Effectiveness of a Guided Internet- and Mobile-Based Intervention for Patients with Chronic Back Pain and Depression (WARD-BP): A Multicenter, Pragmatic Randomized Controlled Trial

Research output: Journal contributionsJournal articlesResearchpeer-review

Authors

  • Harald Baumeister
  • Sarah Paganini
  • Lasse Bosse Sander
  • Jiaxi Lin
  • Sandra Schlicker
  • Yannik Terhorst
  • Morten Moshagen
  • Jürgen Bengel
  • Dirk Lehr
  • David Daniel Ebert

Introduction: There is neither strong evidence on effective treatments for patients with chronic back pain (CBP) and depressive disorder nor sufficiently available mental health care offers. Objective: The aim is to assess the effectiveness of internet- A nd mobile-based interventions (IMI) as a scalable approach for treating depression in a routine care setting. Methods: This is an observer-masked, multicenter, pragmatic randomized controlled trial with a randomization ratio of 1:1.Patients with CBP and diagnosed depressive disorder (mild to moderate severity) were recruited from 82 orthopedic rehabilitation clinics across Germany. The intervention group (IG) received a guided depression IMI tailored to CBP next to treatment-as-usual (TAU; including medication), while the control group (CG) received TAU. The primary outcome was observer-masked clinician-rated Hamilton depression severity (9-week follow-up). The secondary outcomes were: Further depression outcomes, pain-related outcomes, health-related quality of life, and work capacity. Biostatistician blinded analyses using regression models were conducted by intention-to-treat and per protocol analysis. Results: Between October 2015 and July 2017, we randomly assigned 210 participants (IG, n = 105; CG, n = 105), mostly with only a mild pain intensity but substantial pain disability. No statistically significant difference in depression severity between IG and CG was observed at the 9-week follow-up (β =-0.19, 95% CI-0.43 to 0.05). Explorative secondary depression (4/9) and pain-related (4/6) outcomes were in part significant (p < 0.05). Health-related quality of life was significantly higher in the IG. No differences were found in work capacity. Conclusion: The results indicate that an IMI for patients with CBP and depression in a routine care setting has limited impact on depression. Benefits in pain and health-related outcomes suggest that an IMI might still be a useful measure to improve routine care.

Original languageEnglish
JournalPsychotherapy and Psychosomatics
Volume90
Issue number4
Pages (from-to)255-268
Number of pages14
ISSN0033-3190
DOIs
Publication statusPublished - 2021

Bibliographical note

Funding Information:
L.B.S. and S.S. have received payments for workshops on e-mental-health. H.B. received consultancy fees, reimbursement of congress attendance and travel costs as well as payments for lectures from Psychotherapy and Psychiatry Associations as well as Psychotherapy Training Institutes in the context of E-Mental-Health topics. He has been the beneficiary of study support (third-party funding) from several public funding organizations. D.D.E. and D.L. possess shares in the GET.On Institut GmbH, which works to transfer research findings on internet-and mobile-phone-based health interventions into routine care. D.D.E. has received payments from several companies and health insurance providers for advice on the use of Internet-based interventions. He has received payments for lectures from Psychotherapy and Psychiatry Associations and has been the beneficiary of third-party funding from health insurance providers. J.B. is a member of the committee on E-Mental Health in the Association of Psychotherapists (Landespsychotherapeutenkammer Baden-Württemberg).

Publisher Copyright:
© 2020

    Research areas

  • Chronic back pain, Comorbidity, Depression, eHealth, Internet-delivered CBT

DOI

Recently viewed

Publications

  1. Exploring the dark and unexpected sides of digitalization
  2. Material flow analysis between dynamic modelling and life cycle assessment
  3. Markups and Concentration in the Context of Digitization
  4. Advancing understanding of natural resource governance
  5. Ensuring the Long-Term Provision of Heathland Ecosystem Services—The Importance of a Functional Perspective in Management Decision Frameworks
  6. Modeling and simulation of the heterogenous material behavior in thermal-sprayed coatings
  7. Does isolation affect phenotypic variability and fluctuating asymmetry in the endangered Red Apollo?
  8. Dynamic control of internal force for visco-elastic contact grasps
  9. Atomic Animals
  10. Tree cover mediates the effect on rapeseed leaf damage of excluding predatory arthropods, but in an unexpected way
  11. Disentangling trade-offs and synergies around ecosystem services with the influence network framework
  12. Using Daily Stretching to Counteract Performance Decreases as a Result of Reduced Physical Activity—A Controlled Trial
  13. The Radius of Trust Problem Remains Resolved
  14. Fruit Detection and Yield Mass Estimation from a UAV Based RGB Dense Cloud for an Apple Orchard
  15. What drives the spatial distribution and dynamics of local species richness in tropical forest?
  16. Towards a Concept for Integrating IT Innovation Management into Business IT Management
  17. Grounds different from, though equally solid with
  18. Reframing the technosphere
  19. Using Reading Strategy Training to Foster Students´ Mathematical Modelling Competencies
  20. Communicating Uncertainties About the Effects of Medical Interventions Using Different Display Formats
  21. Solvable problems or problematic solvability?
  22. Electrical and Mechanical Characterization of Polymer Nanofibers for Sensor Application
  23. Variational pragmatics in the foreign language classroom
  24. Assessment of cognitive load in multimedia learning with dual-task methodology
  25. Consequences of extreme weather events for developing countries based on the example of Mongolia
  26. Microstructure, mechanical and functional properties of refill friction stir spot welds on multilayered aluminum foils for battery application
  27. Land use affects dung beetle communities and their ecosystem service in forests and grasslands
  28. Contested Promises