The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: A systematic review and meta-analysis.

Computer-based interventions target improvement of physical and emotional functioning in patients with chronic pain and functional somatic syndromes. However, it is unclear to what extent which interventions work and for whom. This systematic review and meta-analysis (registered at PROSPERO, 2016: CRD42016050839) assesses efficacy relative to passive and active control conditions, and explores patient and intervention factors. Controlled studies were identified from MEDLINE, EMBASE, PsychInfo, Web of Science, and Cochrane Library. Pooled standardized mean differences by comparison type, and somatic symptom, health-related quality of life, functional interference, catastrophizing, and depression outcomes were calculated at post-treatment and at 6 or more months follow-up. Risk of bias was assessed. Sub-group analyses were performed by patient and intervention characteristics when heterogeneous outcomes were observed. Maximally, 30 out of 46 eligible studies and 3,387 participants were included per meta-analysis. Mostly, internet-based cognitive behavioral therapies were identified. Significantly higher patient reported outcomes were found in comparisons with passive control groups (standardized mean differences ranged between -.41 and -.18), but not in comparisons with active control groups (SMD = -.26 - -.14). For some outcomes, significant heterogeneity related to patient and intervention characteristics. To conclude, there is a minority of good quality evidence for small positive average effects of computer-based (cognitive) behavior change interventions, similar to traditional modes. These effects may be sustainable. Indications were found as of which interventions work better or more consistently across outcomes for which patients. Future process analyses are recommended in the aim of better understanding individual chances of clinically relevant outcomes

Numbers of studies in which behavioral change techniques were identified by comparison.

<p>Numbers of studies in which behavioral change techniques were identified by comparison.</p

PRISMA flow-diagram of studies.

<p>Abbreviations and symbols: k = number of studies, <i>n</i> = number of study participants, OC = outcome, SS = Somatic Symptoms, HRQOL = Health Related Quality Of Life, FI = Functional Interference, CAT = Catastrophizing, DEP = Depression.</p

Risk of bias assessment by the 7 key categories of the Cochrane risk of bias tool.

<p>Risk of bias assessment by the 7 key categories of the Cochrane risk of bias tool.</p

Funnel plot for symptom severity scores post treatment by various types of control groups.

<p><i>SE</i> = Standard Error, <i>SMD</i> = Standardized Mean Difference. Comments: The meta-analysis presented here included the results for active comparisons (not the passive ones) from Trompetter et al. (2015) and Dear et al. (2015) to avoid double entries. Online discussion was facilitated for control group participants while being on a waiting list for receiving the experimental CBI.</p

Overview of meta-analyses results for direct effects based on all eligible studies with relevant data.

<p>Overview of meta-analyses results for direct effects based on all eligible studies with relevant data.</p

Funnel plot for symptom severity scores post treatment by various patient conditions.

<p><i>SE</i> = Standard Error, <i>SMD</i> = Standardized Mean Difference.</p