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Table 63 Residential treatment for 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

Change in Mean Body Mass Index at Discharge (assessed with: Calculated BMI), change in purge frequency, EDI 3 Drive for thinness, EDE-Q, Readiness for Change

 4

Case Series

very serious a

serious b

not serious

serious c,d

none

Studies included patients with AN, BN and EDNOS for a total n = 1068. Reasons for admission to residential treatment were not noted and all studies took place in the US (ie decision for admission likely influenced by insurance coverage/parental finances). One study noted that they included only data from the first admission for patients admitted more than once to residential treatment and that only patients who remained in treatment > 2 weeks were included. Another study noted that patients had a mean of 1.2 previous inpatient admissions prior to residential treatment. Otherwise there was a paucity of information describing previous treatments. They measured change in weight in various ways. Four studies utilized BMI. Admission mean BMI varied from 15.8 to 18.65. Discharge mean BMI varied from 17.8 to 21.3. Change in mean BMI from admission to discharge varied from 1.92 to 2.72. Two studies additionally reported on %TGW at admission and discharge. Admission mean %TGW were 83.4 and 76.7% and discharge mean %TGW were 94.7 and 86.6% respectively.

VERY LOW

CRITICAL

very serious e

serious f

not serious

serious d

all plausible residual confounding would reduce the demonstrated effect

One study reported on 361 patients that were purging at admission a mean of 3.25 times per day. At discharge they were purging a mean of 0.02 times per day. Differing diagnostic groups not reported separately. LOS 51.8 days +/− 25.8. Treatment was multimodal.

VERY LOW

IMPORTANT

very serious g

serious b

not serious

serious c

all plausible residual confounding would reduce the demonstrated effect

Three studies looked at EDI 3 scores and included 313 patients with AN, BN and EDNOS. Treatment provided was multimodal. Various subscales and EDI-3 Risk Composite as well as EDI-3 Global were reported in the some of the studies. EDI-3 Risk Composite was reported in 2 studies (total n = 212) mean decrease in EDI-3 RC varied from 14 to 31 (SD = 23.1 and 17.62 respectively). EDI-3 Global was reported in 1 study (n = 101) where it decreased a mean of 39.3 points (SD = 55.2). EDI-3 Drive for Thinness was reported in 3 studies (n = 277) where it decreased a mean of 3.53, 5.11 and 12.37 (SD 6.9, 7.81 and 6.42). EDI-3 was reported in 1 study (n = 111) and decreased 3.75 (SD = 2.21). EDI-3 Body Dissatisfaction was reported in 1 study (n = 101) where it decreased 3.45 (SD = 10.88). LOS varied between studies from 28.5–56.4 days, one study did not report their LOS.

VERY LOW

CRITICAL

very serious g

not serious

not serious

not serious

all plausible residual confounding would reduce the demonstrated effect

One study looked at the EDE-Q Pre to Post and included 105 patients with AN, BN and EDNOS. Treatment was multimodal and mean LOS was 56 days. EDE-Q changed from 3.6 (SD = 1.58) to 1.95 (SD = 1.35), mean change − 1.56 (SD = 1.27) -- similar to reported norms in adolescent girls.

VERY LOW

CRITICAL

very serious c,g

not serious

not serious

not serious

all plausible residual confounding would reduce the demonstrated effect

One study included 65 patients with AN and treatment was multimodal. Mean readiness for change (ANSOQC) at admission was 53.98 (SD 16.36) and at discharge was 67.28 (SD 20.06). This difference was statistically significant, but signifies no change in actual stage of change (ie Preparation Phase scores are 50–69). They were further divided into low readiness and high readiness. High readiness patients had a shift from 66.86 (SD 11.78) at admit to 76.80 (SD 15.71) at d/c, signifying a shift from Preparation to Action Phases. Low readiness patients shifted from 40.70 (SD 7.12) to 57.47 (SD 19.5), signifying shift from Contemplative to Preparation Phases. LOS was 28.5 days.

VERY LOW

IMPORTANT

Weight gain

 2

Case Reports

very serious g

not serious

not serious

not serious

none

The 2 case reports both described patients with Type 1 diabetes and reported weight gains of 2.2 and 4.3 kg during admission. Varying types of treatment provided in multimodal format. LOS varied among studies from 28 days to 56 days and in one study LOS was not reported.

VERY LOW

IMPORTANT

  1. Explanations
  2. aObservational study with no comparison
  3. bMixed diagnostic group (AN, BN and EDNOS)
  4. cLarge or overlapping confidence intervals wide in some studies included here
  5. dConfidence intervals not reported or not reported in all studies
  6. eObservational study with no comparison, self-reported # of purges/day
  7. fMixed diagnostic group (AN-B/P and BN) - results not differentiated
  8. gObservational study with no comparison, self-rated scale
  9. Bibliography:
  10. Case Series - Fisher 2015 [284], Weltzin 2014 [285], Twohig 2016 [286], McHugh 2007 [287]
  11. Case Reports – Pitel 1998 [288], Rodigue 1990 [289]