Background IntelliCare is a modular platform that includes 12 simple apps targeting specific psychological strategies for common mental health problems. Objective This study aimed to examine the effect of 2 methods of maintaining engagement with the IntelliCare platform, coaching, and receipt of weekly recommendations to try different apps on depression, anxiety, and app use. Methods A total of 301 participants with depression or anxiety were randomized to 1 of 4 treatments lasting 8 weeks and were followed for 6 months posttreatment. The trial used a 2X2 factorial design (coached vs self-guided treatment and weekly app recommendations vs no recommendations) to compare engagement metrics. Results The median time to last use of any app during treatment was 56 days (interquartile range 54-57), with 253 participants (84.0%, 253/301) continuing to use the apps over a median of 92 days posttreatment. Receipt of weekly recommendations resulted in a significantly higher number of app use sessions during treatment (overall median=216; P=.04) but only marginal effects for time to last use (P=.06) and number of app downloads (P=.08). Coaching resulted in significantly more app downloads (P<.001), but there were no significant effects for time to last download or number of app sessions (P=.36) or time to last download (P=.08). Participants showed significant reductions in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) across all treatment arms (P s<.001). Coached treatment led to larger GAD-7 reductions than those observed for self-guided treatment (P=.03), but the effects for the PHQ-9 did not reach significance (P=.06). Significant interaction was observed between receiving recommendations and time for the PHQ-9 (P=.04), but there were no significant effects for GAD-7 (P=.58). Conclusions IntelliCare produced strong engagement with apps across all treatment arms. Coaching was associated with stronger anxiety outcomes, and receipt of recommendations enhanced depression outcomes. Trial Registration ClinicalTrials.gov NCT02801877; https://clinicaltrials.gov/ct2/show/NCT02801877

low, study results were pooled per factor. If pooling was considered not appropriate a best evidence synthesis was conducted. The best evidence synthesis was conducted as follows: associations were categorized as positive, negative or no association. The ranking of levels of evidence was formulated as 1. Strong evidence: consistent finding ( 75% of the studies showing the same association) in multiple studies with a low risk of bias in all domains of the QUIPS tool, 2. Moderate evidence: consistent findings (75% of the studies showing the same association) in multiple studies with a moderate of high risk of bias in one or more domains of the QUIPS tool, 3. Limited evidence: one study with a low risk of bias in all domains of the QUIPS tool or 2 studies with moderate of high risk of bias in one or more domains of the QUIPS tool, 4. Conflicting evidence: <75% of the studies showing the same association, 5. No evidence: No studies found. Results: We included 56 different articles, describing 147 different factors. Three studies were assessed as low risk of bias in all domains of the QUIPS tool. Seventy-nine factors were reported once (one study). The clinical heterogeneity of the studies describing the other 68 factors (reported more than once) was considered too large to conduct a metaanalysis. Therefore we conducted a best evidence synthesis, separately for each factor regarding clinical progression (C), radiological progression (R) or progression to THR (T). No strong evidence was found for any prognostic factor. Moderate evidence was found for more or faster progression in patients having comorbidity (C), a family history of OA (R), more pain at baseline (T), a lower global assessment reported by the patient at baseline (T), certain modes created by statistical shape modelling (T) and a higher K-L grade at baseline (T).

BackgroundOsteoarthritis (OA) is the most prevalent joint disease and the leading cause of disability from 60 years onwards. In fact, 14,8% of the Spanish population has OA.ObjectivesThis study aimed to analyze the indications and average doses prescribed in the treatment of knee osteoarthritis in Primary Care in Spain.MethodsThe EMARTRO study was designed as an observational, multicenter, transversal study to compare probability of suffering a comorbidities based on presence of symptomatic knee OA visited by GPs. Sociodemographic, anthropometric, clinical parameters and clinical variables of interest were recorded. The prescribed medications and doses indicated in syntomatic knee OA were analyzed in patients included in the EMARTRO study.ResultsA total of 1173 patients were included, of whom 646 had knee OA. Patients with OA had a mean (SD) BMI of 30.9 (5.1), systolic blood pressure 132.8 (14.5) and diastolic blood pressure 77.9 (9.1) mm Hg. They also had a mean of 4.3 (1.9) comorbidities, the most frequent were hypertension 358 (62.2%), dyslipidemia 336 (58.3%), diabetes mellitus II 126 (21.9%), and gastroesophageal reflux 110 (19.1%). As for the symptomatology, the patients presented a mean (SD) pain in Huskisson's VAS of 65.18 (15.27) mm and algofunctional Lequesne score of 11.35 (4.86).Patients were treated with a mean of 2,2 medications. The 45.5% of osteoarthritic patients were treated as monotherapy, 35.5% were taking 2 medications for osteoarthritis, 15.3% 3 and 3.7% 4 or more medications. It should be noted, taking into account the high levels of pain, that 15% of the patients did not receive any treatment.Regarding prescribed medications for knee OA, 378 (58.2%) patients were treated with paracetamol at a mean daily dose (SD) of 1,150.5 (1,815.5) mg; 232 (35.9%) received NSAIDs, with metamizole being the most prescribed at doses 1,092 (538) mg, ibuprofen at doses 1,136 (528,8) mg and naproxen at doses 941,8 (238,5) mg. Next, 131 (20.3%) patients were treated with opioids, tramadol being the most frequent at doses 102.7 (49.7) mg; 87 (13.3%) with SYSADOA being chondroitin sulphate the most frequent at doses 758.7 (247.7) mg. Finally, 87 (13.3%) of the patients were treated with COX-2, mainly with etoricoxib at doses of 69.3 (27.1) mg.ConclusionsAlthough the patients presented many concomitant pathologies, it is frequent to approach osteoarthritis in polytherapy. In addition, despite the high symptomatology, patients are treated primarily with a mild analgesic such as paracetamol at doses lower than those recommended. It is paradoxical the high prescription of NSAIDs in a population with a high prevalence of cardiovascular and gastrointestinal pathologies as well as an increase in the prescription of opioids.Disclosure of InterestM. Herrero Barbero Employee of: Bioiberica, S. Gimenez: None declared, J. Vergara: None declared, E. Viles I Lladό Employee of: Bioiberica, H. Martinez Employee of: Bioiberica, G. Rodríguez Roca: None declared, L. Sánchez Employee of: Bioiberica, J. A. Díaz Muñoz: None declared, ...

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