Table 56 Family-based day treatment for children and adolescents with anorexia nervosa and low-weight 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 Weight (assessed with: Pre-post change in weight outcomes), Change in EDE-Q scores, change in symptoms | |||||||||
9 | Case Control and Case Series | very serious a | serious b | not serious | serious c | strong association all plausible residual confounding would reduce the demonstrated effect | Nine studies for a total of 427 patients. Studies varied with regards to degree/method of including parents in treatment, # of hours/week of programming and LOS. Criteria/reasons for admission to the DTP program varied, studies which reported referral source/reasons described that patients could be referred from either initially assessment, inpatient or outpatient based on the severity of their symptoms. Five studies reported on change in BMI which rose from 17.5 (SD 0.4) to 19.5 (SD 0.4), 16.4 to 19.6, 16.3 (+/−1.6) to 17.3 (+/− 1.3), 17.01 (range 12.3–22.1) to 20.05 (range 14.8–25.1), and 16.2 (+/− 1.98) to 19.4 (+/−2.87). Three studies reported on total weight gained in program (8.6 kg +/− 4.5 kg; 5.0 kg +/− 2.5; 7.3 kg +/− 3.1 and 17.58 kg). Two studies reported on change in %TGW which rose from 82.56 to 93.00% in one study and 82.3 to 97.99%. LOS in these studies varied from 27.6 (SD 12.13) days to 1.3 (SD 0.2) years. One study reported on difference in weight outcomes between their Maudsley and non-Maudsley DTP, noting no difference between these 2 groups. One other study reported on differences between patients who received “formal psychotherapy” (individual and/or family) outside of program thereby needing to leave program for approx 2 h/week and noted that patients who received psychotherapy within the first 2 months of entering DTP gained significantly less weight (ie 5.0 +/− 2.5 kg vs 7.3 +/− 3.1 kg). One study examined predictors of weight restoration in DTP and reported that Higher BMI at admission (range 12.3–22.1), greater gain in %TGW in first 4 weeks (range − 0.18 to 25.27% TGW) and lower caregiver empowerment at baseline were predictive of weight restoration at end of intensive treatment (ie DTP + IOP). | ⨁◯◯◯ VERY LOW | CRITICAL |
very serious d | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | Five studies receiving a family-based DTP treatment. LOS was 37.05 days, 28.41 days (SD 13.55) over 11.7 weeks (patients did not attend every day as they were transitioning back to school), 27.6 days (SD 12.13) and 11.56 days (SD 6.61), and one was a 3 month follow up. Weight at onset in 4 studies were similar although reported in different ways (ie 80.94%TGW in first study, BMI 16.3/79.9% in the second study, 82.56% in third study and BMI 16.4 in forth study). EDE scores, global and all subscales decreased significantly in all studies, although confidence intervals overlapped with size of effect. In the study reporting on a control group which was treated in the same program, but without the inclusion of Maudsley/family interventions, the EDE-Q scores decreased more in the Maudsley group than the non-Maudsley as the Maudsley group started with higher EDE-Q scores and at the end of the treatment period their scores were similar to the non-Maudsley. Of note the scores for Wt Concern and Restraint Concerns did not change significantly in the non-Maudsley group whereas they decreased significantly in the Maudsley group. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious e | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study consisted of 32 patients. LOS not reported in study. Body image disturbance disappeared completely in 59%, decreased partially in 28% and remained unchangedin 13%. Prolonged duration of meals improved during treatment and “normalized” in 87.5% by end of treatment. Eighty-seven percent stopped ritualistic exercise habits by end of treatment. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One study including 60 patients, LOS median stay 8 months (SD 2.27). Statistically significant change was reported in EDI-3 Drive for Thinness (53.40 +/− 35 to 30.68 +/− 31.70) and Dissatisfaction (50.88 +/− 27.60 to 31.62 +/− 29.80), p < 0.001. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||
very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One study including 60 patients, LOS median stay 8 months (SD 2.27). Statistically significant change was reported in EAT-26. Mean EAT-26 score was 26.70 (+/− 17.7) at admission and 7.97 (+/− 11.5) at discharge, p < 0.001. | ⨁◯◯◯ VERY LOW | IMPORTANT | ||