安全性以及 iCBT 成功的调节因素，但我们的结果表明，引导式 iCBT 可能是风湿病药物治疗的重要补充。引导式 iCBT 可以改善风湿病患者的心理和对日常生活结果的影响，这对于 iCBT 在临床实践中的实施很有希望。