Background
Methods
Results
DiGA | Indication area | Quantity ICD-10 3 digit | Quantity ICD-10 4 digit | Quantity ICD-10 5 digit |
---|---|---|---|---|
mental health | 0 | 6 | 0 | |
Elevida [19] | nervous system | 1 | 0 | 0 |
hormones and metabolism | 2 | 0 | 0 | |
mental health | 0 | 1 | 1 | |
mental health | 1 | 0 | 0 | |
mental health | 0 | 2 | 0 | |
Kalmeda [28] | ears | 0 | 1 | 0 |
Selfapy Depression [29] | mental health | 0 | 2 (9)
a
| 0 |
Somnio [30] | mental health | 0 | 1 | 0 |
Velibra [31] | mental health | 0 | 3 | 1 |
Vivira [32] | muscles, bones, joints | 0 | 11 (16)
a
| 9 (29)
a
|
Vorvida [33] | nervous system | 0 | 2 | 0 |
Zanadio [34] | hormones and metabolism | 0 | 0 | 2 |
Patient population and patient characteristics
DiGA | Patient population | Patient characteristics | ||||||
---|---|---|---|---|---|---|---|---|
Gender
|
Age
|
Gender
|
Age
|
Education and/or employment status
| ||||
IG
|
CG
|
IG
|
CG
|
IG
|
CG
| |||
Deprexis
| ||||||||
Study 1 [17] | m / f | 18-65 years | f=58 (74.4 %) m=20 (25.6 %) | f=64 (75.3 %) m=21 (24.7 %) | M=44 (11.02) | M=40 (11.48) |
Educational status:
Lower secondary=4 (5.1 %) Middle secondary=23 (29.5 %) Higher secondary=14 (17.9 %) Highest secondary=37 (47.4 %)
Employment status:
Full time=38 (48.7 %) Regular part-time=9 (11.5 %) Not working=31 (39.7 %) |
Educational status:
Lower secondary=3 (3.5 %) Middle secondary=14 (16.5 %) Higher secondary=12 (14.1 %) Highest secondary=53 (62.4 %)
Employment status:
Full time=31 (36.5 %) Regular part-time=16 (18.8 %) Not working=38 (44.7 %) |
Study 2 [18] | m / f | 18-65 years | f=350 (68.8 %) m=159 (31.2 %) | f=345 (68.5 %) m=159 (31.5 %) | M=42.8 (11.0) | M=42.9 (11.0) |
Educational status:
Not yet completed=2 (0.4 %) No degree=1 (0.2 %) Lower secondary school=29 (5.7 %) Middle secondary school=131 (25.8 %) Higher secondary school qualifying for university of applied science=87 (17.1 %) Higher secondary school qualifying for university=249 (48.9 %) Other=10 (2.0 %)
Employment status:
Full time=220 (43.3 %) Part time=117 (23.0 %) |
Educational status:
Not yet completed=0 (0.0 %) No degree=0 (0.0 %) Lower secondary school=24 (4.8 %) Middle secondary school=112 (22.2%) Higher secondary school qualifying for university of applied science=85 (16.8 %) Higher secondary school qualifying for university=271 (53.8%) Other=12 (2.4 %)
Employment status:
Full time=214 (42.4 %) Part time=114 (22.6 %) |
Elevida [19] | m / f | ≥18 years | f=114 (82.0 %) m=25 (18 %) | f=108 (79 %) m=28 (21 %) | M=40.8 (11.1) | M=41.9 (9.4) |
Employment status:
Full-time/part-time=71 (51 %) Housemaker/student/other=13 (9 %) Unemployed/unable to work/retired= 55 (40 %) |
Employment status:
Full-time/part-time=64 (47 %) Housemaker/student/other=11 (8 %) Unemployed/unable to work/retired=61 (45 %) |
m / f | ≥18 years | f=81 (63.3%) m=47 (36.7 %) | f=79 (62.7%) m=47 (37.3 %) | M=50.2 (11.6) | M=51.3 (11.9) |
Educational status:
Low=19 (14.8 %) Middle=76 (59.4 %) High=32 (25.0 %)
Employment status:
Employed=77 (60.2 %) |
Educational status:
Low=17 (13.5 %) Middle=64 (50.8 %) High=45 (35.7 %)
Employment status:
Employed=79 (62.7 %) | |
m / f | >18 years | f=27 (60 %) m=18 (40 %) | f=24 (51.1 %) m=23 (48.9 %) | M=39.33 (10.83) | M=37.43 (10.03) |
Educational status:
Low=3 (6.7 %) Middle=11 (24.4 %) High=31 (68.9 %)
Employment status:
Full-time=27 (60.0 %) Part-time=15 (33.3 %) Not employed=3 (6.7 %) Unemployed=0 Currently sick=0 |
Educational status:
Low=4 (8.5 %) Middle=14 (29.8 %) High=29 (61.7 %)
Employment status:
Full-time=25 (53.2 %) Part-time=15 (31.9 %) Not employed=3 (6.4 %) Unemployed=1 (2.1 %) Currently sick=3 (6.4 %) | |
m / f | ≥18 years | f=97 (73.5 %) m=35 (26.5 %) | f=96 (72.7 %) m=36 (27.3 %) | M=42.4 (10.7) | M=44.2 (9.6) |
Educational status:
Low=3 (2.3 %) Middle=25 (18.9 %) High=104 (78.8 %)
Employment status:
Full-time=105 (79.5 %) Part-time=25 (18.9 %) Currently sick=2 (1.5 %) |
Educational status:
Low=2 (1.5 %) Middle=31 (23.5 %) High=99 (75.0 %)
Employment status:
Full-time=99 (75.0 %) Part-time=32 (24.2 %) Currently sick=1 (0.8 %) | |
f | ≥18 years | f=100 (100 %) m=0 | f=100 (100 %) m=0 | M=29.46 (9.82) | M=28.04 (7.84) |
Educational status:
Low=0 (0.00 %) Middle=42 (42.00 %) High=58 (58.00 %) |
Educational status:
Low=4 (4.00 %) Middle=47 (47.00 %) High=49 (49.00 %) | |
Kalmeda [28] | m / f | ≥18 years | f= 49 (52.1%) m=45 (47.9%) | f=41 (44.1%) m=52 (55.9%) | M=48.1 (12.8) | M= 48.4 (12.2) | n.r. | n.r. |
Selfapy Depression [29] | m / f | 18-65 years | IG1: f=126 (83.4 %) m=25 (16.6 %) IG2: f=126 (84.0 %) m=24 (16.0 %) | f=81 (81.0 %) m=19 (19.0 %) | IG1: M=38 (10.7) IG2: M=37 (10.8) | M=36 (11.9) |
Employment status:
Employee: IG 1=82 (54.3 %), IG2=86 (57.3 %) Self-employed: IG1=3 (2.0 %), IG2=4 (2.7 %) Trainee: IG1=12 (7.9 %), IG2=6 (4.0 %) Other: IG1=7 (4.6 %), IG2=3 (2.0 %) Not reported: IG1=47 (31.3 %), IG2=51 (34.0 %) |
Employment status:
Employee=57 (57.0 %) Self-employed=2 (2.0 %) Trainee=25 (25.0 %) Other=14 (14.0 %) Not reported=2 (2.0 %) |
Somnio [30] | m / f | ≥18 years | f=21 (72 %) m=8 (28 %) | f=18 (67 %) m=9 (33 %) | M=41.72 (17.31) | M=44.04 (20.05) |
Educational status:
Obligatory school=1 (3 %) Basic apprenticeship=3 (10 %) Higher apprenticeship=6 (21 %) College=5 (17 %) University=11 (38 %) Other=3 (10 %)
Employment status:
Self-employed=3 (10 %) Employee=17 (59 %) Retired=4 (14 %) Housewife/man=1 (3 %) Unemployed=2 (7 %) Other=2 (7 %) |
Educational status:
Obligatory school=2 (7 %) Basic apprenticeship=5 (19 %) Higher apprenticeship=1 (4 %) College=4 (15 %) University=11 (41 %) Other=4 (15 %)
Employment status:
Self-employed=3 (11 %) Employee=13 (48 %) Retired=4 (15 %) Housewife/man=2 (7 %) Unemployed=3 (11 %) Other=2 (7 %) |
Velibra [31] | m / f | ≥18 years | f=48 (69 %) m=22 (31 %) | f=50 (72 %) m=19 (28 %) | M=42.1 (12.2) | M=41.8 (12.2) |
Educational status:
Compulsory school=5 (7 %) Apprenticeship=32 (46 %) College=9 (13 %) University=24 (34 %)
Employment status:
Full-time paid work=22 (31 %) Part-time paid work=21 (30 %) Unemployed =13(19 %) At-home parent=2 (3 %) Student=2 (3 %) Retired=10 (14 %) |
Educational status:
Compulsory school=4 (6 %) Apprenticeship=25 (36 %) College=10 (14 %) University=30 (43 %)
Employment status:
Full-time paid work=27 (39 %) Part-time paid work=13 (19 %) Unemployed=11 (16 %) At-home parent=3 (4 %) Student=5 (7 %) Retired=10 (15 %) |
Vivira [32] | m / f | ≥18 years |
No data published yet
| |||||
Vorvida [33] | m / f | ≥18 years | f=170 (56 %) m=136 (44 %) | f=149 (49 %) m=153 (51 %) | M=40.4 (11.2) | M=40.7 (12.1) |
Educational status:
Apprenticeship/technical school=203 (66.3 %) University/college=78 (25.5 %) No vocational training=17 (5.6 %) Other=8 (2.6 %)
Employment status:
Employed=236 (77.1 %) Not employed=45 (14.7 %) Learning=15 (4.9 %) Other=10 (3.3 %) |
Educational status:
Apprenticeship/technical school=185 (61.3 %) University/college=97 (32.1 %) No vocational training=18 (6.0 % Other=2 (0.7 %)
Employment status:
Employed=239 (79.1 %) Not employed=41 (13.6 %) Learning=20 (6.6 %) Other=2 (0.7 %) |
Zanadio [34] | m / f | 18-65 years | f=n.r m=7 | f=n.r. m=6 |
No data published yet
|
Positive healthcare effect and study endpoints
DiGA | Positive care effect | Medical benefit | Patient-relevant improvement of structure and processes | Study design | Observation duration and survey times | Sample size | IG | CG | Location of study | Time period of studyb
|
---|---|---|---|---|---|---|---|---|---|---|
Deprexis
| medical benefit | improvement in the state of health | n.a | RCT |
3 months
t1 = 3 months t2 = 6 months follow-up | DiGA + UC UC + waiting group | ||||
Study 1 [17] |
n
= 163
IG = 78 CG = 85 | Hamburg, Lübeck, Bern | 02/2013–05/2014 | |||||||
Study 2 [18] |
n
= 1013
IG = 509 CG = 504 | Berlin, Bielefeld, Hamburg, Lübeck | 07/2012–02/2017 | |||||||
Elevida [19] | medical benefit | improvement in the state of health | n.a | RCT |
12 weeks
t1 = 12 weeks t2 = 24 weeks follow-up |
n
= 275
IG = 139 CG = 136 | DiGA + UC | UC + waiting group | Hamburg | 07/2014–05/2016 |
Hello Better
| medical benefit | improvement in the state of health | n.a | RCT |
8 weeks
t1 = 8 weeks t2 = 6 months follow-up 1 t3 = 12 months follow-up 2 |
n
= 254
IG = 128 CG = 126 | DiGA + UC | UC + waiting group + online program for knowledge transfer | Lüneburg | 03/2013–01/2015 |
Hello Better
| medical benefit | improvement in the state of health | n.a | RCT |
8 weeks
t1 = 8 weeks t2 = 3 months follow-up 1 t3 = 6 months follow-up 2 |
n
= 92
IG = 45 CG = 47 | DiGA + UC | UC + waiting group | Lüneburg | 08/2013–05/2015 |
Hello Better
| medical benefit | improvement in the state of health | n.a | RCT |
7 weeks
t1 = 7 weeks t2 = 6 months follow-up 1 t3 = 12 months follow-up 2, only IG |
n
= 264
IG = 132 CG = 132 | DiGA + UC | UC + waiting group | Lüneburg | 03/2013–11/2014 |
Hello Better
| medical benefit | improvement in the state of health | n.a | RCT |
12 weeks
t1 = 12 weeks t2 = 6 months follow-up |
n
= 200
IG = 100 CG = 100 | DiGA + UC | UC + waiting group | Erlangen | 04/2016–9/2018 |
Kalmeda [28] | medical benefit | improvement in the state of health | n.a | RCT |
9 months (IG)
12 months (CG)
t1 = 3 months t2 = 9 months (IG) t3 = 12 months (CG) |
n
= 187
IG = 94 CG = 93 | DiGA | waiting group + general information about tinnitus | Duisburg | 08/2020–04/2022 |
Selfapy
Depression [29] | medical benefit | improvement in the state of health | n.a | RCT |
12 weeks
t1 = 6 weeks t2 = 12 weeks t3 = 24 weeks follow-up |
n
= 401
IG1 = 151 IG2 = 150 CG = 100 | IG1: DiGA with psychological support (proof not provided) IG2: DiGA without any support | waiting group + weekly standardized mindfulness exercises via email | Berlin | 08/2019-n.r |
Somnio [30] | medical benefit | improvement in the state of health | n.a | RCT |
6 weeks
t1 = 6 weeks t2 = 12 months follow-up |
n
= 56
IG = 29 CG = 27 | DiGA | waiting group | Zurich | 01/2016–10/2016 |
Velibra [31] | medical benefit + patient-relevant improvement of structure and processes | improvement in the state of health | reduction of therapy-related efforts and strains for patients and their relatives | RCT |
9 weeks
t1 = 9 weeks t2 = 6 months follow-up |
n
= 139
IG = 70 CG = 69 | DiGA + UC | UC + waiting group | Bern | 05/2014–05/2016 |
Vivira [32] | medical benefit | improvement in the state of health | n.a | RCT |
12 weeks
t1 = 2 weeks t2 = 6 weeks t3 = 12 weeks |
n
= 215
| DiGA | UC (physiotherapy) | Tübingen | 11/2020–03/2021 |
pre-post studya
|
12 weeks
| hip = 256 knee = 402 | ||||||||
Vorvida [33] | medical benefit + patient-relevant improvement of structure and processes | improvement in the state of health | patient autonomy | RCT |
6 months
t1 = 3 months t2 = 6 months |
n
= 608
IG = 306 CG = 302 | DiGA + UC | UC + waiting group | Hamburg | 03/2015-ongoing |
Zanadio [34] | medical benefit | improvement in the state of health | n.a | RCT |
9 months
t1 = 3 months t2 = 6 months t3 = 9 months t4 = 12 months follow-up |
n
= 149
| DiGA | UC | online in Germany | 02/2021-ongoing |
Study design
Study location
Observation period and observation times
Sample size and drop-out
DiGA | Case number | Drop-out at primary survey time point | Total drop-out at the end of the study | ||||||
---|---|---|---|---|---|---|---|---|---|
total
|
IG
|
CG
|
total
|
IG
|
CG
|
total
|
IG
|
CG
| |
Deprexis
| |||||||||
Study 1 [17] | 163 | 78 | 85 | 29 (17.8%) | 17 | 12 | 45 (27.6%) | 21 | 24 |
Study 2 [18] | 1013 | 509 | 504 | 219 (21.6%) | 114 | 105 | 259 (25.6%) | 131 | 128 |
Elevida [19] | 275 | 139 | 136 | 51 (18.5%) | 36 | 15 | 64 (23.3%) | 44 | 20 |
Hello Better
| 254 | 128 | 126 | 47 (18.5%) | 31 | 16 | 74 (29.1%) | 50 | 24 |
Hello Better
| 92 | 45 | 47 | 8 (8.7%) | 4 | 4 | 20 (21.7%) | 10 | 10 |
Hello Better
| 264 | 132 | 132 | 21 (8.0%) | 16 | 5 | 51 (19.3%) | 40 | 11 |
Hello Better
| 200 | 100 | 100 | 30 (15.0%) | 22 | 8 | 51 (25.5%) | 42 | 9 |
Kalmeda [28] | 187 | 94 | 93 | 24 (12.8%) | 16 | 8 | 92 (48.9%) | 41 | 51 |
Selfapy Depression [29] | 401 | IG1 = 151 IG2 = 150 | 100 | 95 (23.7%) | IG1 = 19 IG2 = 30 | 46 | 246 (61.3%) | IG1 = 87 IG2 = 88 | 71 |
Somnio [30] | 56 | 29 | 27 | 4 (7.1%) | 4 | 0 | 3 (5.4%) | 3 | 0 |
Velibra [31] | 139 | 70 | 69 | 19 (13.7%) | 13 | 6 | 26 (37.0%) | 26 | n.a |
Vivira [32] | |||||||||
RCT | 215 | 2 | n.r | n.r | n.r | n.r | n.r | n.r | n.r |
Pre-Post-Study | hip = 256 knee = 402 | n.r | n.r | hip = 242 (94.5%) knee = 372 (92.5%) | n.r | n.r | n.r | n.r | n.r |
Vorvida [33] | 608 | 306 | 302 | 183 (30.0%) | 114 | 69 | 183 (30.1%) | 114 | 69 |
Zanadio [34] | 149 | n.r | n.r | 10 (6.7%) | n.r | n.r | n.r | n.r | n.r |
Study results
DiGA | Positive care effect | Primary endpoint | Operationalization | Interpretation | MCID | Results | |||
---|---|---|---|---|---|---|---|---|---|
Deprexis
| t0 (Baseline) | t1 (3 months)a
| t2 (6 months follow-up) | ||||||
Study 1 [17] | improvement of the state of health | depression severity | Patient Health Questionnaire-9 (PHQ-9) | 0–27 higher scores indicate stronger symptoms level of depression: 0–4 = minimal 5–9 = mild 10–14 = moderate 15–19 = moderately severe 20–27 = severe [35] | 5-point reduction [35] | IG: M = 16.62 (3.44) CG: M = 17.20 (3.86) | IG: M = 10.08 (6.37) CG: M = 13.64 (6.14)
p
< 0.01
Cohens d = 0.57 [0.22, 0.92] | IG: M = 11.28 (6.04) CG: M = 13.39 (6.59) Cohens d = 0.33 [0.3, 0.69] | |
Study 2 [18] | IG: M = 10.23 (2.41) CG: M = 10.34 (2.40) | IG: M = 7.54 (4.04) CG: M = 9.15 (4.30) Cohens d = 0.39 [0.13, 0.64] | IG: M = 7.31 (4.18) CG: M = 8.69 (4.41) Cohens d = 0.32 [0.06, 0.59] | ||||||
t0 (Baseline)
|
t1 (12 weeks)
a
|
t2 (24 weeks follow-up)
| |||||||
improvement of the state of health | fatigue | Chalder Fatigue Scale | 0–33 higher scores indicate stronger symptoms [37] | between | IG: M = 21.58 (5.32) CG: M = 21.17 (5.02) | Intergroup difference -2.74 [-1.16, -4.32]
p
= 0.0007
Cohens d = 0.53 | Intergroup difference -2.19 [-0.57, -3.82]
p
= 0.0080
| ||
Hello Better
|
t0 (Baseline)
|
t1 (8 weeks)
a
|
t2 (6 months follow-up 1)
|
t3 (12 months follow-up 2)
| |||||
improvement of the state of health | depressive symptom severity | Allgemeine Depressionsskala (ADS) | 0–60 higher scores indicate stronger symptoms [39] score of 23 or higher is indicative of clinically relevant depressive symptoms in German populations [40] | standardized mean difference ≥ 0.24 [41] | IG: M = 32.22 (6.96) CG: M = 31.55 (7.57) | IG: M = 20.86 (9.73) CG: M = 29.1 (9.08) MD = 8.07 (1.37)
p
< 0.001
Cohens d = 0.94 [0.62, 1.25] | IG: M = 20.09 (11.15) CG: M = 27.13 (10.14) MD = 5.78 (1.95)
p
< 0.001
Cohens d = 0.62 [0.21, 1.04] | IG: M = 19.88 (10.15) KG: M = 26.73 (10.43) MD = 5.57 (2.02)
p
= 0.002
Cohens d = 0.63 [0.18, 1.08] | |
Hello Better
|
t0 (Baseline)
|
t1 (8 weeks)
a
|
t2 (6 months follow-up 1)
|
t3 (12 months follow-up 2)
| |||||
improvement of the state of health | severity of panic and agoraphobia symptoms | Panic Symptom Severity and Self-Rating (German: PAS) | 0–52 higher scores indicate stronger symptoms 0–8 = no clinically relevant symptoms 9–28 = moderate symptoms > 29 = severe level of symptoms [42] | IG: M = 18.18 (6.54) CG: M = 19.43 (5.49) | IG: M = 11.73 (6.90) CG: M = 17.60 (8.86) MD = 5.99 (1.86)
p
= 0.009
Cohens d = 0.78 [0.31, 1.26] | IG: M = 9.66 (7.65) CG: M = 16.32 (7.13) MD = 6.72 (1.97)
p
= 0.009
Cohens d = 1.00 [0.42, 1.58] | IG: M = 8.63 (6.33) CG: M = 14.68 (7.65) MD = 6.07 (1.90)
p
= 0.009
Cohens d = 0.96 [0.37, 1.56] | ||
Hello Better
|
t0 (Baseline)
|
t1 (7 weeks)
a
|
t2 (6 months follow-up 1)
|
t3 (12 months follow-up 2)
| |||||
improvement of the state of health | level of perceived stress | Perceived Stress Scale (PSS-10) | 0–40 higher scores indicate stronger symptoms 0–13 = low 14–26 = moderate 27–40 = high perceived stress [43] | IG: M = 25.89 (3.85) CG: M = 25.15 (3.96) | IG: M = 17.88 (6.17) CG: M = 22.96 (6.07)
p
< 0.001
Cohens d = 0.83 [0.58–1.08] | IG: M = 16.08 (6.03) CG: M = 22.10 (5.81)
p
< 0.001
Cohens d = 1.02 [0.76–1.27] | IG: M = 16.25 (6.35) | ||
Hello Better
|
t0 (Baseline)
|
t1 (12 weeks)
a
|
t2 (6 months follow-up)
| ||||||
improvement of the state of health | intercourse penetration behavior | Primary Endpoint Questionnaire (PEQ) | 0 = not attempted or attempted, but unsuccessful 1 = attempted and sometimes successful or attempted and always successful [44] | IG: M = 0 CG: M = 0 | IG = 31 (31%) CG = 13 (13%) Chi-Quadrat = 9.44
p
< 0.01
OR = 3.01 [1.46–6.18] | IG = 29 (29%) CG = 20 (20%) Chi-Quadrat = 2.19
p
= 0.19
OR = 1.63 [0.85–3.14] | |||
Kalmeda [28] |
t0 (baseline)
|
t1 (3 months)
a
|
t2 (9 months) only IG
|
t3 (12 months) only CG
| |||||
improvement of the state of health | tinnitus exposition | Tinnitus questionnaire according to Göbel and Hiller | 0–84 higher scores indicate stronger symptoms 0–30 = mild 31–46 = medium 47–59 = severe 60–84 = severely [45] | IG: M = 37.14 (13.01) CG: M = 37.46 (14.29) | IG: M = 23.43 (11.77) CG: M = 24.76 (15.71)
p
< 0.0001
| IG: M = 17.61 (10.21)
p
< 0.0001
| CG: M = 20.27 (13.01)
p
< 0.0001
| ||
Selfapy
Depression [29] |
t0 (Baseline)
|
t1 (6 weeks)
|
t2 (12 weeks)
a
|
t3 (24 weeks follow-up)
| |||||
improvement of the state of health | depressive symptoms | Beck-Depressions-Inventar II (BDI-II) | 0–63 higher scores indicate stronger symptoms 0–8 = no depression 9–13 = minimal depression 14–19 = mild depression 20–28 = moderate depression | IG1: M = 30.09 (9.18) IG2: M = 30.54 (8.53) CG: M = 30.88 (10.74) | IG1: M = 20.71 (6.98) IG2: M = 22.51 (7.83) CG: M = 29.09 (6.39) IG1 vs. IG2: Cohens d = 0.24 [0.02, 0.48] IG1 vs. CG: Cohens d = 1.25 [0.99, 1.54] IG2 vs. CG: Cohens d = 0.92 [0.65, 1.20] | IG1: M = 16.61 (9.55) IG2: M = 18.49 (8.88) CG: M = 30.26 (6.97) IG1 vs. IG2: Cohens d = 0.20 [− 0.04, 0.45]
p
= 0.18
IG1 vs. CG: Cohens d = 1.63 [1.37, 1.93]
p
< 0.001
IG2 vs. CG: Cohens d = 1.47 [1.22, 1.73]
p
< 0.001
|
for the 24-week follow-up assessment only per protocol data were used
| ||
Somnio [30] |
t0 (Baseline)
|
t1 (6 weeks)
a
|
t2 (12 months follow-up)
| ||||||
improvement of the state of health | insomnia | Insomnia severity index (ISI) | 0–28 higher scores indicate stronger symptoms 0–7 = normal 8–14 = sub-threshold insomnia 15–21 = moderate insomnia > 21 = severe clinical insomnia [48] | IG: M = 15.38 (3.74) CG: M = 13.26 (3.29) | IG: M = 7.80 (4.94) CG: M = 12.04 (3.86) t = 5.06
p
< 0.001
Cohens d = 1.79 | IG: M = 7.36 (5.38) Cohens d = 1.98 [1.31, 2.66] | |||
t0 (Baseline)
|
t1 (9 weeks)
a
|
t2 (6 months follow-up)
| |||||||
improvement of the state of health | depression, anxiety and tension/stress | Depression Anxiety Stress Scales – Short Form (DASS-21) | 0–120 higher scores indicate stronger symptoms [50] | Δ = 6.42 [51] d = 0.24 [41] | IG: M = 58.2 (24.4) CG: M = 55.8 (21.3) | IG: M = 40.9 (25.7) CG: M = 52.7 (24.7)
p
< 0.01
Cohens d = 0.47 [0.13–0.81] | IG: M = 41.9 (30.0) | ||
reduction of therapy-related efforts and strains for patients/their relatives | general psycho- pathology | Brief Symptom Inventory (BSI) | Short version of the Symptom Checklist-90 (SCL-90) | IG: M = 1.34 (0.56) CG: M = 1.27 (0.57) | IG: M = 0.94 (0.63) CG: M = 1.18 (0.71)
p
< 0.001
Cohens d = 0.42 [0.08–0.75] | IG: M = 0.97 (0.77) | |||
anxiety-related symptoms | Beck Anxiety Inventory (BAI) | 0–63 higher scores indicate stronger symptoms 0–21 = low anxiety 22–35 = moderate anxiety > 36 = potentially concerning levels of anxiety [46] | IG: M = 34.9 (9.1) CG: M = 33.3 (10.3) | IG: M = 27.8 (9.1) CG: M = 31.4 (10.0)
p
< 0.001
Cohens d = 0.41 [0.07–0.74] | IG: 26.6 (9.4) | ||||
depressive symptoms | Beck Depression Inventory-II (BDI-II) | 0–63 higher scores indicate stronger symptoms 0–8 = no depression 9–13 = minimal depression 14–19 = mild depression 20–28 = moderate depression | IG: M = 22.6 (10.6) CG: M = 22.0 (11.0) | IG: M = 15.8 (12.4) CG: M = 22.9 (12.6)
p
< 0.001
Cohens d = 0.61 [0.27–0.95] | IG: M = 16.3 (13.7) | ||||
quality of life | SF-12 Mental Health | 0–100 higher scores indicate higher quality of life [52] | IG: M = 31.2 (8.8) CG: M = 33.2 (9.5) | IG: M = 37.5 (11.8) CG: M = 33.0 (9.2)
p
< 0.001
Cohens d = 0.49 [0.15–0.83] | IG: M = 39.9 (12.2) | ||||
SF-12 Physical Health | 0–100 higher scores indicate higher quality of life [52] | IG: M = 48.5 (11.2) CG: M = 48.3 (10.8) | IG: M = 48.3 (11.4) CG: M = 47.2 (9.5)
p
= 0.19
Cohens d = 0.16 [− 0.17–0.50] | IG: M = 48.6 (11.1) | |||||
Vivira [32] |
t0 (Baseline)
|
t1 (2 weeks)
|
t2 (6 weeks)
|
t3 (12 weeks)
a
| |||||
improvement of the state of health | back, knee and hip pain | visual numeric rating scale | difference in change from baseline = -2.34 [-2.84; -1.83]
p
< 0.0001
| difference in change from baseline = -2.44 [-2.92; -1.95]
p
< 0.0001
| |||||
Vorvida [33] |
t0 (Baseline)
|
t1 (12 weeks)
a
|
t2 (6 months)
| ||||||
improvement of the state of health | daily average consumption of pure alcohol in grams) | Quantity-frequency index: self-reported quantities of alcohol in g (last 30 days) | IG: M = 63.69 (61.84) CG: M = 61.64 (58.84) | IG: mM = 40.8 (3.3) CG: mM = 56.8 (3.3)
p
= 0.001
Cohens d = 0.278 | IG: mM = 32.3 (2.1) CG: mM = 44.1 (2.1)
p
< 0.001
Cohens d = 0.327 | ||||
Timeline-Follow-Back: self-reported amount of alcohol in g (last 7 days) | IG: M = 52.91 (56.68) CG: M = 46.82 (41.18) | IG: mM = 34.3 (1.3) CG: mM = 43.7 (1.3)
p
< 0.001
Cohens d = 0.419 | IG: mM = 25.7 (1.5) CG: mM = 38.6 (1.4)
p
< 0.001
Cohens d = 0.540 | ||||||
Zanadio [34] |
t0 (Baseline)
|
t1 (9 months)
a
|
t2 (12 months)
| ||||||
improvement of the state of health | weight reduction of at least 5% | BMI | MD = -5.67%
p
= 0.001
95% CI [-7.32, -4.02] | MD = -7.75%
p
= 0.001
95% CI: [-9.61, -5.89] |