Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial.
Study Goal
The researchers aimed to evaluate the feasibility, acceptability, and usability of mobile and therapist-led mindfulness interventions for reducing psychological distress and physical symptoms in ICU survivors post-discharge.
Results Summary
The study found that both mobile and therapist-led mindfulness interventions were feasible, acceptable, and usable, with clinically significant improvements in depression, anxiety, PTSD, and physical symptoms, comparable to an education-based control.
Population
Adult ICU patients (≥18 years) treated for cardiorespiratory failure post-discharge.
Effective Dosage
Month-long interventions (self-directed mobile app-based mindfulness, therapist-led telephone-based mindfulness, or web-based critical illness education).
Duration
1 month
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
self-directed mobile app-based mindfulness programme | neutral | feasibility, acceptability, usability | ICU patients | - | demonstrated evidence of feasibility, acceptability and usability | #1 |
self-directed mobile app-based mindfulness programme | decrease | psychological distress and physical symptoms | ICU patients | - | had a similar impact on psychological distress and physical symptoms as a therapist-led programme | #2 |
self-directed mobile app-based mindfulness programme | decrease | Patient Health Questionnaire depression scale | ICU patients | -4.8 (-6.6, -2.9) | reflected clinically significant group-based changes | #3 |
self-directed mobile app-based mindfulness programme | decrease | Generalized Anxiety Disorder scale | ICU patients | -2.1 (-3.7, -0.5) | reflected clinically significant group-based changes | #4 |
self-directed mobile app-based mindfulness programme | decrease | Post-Traumatic Stress Scale | ICU patients | -2.6 (-6.3, 1.2) | reflected clinically significant group-based changes | #5 |
self-directed mobile app-based mindfulness programme | decrease | Patient Health Questionnaire physical symptom scale | ICU patients | -5.3 (-7.0, -3.7) | reflected clinically significant group-based changes | #6 |
therapist-led telephone-based mindfulness programme | decrease | Patient Health Questionnaire depression scale | ICU patients | -3.9 (-5.6, -2.2) | reflected clinically significant group-based changes | #7 |
therapist-led telephone-based mindfulness programme | decrease | Generalized Anxiety Disorder scale | ICU patients | -1.6 (-3.0, -0.1) | reflected clinically significant group-based changes | #8 |
therapist-led telephone-based mindfulness programme | decrease | Post-Traumatic Stress Scale | ICU patients | -2.2 (-5.6, 1.2) | reflected clinically significant group-based changes | #9 |
therapist-led telephone-based mindfulness programme | decrease | Patient Health Questionnaire physical symptom scale | ICU patients | -3.7 (-5.2, 2.2) | reflected clinically significant group-based changes | #10 |
web-based critical illness education programme | decrease | Patient Health Questionnaire depression scale | ICU patients | -3.0 (-5.3, 0.8) | reflected clinically significant group-based changes | #11 |
web-based critical illness education programme | decrease | Generalized Anxiety Disorder scale | ICU patients | -0.6 (-2.5, 1.3) | reflected clinically significant group-based changes | #12 |
web-based critical illness education programme | decrease | Post-Traumatic Stress Scale | ICU patients | -3.5 (-8.0, 1.0) | reflected clinically significant group-based changes | #13 |
web-based critical illness education programme | decrease | Patient Health Questionnaire physical symptom scale | ICU patients | -4.8 (-6.8, 2.7) | reflected clinically significant group-based changes | #14 |
BACKGROUND: Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs. METHODS: Pilot randomised clinical trial with 3-month follow-up conducted at two academic medical centres. Adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomised after discharge home to 1 of 3 month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme. RESULTS: Among 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean Client Satisfaction Questionnaire 27.6 (SD 3.8)) and usability (mean Systems Usability Score 89.1 (SD 11.5)). For secondary outcomes, mean values (and 95% CIs) reflected clinically significant group-based changes on the Patient Health Questionnaire depression scale (mobile (-4.8 (-6.6, -2.9)), telephone (-3.9 (-5.6, -2.2)), education (-3.0 (-5.3, 0.8)); the Generalized Anxiety Disorder scale (mobile -2.1 (-3.7, -0.5), telephone -1.6 (-3.0, -0.1), education -0.6 (-2.5, 1.3)); the Post-Traumatic Stress Scale (mobile -2.6 (-6.3, 1.2), telephone -2.2 (-5.6, 1.2), education -3.5 (-8.0, 1.0)); and the Patient Health Questionnaire physical symptom scale (mobile -5.3 (-7.0, -3.7), telephone -3.7 (-5.2, 2.2), education -4.8 (-6.8, 2.7)). CONCLUSIONS: Among ICU patients, a mobile mindfulness app initiated after hospital discharge demonstrated evidence of feasibility, acceptability and usability and had a similar impact on psychological distress and physical symptoms as a therapist-led programme. A larger trial is warranted to formally test the efficacy of this approach. TRIAL REGISTRATION NUMBER: Results, NCT02701361.