Table 3.
Summary of findings and confidence in effect estimates for the treatment studies.
| Outcome | k | N | Effect size (95% CI) | Heterogeneity (% I2) | Confidence in effect estimates (GRADE) |
|---|---|---|---|---|---|
| CBT-based e-therapy for the treatment of bulimia nervosa versus waitlist control | |||||
| Binge eating | |||||
| End of intervention | 2 | 146 | SMD −0.44 (−0.77 to −0.11)* | 0 | Lowa, c, d |
| Follow-up | 1 | 76 | SMD −0.57 (−1.03 to −0.11)* | NA | Lowa, c, d |
| Vomiting and/or laxative misuse | |||||
| End of intervention | 2 | 146 | SMD −0.43 (−0.75 to −0.10)* | 0 | Lowa, c, d |
| Follow-up | 1 | 76 | SMD −0.56 (−1.02 to −0.10)* | NA | Lowa, c, d |
| Global eating disorder psychopathology | |||||
| End of intervention | 3 | 220 | SMD −0.54 (−1.28 to 0.20) | 86 | Very lowa, b, c, d |
| Follow-up | 1 | 76 | SMD −0.94 (−1.42 to −0.47)* | NA | Lowb, d |
| Weight concern | |||||
| End of intervention | 2 | 151 | SMD −0.37 (−1.36 to 0.63) | 89 | Very lowa, b, c, d |
| Follow-up | 1 | 76 | SMD −0.57 (−1.03 to −0.12)* | NA | Lowb, d |
| Shape concern | |||||
| End of intervention | 2 | 150 | SMD −0.67 (−1.67 to 0.33) | 89 | Very lowa, b, c, d |
| Follow-up | 1 | 76 | SMD −1.02 (−1.50 to −0.54)* | NA | Lowb, d |
| Dietary restraint | |||||
| End of intervention | 2 | 151 | SMD −0.46 (−1.28 to 0.35) | 84 | Very lowa, b, c, d |
| Follow-up | 1 | 76 | SMD −0.64 (−1.10 to −0.17)* | NA | Lowb, d |
| Remission from BN/EDNOS diagnosis | |||||
| End of intervention | 2 | 150 | RR 2.82 (0.54 to 14.85) | 62 | Lowb, d |
| Cessation of binge eating, vomiting and/or laxative misuse | |||||
| End of intervention | 3 | 218 | RR 1.94 (1.07 to 3.52)* | 0 | Lowb, d |
| CBT-based e-therapy for the treatment of bulimia nervosa versus bibliotherapy | |||||
| Binge eating | |||||
| End of intervention | 1 | 122 | SMD −0.03 (−0.39 to 0.33) | NA | Lowa, d |
| Follow-up | 1 | 122 | SMD −0.13 (−0.49 to 0.23) | NA | Lowa, d |
| Vomiting | |||||
| End of intervention | 1 | 122 | SMD 0.14 (−0.22 to 0.50) | NA | Lowa, d |
| Follow-up | 1 | 122 | SMD −0.04 (−0.40 to 0.32) | NA | Lowa, d |
| Laxative misuse | |||||
| End of intervention | 1 | 122 | SMD 0.16 (−0.20 to 0.52) | NA | Lowa, d |
| Follow-up | 1 | 122 | SMD 0.18 (−0.18 to 0.54) | NA | Lowa, d |
| Excessive exercise | |||||
| End of intervention | 1 | 122 | SMD 0.08 (−0.28 to 0.44) | NA | Lowa, d |
| Follow-up | 1 | 122 | SMD −0.01 (−0.37 to 0.35) | NA | Lowa, d |
| Global eating disorder psychopathology | |||||
| End of intervention | 2 | 193 | SMD −0.21 (−0.50 to 0.07) | 0 | Lowa, d |
| Follow-up | 2 | 193 | SMD 0.01 (−0.27 to 0.30) | 0 | Lowa, d |
| Dietary restraint | |||||
| End of intervention | 1 | 122 | SMD 0.12 (−0.24 to 0.48) | NA | Lowa, d |
| Follow-up | 1 | 122 | SMD −0.27 (−0.63 to 0.09) | NA | Lowa, d |
| Drive for thinness | |||||
| End of intervention | 1 | 123 | SMD −0.07 (−0.42 to 0.29) | NA | Lowa, d |
| Follow-up | 1 | 123 | SMD 0.02 (−0.34 to 0.38) | NA | Lowa, d |
| Bulimia | |||||
| End of intervention | 1 | 123 | SMD −0.14 (−0.50 to 0.22) | NA | Lowa, d |
| Follow-up | 1 | 123 | SMD −0.12 (−0.48 to 0.23) | NA | Lowa, d |
| Cessation of binge eating and other inappropriate weight control behaviours | |||||
| End of intervention | 2 | 150 | RR 1.60 (0.62 to 4.15) | 54 | Lowa, d |
| Follow-up | 2 | 146 | RR 0.91 (0.47 to 1.75) | 33 | Lowa, d |
| Remission from BN diagnosis | |||||
| End of intervention | 1 | 80 | RR 0.94 (0.47 to 1.87) | NA | Lowa, d |
| Follow-up | 1 | 76 | RR 1.11 (0.64 to 1.95) | NA | Lowa, d |
| CBT-based e-therapy for the treatment of binge eating disorder versus waitlist control | |||||
| Binge eating | |||||
| End of intervention | 2 | 158 | SMD −0.23 (−0.71 to 0.25) | 40 | Lowa, c, d |
| Follow-up | 1 | 74 | SMD 0.04 (−0.41 to 0.50) | NA | Lowa, c, d |
| Global eating disorder psychopathology | |||||
| End of intervention | 1 | 74 | SMD −0.38 (−0.84 to 0.08) | NA | Lowa, c, d |
| Follow-up | 1 | 74 | SMD −0.30 (−0.76 to 0.16) | NA | Lowa, c, d |
| Shape concern | |||||
| End of intervention | 1 | 74 | SMD −0.30 (−0.76 to 0.15) | NA | Lowa, c, d |
| Follow-up | 1 | 74 | SMD −0.23 (−0.69 to 0.23) | NA | Lowa, c, d |
| Dietary restraint | |||||
| End of intervention | 1 | 74 | SMD −0.07 (−0.53 to 0.38) | NA | Lowa, c, d |
| Follow-up | 1 | 74 | SMD 0.08 (−0.37 to 0.54) | NA | Lowa, c, d |
| Drive for thinness | |||||
| End of intervention | 1 | 74 | SMD −0.38 (−0.84 to 0.08) | NA | Lowa, c, d |
| Follow-up | 1 | 74 | SMD −0.44 (−0.90 to 0.02) | NA | Lowa, c, d |
| Bulimia | |||||
| End of intervention | 1 | 74 | SMD −0.85 (−1.33 to −0.37)* | NA | Lowa, c, d |
| Follow-up | 1 | 74 | SMD −0.32 (−0.78 to 0.14) | NA | Lowa, c, d |
| Cessation of binge eating | |||||
| End of intervention | 2 | 109 | RR 4.58 (1.54 to 13.60)* | 0 | Lowa, c, d |
| CBT-based e-therapy for the treatment of binge eating disorder versus face-to-face group CBT | |||||
| Binge eating | |||||
| End of intervention | 1 | 44 | SMD 0.41 (−0.19 to 1.01) | NA | Lowa, d |
| Cessation of binge eating | |||||
| End of intervention | 1 | 28 | RR 0.87 (0.14 to 5.32) | NA | Lowa, d |
| Follow-up | 1 | 17 | RR 1.13 (0.08 to 15.19) | NA | Lowa, d |
Note.
BN = bulimia nervosa; BED = binge eating disorder; EDNOS = eating disorder not otherwise specified; k = number of studies; N = number of participants; NA = not applicable; SMD = standardised mean difference; RR = risk ratio; CI = confidence interval.
*p < 0.05.
Reasons for downgrading, based on the GRADE approach:
a
Risk of bias (one or more of the following: selection bias, performance bias, detection bias, attrition bias, selective outcome reporting bias).
b
Inconsistency (I2 > 50%, p < 0.05).
c
Indirectness (comparison: waitlist control).
d
Imprecision (optimal information size for dichotomous outcomes = 300 events, and for continuous outcomes = 400 participants).