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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Computer-delivered interventions for alcohol and tobacco use: a meta-analysis

S Rooke, E Thorsteinsson, A Karpin, J Copeland, and D Allsop.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

The review found indications that computer-delivered treatments for reducing alcohol and tobacco use had a significant effect. The authors' conclusions reflect the evidence presented. However, given the potential for publication bias and the lack of reporting of review methods, the reliability of these conclusions is uncertain.

Authors' objectives

To determine the effectiveness of computer-delivered interventions for alcohol and tobacco use.

Searching

PubMed and PsycINFO were searched for studies published until January 2009; search terms were reported. Reference lists of relevant studies were checked for additional articles.

Study selection

Randomised controlled trials (RCTs) that assessed the efficacy of a computer-delivered intervention for reducing substance use behaviour were eligible for inclusion. Trials had to involve direct participant contact with computers to be included. Trials that compared two computer-based treatments were excluded, as were trials of interventions which required the use of specialised medical equipment. Outcomes of interest were abstinence, and alcohol and tobacco use.

Intervention characteristics included web-based or offline computer program, normative feedback, chat, entertainment, and relapse prevention. The number of sessions ranged from one to 20 (where reported). More than half the interventions were conducted at home; the remainder were conducted in a research setting. The level of therapist involvement varied widely between trials, but was minimal in most trials. Comparison groups included attention/placebo, or assessment only, or an active comparison (including booklet, cognitive behavioural therapy, or treatment as usual). Most trials included young adults only; the other trials included adolescents only or adults aged 30 or over.

The authors did not state how many reviewers selected studies for inclusion.

Assessment of study quality

Trial quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Criteria assessed were randomisation; screening prior to assessment; similarity between groups at baseline; blinding of participants, therapists and assessors; rates of attrition; use of intention-to-treat analyses; between group statistical comparisons for key outcomes; and provision of point measurements and measurements of variability. The maximum score was 10 points.

The authors did not state how many reviewers assessed validity.

Data extraction

Data to enable calculation of standardised mean difference (adjusted for sample size) were extracted for abstinence, change from pre-intervention to follow-up and post-intervention alcohol and tobacco use. Where there was more than one arm in a trial receiving computer-delivered interventions, an effect size was calculated for each intervention arm compared to the control group. Authors were contacted for additional information where necessary.

The authors did not state how many reviewers extracted data.

Methods of synthesis

A pooled estimate of the effect size (d) was calculated, together with corresponding 95% confidence intervals (CIs) using a random-effects model. The Q statistic was used to estimate heterogeneity for each pooled result, as well as heterogeneity between subgroups investigated in moderator analyses.

Moderator analyses were conducted for a range of variables including age, gender, substance, comparison group, and intervention content. Subgroup analyses were conducted excluding trials that used an active treatment as the comparator.

Results of the review

Thirty-four RCTs, providing 43 effect sizes, were included in the review (n=10,632 participants). Sample sizes ranged from 29 to 2,318 patients. Quality scores ranged from 5 to 8 points out of a maximum possible score of 10 points. Duration of follow-up ranged from one week to 156 weeks.

The overall effect of the interventions was small (d=0.20, 95% CI 0.13 to 0.27). There was evidence of significant statistical heterogeneity (p<0.001).

Effects were greater for trials where the intervention was compared with an attention/placebo comparator (d=0.22, 95% CI 0.15 to 0.30; 35 comparisons) than those compared with an active comparator (d=0.10, 95% CI -0.06 to 0.25; seven comparisons).

Smaller effects were associated with interventions aimed at treating tobacco use (d=0.14, 95% CI 0.06 to 0.23; 13 comparisons) than those treating alcohol use (d=0.22, 95% CI 0.14 to 0.29; 28 comparisons), interventions that included entertainment (d=0.14, 95% CI 0.04 to 0.25; 13 comparisons), chat/discussion features (d=0.12, 95% CI -0.01 to 0.25; eight comparisons), interventions that involved moderate therapist contact (d=0.09, 95% CI -0.04 to 0.22; eight comparisons) and trials that evaluated abstinence as an outcome variable (d=0.14, 95% CI 0.05 to 0.24; 13 comparisons). There was no evidence of significant statistical heterogeneity between the subgroups for any of the moderator variables.

There were no significant correlations between treatment effect and number of sessions, weeks of follow-up, or methodological score.

Subgroup analyses excluding seven trials that used an active treatment as comparator: A greater effect was reported for trials that assessed alcohol (d=0.26) than trials that assessed tobacco (d=0.12). Smaller effects were associated with trials that measured abstinence (d=0.12) than trials that measured post-intervention substance use (d=0.28) or reduction in substance use (d=0.30). A greater effect was reported for offline programs (d=0.37) than web programs (d=0.18).

Authors' conclusions

The findings indicated that computer-delivered treatments for reducing alcohol and tobacco use had a significant effect, and may be a cost-effective and highly accessible means of treating uncomplicated substance use and related problems.

CRD commentary

The review question was clear with appropriate (although broad) inclusion criteria. Some relevant sources were searched, but the restriction to published studies meant there was the potential for publication bias. The authors did not report whether language restrictions were applied, so it was unclear whether there was potential for language bias. Methods used to select studies, assess validity and extract data were not reported. so it was unclear whether steps were taken to reduce reviewer error and bias.

Trial quality was assessed using suitable criteria, although only the composite score was reported, and there appeared to be differences reported in the tables for overall score for some trials. Trials were combined in a meta-analysis. Statistical heterogeneity was assessed; the authors commented on some potential sources of heterogeneity. Where multiple comparison groups shared a control group, no adjustment was made for potential correlation between effect sizes. The authors' conclusions relating to effectiveness reflect the evidence presented. However, cost-effectiveness and accessibility were not specifically investigated in this review, so the reliability of these conclusions is uncertain. In addition, the potential for publication bias and lack of reporting of review methods should be borne in mind.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that future research should explore the effects of computer-delivered interventions for the treatment of excessive use of illicit and prescription drugs.

Funding

Not stated.

Bibliographic details

Rooke S, Thorsteinsson E, Karpin A, Copeland J, Allsop D. Computer-delivered interventions for alcohol and tobacco use: a meta-analysis. Addiction 2010; 105(8): 1381-1390. [PubMed: 20528806]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Adult; Alcohol-Related Disorders /psychology /therapy; Cognitive Therapy /methods; Confidence Intervals; Data Interpretation, Statistical; Female; Humans; Internet; Male; Outcome and Process Assessment (Health Care) /statistics & numerical data; Program Evaluation; Randomized Controlled Trials as Topic; Recurrence /prevention & control; Smoking /prevention & control /psychology; Therapy, Computer-Assisted /methods /statistics & numerical data; Treatment Outcome; Young Adult

AccessionNumber

12010006406

Database entry date

07/09/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20528806

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