Table 55 Multimodal day treatment be used in the treatment of children and adolescents with eating disorders
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 | |||
Weight Change (assessed with: BMI/TGW), Change in self esteem, successful completion, change in motivation | |||||||||
5 | Case series | very serious a | not serious | not serious | serious b | none | Reasons for referral to DTP were based on severity of symptomatology, but could occur from inpatient or outpatient or initial assessment. Two studies reported all patients together, the other (n = 160) reported AN (n = 116) vs BN (n = 44). In one mixed study the mean BMI rose from 18.9 (SD 2.6) to 20.9 (SD 2.9) which related to a change in %TGW from 94% at admission to 102% at discharge. In the other mixed study the weight gain was reported as 0.95 kg over the 2.6 weeks LOS. It was noted that approx one-quarter of patients lost weight, one quarter gained 0–0.9 kg, on quarter gained 0.9–1.8 kg and one quarter gained > 1.8 kg. Weight gain was correlated with dx of AN or EDNOS vs BN, longer LOS and lower weight at admission. The last study reported that patients with AN started at a mean BMI of 18.3 (SD 1.2) and gained 0.9 points, whereas patients with BN started with a mean BMI of 20.3 (SD 3.3) and gained a mean of 0.3 points. The LOS in these studies was 15.3 weeks and 13.1 weeks respectively. | ⨁◯◯◯ VERY LOW | CRITICAL |
very serious a | not serious | not serious | serious b | all plausible residual confounding would reduce the demonstrated effect | One study - Total of 160 patients (ie 116 AN patients and 44 BN patients). Mean LOS was 15 weeks. For AN group the SEED in relation to others decreased from 16.5 (SD 9.7) to 15.0 (SD 10.7) (p = 0.039) and SEED related to weight and shape changed from 14.6 (SD 7.8) to 13.5 (SD 9.0) (p = 0.046). In the BN group SEED in relation to others changed from 17.3 (SD 7.8) to 13.2 (SD 8.5) (p = 0.000) and SEED related to weight and shape changed from 17.6 (SD 7.0) to 13.2 (SD 8.0) (p = 0.001). No significant difference in effect between AN and BN. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | not serious | none | Two studies for total of 61 patients. Success defined using various criteria such as adequate weight gain, symptom reduction, and no AMA discharge or inpatient admission. “Success” rate was 49 and 50% in these 2 studies. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study including 30 patients. LOS was 10.5 weeks. Motivational Stage of Change was measured pre-post with the MSCARED. Patients were noted to progress through 1.9 +/− 1.3 stages from beginning to end of treatment (p < 0.0001). The change in SOC from intake to discharge was significantly correlated with the change in the ChEAT score during the same time period (p = 0.001). | ⨁◯◯◯ VERY LOW | IMPORTANT | ||