Table 57 Family-based day treatment/intensive outpatient for 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 | |||
Improved Weight at Discharge (assessed with: %TGW/BMI), Change in EDE-Q (assessed with: Pre-post EDE-Q scores) | |||||||||
5 | Case Series | very serious a | serious b | not serious | serious c | none | Five studies for total of 254 patients. Studies varied with regard to the form of parent involvement, hours/week in treatment and admission criteria. Referral to receive treatment in DTP or IOP was noted in the studies to be due to the presence of severe symptoms impairing the patients’ functioning or physical health. In some cases the patients had to have already received another form of treatment (ie inpatient or outpatient), but in other cases patients could be referred directly for services in DTP/IOP. Weight related outcomes reported as change in BMI or %TGW. Four studies reported change in BMI from admission to discharge and found that weight rose from 17.4 (SD 2.0) to 18.3 (SD 1.8); 16.5 (SD 2.3) to 18.4 (SD 1.6);18.7 (SD 2.4) to 20.5 (SD 2.0) and by a mean of 0.91+/−0.55 in the final study. Three studies reported on change in %TGW and found an increase in %TGW from 86 (SD 10) to 96 (SD 7) and 91.7 (SD 6.1) to 101.8% (SD 7.7) and 88 to 93.47%. One study reported weight change as 12/19 patients reaching 100%TGW at 3 months and the other 7/19 reaching a mean %TGW of 94% with mean %TGW at admission of 88%). The mean LOS varied between these studies from 3.2 weeks to 28.5 weeks. | ⨁◯◯◯ VERY LOW | CRITICAL |
very serious a | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study with total of 51 patients looking at EDE-Q. Fifty-three % of patients were referred directly from the inpatient unit in which case the treating inpatient clinician and insurance provider had to have determined that the patient/family required higher intensity treatment than outpatient could provide. Thirty-five % were referred due to inability to make progress in outpatient treatment. In 12% of cases, no referral source was recorded/available. Previous treatment and route of referral was not noted in other study. LOS was 7 weeks and mean of 40 +/− 17.2 days in each program. Global EDE-Q score decreased from 3.76 (SD 1.55) to 2.08 (SD 1.4) from admission to discharge (p = 0.001) in one study and from a mean of 3.83 +/− 0.95 to 1.50 (+/−1.03) in the other study (p = 0.012). Adolescent norm score reported in study was 1.6 (SD 1.4). | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | Two studies for a total of 82 patients reported on change in EDI. Admission to the program was determined based on clinical assessment that the patients required a high level of treatment intensity based on symptomatology, in some cases patients had not received any prior treatment. LOS were 15 and 21.4 weeks. Change in EDI-2 was reported in one study and stated that EDI-DT decreased from 16.05 (SD 6.04) to 11.56 (SD 7.42) and EDI-BD decreased from 19.85 (SD 8.39) to 17.31 (SD 9.21), this study also reported that of those starting above the norm at beginning of study, 40% of patients improved on EDI-DT and 24.6% on EDI-BD). In the second study EDI-3 scores were reported to have improved significantly on all subscales other than maturity fears by 3 months. Scores for EDI-DT decreased from 49.24 (SD 12.61) to 42.06 (SD 11.52) and EDI-BD from 48.47 (SD 11.85) to 46.65 (SD 11.74). | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One study involved 56 patients, only 30 patients had pre-post data to analyze, mean LOS of 10.3 weeks. ChEAT scores reported only in graph format, all subscales significantly improved, although upper and lower confidence intervals overlapped with median effect in all subcales. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | not serious | none | Completion rate - One study with 51 patients. Patients were referred from both inpatient and outpatient sources based on severity of symptoms. 15/36 patients (30%) were considered not successful (ie premature d/c) due to need for higher level of care, psychiatric hospitalization or left treatment AMA. Mean LOS was 22.2 (SD 3.8) days. | ⨁◯◯◯ VERY LOW | CRITICAL | ||
Change in EDE, YBC-EDS (assessed with: Pre/post YBC-EDS), Body Checking Questionnaire | |||||||||
1 | Case Report | very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One study with 8 patients and their parents. LOS mean of 40 days +/−17.2. Intervention was family-based with CBT principles. EDE-Q subscales --statistically significant decreases in all subscales (range p = 0.012 to 0.028). | ⨁◯◯◯ VERY LOW | |
very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | YBC-EDS total score decreased from mean 39.29 (+/−8.42) to 17.12 (+/−11.47) (p = 0.028), Concerns scores from mean of 15.57 to 9.43 (p = 0.034) and Rituals from mean of 14.71 to 7.71 (p = 0.028). | ⨁◯◯◯ VERY LOW | |||
very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | BCQ total scores decreased pre/post from 59.67 (+/−20.96) to 43.50 (+/−15.15) (p = 0.075). Scores also decreased for idiosyncratic checking and body dimensions subscales (p = 0.027 and 0.046) | ⨁◯◯◯ VERY LOW | |||