@Article{信息:doi 10.2196 / / jmir。2771，作者=“Donkin, Liesje和Hickie, Ian B和Christensen, Helen和Naismith, Sharon L和Neal, Bruce和Cockayne, Nicole L和Glozier, Nick”，标题=“重新思考抑郁症在线干预中使用与结果之间的剂量-反应关系:随机对照试验”，期刊=“J Med Internet Res”，年=“2013”，月=“10”，日=“17”，卷=“15”，数=“10”，页=“e231”，关键词=“坚持;互联网;电子健康;抑郁症;背景:现在有大量证据表明，基于网络的干预可以有效地改变行为，并成功地治疗心理障碍。然而，对药物使用对干预结果的影响的兴趣直到最近才发展起来。到目前为止，持续或完成干预是最常被报道的使用指标，但这并不能充分描述用户的在线行为。对使用的替代措施及其与结果的关系的分析可能有助于理解干预使用者可能需要多少才能从项目中获得临床显著的益处。目的:本研究的目的是确定哪些使用指标(如果有的话)与在线抑郁症治疗试验的结果相关。 Methods: Cardiovascular Risk E-couch Depression Outcome (CREDO) is a randomized controlled trial evaluating an unguided Web-based program (E-couch) based on cognitive behavioral therapy and interpersonal therapy for people with depression and cardiovascular disease. In all, 280 participants in the active arm of the trial commenced the program, delivered in 12 modules containing pages of text and activities. Usage data (eg, number of log-ins, modules completed, time spent online, and activities completed) were captured automatically by the program interface. We estimated the association of these and composite metrics with the outcome of a clinically significant improvement in depression score on the Patient Health Questionnaire (PHQ-9) of ≥5 points. Results: In all, 214/280 (76.4{\%}) participants provided outcome data at the end of the 12-week period and were included in the analysis. Of these, 94 (43.9{\%}) participants obtained clinically significant improvement. Participants logged into the program an average of 18.7 times (SD 8.3) with most (62.1{\%}, 133/214) completing all 12 modules. Average time spent online per log-in was 17.3 minutes (SD 10.5). Participants completed an average of 9 of 18 activities available within the program. In a multivariate regression model, only the number of activities completed per log-in was associated with a clinically significant outcome (OR 2.82, 95{\%} CI 1.05-7.59). The final model predicted 7.4{\%} of variance in outcome. Curve estimates indicated that significant logarithmic (P=.009) and linear (P=.002) relationships existed between activities completed per log-in and clinically significant change. Conclusions: Only one objective measure of usage was independently associated with better outcome of a Web-based intervention of known effectiveness. The 4 usage metrics retained in the final step of the regression accounted for little outcome variance. Medium level users appeared to have little additional benefit compared to low users indicating that assumptions of a linear relationship between use and outcome may be too simplistic and further models and variables need to be explored to adequately understand the relationship. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077; http://www.anzctr.org.au/ACTRN12610000085077.aspx (Archived by WebCite at http://www.webcitation.org/6K9FQtKBn). ", issn="14388871", doi="10.2196/jmir.2771", url="//www.mybigtv.com/2013/10/e231/", url="https://doi.org/10.2196/jmir.2771", url="http://www.ncbi.nlm.nih.gov/pubmed/24135213" }