Online Psychosocial Intervention for Persons with Spinal Cord Injury: A Meta-Analysis

Abstract

<h3>Objective(s)</h3> To investigate the efficacy of internet-based psychosocial interventions on symptoms of anxiety and depression amongst those with spinal cord injury (SCI). <h3>Data Sources</h3> Medline, PsycInfo and EMBASE databases. Only English studies with sufficient data were included. <h3>Study Selection</h3> Study selection articles reviewed by 2 independent reviewers (R.S. and S.M.) and were included if they met the following inclusion criteria: study involved application of an online psychosocial intervention; study sample was adults with SCI; and study reported the effects of the intervention on depression and/or anxiety. 5 met inclusion criteria. <h3>Data Extraction</h3> Two independent reviewers extracted the following data from selected articles: author, study design, sample size, age, sex, time since injury, level of SCI, severity of SCI, inclusion criteria, exclusion criteria, intervention type, comparator, contact with therapist, intervention duration, time points of measures, outcomes, dropout rates, concomitant treatments, and adverse effects. <h3>Data Synthesis</h3> Low heterogeneity was evident for the primary outcomes of anxiety(I2=13.1%, p=0.33) and depression(I2=29.3, p=0.23). Fixed-effects model was used. Pooled analysis demonstrated small improvements for anxiety(SDM=0.42±0.09, p < 0.001) and depression(SDM=0.41±0.09, p < 0.001) at post-treatment, and moderate improvements at 3-month follow-up for anxiety(SDM=0.50±0.1, p < 0.001) and depression(SDM=0.64±0.10, p < 0.001) outcomes. Low heterogeneity for the secondary outcome of pain was reported(I2=33.8%, p=0.22). Fixed effects model was used. Pooled analysis demonstrated small improvements for pain(SDM=0.41±0.10, p < 0.001) at post-treatment and 3-month follow-up(SDM=0.34±0.10, p=0.001) as well. Dropout rates ranged from 10-28%, including incomplete post-treatment measures and not only those who did not complete the programs. <h3>Conclusions</h3> Pooled analysis of the 5 studies included revealed that online psychosocial interventions resulted in significant improvements in overall anxiety and depressive symptoms, small improvements in pain outcomes, and similar effect sizes to those reported in previous systematic reviews on psychosocial outcomes among similar populations. <h3>Author(s) Disclosures</h3> N/A.