Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial

Conversational agents in physical and psychological symptom management: A systematic review of randomized controlled trials

BACKGROUND

Effective management of physical and psychological symptoms is a critical component of comprehensive care for both chronic disease patients and apparently healthy individuals experiencing episodic symptoms. Conversational agents, which are dialog systems capable of understanding and generating human language, have emerged as a potential tool to enhance symptom management through interactive support.

OBJECTIVE

To examine the characteristics and effectiveness of conversational agent-delivered interventions reported in randomized controlled trials (RCTs) in the management of both physical and psychological symptoms.

DESIGN

A systematic review.

METHODS

A comprehensive search was performed in Pubmed, ACM Digital Library, CINAHL, EMBASE, PyscInfo, Web of Science, Scopus and gray literature sources from their inception to Oct 2024. Search terms included "conversational agent", "symptom", "randomized controlled trial" and their synonyms and hyponyms. Duplicates were identified by EndNote, and titles, abstracts and full texts were independently screened according to predefined criteria. Data extraction focused on basic study characteristics and conversational agent details, with The Cochrane Risk of Bias 2.0 tool employed for bias assessment.

RESULTS

The search yielded 2756 articles and 29 were finally included for review. The included studies predominantly came from developed countries (n = 23) and were conducted between 2020 and 2024 (n = 24). The studies frequently evaluated the feasibility and acceptability of conversational agent interventions (n = 14), with a predominantly focus on psychological symptoms (depression, anxiety, etc.) (n = 17). A few studies focused on physical symptoms (pain, etc.) (n = 4), while others addressed both symptoms (n = 8). Twenty-five distinct conversational agents (Woebot, Tess, etc.) were evaluated, utilizing platforms ranging from proprietary applications to common messaging channels like WeChat and Facebook Messenger. Cognitive Behavioral Therapy (CBT) was a commonly integrated approach (n = 22), with rule-based dialogs (n = 22) as the most commonly dialog system methods and Natural Language Processing (NLP) (n = 15) as the predominant AI techniques. The median recruitment and completion rates were 72 % and 79 %, respectively. The majority of studies reported positive user experiences and significant symptom management improvements (n = 22). However, risk of bias was high in seventeen studies and presented some concerns in nine others.

CONCLUSIONS

Conversational agents have shown promise in enhancing both physical and psychological symptom management through positive user experiences and effectiveness. However, the high risk of bias identified in many studies warrants caution in interpreting these findings. Future research should prioritize the methodological quality of RCTs to strengthen the evidence base supporting the use of conversational agents as a complementary tool in symptom management.

Association Between Dietary Alcohol Intake and Migraine or Severe Headache Miscellaneous Pain: The NHANES 1999-2004

BACKGROUND

The relationship between alcohol consumption and migraine or severe headache remains controversial in the existing literature. Given that alcohol is a widely consumed beverage, clarifying the relationship between alcohol and migraine or severe headaches can help manage the patient's condition.

AIM

This study aimed to investigate the potential relationship between alcohol consumption and migraine or severe headache.

METHODS

Employing National Health and Nutrition Examination Survey (NHANES) database records spanning March 1999 to December 2004, our analysis encompassed threshold effects, smoothed curve fitting, and multivariate logistic regression to elucidate the relationship between alcohol consumption level and migraine or severe headaches. We utilized subgroup analyses and interaction tests to explore the stability of this relationship across different stratified populations.

RESULTS

A total of 13,083 subjects were enrolled. The odds of migraine or severe headache decreased with increasing dietary alcohol intake. This was more pronounced in the older and male subgroups.

CONCLUSIONS

There was a significant negative association between dietary alcohol intake and the odds of having migraine or severe headache.

Health behavior and disease self-management indicators in patients with cardiovascular diseases using a health app: Findings from an RCT

Background

Prevention of acute cardiovascular events in patients with cardiovascular disease (CVD) requires promoting health-protective behaviors (e.g., physical activity) and reducing health-compromising behaviors (e.g., sitting). Digital interventions addressing health behavior offer great potential. Based on a multiple behavior change theory, an intervention in the form of a digital health application (app) was evaluated in a pilot trial, testing the following hypotheses (H): H1: Health behaviors (physical activity, sitting) and disease self-management (self-care maintenance, self-care confidence) are closely related; H2: changes in health behaviors and disease self-management indicators over time (T0 to T1) are more pronounced in the intervention group (IG, app users) than in the control group (CG); H3: within the IG, changes in systolic and diastolic blood pressure indicate a positive trajectory.

Methods

A 12-week randomized controlled trial (RCT) was conducted with two measurement points. The IG received an app addressing self-management and health behavior change. A total of N = 40 CVD patients were randomized equally to the CG (45% women; mean age = 60.6 years) and the IG (35% women; mean age = 61.5 years).

Results

Findings support H1 with correlations between behaviors (r = -0.66-0.79) and disease self-management (r = -0.06-0.70). H2 was also partially supported, with significant improvements over time in self-management indicators, especially self-care maintenance, in the IG (Eta² = 0.35; p < 0.001). H3 could not be confirmed as no significant changes were found.

Conclusions

This study provides evidence that an app addressing different behavior change techniques (BCTs) can help to manage CVD by promoting health-protective behaviors and preventing health-compromising behaviors. Taking different behaviors into account may increase the effectiveness of behavioral intervention, thereby improving individual and public health. Replications with larger samples and more objective measures are needed.

Hybrid Virtual Coaching and Telemonitoring in COPD Management: The CAir Randomised Controlled Study

Objective

To investigate the effectiveness of 12-weeks hybrid virtual coaching on health-related quality-of-life (HrQoL) in patients with stable COPD.

Methods

We equipped all patients with a CAir Desk for telemonitoring, the intervention group additionally received hybrid virtual coaching through the built-in smartphone. The multimodal intervention based on the Living well with COPD programme, containing educational content, physical activity coaching, and home-based exercises. Primary outcome was HrQoL as measured by the SGRQ. Secondary outcomes were symptom burden, physical activity, functional exercise capacity, and lung function. Between-group differences were calculated using linear regression models, controlling for baseline differences.

Results

We included 30 participants with COPD (13/17 women/men; 63 [9] years; FEV1 54 [22] % predicted), 24 (80%) completed the study. SGRQ improved in both groups (intervention: -4.5 [20.1]; control: -2.7 [7.4] points) without statistically significant or clinically relevant between-group differences (B = -2.5 points, 95% CI = -24.3, 19.3, p = 0.81). Physical activity increased only in the intervention group (313 [1561] vs -364 [2399] steps) without statistically significant but clinically relevant between-group difference (B = 2147 steps, 95% CI = -86, 4395, p = 0.06). Symptom burden decreased in both groups (-4.2 [6.7] vs -1.0 [2.8] points) without statistically significant but clinically relevant between-group difference (B = -3.0 points, 95% CI = -10.8, 5.0, p = 0.43).

Conclusion

Twelve-weeks hybrid virtual coaching did not improve HrQoL more than telemonitoring only in patients with stable COPD. The intervention group improved their physical activity and symptom burden clinically relevant more than the control group.

The therapeutic effectiveness of artificial intelligence-based chatbots in alleviation of depressive and anxiety symptoms in short-course treatments: A systematic review and meta-analysis

BACKGROUND

The emergence of artificial intelligence-based chatbot has revolutionized the field of clinical psychology and psychotherapy, granting individuals unprecedented access to professional assistance, overcoming time constraints and geographical limitations with cost-effective convenience. However, despite its potential, there has been a noticeable gap in the literature regarding their effectiveness in addressing common mental health issues like depression and anxiety. This meta-analysis aims to evaluate the efficacy of AI-based chatbots in treating these conditions.

METHODS

A systematic search was executed across multiple databases, including PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase on April 4th, 2024. The effect size of treatment efficacy was calculated using the standardized mean difference (Hedge's g). Quality assessment measures were implemented to ensure trial's quality.

RESULTS

In our analysis of 18 randomized controlled trials involving 3477 participants, we observed noteworthy improvements in depression (g = -0.26, 95 % CI = -0.34, -0.17) and anxiety (g = -0.19, 95 % CI = -0.29, -0.09) symptoms. The most significant benefits were evident after 8 weeks of treatment. However, at the three-month follow-up, no substantial effects were detected for either condition.

LIMITATIONS

Several limitations should be considered. These include the lack of diversity in the study populations, variations in chatbot design, and the use of different psychotherapeutic approaches. These factors may limit the generalizability of our findings.

CONCLUSION

This meta-analysis highlights the promising role of AI-based chatbot interventions in alleviating depressive and anxiety symptoms among adults. Our results indicate that these interventions can yield substantial improvements over a relatively brief treatment period.

A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial

BACKGROUND

Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited.

OBJECTIVE

This study aims to develop a conversational agent-delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance.

METHODS

In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations.

RESULTS

The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=-0.36 to Cohen d=-0.60), while anxiety and active coping did not change (Cohen d=-0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (β estimate=-0.13, 95% CI -0.20 to -0.05; P<.001), depressive symptoms (β estimate=-0.23, 95% CI -0.38 to -0.08; P=.003), and psychosomatic symptoms (β estimate=-0.16, 95% CI -0.27 to -0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high.

CONCLUSIONS

Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls.

TRIAL REGISTRATION

German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004.