Table 53 Inpatient medical stabilization followed by outpatient treatment versus inpatient weight restoration for children and adolescents with anorexia nervosa
From: Canadian practice guidelines for the treatment of children and adolescents with eating disorders
Certainty assessment | Impact | Certainty | Importance | ||||||
|---|---|---|---|---|---|---|---|---|---|
№ of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | |||
Change in weight (assessed with: Pre/post measures of weight), Rate of Readmission, psychological symptoms (EDE and EDI) | |||||||||
2 | randomised trials | serious a | not serious | not serious | not serious | none | Two RCT examined the difference between patients randomized to receive a relatively short inpatient admission followed by either 20 sessions of FBT (n = 82) or DTP (n = 172). In the FBT F/U study patients had all been unwell less than 3 years and in the day treatment F/U study the patients we only included if it was their first admission. The first study randomized patients to be d/c once medically stable (mean LOS 21.73 +/− 5.92 days) vs to remain in hospital until 90%TGW (mean LOS 36.89 +/− 17.06). Both groups received 20 sessions of FBT following discharge. Patients discharged at point of medical stability (ie mean 84.40%TGW) had attained a mean of 95.20%TGW by the end of 20 sessions of FBT, whereas those who remained in hospital until they were 90%TGW (ie mean 92.00%TGW) were at a mean of 93.10%TGW by session 20. ES in this study was 1.28 at the end of hospitalization and 0.27 at end of session 20. There was a significant difference in weight at end of hospitalization, but not by end of session 20. The other study randomized patients to remain as inpatients for 3 weeks vs until attaining TGW (total mean treatment time 14.6 weeks). Those d/c at 3 weeks entered a DTP with similar programming (total mean treatment time 16.5 weeks). At end of treatment patients in inpatient only group had reached a mean of 89%TGW (+/− 3.8) and those in inpt + DTP had reached 88.1%TGW (+/− 4.7) - no significant difference in weight outcome in intention to treat analysis. | ⨁⨁⨁◯ MODERATE | CRITICAL |
serious a | not serious | not serious | not serious | none | Both RCTs examined Rate of readmission measured over the 12 months following admission in the FBT-f/u study (n = 82). Readmission rates were similar regardless of allocation (ie 35% in med stability group vs 36.8% in the weight restoration group). However, given that the med stability group had a shorter initial admission, the total hospital days was 45.2 d in this group vs 65.5 in the weight restoration group. In inpatient weight restoration vs DTP F/U 8/87 patients were readmitted during their DTPtreatment due to medical instability and 25.3% (inpt WR) vs 15.1% (DTP), p = 0.12 required readmission to inpatient unit at 12 months F/U. | ⨁⨁⨁◯ MODERATE | IMPORTANT | ||
serious a | not serious | not serious | not serious | none | One study - EDI-2 scores pre treatment and post treatment similar between groups regardless of allocation (total n = 143). | ⨁⨁⨁◯ MODERATE | IMPORTANT | ||
serious a | not serious | not serious | not serious | none | One study - EDE global scores not significantly different between groups at baseline or at end of FBT, 6 month or 12 month F/U (n = 69). | ⨁⨁⨁◯ MODERATE | IMPORTANT | ||