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Table 1 Overview on main characteristics and findings of RCTs investigating the efficacy of post-inpatient aftercare interventions for anorexia nervosa

From: Efficacy of post-inpatient aftercare treatments for anorexia nervosa: a systematic review of randomized controlled trials

Study

Aftercare intervention

Comparator

Adjunctive treatment

Duration

N

BMI at inclusion

Primary outcome

Definition of relapse

Main findings

Fichter et al. [28]

Internet-based guided self-help intervention (IGSH)

TAU

Outpatient or inpatient treatment and medication possible

9 months

258

IGSH:

17.8 ± 1.4

TAU:

17.7 ± 1.2

BMI

None provided

Primary outcome

No significant group difference in weight gain after controlling for dosage of adjunctive inpatient treatment as the GSH group received more inpatient treatment as the TAU group

Secondary outcomes

Patients of the GSH had improved scores on some self-report dimensions related to ED cognitions and behaviors

Kaye et al. [25]

20 mg Fluoxetine/day (adjustment possible by a blinded physician)

Placebo

Optional adjunctive outpatient CBT

One year

35

89% average body weight

Prevention of relapse

Dropout from trial due to deteriorating clinical course (e.g. severe weight loss or severe ED symptoms), initiated by the patient, carer or physician

Primary outcome

Significantly more patients receiving placebo had a relapse (dropped out) as compared to those receiving fluoxetine

Secondary outcomes

Patients who completed fluoxetine treatment over one year had higher weight, less ED symptoms, less obsessive thoughts, less depression and anxiety than the remaining group

Neumayr et al. [23]

Smartphone-based guided self-help intervention (SGSH)

TAU

SGSH is additional to TAU

8 weeks

40

SGSH:

19.1 ± 1.9

TAU:

18.6 ± 1.0

BMI self-reported ED symptoms

None provided

Primary outcome

No significant group difference in weight gain or self-reported ED symptoms

Secondary outcomes

High levels of adherence and acceptance of SGSH

Parling et al. [29]

Acceptance and commitment therapy (ACT)

TAU

Optional additional daycare and other treatments; no additional psychotherapy for ACT patients

19 sessions

42

ACT:

17.5 ± 2.3

TAU:

18.1 ± 2.6

Good outcome defined as BMI ≥ 19 and EDE-Q global score ≤ 2.83

None provided

Primary outcome

No significant group difference in good outcome

Secondary outcomes

Significant improvements in BMI and ED symptoms across time in both groups

Pike et al. [30]

Cognitive-behavior therapy (CBT)

Nutritional Counselling (NC)

Adjunctive pharmacotherapy possible

50 sessions over one year

33

Not reported

BMI at admission: CBT:

16.0 ± 2.1

NC:

15.2 ± 1.5

Time to relapse

(a) BMI below 17.5 for more than 10 days

(b) severe ED-related medical complications requiring inpatient care

(c) exacerbation of non-ED psychopathology requiring other care

Primary outcome

Patients in the CBT group had a significant longer relapse-free interval than patients receiving NC

Secondary outcomes

Patients in the CBT group showed a lower relapse rate and were more likely to meet criteria for good outcome

Sternheim et al. [26]

Internet-based guided self-help intervention based on MANTRA (iMANTRA) added to TAU

TAU

iMANTRA is additional to TAU

12 months

41

iMANTRA:

18.1 ± 2.2

TAU:

17.9 ± 1.4

Not defined due to feasibility focus

None provided

iMANTRA feasible and acceptable

Effect sizes for BMI, ED pathology and general psychopathology at 6 months were small and tended to favor iMANTRA at 12 months assessment

Walsh et al. [24]

60 mg Fluoxetine/day (adjustment possible)

Placebo

Adjunctive outpatient CBT with specific focus on relapse prevention

One year

93

Fluoxetine:

20.2 ± 0.5

Placebo:

20.5 ± 0.5

Time to relapse

(a) BMI below 16.5 for 2 consecutive weeks

(b) severe ED-related medical complications

(c) imminent suicide risk

(d) development of other severe psychiatric disorder

Primary outcome

No difference in time to relapse between the fluoxetine and placebo group

Secondary outcomes

No difference in any secondary outcome between the fluoxetine and placebo group

  1. ACT, Acceptance and Commitment Therapy; BMI, Body Mass Index; CBT, Cognitive Behavior Therapy; ED, eating disorder; EDE-Q, Eating Disorder Examination Questionnaire; IGSH, Internet-based Guided Self-help; iMANTRA, internet-based Maudsley Model of Anorexia Nervosa Treatment for Adults; NC, Nutritional Counselling; SGSH, Smartphone-based Guided Self-help; TAU, Treatment as usual