title: Effects of a Web-Based Intervention for Stress Reduction in Primary Care: A Cluster Randomized Controlled Trial.
abstract: BACKGROUND
  Preliminary findings suggest that Web-based interventions may be effective in achieving significant stress reduction. To date, there are no findings available for primary care patients. This is the first study that investigates a Web-based intervention for stress reduction in primary care.
  
  
  OBJECTIVE
  The aim was to examine the short-term effectiveness of a fully automated Web-based coaching program regarding stress reduction in a primary care setting.
  
  
  METHODS
  The study was an unblinded cluster randomized trial with an observation period of 12 weeks. Individuals recruited by general practitioners randomized to the intervention group participated in a Web-based coaching program based on education, motivation, exercise guidance, daily text message reminders, and weekly feedback through the Internet. All components of the program were fully automated. Participants in the control group received usual care and advice from their practitioner without the Web-based coaching program. The main outcome was change in the Perceived Stress Questionnaire (PSQ) over 12 weeks.
  
  
  RESULTS
  A total of 93 participants (40 in intervention group, 53 in control group) were recruited into the study. For 25 participants from the intervention group and 49 participants from the control group, PSQ scores at baseline and 12 weeks were available. In the intention-to-treat analysis, the PSQ score decreased by mean 8.2 (SD 12.7) in the intervention group and by mean 12.6 (SD 14.7) in the control group. There was no significant difference identified between the groups (mean difference -4.5, 95% CI -10.2 to 1.3, P=.13).
  
  
  CONCLUSIONS
  This trial could not show that the tested Web-based intervention was effective for reducing stress compared to usual care. The limited statistical power and the high dropout rate may have reduced the study's ability to detect significant differences between the groups. Further randomized controlled trials are needed with larger populations to investigate the long-term outcome as well as the contents of usual primary care.
  
  
  BACKGROUND
  German Clinical Trials Register DRKS00003067; http://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?=DRKS00003067 (Archived by WebCite at http://www.webcitation.org/6eXk0PXmO).
authors.affiliation: Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. michael.mehring@tum.de.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0001-5238-8703
authors.initials: M
authors.lastname: Mehring
authors.forename: Max
authors.identifier: http://orcid.org/0000-0001-9295-6525
authors.initials: M
authors.lastname: Haag
authors.forename: Klaus
authors.identifier: http://orcid.org/0000-0002-2902-970X
authors.initials: K
authors.lastname: Linde
authors.forename: Stefan
authors.identifier: http://orcid.org/0000-0002-4558-4041
authors.initials: S
authors.lastname: Wagenpfeil
authors.forename: Antonius
authors.identifier: http://orcid.org/0000-0002-2847-8626
authors.initials: A
authors.lastname: Schneider
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011320:Primary Health Care; D013315:Stress, Psychological / Q000517:prevention & control* / Q000523:psychology*; D011795:Surveys and Questionnaires; D018910:Video Games / Q000523:psychology*
keywords: Web-based; life stress; randomized controlled trial; stress reduction