JAMA INTERN MED Early Recent, Aug 08, 2022 10.1001/jamainternmed.2022.3178 本文由“天纳”临床学术信息人工智能系统自动翻译Can a cognitive behavioral therapy intervention for chronic pain (CBT-CP) that adjusts treatment using artificial intelligence (AI-CBT-CP) based on feedback about patient progress achieve outcomes that are not inferior to standard telephone CBT-CP while reducing therapist time?基于患者进展反馈调整人工智能治疗（AI-CBT-CP）的慢性疼痛认知行为治疗干预（CBT-CP）能否在减少治疗师时间的同时达到不低于标准电话CBT-CCP的效果？This randomized comparative effectiveness trial of AI-CBT-CP found that its outcomes were not inferior to those of 45-minute telephone therapist sessions, with less than half the therapist time. At 6 months, more patients who experienced AI-CBT-CP had clinically meaningful improvements in physical function and pain intensity.这项AI-CBT-CP的随机比较有效性试验发现，其结果并不低于45分钟的电话治疗师疗程，治疗师的时间不到一半。在6个月时，更多经历AI-CBT-CP的患者在身体功能和疼痛强度方面有临床意义的改善。The findings of this randomized trial indicated that AI-CBT-CP can achieve noninferior and possibly better outcomes relative to standard CBT-CP while increasing access and reducing therapist costs.这项随机试验的结果表明，AI-CBT-CP与标准CBT-CP相比，可以达到非劣效且可能更好的结果，同时增加访问量并降低治疗师成本。Cognitive behavioral therapy for chronic pain (CBT-CP) is a safe and effective alternative to opioid analgesics. Because CBT-CP requires multiple sessions and therapists are scarce, many patients have limited access or fail to complete treatment.慢性疼痛认知行为疗法（CBT-CP）是阿片类镇痛药的安全有效的替代方案。由于CBT-CP需要多次治疗，且治疗师稀缺，许多患者获得治疗的机会有限或无法完成治疗。To determine if a CBT-CP program that personalizes patient treatment using reinforcement learning, a field of artificial intelligence (AI), and interactive voice response (IVR) calls is noninferior to standard telephone CBT-CP and saves therapist time.为了确定使用强化学习、人工智能（AI）和交互式语音应答（IVR）呼叫对患者治疗进行个性化的CBT-CP程序是否不低于标准电话CBT-CP，并节省治疗师时间。This was a randomized noninferiority, comparative effectiveness trial including 278 patients with chronic back pain from the Department of Veterans Affairs health system (recruitment and data collection from July 11, 2017-April 9, 2020). More patients were randomized to the AI-CBT-CP group than to the control (1.4:1) to maximize the system’s ability to learn from patient interactions.这是一项随机、非劣性、比较有效性试验，包括退伍军人事务部卫生系统的278名慢性背痛患者（招募和数据收集时间为2017年7月11日至2020年4月9日）。将更多患者随机分为AI-CBT-CP组而非对照组（1.4:1），以最大限度地提高系统从患者互动中学习的能力。All patients received 10 weeks of CBT-CP. For the AI-CBT-CP group, patient feedback via daily IVR calls was used by the AI engine to make weekly recommendations for either a 45-minute or 15-minute therapist-delivered telephone session or an individualized IVR-delivered therapist message. Patients in the comparison group were offered 10 therapist-delivered telephone CBT-CP sessions (45 minutes/session).所有患者均接受10周的CBT-CP。对于AI-CBT-CP组，AI引擎使用通过每日IVR电话的患者反馈，每周为45分钟或15分钟的治疗师电话会议或个性化IVR治疗师信息提出建议。对照组的患者接受了10次治疗师提供的电话CBT-CP治疗（45分钟/疗程）。The primary outcome was the Roland Morris Disability Questionnaire (RMDQ; range 0-24), measured at 3 months (primary end point) and 6 months. Secondary outcomes included pain intensity and pain interference. Consensus guidelines were used to identify clinically meaningful improvements for responder analyses (eg, a 30% improvement in RMDQ scores and pain intensity). Data analyses were performed from April 2021 to May 2022.主要结果是罗兰·莫里斯残疾问卷（RMDQ；范围0-24），在3个月（主要终点）和6个月时测量。次要结果包括疼痛强度和疼痛干扰。共识指南用于确定应答者分析的临床意义改善（例如，RMDQ评分和疼痛强度改善30%）。数据分析从2021 4月至2022年5月进行。The study population included 278 patients (mean [SD] age, 63.9 [12.2] years; 248 [89.2%] men; 225 [81.8%] White individuals). The 3-month mean RMDQ score difference between AI-CBT-CP and standard CBT-CP was −0.72 points (95% CI, −2.06 to 0.62) and the 6-month difference was -1.24 (95% CI, -2.48 to 0); noninferiority criterion were met at both the 3- and 6-month end points (P < .001 for both). A greater proportion of patients receiving AI-CBT-CP had clinically meaningful improvements at 6 months as indicated by RMDQ (37% vs 19%; P = .01) and pain intensity scores (29% vs 17%; P = .03). There were no significant differences in secondary outcomes. Pain therapy using AI-CBT-CP required less than half of the therapist time as standard CBT-CP.研究人群包括278名患者（平均[SD]年龄，63.9[12.2]岁；248名[89.2%]男性；225名[81.8%]白人）。AI-CBT-CP和标准CBT-CP之间的3个月平均RMDQ得分差异为：−0.72分（95%CI，−2.06至0.62），6个月差异为-1.24（95%可信区间-2.48至0）；在3个月和6个月的终点均符合非劣性标准（P < .001）。如RMDQ所示，接受AI-CBT-CP治疗的患者中有较大比例在6个月时有临床意义的改善（37%对19%；P = .01）和疼痛强度得分（29%比17%；P = .03). 次要结果无显著差异。使用AI-CBT-CP进行疼痛治疗所需时间不到标准CBT-CP的一半。The findings of this randomized comparative effectiveness trial indicated that AI-CBT-CP was noninferior to therapist-delivered telephone CBT-CP and required substantially less therapist time. Interventions like AI-CBT-CP could allow many more patients to be served effectively by CBT-CP programs using the same number of therapists.这项随机比较有效性试验的结果表明，AI-CBT-CP不劣于治疗师提供的电话CBT-CP，并且需要的治疗师时间更少。像AI-CBT-CP这样的干预措施可以让更多的患者通过使用相同数量的治疗师的CBT-CP计划得到有效服务。ClinicalTrials.gov Identifier: NCT02464449临床试验。政府标识符：NCT0246449
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JAMA INTERN MED Early Recent, Aug 08, 2022 10.1001/jamainternmed.2022.3178