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
Open accessAbstract
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 (â '4.8 (â 6.6, â 2.9)), telephone (â 3.9 (â 5.6, â 2.2)), education (â 3.0 (â 5.3, 0.8)); the Generalized Anxiety Disorder scale (mobile â 2.1 (â 3.7, â 0.5), telephone â '1.6 (â '3.0, â '0.1), education â '0.6 (â '2.5, 1.3)); the Post-Traumatic Stress Scale (mobile â '2.6 (â '6.3, 1.2), telephone â '2.2 (â '5.6, 1.2), education â '3.5 (â '8.0, 1.0)); and the Patient Health Questionnaire physical symptom scale (mobile â '5.3 (â '7.0, â '3.7), telephone â '3.7 (â '5.2, 2.2), education â '4.8 (â '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. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved.
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Claims the paper makes
10 of 25 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Patients admitted to an intensive care unit commonly experience psychological distress after discharge.
“Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge”
- Also stated in: § INTRODUCTION · plain
“millions of patients who require treatment in intensive care units (ICUs) are left not only with physical symptoms,1–3 but with psychological long-term distress.4”
Quote in the paperSubstantial claim2 of 4 sources checked- cites [1] source
The Results (The day to day impact of new disability) report depression, anxiety, fear, and emotional lability after discharge, and the Discussion describes patients’ psychological distress. However, the Methods (Study design) show that the study enrolled ARDS survivors who required mechanical ventilation, so its findings do not establish how commonly psychological distress occurs among all ICU patients. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [2] source
- cites [3] source
- cites [4] source
The Introduction (page unavailable) says ARDS survivors frequently experience persistent mental-health impairments, including anxiety, after discharge. This supports the claim for ARDS survivors, but the source does not establish how common psychological distress is among ICU patients generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Also stated in: § INTRODUCTION · plain
- Premisecitation
Standard mindfulness training has proven efficacious in improving psychological distress in medical patient populations such as cancer, cardiovascular disease, and chronic pain.
“Standard mindfulness training, typically provided face to face in group settings, has proven efficacious in improving psychological distress in various medical patient populations such as cancer, cardiovascular disease, and chronic pain.1314”
Quote in the paperNot a substantial claim1 of 2 sources checked - Interpretationown data
The data linking frequency, quality, and duration of app use with reduction in depression symptoms demonstrate the importance of optimizing user engagement.
“Our data closely linking the frequency, quality, and duration of app use with reduction in depression symptoms demonstrates the importance of optimizing user engagement as a means to improve adherence, retention, dose, and effect.3738”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [37] Services DoHaH. Research-based web design & usability guidelines, 2013.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [38] source
The Discussion (Principal Findings; page unavailable) says that time spent practicing has a dose–response relationship with improvement and that poor adherence can hamper the effectiveness of Web-based mindfulness interventions. It supports the general rationale for engagement, but does not report the citing authors’ data linking the frequency, quality, and duration of app use specifically to reduced depressive symptoms. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Findingown data
Mean System Usability Scale score was 86.5 (SD 13.3), demonstrating strong usability.
“Mean CSQ (27.6 [SD 3.8]) and SUS (86.5 [SD 13.3]) scores demonstrated strong acceptability and usability”
Quote in the paperSubstantial claim - Findingown data
Depression symptom improvement had a stronger correlation with activity in later intervention stages than in earlier stages.
“Depression symptom improvement had a stronger correlation with activity in the later stages of the intervention (r=−0.42 [week 4]) compared to earlier stages (r = 0.02 [week 1]).”
Quote in the paperNot a substantial claim
- Findingown data
Observed primary outcome metrics of feasibility, acceptability, and usability met or exceeded benchmark targets.
“Observed primary outcome metrics of feasibility, acceptability, and usability met or exceeded benchmark targets (Table 2).”
Quote in the paperSubstantial claim - Findingown data
At 3 months, reductions in mean PHQ-9 scores were similar between mobile mindfulness and telephone groups, compared with the education program.
“In comparison to the education program (−3.0 [95% confidence interval −5.3, −0.8]), reductions in mean PHQ-9 scores were similar between mobile mindfulness (−4.8 [−6.6, −2.9]) and telephone (−3.9 [−5.6, −2.2]) groups at 3 months.”
Quote in the paperSubstantial claim - Findingown data
Mean Client Satisfaction Questionnaire score was 27.6 (SD 3.8), demonstrating strong acceptability.
“Mean CSQ (27.6 [SD 3.8]) and SUS (86.5 [SD 13.3]) scores demonstrated strong acceptability and usability”
Quote in the paperSubstantial claim - Findingown data
The telephone group had slightly better adherence and retention than the mobile mindfulness group.
“the telephone group had slightly better adherence and retention.”
Quote in the paperNot a substantial claim - Findingown data
Participants' severity ratings for self-named stressors did not improve in any treatment group.
“Participants’ severity ratings for self-named stressors, generally focused on physical and functional concerns, did not improve in any treatment group (see Online Supplement 2 eTable 3).”
Quote in the paperNot a substantial claim - Findingown data
In the mobile mindfulness group, frequency and duration of app use correlated with improvement in distress symptoms.
“In the mobile mindfulness group, the frequency and duration of app use correlated with improvement in distress symptoms (see Online Supplement 2 eTables 6 and 7).”
Quote in the paperNot a substantial claim - Premisecitation
There are no effective approaches to treating the psychological component of ICU survivors' experience of critical illness.
“However, there are no effective approaches to treating this prominent component of ICU survivors’ personal experience of critical illness.19”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] source
- Premisecitation
A telephone-delivered mindfulness-based training program for ICU survivors was associated with improved depression, anxiety, and PTSD symptoms in an uncontrolled pilot.
“we recently developed a telephone-delivered mindfulness-based training program for ICU survivors, finding in an uncontrolled pilot that it was associated with improved symptoms of depression, anxiety, and PTSD.10”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [10] Cox, 2014, Development and preliminary evaluation of a telephone-based mindfulness training intervention for survivors of critical illness, Ann Am Thorac Soc source
- Premisecitation
That trial also showed that the ICU survivor-specific education control used in the current trial had an active effect on 3-month distress.
“That trial also showed that the ICU survivor-specific education control also used in the current mindfulness trial had an active effect on 3-month distress.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Kabat-Zinn J . Full catastrophe living. New York, NY: Delta Publishing, 1990.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Recent multi-center trials have demonstrated challenges of scheduling and delivering psychosocial therapy effectively by telephone.
“However, recent multi-center trials have demonstrated the challenges of scheduling and delivering psychosocial therapy effectively by telephone,17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Cox, 2018, Effects of a Telephone- and Web-based Coping Skills Training Program Compared with an Education Program for Survivors of Critical Illness and Their Family Members. A Randomized Clinical Trial, Am J Respir Crit Care Med source
- Study design and conductreasoning
The small sample size limits a better understanding of differential attrition.
“While likely due to chance, the small sample size limits a better understanding of differential attrition.”
Quote in the paperNot a substantial claim - Interpretationown data
Relatively mild baseline distress across groups may have contributed to an impact-limiting floor effect.
“Last, the relatively mild baseline distress across groups may have contributed to an impact-limiting floor effect.”
Quote in the paperSubstantial claim - Premisecitation
The mindfulness program strategy was shorter than most.
“Last, while there is not clear consensus about an optimal duration for a mindfulness program, our strategy that emphasized convenience, a relatively brief period of daily guided meditation (10 minutes), and a brief intervention duration is shorter than most.42”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] source
- Interpretationcitation
Adherence and retention for mobile mindfulness was substantially higher than in a recent telephone-based coping skills training program for ICU survivors of similar length.
“It is important to note that adherence and retention for mobile mindfulness was substantially higher than that observed in a recent telephone-based coping skills training program for ICU survivors of similar length.17”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] Cox, 2018, Effects of a Telephone- and Web-based Coping Skills Training Program Compared with an Education Program for Survivors of Critical Illness and Their Family Members. A Randomized Clinical Trial, Am J Respir Crit Care Med source
- Interpretationreasoning
Some study design elements may have diluted the comparative effects of mobile mindfulness.
“Third, some study design elements that may have diluted the comparative effects of mobile mindfulness.”
Quote in the paperSubstantial claim - Premisecitation
In a recent RCT, psychosocial intervention effect was concentrated among ICU survivors with elevated baseline distress.
“However, in a recent RCT we found a concentration of psychosocial intervention effect among only ICU survivors with elevated baseline distress.11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Kabat-Zinn J . Full catastrophe living. New York, NY: Delta Publishing, 1990.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
Retention of participants is significantly better than in a similarly structured mobile coping skills training intervention among ICU patients.
“Though the retention of participants is significantly better than that observed in a similarly structured mobile coping skills training intervention conducted among ICU patients,17 further study is required to understand the two approaches’ possible tradeoffs (e.g., personalization, dose, costs, scalability), as well as to determine the value of an initial motivational interview at kickoff or”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] Cox, 2018, Effects of a Telephone- and Web-based Coping Skills Training Program Compared with an Education Program for Survivors of Critical Illness and Their Family Members. A Randomized Clinical Trial, Am J Respir Crit Care Med source
- Classified as probably not a substantial claim. 7
- May combine two claims. 21
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAs many as 66% of acute respiratory distress syndrome survivors report clinically important depression, anxiety, and PTSD symptoms at 1 year post-discharge.
“As many as 66% of acute respiratory distress syndrome (ARDS) survivors report clinically important symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) at 1 year post-discharge.5–8”
Quote in the paperNot a substantial claim4 of 4 sources checked- cites [5] Huang, 2016, Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study, Crit Care Med source
The Results (Individual Psychiatric Domains and their Co-occurrence) report that 416 of 629 survivors (66%) had substantial symptoms in at least one of the three domains during one-year follow-up, not specifically at the 12-month assessment. The same section reports 53% with symptoms in at least one domain at six months and says results were similar at 12 months. Thus the source supports the symptom types and 66% figure, but not the claim's single-time-point framing. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites [6] Bienvenu, 2015, Cooccurrence of and remission from general anxiety, depression, and posttraumatic stress disorder symptoms after acute lung injury: a 2-year longitudinal study, Crit Care Med source
The Abstract (Measurements and Main Results) reports substantial anxiety, depression, and PTSD symptoms among acute lung injury survivors, with more than half having symptoms in at least one domain during two-year follow-up. It does not report 66% at one year. The Study population section also dates the 12-month assessment from the onset of lung injury, not hospital discharge. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [7] source
The Discussion reports clinically important depressive symptoms in about 30% of general ICU survivors during the first 12 months after discharge, and the Results report correlations with anxiety and PTSD symptoms. Neither passage establishes the claimed 66% prevalence for ARDS survivors at one year; the paper cites an ARDS-specific study in its References but does not report that figure here. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [8] Jackson, 2014, Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU study: a longitudinal cohort study, Lancet Respir Med source
The Mental Health Outcomes sections (page not provided) report depressive symptoms in 33% and probable PTSD in 7% of respondents at 12 months. This supports the presence of those symptoms after critical illness, but the study reports results for a general ICU cohort, not specifically ARDS survivors; it does not report anxiety or a 66% prevalence for the claimed combination. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe study's methods and reporting were guided by the 2016 CONSORT extension for randomized pilot and feasibility trials.
“Study methodologies and reporting are guided by the 2016 CONSORT statement extension to randomized pilot and feasibility trials.18”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [18] source
May combine two claims.
Study design and conductown dataThe full cohort had mild baseline depression and anxiety symptoms and mild to moderate PTSD symptoms, which did not differ by group assignment.
“The full cohort demonstrated mild baseline symptoms of depression and anxiety, as well as mild to moderate PTSD symptoms that did not differ by group assignment (Table 3; see also Online Supplement eTables 5 and 6).31”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [31] Black, 2015, Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial, JAMA Intern Med source
The Results, “Participant Flow and Characteristics” (page unavailable), reports nonclinical baseline depression and anxiety scores and says baseline variables did not differ between treatment groups. It does not report PTSD symptoms or establish their severity or similarity across groups. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
Findingnone givenThe CAMS-R and Brief COPE did not appear responsive to change.
“The CAMS-R and Brief COPE did not appear responsive to change.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data27 (93%) telephone and 17 (94%) education patients completed all intervention sessions.
“Similarly, 27 (93%) of telephone and 17 (94%) of education patients completed all intervention sessions.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataPost-randomization dropout was higher in the mobile mindfulness group, but most occurred before patients had contact with study staff or used the app.
“Third, though post-randomization dropout was higher in the mobile mindfulness group, most of it occurred before patients either had contact with study staff or used the app.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOf 121 potentially eligible patients, 90 provided informed consent and 80 were randomized after discharge home to mobile mindfulness, telephone mindfulness, or education.
“Of 121 potentially eligible patients, 90 provided informed consent during hospitalization and 80 were randomized (Site 1 n=48, 60%; Site 2 n=32, 40%) after discharge home to mobile mindfulness (n=31, 39%), telephone mindfulness (n=31, 39%), and education (n=18, 22%) (Figure 1).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataEducation recipients had numerically less improvement on PHQ-9 and GAD-7 than mindfulness groups, but similar changes on PTSS.
“Among education recipients in comparison to the mindfulness groups, there was numerically less impact seen on PHQ-9 (−3.0 [−5.3, −0.8]) and GAD-7 (−0.6 [−2.5,1.3]) scores at 3 months, though similar changes on the PTSS score (−3.5 [−8.0, 1.0]).”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataThe similar impact between mobile and telephone mindfulness was consistent across GAD-7, PTSS, and PHQ-15 measures.
“This similar impact was consistent across the GAD-7 (mobile mindfulness −2.1 [−3.7, −0.5]; telephone −1.6 [−3.0, −0.1]), PTSS (mobile mindfulness −2.6 [−6.3, 1.2]; telephone −2.2 [−5.6, 1.2]), and PHQ-10 (mobile mindfulness −5.3 [−7.0, −3.7]; telephone −3.7 [−5.2, −2.2]); see also Online Supplement 2 eFigure 1.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataFeasibility benchmarks were exceeded: consent 74%, randomization 91%, and retention 83%.
“target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomization 91%, retention 83%)”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAmong 24 mobile mindfulness patients who initiated the app, 93 of 96 possible weekly app sessions were completed, and 22 completed all 4 app sessions and all 4 weekly surveys.
“Among the 24 mobile mindfulness patients who initiated the app, 93 of 96 (97%) possible weekly app sessions were completed; 22 (92%) completed all 4 app sessions and all 4 weekly surveys as determined by app analytics.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataA total of 66 randomized patients completed the study, representing 83% overall and 89% of those with any post-discharge contact with study staff.
“A total of 66 randomized patients completed the study, representing 83% overall and 89% of those with any post-discharge contact with study staff.”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenThe education group had a lower prevalence of shock and ARDS and returned to normal duties over two weeks earlier than the mobile mindfulness group.
“Furthermore, despite less improvement in distress compared to the mobile mindfulness group, the education group had a lower prevalence of shock and ARDS and returned to normal duties over two weeks earlier.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDepression symptom improvement correlated with number of pages viewed per session, screen clicks per session, and app sessions viewed overall.
“For example, depression symptom improvement (i.e., PHQ-9 score change) was correlated with number of pages viewed per session (r=−0.54), number of screen clicks per app session (r=−0.49), and number of app sessions viewed overall (r=−0.46).”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataA self-directed, four-session post-discharge mindfulness program for ICU survivors delivered by a mobile app was feasible, acceptable, usable, and demonstrated evidence for impact on psychological distress similar to a therapist-delivered mindfulness program.
“A self-directed, four-session post-discharge mindfulness program for ICU survivors delivered by a mobile app was feasible, acceptable, usable, and demonstrated evidence for impact on psychological distress that was similar to a therapist-delivered mindfulness program.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningThe small sample limits the precision and generalizability of results and the ability to understand the impact of clinical and demographic variables.
“First, the small sample limits the precision and the generalizability of results as well as our ability to understand the impact of clinical and demographic variables.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningThe sample size of 90 was pragmatic and not based on formal power calculations.
“A pragmatic sample size of 90 was chosen not based on formal power calculations, but rather because it represented a cohort large enough to inform the investigators about the potential challenges of delivering an app-based intervention in the context of post-discharge care.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductnone givenThis pilot study was not designed to evaluate efficacy.
“Second, while the results are compelling, this pilot study was not designed to evaluate efficacy.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenAll participant data collected were included in models and analyzed according to original group allocation.
“All participant data collected were included in models and analyzed according to the original group allocation.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataMobile mindfulness performed similarly to therapist-led mindfulness and generally better than an education program.
“Importantly, mobile mindfulness performed similarly to therapist-led mindfulness training program and generally better than an education program.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningMobile mindfulness appears promising as a scalable patient-centered approach to addressing ICU survivors' psychological distress and overcoming post-discharge access barriers.
“Mobile mindfulness therefore appears to show promise as a scalable patient-centered approach to addressing ICU survivors’ widely prevalent psychological distress that can also overcome many post-discharge access to care barriers these patients experience.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenAn independent data safety monitoring board approved the protocol and reviewed safety every 6 months.
“An independent data safety monitoring board approved the protocol and reviewed safety at 6-month intervals.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataA computer algorithm allocated participants at a 1.75:1.75:1 ratio using simple randomization for the first 18 participants and then dynamic allocation via minimization to balance across specified strata.
“A computer algorithm allocated participants at a 1.75:1.75:1 ratio (mobile, telephone, education) using simple randomization for the first 18 participants and then dynamic allocation via a method of minimization approach 19 to ensure balance across strata including: baseline Patient Health Questionnaire 9-item depression scale (PHQ-9) score (<15 vs. ≥15; representing a cutoff of ‘moderately severe”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] source
May combine two claims.
Interpretationown dataIn this multicenter pilot RCT, mobile mindfulness was supported for feasibility, acceptability, usability, and impact on psychological distress.
“In this multicenter pilot RCT, we found support for the feasibility, acceptability, usability, and impact on psychological distress of a novel self-directed mindfulness training program delivered by a mobile app.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationSelf-directed mobile mindfulness had a favorable effect on symptoms, which is uncommon for a comparative web-based therapy.
“Second, while the self-directed mobile mindfulness had a favorable effect on symptoms, uncommon for a comparative web-based therapy,3739 the telephone group had slightly better adherence and retention.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [37] Services DoHaH. Research-based web design & usability guidelines, 2013.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [39] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe institutional review boards of the participating sites approved the study protocol.
“The institutional review boards of the participating sites approved the study protocol (Online Supplement 1).”
Quote in the paperNot a substantial claim
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Education group PHQ-15 confidence interval is inconsistent
MajorThe reported 95% CI for the education group's PHQ-15 change excludes the point estimate on the lower side. The interval and estimate do not match each other as written.
Reported 2.7 · recomputed -2
“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]).”
Telephone PHQ-15 confidence interval is inconsistent
MajorThe telephone group's PHQ-15 interval has an upper bound that is higher than the point estimate by 5.9, but elsewhere the same result is reported with a different upper bound. The interval as printed here conflicts with the corresponding results section.
Reported 2.2 · recomputed 5.9
“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]).”
Usability scores differ between the abstract and results
MajorThe abstract reports a mean usability score of 89.1 with an SD of 11.5, while the results report 86.5 with an SD of 13.3.
“mean Systems Usability Score 89.1 [SD 11.5]”
“Mean CSQ (27.6 [SD 3.8]) and SUS (86.5 [SD 13.3]) scores”
Education-group depression interval changes sign
MajorThe abstract gives 0.8 as the upper confidence limit for the education group's depression change; the results give −0.8. The discrepancy changes whether the interval includes zero.
“education (−3.0 [−5.3, 0.8])”
“education program (−3.0 [95% confidence interval −5.3, −0.8])”
Telephone-group physical-symptom interval changes sign
MajorThe abstract gives 2.2 as the upper confidence limit for the telephone group's physical-symptom change; the results give −2.2. The discrepancy changes whether the interval includes zero.
“telephone −3.7 [−5.2, 2.2]”
“telephone −3.7 [−5.2, −2.2]”
Physical-symptom scale is named inconsistently
MinorThe results label the measure accompanying the physical-symptom changes as PHQ-10, whereas the methods identify the physical-symptom measure as PHQ-15.
“and PHQ-10 (mobile mindfulness −5.3 [−7.0, −3.7]; telephone −3.7 [−5.2, −2.2])”
“The PHQ-15 was used to measure distress associated with physical symptoms (range 0 [none] to 30 [very troublesome]).27”
Cited works that were retracted
Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.
Cites a retracted work: 10.1371/journal.pone.0124344
InfoThe cited work was retracted on 2019-04-12 (notice 10.1371/journal.pone.0215608), not before this paper was published (2018-05-23).
Cited work 10.1371/journal.pone.0124344 · retracted 2019-04-12 · notice 10.1371/journal.pone.0215608 · this paper published 2018-05-23
“Gotink RA , Chu P , Busschbach JJ , et al . Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS One 2015;10:e0124344.doi:10.1371/journal.pone.0124344”
Cites
1 retracted
Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M. G. M. (2015) · PLOS ONE · doi:10.1371/journal.pone.0124344 · Cited by 539 · see citing works
RetractedThe PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
EuroQol: a new facility for the measurement of health-related quality of life
(1990) · Health Policy · doi:10.1016/0168-8510(90)90421-9 · Cited by 15,736 · cited 1× · see citing works
“26 The PHQ-15 was used to measure distress associated with physical symptoms (range 0 (none) to 30 (very troublesome)).”
MethodAdapting a clinical comorbidity index for use with ICD-9-CM administrative databases
DEYO, R. (1992) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(92)90133-8 · Cited by 10,452 · see citing works
You want to measure coping but your protocol’ too long: Consider the brief cope
Carver, C. S. (1997) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm0401_6 · Cited by 7,361 · see citing works
Usability Evaluation In Industry
(1996) · CRC Press eBooks · doi:10.1201/9781498710411 · Cited by 4,400 · see citing works
CONSORT 2010 statement: extension to randomised pilot and feasibility trials.
Eldridge, S. M., Chan, C. L., Campbell, M. J., Bond, C. M., Hopewell, S., Thabane, L., & Lancaster, G. A. (2016) · BMJ · doi:10.1136/bmj.i5239 · Cited by 3,404 · see citing works
The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002) · Psychosomatic Medicine · doi:10.1097/00006842-200203000-00008 · Cited by 3,305 · see citing works
CONSORT 2010 statement: extension to randomised pilot and feasibility trials
on behalf of the PAFS consensus group, Eldridge, S. M., Chan, C. L., Campbell, M. J., Bond, C. M., Hopewell, S., Thabane, L., & Lancaster, G. A. (2016) · Pilot and Feasibility Studies · doi:10.1186/s40814-016-0105-8 · Cited by 2,843 · see citing works
Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H., Zawistowski, C., Bemis-Dougherty, A., Berney, S. C., Bienvenu, O. J., et al. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e318232da75 · Cited by 2,639 · see citing works
One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome
Herridge, M. S., Cheung, A. M., Tansey, C. M., Matte-Martyn, A., Diaz-Granados, N., Al-Saidi, F., Cooper, A. B., Guest, C. B., Mazer, C. D., Mehta, S., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022450 · Cited by 2,334 · see citing works
The client satisfaction questionnaire
Attkisson, C. C., & Zwick, R. (1982) · Evaluation and Program Planning · doi:10.1016/0149-7189(82)90074-x · Cited by 1,743 · see citing works
Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.-P. (2007) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-006-9035-8 · Cited by 1,630 · see citing works
Self-citation(1990) · Cited by 1,282 · see citing works
Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.03.009 · Cited by 975 · cited 1× · see citing works
“36 37 Second, while the self-directed mobile mindfulness programme had a favourable effect on symptoms, uncommon for a comparative web-based therapy, 36 38 the telephone group had slightly better adherence and retention.”
BackgroundLudwig, D. S. (2008) · JAMA · doi:10.1001/jama.300.11.1350 · Cited by 957 · see citing works
Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2011.01704.x · Cited by 803 · see citing works
Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016) · JAMA · doi:10.1001/jama.2016.2323 · Cited by 729 · see citing works
Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., Pun, B. T., Vasilevskis, E. E., Morandi, A., Shintani, A. K., et al. (2014) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(14)70051-7 · Cited by 673 · see citing works
The method of minimization for allocation to clinical trials
Scott, N. W., McPherson, G. C., Ramsay, C. R., & Campbell, M. K. (2002) · Controlled Clinical Trials · doi:10.1016/s0197-2456(02)00242-8 · Cited by 651 · see citing works
Carmody, J., & Baer, R. A. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20555 · Cited by 568 · see citing works
Black, D. S., O’Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.8081 · Cited by 491 · cited 1× · see citing works
“As mindfulness grows in general popularity and evidence accrues for its efficacy, 31–34 the delivery of mindfulness content by a mobile web app accessible on any digital device could become an attractive approach for providers and patients alike.”
BackgroundDepressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis
Rabiee, A., Nikayin, S., Hashem, M. D., Huang, M., Dinglas, V. D., Bienvenu, O. J., Turnbull, A. E., & Needham, D. M. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001811 · Cited by 434 · see citing works
Herridge, M. S., Chu, L. M., Matte, A. L., TOMLINSON, G. A., Chan, L. S., Thomas, C., Friedrich, J. O., Mehta, S., Lamontagne, F., Levasseur, M., et al. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201512-2343oc · Cited by 416 · see citing works
Research-based web design & usability guidelines
Shneiderman, B. (2006) · Cited by 379 · see citing works
Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., Rodman, J. L., & Lim, K. O. (2015) · JAMA · doi:10.1001/jama.2015.8361 · Cited by 315 · see citing works
Girard, T. D., Shintani, A., Jackson, J. C., Gordon, S. M., Pun, B. T., Henderson, M. S., Dittus, R. S., Bernard, G. R., & Ely, E. W. (2007) · Critical Care · doi:10.1186/cc5708 · Cited by 286 · see citing works
Stoll, C., Kapfhammer, H. P., Rothenhäusler, H. B., Haller, M., Briegel, J., Schmidt, M., Krauseneck, T., Durst, K., & Schelling, G. (1999) · Intensive Care Medicine · doi:10.1007/s001340050932 · Cited by 278 · see citing works
Schmidt, K., Worrack, S., Von Korff, M., Davydow, D., Brunkhorst, F., Ehlert, U., Pausch, C., Mehlhorn, J., Schneider, N., Scherag, A., et al. (2016) · JAMA · doi:10.1001/jama.2016.7207 · Cited by 179 · see citing works
Huang, M., Parker, A. M., Bienvenu, O. J., Dinglas, V. D., Colantuoni, E., Hopkins, R. O., & Needham, D. M. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001621 · Cited by 157 · see citing works
Cox, C. E., Hough, C. L., Carson, S. S., White, D. B., Kahn, J. M., Olsen, M. K., Jones, D. M., Somers, T. J., Kelleher, S. A., & Porter, L. S. (2018) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201704-0720oc · Cited by 145 · see citing works
Self-citationWunsch, H., Christiansen, C. F., Johansen, M. B., Olsen, M., Ali, N., Angus, D. C., & Sørensen, H. T. (2014) · JAMA · doi:10.1001/jama.2014.2137 · Cited by 143 · see citing works
Self-citationCox, C. E., Docherty, S. L., Brandon, D. H., Whaley, C., Attix, D. K., Clay, A. S., Dore, D. V., Hough, C. L., White, D. B., & Tulsky, J. A. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e3181b6f64a · Cited by 136 · see citing works
Self-citationBienvenu, O. J., Colantuoni, E., Mendez-Tellez, P. A., Shanholtz, C., Dennison-Himmelfarb, C. R., Pronovost, P. J., & Needham, D. M. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000000752 · Cited by 128 · see citing works
Kamdar, B. B., Sepúlveda, K. A., Chong, A., Lord, R. K., Dinglas, V. D., Méndez-Téllez, P. A., Shanholtz, C. B., Colantuoni, E., von Wachter, T., Pronovost, P. J., et al. (2017) · Thorax · doi:10.1136/thoraxjnl-2017-210217 · Cited by 126 · see citing works
Web-Based Mindfulness Interventions for People With Physical Health Conditions: Systematic Review
Toivonen, K. I., Zernicke, K., & Carlson, L. E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7487 · Cited by 106 · see citing works
Mindfulness and mind wandering: the protective effects of brief meditation in anxious individuals
Xu, M., Purdon, C., Seli, P., & Smilek, D. (2017) · Consciousness and Cognition · doi:10.1016/j.concog.2017.03.009 · Cited by 92 · see citing works
Brown, S. M., Wilson, E. L., Presson, A. P., Dinglas, V. D., Greene, T., Hopkins, R. O., & Needham, D. M. (2017) · Thorax · doi:10.1136/thoraxjnl-2017-210337 · Cited by 82 · see citing works
Carlson, L. E., Tamagawa, R., Stephen, J., Doll, R., Faris, P., Dirkse, D., & Speca, M. (2014) · JNCI Monographs · doi:10.1093/jncimonographs/lgu034 · Cited by 69 · see citing works
Long, A. C., Kross, E. K., Davydow, D. S., & Curtis, J. R. (2014) · Intensive Care Medicine · doi:10.1007/s00134-014-3306-8 · Cited by 67 · see citing works
Cox, C. E., Porter, L. S., Buck, P. J., Hoffa, M., Jones, D., Walton, B., Hough, C. L., & Greeson, J. M. (2014) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201308-283oc · Cited by 56 · see citing works
Self-citationUsability Testing of an Electronic Patient-Reported Outcome System for Survivors of Critical Illness
Cox, C. E., Wysham, N. G., Kamal, A. H., Jones, D., Cass, B., Tobin, M., White, D. B., Kahn, J. M., Hough, C. L., & Carson, S. S. (2016) · American Journal of Critical Care · doi:10.4037/ajcc2016952 · Cited by 19 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., & Fuller‐Tyszkiewicz, M. (2019) · World Psychiatry · doi:10.1002/wps.20673 · Cited by 886 · see citing works
Torous, J., Lipschitz, J., Ng, M., & Firth, J. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.167 · Cited by 546 · see citing works
Gál, É., Ștefan, S., & Cristea, I. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.134 · Cited by 289 · see citing works
Post-intensive care syndrome (PICS): recent updates
Hiser, S. L., Fatima, A., Ali, M. A. A., & Needham, D. M. (2023) · Journal of Intensive Care · doi:10.1186/s40560-023-00670-7 · Cited by 291 · see citing works
“[40] (USA, 2018, N = 80) Mean (95% CI) change from baseline for PHQ-9 at 3 months: Telephone group (TG) − 3.”
BackgroundSommers-Spijkerman, M., Austin, J., Bohlmeijer, E., & Pots, W. (2021) · JMIR Mental Health · doi:10.2196/28168 · Cited by 179 · see citing works
“Population, intervention, and methodological characteristics (Multimedia Appendix 1; Gao et al, unpublished data, 2021; [32-125]) as well as effect size data were extracted from the full-text papers by 3 raters (ie, MSS, JA, and WP) independently.”
BackgroundMethodLinardon, J. (2020) · Behavior Therapy · doi:10.1016/j.beth.2019.10.002 · Cited by 133 · see citing works
Geense, W. W., van den Boogaard, M., van der Hoeven, J. G., Vermeulen, H., Hannink, G., & Zegers, M. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003974 · Cited by 119 · see citing works
“Ten RCTs (37, 40, 44, 46, 59–61, 65, 66, 70) reporting physical outcomes were included in the metaanalyses, all evaluating exercise and physical rehabilitation programs.”
InfluentialGoldberg, S. B., Imhoff-Smith, T., Bolt, D. M., Wilson-Mendenhall, C. D., Dahl, C. J., Davidson, R. J., & Rosenkranz, M. A. (2020) · JMIR Mental Health · doi:10.2196/23825 · Cited by 97 · see citing works
“These studies have begun to examine efficacy in various clinical and nonclinical populations [31-38].”
BackgroundGoldberg, S. B., Imhoff-Smith, T., Bolt, D. M., Wilson-Mendenhall, C. D., Dahl, C. J., Davidson, R. J., & Rosenkranz, M. A. (2020) · doi:10.2196/preprints.23825 · Cited by 97 · see citing works
Mindfulness and physical disease: a concise review
Greeson, J. M., & Chin, G. R. (2019) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2018.12.014 · Cited by 85 · see citing works
“One promising telephone- and app-based intervention designed for patients who survived a critical illness may serve as a model for delivering the basic principles and practices of mindfulness to medical patients who experience prolonged challenges with physical mobility, chronic pain, post-traumatic stress and anxiety…”
BackgroundSelf-citationLinardon, J., Messer, M., Goldberg, S. B., & Fuller‐Tyszkiewicz, M. (2023) · Clinical Psychology Review · doi:10.1016/j.cpr.2023.102370 · Cited by 78 · see citing works
Linardon, J. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104421 · Cited by 69 · see citing works
Roberts, N. P., Kitchiner, N., Kenardy, J. A., Robertson, L., Lewis, C., & Bisson, J. I. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006869.pub3 · Cited by 71 · see citing works
Semler, M. W., Bernard, G. R., Aaron, S. D., Angus, D. C., Biros, M. H., Brower, R. G., Calfee, C. S., Colantuoni, E., Ferguson, N. D., Gong, M. N., et al. (2020) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201908-1595ws · Cited by 60 · see citing works
Self-citationBirk, J. L., Sumner, J. A., Haerizadeh, M., Heyman-Kantor, R., Falzon, L., Gonzalez, C. J., Gershengoren, L., Shapiro, P. A., Edmondson, D. E., & Kronish, I. M. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.03.003 · Cited by 56 · see citing works
“Among the five studies testing CBT interventions, Cox (2018) administered a telephonebased coping skills CBT intervention for patients after discharge from the ICU; Irvine et al. (2011) adapted a CBT intervention for patients after first receipt of an implantable cardioverter-defibrillator (ICD);…”
MethodRung, A. L., Oral, E., Berghammer, L., & Peters, E. S. (2020) · JMIR mHealth and uHealth · doi:10.2196/15943 · Cited by 39 · see citing works
“Most of the comprehensive reviews of depression and MBSR conducted in clinical samples using noninternet-based interventions [3,4,49,50] have demonstrated improvements in depression following MBSR, and studies in both clinical and community samples using internet- or mobile-based delivery have also noted decreases in…”
BackgroundSmith, J. L., Allen, J. W., Haack, C., Wehrmeyer, K., Alden, K., Lund, M. B., & Mascaro, J. S. (2021) · Mindfulness · doi:10.1007/s12671-020-01502-7 · Cited by 37 · see citing works
“By some accounts, the relational didactic interaction between the participant and an instructor is an essential feature of a mindfulness-based program (Crane et al. 2017).”
BackgroundDying Patient and Family Contributions to Nurse Distress in the ICU
Lief, L., Berlin, D., Maciejewski, R. C., Westman, L., Su, A., Cooper, Z. R., Ouyang, D. J., Epping, G., Derry, H. M., Russell, D., et al. (2018) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201804-284oc · Cited by 37 · see citing works
Tan, Z. Y. A., Wong, S. H., Cheng, L. J., & Lau, S. T. (2022) · Mindfulness · doi:10.1007/s12671-022-01962-z · Cited by 30 · see citing works
“Some reported based on adherence to the training program, others reported based on defined criteria or completion rate (Carissoli et al., 2015; Cox et al., 2019; Garrison et al., 2018; Laird, 2020; Lindsay et al., 2018, 2019; McClain, 2017; Rosen et al., 2018; Walsh et al., 2019).”
BackgroundMethodTypes of Digital Mindfulness: Improving Mental Health Among College Students – A Scoping Review
Yosep, I., Suryani, S., Mediani, . S., Mardhiyah, A., & Ibrahim, K. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s443781 · Cited by 35 · see citing works
“45 High levels of digital literacy in developed countries indicate that their people are better able to access and use mental health technology, strengthening the adoption of digital mindfulness.”
BackgroundPratt, E. H., Hall, L., Jennings, C., Olsen, M. K., Jan, A., Parish, A., Porter, L. S., & Cox, C. E. (2023) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202301-025oc · Cited by 26 · see citing works
Self-citationWang, M., Chen, H., Yang, F., Xu, X., & Li, J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.057 · Cited by 25 · see citing works
Mobile Mindfulness Intervention for Psychological Distress Among Intensive Care Unit Survivors
Cox, C. E., Gallis, J. A., Olsen, M. K., Porter, L. S., Gremore, T. M., Greeson, J. M., Morris, C. D., Moss, M., & Hough, C. L. (2024) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2024.0823 · Cited by 26 · see citing works
Self-citationReangsing, C., Trakooltorwong, P., Maneekunwong, K., Thepsaw, J., & Oerther, S. E. (2023) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-023-04102-9 · Cited by 23 · see citing works
Dal‐Pizzol, F., de Medeiros, G. F., Michels, M., Mazeraud, A., Bozza, F. A., Ritter, C., & Sharshar, T. (2021) · Neurotherapeutics · doi:10.1007/s13311-020-00981-9 · Cited by 22 · see citing works
Alexandersen, I., Haugdahl, H. S., Stjern, B., Paulsby, T. E., Lund, S. B., & Haugan, G. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.15812 · Cited by 20 · see citing works
Mobile applications for the management of chronic physical conditions: a systematic review
Jiménez-Muñoz, L., Gutiérrez-Rojas, L., Porras‐Segovia, A., Courtet, P., & Baca‐García, E. (2020) · Internal Medicine Journal · doi:10.1111/imj.15081 · Cited by 18 · see citing works
Cox, C. E., Kelleher, S. A., Parish, A., Olsen, M. K., Bermejo, S. D., Dempsey, K., Jaggers, J., Hough, C. L., Moss, M., & Porter, L. S. (2023) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202210-890oc · Cited by 19 · see citing works
Self-citationLai, D. J., Liu, Z., Johnston, E., Dikomitis, L., D’Oliveira, T. C., & Shergill, S. S. (2024) · Critical Care · doi:10.1186/s13054-024-05089-6 · Cited by 17 · see citing works
“Studies measuring Health-Related Quality of Life all used the EQ-5D-5L [28, 36, 37].”
BackgroundMethodInfluentialSingh, H., Tang, T., Gray, C. S., Kokorelias, K. M., Thombs, R., Plett, D., Heffernan, M. G., Jarach, C. M., Armas, A., Law, S., et al. (2022) · JMIR Aging · doi:10.2196/35929 · Cited by 20 · see citing works
“To address the technology’s fit with workflows, workloads, and buy-in, some researchers believed that participants, family, caregivers, and providers should be engaged in helping to design the intervention [136,148,228].”
BackgroundPost intensive care syndrome: A review of clinical symptoms, evaluation, intervention
He, X., Song, Y., Cao, Y., Miao, L., & Zhu, B. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e31278 · Cited by 27 · see citing works
“Virtual reality technology [95], narrative care [96], music therapy [97], positive thinking therapy [98], and behavioral cognitive therapy [99] have all shown to be effective in this regard.”
BackgroundCox, C. E., Olsen, M. K., Gallis, J. A., Porter, L. S., Greeson, J. M., Gremore, T. M., Frear, A., Ungar, A., McKeehan, J. D., McDowell, B., et al. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.106119 · Cited by 16 · see citing works
“The LIFT pilot RCT demonstrated that the clinical effect on depression, anxiety, and physical symptoms of the app-delivered intervention was more powerful than the therapist-delivered version [7].”
InfluentialSelf-citationParker, A. M., Nelliot, A., Chessare, C. M., Malik, A. M., Koneru, M., Hosey, M. M., Ozok, A. A., Lyons, K. D., & Needham, D. M. (2020) · Australian Critical Care · doi:10.1016/j.aucc.2020.02.010 · Cited by 15 · see citing works
Kulakli, A., & Shubina, I. (2020) · JMIR mhealth and uhealth · doi:10.2196/19391 · Cited by 15 · see citing works
“New mobile technologies are accessible and cost-effective tools to assist in identifying PTSD symptoms [5,6] and suicidal behaviors [7].”
BackgroundEffects of MBSR therapy on negative emotions, fatigue, and sleep quality in “post-ICU patients”
Chen, Y., Wang, R., Yu, J., Zhu, L., Lu, Y., & Deng, X. (2022) · Medicine · doi:10.1097/md.0000000000028331 · Cited by 14 · see citing works
“Mindfulness is a learned practice of non-judgmental awareness that aims to alleviate distress by uncoupling emotional reactions and habitual behavior from unpleasant symptoms, memories, thoughts, and emotions.([15,16]) Meta-analyses show that mindfulness-based stress reduction (MBSR) can effectively relieve emotional…”
BackgroundSizemore, K. M., Gray, S., Wolfer, C., Forbes, N., Talan, A. J., Millar, B. M., Park, H. H., Saslow, L. R., Moskowitz, J. T., & Rendina, H. J. (2022) · Journal of Happiness Studies · doi:10.1007/s10902-022-00587-2 · Cited by 14 · see citing works
“Further, our rates of EMA completion were above target benchmarks set for other m-Health intervention studies (> 60%; Cox et al., 2019).”
BackgroundDigital solutions and the future of recovery after critical illness
Rose, L., & Cox, C. E. (2023) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001075 · Cited by 13 · see citing works
Self-citationLi, Y., Cen, J., Wu, J., Tang, M., Guo, J., Hang, J., Zhao, Q., Zhao, G., Huang, X., & Han, B. (2023) · Journal of Medical Internet Research · doi:10.2196/48750 · Cited by 13 · see citing works
“Some clinical studies using mobile apps for psychological intervention have found that patients’ participation is lower than with an offline intervention [33,34].”
Leggett, N. E., Abdelhamid, Y. A., Deane, A. M., Emery, K., Hutcheon, E., Rollinson, T. C., Preston, A., Witherspoon, S. A., Zhang, C., Merolli, M., et al. (2024) · Australian Critical Care · doi:10.1016/j.aucc.2024.101134 · Cited by 13 · see citing works
A Bibliometric Study on Mobile Applications for PTSD Treatment : The Period of 2010-2019
Kulakli, A., & Shubina, I. (2020) · International Conference on Information Management · doi:10.1109/icim49319.2020.244717 · Cited by 13 · see citing works
“• There is no significant difference between the training programs delivered by mobile app or by therapist [5]; • The use of mobile apps in treatment for smokers with PTSD was beneficial [11], [12] [22], [23]; • mobile apps can be used as supportive tools in managing pain [30] and anger [29]; •…”
BackgroundYoshihiro, S., Taito, S., Yamauchi, K., Kina, S., Terayama, T., Tsutsumi, Y., Kataoka, Y., & Unoki, T. (2023) · PeerJ · doi:10.7717/peerj.15260 · Cited by 15 · see citing works
Usabilidade de aplicativo móvel em saúde: uma revisão bibliométrica
da Silva, L. V. F., Santos, J. S., de Carvalho, A. L. A., de Andrade, D. M., de Sá, D. D., Alves, É. P., Felix, F. K. S., Medeiros, L. L. D. M., de Andrade, B. M., & Almeida, T. D. C. F. (2021) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e6676.2021 · Cited by 10 · see citing works
Treatment of Anxiety Disorders in the Digital Age
Blackburn, A. M., & Goetter, E. M. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-30687-8_16 · Cited by 8 · see citing works
A pilot study of trained ICU doulas providing early psychological support to critically ill patients
Karnatovskaia, L. V., Varga, K., Niven, A. S., Schulte, P. J., Mujic, M., Gajic, O., Bauer, B. A., Clark, M. M., Benzo, R. P., & Philbrick, K. L. (2021) · Critical Care · doi:10.1186/s13054-021-03856-3 · Cited by 10 · see citing works
“A single-center randomized trial of a mindfulness app following hospital discharge compared to a therapist-led telephone-based mindfulness program demonstrated similar reduction in depression scores between the two interventions [40].”
Vandenbogaart, E., Gawlinski, A., Grimley, K. A., Lewis, M. A., & Pavlish, C. (2023) · Critical Care Nurse · doi:10.4037/ccn2023411 · Cited by 7 · see citing works
Sloan, E., Parry, S. M., da Silva, A. A., Granger, C. L., Fehlberg, Z., Gustafson, O. D., Voutier, C. R., Short, C. E., & Klaic, M. (2025) · CHEST Critical Care · doi:10.1016/j.chstcc.2025.100142 · Cited by 8 · see citing works
Berger, E., Schol, C. M. A., Gunput, S. T. G., Kiers, D., Gommers, D. A. M. P. J., Rose, L., & van Mol, M. M. C. (2024) · Mayo Clinic Proceedings Digital Health · doi:10.1016/j.mcpdig.2024.11.006 · Cited by 9 · see citing works
Liptáková, S., Světlák, M., Matis, J., Slezáčková, A., & Rastislav, R. (2022) · Ceskoslovenska psychologie · doi:10.51561/cspsych.66.3.233 · Cited by 6 · see citing works
“The results of the study by Cox et al. (2018) indicate that delivery through telephone calls had better adherence and retention than a self-directed mobile mindfulness program.”
BackgroundMindfulness Practice versus Physical Exercise in Enhancing Vitality
Yan, W., Jiang, Z., Zhang, P., Liu, G., & Peng, K. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032537 · Cited by 7 · see citing works
“Though previous research has shown that a self-directed mindfulness program is equally effective as an expert-guided one [50], future studies with stricter matching are needed.”
ResultIshinuki, T., Zhang, L., Harada, K., Tatsumi, H., Kokubu, N., Kuno, Y., Kumasaka, K., Koike, R., Ohyanagi, T., Ohnishi, H., et al. (2023) · Nursing in Critical Care · doi:10.1111/nicc.12880 · Cited by 7 · see citing works
Optimizing Recovery Following Critical Illness: A Systematic Review of Home-Based Interventions
Holod, A. F., Choi, J., & Tate, J. A. (2022) · Home Health Care Management & Practice · doi:10.1177/10848223221127440 · Cited by 6 · see citing works
Nurses, Psychological Distress, and Burnout: Is There an App for That?
Murali, K. P., Brody, A. A., & Stimpfel, A. W. (2023) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202307-629ed · Cited by 4 · see citing works
Historic review of long-term outcomes research
Rylander, C. C. (2019) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000648 · Cited by 5 · see citing works
Elhady, M. M., Elhady, A. M., & Shohieb, S. M. (2025) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2025.104208 · Cited by 4 · see citing works
Zou, H., Chair, S. Y., Luo, D., Liu, Q., Wang, X. Q., & Yang, B. X. (2023) · Heart & Lung · doi:10.1016/j.hrtlng.2023.08.009 · Cited by 4 · see citing works
Parker, A. M., Malik, A. M., & Hosey, M. M. (2018) · Thorax · doi:10.1136/thoraxjnl-2018-211989 · Cited by 4 · see citing works
Cox, C. E., Gallis, J. A., Olsen, M. K., Porter, L. S., Gremore, T. M., Iwashyna, T. J., Caldwell, E., Greeson, J. M., Moss, M. M., & Hough, C. L. (2024) · CHEST Critical Care · doi:10.1016/j.chstcc.2024.100063 · Cited by 3 · see citing works
Self-citationDigital Therapeutics in Cardiovascular Healthcare: A Narrative Review
Shao, X., Hu, Y., Jia, H., & Song, J. (2025) · Current Cardiology Reports · doi:10.1007/s11886-025-02270-3 · Cited by 5 · see citing works
“Additionally, APP-based mindfulness training has been validated for feasibility in critical illness survivors [120] or patients with AF [121].”
Ng, M. S. N., Li, C., Chan, Z. K. W., & Steindl, S. R. (2024) · Mindfulness · doi:10.1007/s12671-024-02436-0 · Cited by 3 · see citing works
“…et al., 2022), compassionate mind-ful movement (Mills & Allen, 2000; Wilson et al., 2022), decentering techniques (Bogosian et al., 2016, 2017, 2022; Carletto et al., 2016; Cox et al., 2019), mindfulness art activities (Newland et al., 2020), and positive behaviour therapy (Weng et al., 2016).”
InfluentialPsychology: Person-Centred Care a Key to Successful Recovery
Highfield, J. A., Beadman, M., & Wade, D. M. (2020) · Springer eBooks · doi:10.1007/978-3-030-38916-1_10 · Cited by 3 · see citing works
Mindfulness-Based Interventions for Patients with Cancer
Porter, L. S., & Gremore, T. M. (2022) · Springer eBooks · doi:10.1007/978-3-030-85702-8_20 · Cited by 2 · see citing works
Self-citationHancke, L., Schmid, N., Krampe, H., Denke, C., Mauersberger, V.-M., Heeren, P., Wunderlich, M. M., Dähnert, E., Balzer, F., & Spies, C. (2025) · Minerva Anestesiologica · doi:10.23736/s0375-9393.24.18331-9 · Cited by 2 · see citing works
Meditation, Mindfulness, and Mental Health
Gupta, S. K. (2021) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-7998-8682-2.ch001 · Cited by 2 · see citing works
The Role of Counselor Trainees' Co-Regulated Mindfulness: A Cluster-Randomized Controlled Study
Warwick, L. (2023) · doi:10.12794/metadc2137602 · Cited by 2 · see citing works
Kapfhammer, H. (2022) · Springer eBooks · doi:10.1007/978-3-662-65873-4_13 · Cited by 1 · see citing works
Psychology: Person-Centred Care a Key to Successful Recovery
Highfield, J. A., Beadman, M., & Wade, D. M. (2024) · Springer eBooks · doi:10.1007/978-3-031-53019-7_10 · Cited by 1 · see citing works
Wang, X., He, R., Long, J., Chen, J., Karunakaran, M., Hariharan, V. S., Rushendar, R., & Xiang, L. (2025) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2025.152042 · Cited by 1 · see citing works
Personalized Interventions to Support Families in the Intensive Care Unit
Cox, C. E. (2018) · Springer eBooks · doi:10.1007/978-3-319-94337-4_14
Self-citationWhat are the long-term outcomes after ARDS?
Hough, C. L. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-64068-8.00031-6 · Cited by 1 · see citing works
Self-citationPredicting Patient Participation to an ICU Follow-Up ProgramPreprint
Prevedello, D., Steckelmacher, C., Devroey, M., Créteur, J., & Preiser, J. (2021) · Research Square · doi:10.21203/rs.3.rs-490751/v1
Mindfulness-Based Stress Reduction for Medical Conditions
Carlson, L. E., Toivonen, K., Flynn, M. J., Deleemans, J. M., Piedalue, K.-A., Subnis, U. B., Oberoi, D. V., Patton, M., Pirbhai, H., & Baydoun, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-81245-4_7
Tanajura, N. P. M., Santana, E. G. D., Flôres, G. L. F., Silva, D. L., Pereira, W. S., Ferreira, Y. L. M., Reis, B. D. S., Batista, L. B., Gomes, M. C. A., & Soares, I. A. (2022) · Revista Eletrônica Acervo Saúde · doi:10.25248/reas.e9699.2022
Shubina, I. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4184290
Zalewski, P., Gruca, D., Raabe, A., Wais, M., & Wróblewski, W. (2023) · Journal of Education Health and Sport · doi:10.12775/jehs.2023.17.01.019
“Despite the need for a larger trial, it seems that a mobile app-based program has feasibility, acceptability, usability, and impact on psychological distress and physical symptom comparable to a therapist-led telephone-based mindfulness program [22].”
BackgroundAnais do I Simpósio Brasileiro de Saúde Mental na Medicina
Lopes, J. R., Pires, B. C., Braga, A. C. A. D. A., Silva, I. Y., Arão, A. E. C. H., & Machado, T. K. F. (2023) · Editora Pascal LTDA eBooks · doi:10.29327/5311658
Personalized Interventions to Support Families in the Intensive Care Unit
Cox, C. E. (2025) · Springer eBooks · doi:10.1007/978-3-031-83786-9_7
Self-citationIntegrating Mindfulness into a Routine Schedule: The Role of Mindfulness Apps
van Emmerik, A., & Schoenmakers, T. M. (2025) · Nutrition and health · doi:10.1007/978-3-031-87441-3_20
Saputra, J. C., Setyosarı, P., & Ulfa, S. U. (2025) · JKTP Jurnal Kajian Teknologi Pendidikan · doi:10.17977/um038v8i22025p107
Do Contemplative Practices Promote Trauma Recovery? A Narrative Review from 2018 to 2023
Scafuto, F., Quinto, R. M., Orrù, G., Lazzarelli, A., Ciacchini, R., & Conversano, C. (2025) · Healthcare · doi:10.3390/healthcare13222825 · Cited by 1 · see citing works
Lentz, T. A., Porter, L. S., McGarvey, L., Rhodes, C., Rocos, B., Gremore, T. M., Reinke, E. K., Eucker, S. A., Green, C. L., Poehlein, E., et al. (2025) · JMIR Research Protocols · doi:10.2196/77236
“Participants then complete daily guided practice sessions (6 ‐ 8 min each) that focus on that week’s mindfulness technique (Table 1) [45,46].”
Self-citationSizemore, K. M., Moskowitz, J. T., Rendina, H. J., Gray, S., Park, H. H., Carrico, A. W., Avery, J., & Millar, B. M. (2025) · JMIR Research Protocols · doi:10.2196/76741
“Target benchmarks include more than 70% of eligible participants providing consent and over 60% of consented participants being successfully randomized [98].”
Wang, S.-L., Li, P.-S., Lee, C.-S., & Hsieh, C. (2025) · Journal of Health Psychology · doi:10.1177/13591053251397760
“One study provided disease-related education via text messages or websites using non-face-to-face methods (Cox et al., 2019), and two studies used telephone interventions with the same frequency (Zou et al., 2023, 2024).”
InfluentialMeditation App Use May Decrease State Anxiety
Burton, L. A., Tatnall, A., & Frumento, A. (2026) · Journal of Educational Cultural and Psychological Studies (ECPS Journal) · doi:10.7358/ecps-2025-032-burt
Li, Q., Wang, T., Wang, Z., Yin, J., Liu, Y., Zhou, Z., Lei, G., Li, Z., Yang, J., Zhang, Z., et al. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1739015 · Cited by 1 · see citing works
“A total of 6 studies (7, 21, 23, 29, 30, 34) reported the immediate effects.”
InfluentialEffects of a program to reduce fatigue among sepsis survivors: a randomized controlled trial
Samart, B., Puwarawuttipanit, W., Kongkar, R., & Rongrungruang, Y. (2026) · Scientific Reports · doi:10.1038/s41598-026-46536-4
Mosack, K. E., Guzmán, C. E. V., Ruiz, C. J. M., Wolwowicz, E., Johnson, K. S., Mantelli, R. A., Anderson, A., McDougal, M., Mejia-Flores, L., Gonzalez-Guarda, R. M., et al. (2026) · Annals of the American Thoracic Society · doi:10.1093/annalsats/aaoag089
Self-citationBaudier, R. L., Mosack, K. E., Lapidus, J., Porter, L. S., Anderson, A., Hope, A. A., johnson, A., Johnson, K. S., Lesowski, K., Mantelli, R. A., et al. (2026) · Contemporary Clinical Trials · doi:10.1016/j.cct.2026.108359
“The control arm, which we call Enlighten Recovery, is an education program [37,46] we developed that contains cardiorespiratory condition-specific content, informed by research on informational needs and past successful education programs [47–49].”
Self-citationCavalcante, F. L. N. F., da Silva, B. R., Teixeira, P. L. C. D., JÚNIOR, F. M. B., Fernandes, A. E. C., Silva, T. G. M. D. C., & Maia, E. M. C. (2026) · Revista Científica Multidisciplinar Núcleo do Conhecimento · doi:10.32749/nucleodoconhecimento.com.br/saude/eficacia-das-intervencoes
Non clinic-Based Interventions to Mitigate Post-Intensive Care Syndrome: A Scoping Review
Fraiha, Y. A., Devanney, J., McNichol, M., Cummiskey, T., Kumaresan, A., & Bose, S. (2026) · Critical Care Explorations · doi:10.1097/cce.0000000000001434
“Each study demonstrated the feasibility, acceptability, and usability of the mobile applications, but their effectiveness was only minor and at least noninferior to mind-fulness sessions (22) or cognitive behavioral therapy (CBT) sessions (23) with a trained therapist.”
Cesari, J., Poujol, A.-L., Guinot, P., Gérard, P., & Laurent, A. (2026) · Journal of Critical Care · doi:10.1016/j.jcrc.2026.155658 · Cited by 2 · see citing works
Wilson, T., McDougal, M., James, L. M., Golden, S., Maxcy, C., Wolwowicz, E., Cox, C. E., Hough, C. L., & Vranas, K. C. (2026) · Critical Care Explorations · doi:10.1097/cce.0000000000001436
“A subsequent pilot randomized clinical trial (Lift 1) demonstrated that a self-guided mobile app-based version had a similar impact to a therapist-lead program (10).”
Self-citationQutishat, M., Albalushi, M., & Sharour, L. M. A. (2026) · Clinical Psychologist · doi:10.1080/13284207.2026.2701913
Kaneva, M., Alguacil, D. E., van Genugten, C., & Kleiboer, A. M. (2026) · JMIR Mental Health · doi:10.2196/98855
- Authors
- Cox, C. E., Hough, C. L., Jones, D. M., Ungar, A., Reagan, W., Key, M. D., Gremore, T., Olsen, M. K., Sanders, L., Greeson, J. M., & Porter, L. S.
- Affiliations
- Duke University (US)
- University of Washington (US)
- Rowan University (US)
- Corresponding author
- Cox, Christopher E
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2018-05-23
- Volume
- 74
- Issue
- 1
- Pages
- 33-42
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- PMC
- PMC6460929
- OpenAlex
- W2803399833
- Cited by
- 102
- References
- 43
- Citations by year
- 2026: 12 · 2025: 12 · 2024: 10 · 2023: 25 · 2022: 10 · 2021: 9 · 2020: 12 · 2019: 8 · 2018: 4
- FWCI
- 9.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Center for Complementary and Integrative Health
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- mindfulness training, intensive care unit survivors, critical illness, mobile health apps, telephone-delivered intervention, psychological distress, depression, anxiety, post-traumatic stress, somatic symptoms, feasibility and acceptability, cardiopulmonary failure, hospital discharge, post-discharge care, self-guided intervention, patient satisfaction, usability, post-ICU rehabilitation
- MeSH terms
- Adult, Aged, Anxiety, Depression, Feasibility Studies, Female, Heart Failure, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Patient Education as Topic, Pilot Projects, Psychiatric Status Rating Scales, Respiratory Insufficiency, Stress Disorders, Post-Traumatic, Telephone, Critical Illness, Patient Satisfaction, Survivors, Mobile Applications, Mindfulness
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