Crisp 1991.
Methods | RCT | |
Participants | Country: UK
Diagnostic tool: DSM‐IIIR
No. screened: No detail
No. randomised: 90: Inpatient (includes FT): 30; Outpatient (includes FT): 20; Outpatient group: 20; Assessment only: 20
No. started trial: 73: Inpatient (includes FT): 18; Outpatient (includes FT): 18; Outpatient group: 17 (1 died); Assessment only: 20
No dropped out during intervention: (not fully reported): Outpatient (includes FT): 3 (attended 5 sessions or fewer); Assessment only: 14 dropped out in the sense that they sought treatment elsewhere
No. analysed: 90 (LOCF): Inpatient (includes FT): 30; Outpatient (includes FT): 20; Outpatient group: 20; Assessment only: 20
Mean age in years (SD): Total: 22: Inpatient (includes FT): 23.2 (4.9); Outpatient (includes FT): 21.2 (5.1); Outpatient group: 19.7 (2.6); Assessment only: 21.9 (4.5)
Age range in years: Total: 20 ‐ 23 (not given by group) Note ‐ the review authors note that this age range is inconsistent with the mean ages provided per treatment group (i.e. outpatient group mean is stated as 19.7).
Gender: All female participants
Subtype: No detail
Age of onset in years (SD): Inpatient (includes FT): 19.8 (4.7); Outpatient (includes FT): 18.4 (3.9); Outpatient group: 17.4 (3.9); Assessment only: 17.4 (3.2)
Duration of illness in months (SD): Total: 39; range 4 ‐ 107 months; Inpatient (includes FT): 41.0 (30.17); Outpatient (includes FT): 33.4 (25.9); Outpatient group: 27.5 (25.8); Assessment only: 53.5 (52.9)
Baseline weight in kgs: Inpatient (includes FT): 40.8 (6.1); Outpatient (includes FT): 40.3 (3.8); Outpatient group: 40.2 (6.0); Assessment only: 41.0 (6.1)
Baseline deviation below MMPW % (SD): Inpatient (includes FT): 28.0 (9.4); Outpatient (includes FT): 26.5 (6.9); Outpatient group: 26.2 (8.7); Assessment only: 25.0 (8.5)
Baseline BMI: Inpatient (includes FT): 15.3; Outpatient (includes FT): 15.5; Outpatient group: 15.5; Assessment only: 15.7
Baseline eating disorder scale score (MRS): Inpatient (includes FT): 3.5 (0.2); Outpatient (includes FT): 3.9 (0.3); Outpatient group: 3.8 (0.4); Assessment only: 3.5 (0.3)
Baseline purging ("usually vomiting"): Inpatient (includes FT): 5; Outpatient (includes FT): 5; Outpatient group: 5; Assessment only: 7
Baseline Purging ("usually bulimic"): Inpatient (includes FT): 3; Outpatient (includes FT): 2; Outpatient group: 5; Assessment only: 3
Comorbidity: No details
Details on living arrangements: No details
Family education/employment/income: No details
Recruitment strategy: Not stated other than “successive referrals” to treatment centre Exclusion criteria:
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Interventions | Setting of care: Inpatient and outpatient
Training/qualification of care provider(s): Paper states ‘trained and experienced’ no other details
Treatment manual: No detail
Supervision of treatment: No detail
Adherence to treatment: No detail Intervention group 1 Description: Outpatient individual therapy and family therapy 12 outpatient sessions including individual work which nearly always but to a variable extent included some family work (more with the younger participants). Family work emphasised establishment of boundaries, and addressing issues such as enmeshment, conflict avoidance (e.g. non‐communication) and attempted solving of family problems. Dietary counselling also included. Length: Several months Intervention group 2 Description: Outpatient group therapy for participants and outpatient group therapy for parents 10 outpatient psychotherapy group meetings for the individual and 10 group meetings for parents separately. Issues addressed included conflict avoidance, sense of self, family relationships, identification of moods, meaning of weight and shape, management of impulse, communication and relationship skills, with parents additionally addressing support of each other in managing shared problems and difficulties over autonomy as well as parental discord and lifestyle issues. Dietary counselling also included Length: 10 sessions Intervention group 3 Description: Inpatient treatment Inpatient stay of several months including weight restoration with weekly individual therapy, family therapy, group therapy, dietary counselling and occupational therapy using psychodrama and projective art techniques. Followed by 12 sessions of outpatient treatment involving both the participant and the family Length: Several months of inpatient plus outpatient treatment over several months Intervention group 4 Description: 'One off' ‐ no further treatment Referred back to their family doctor or local consultant who received a detailed report of the assessment with advice on further management. “of those in option 4, 6 had no treatment of any kind, six had inpatient treatment, 5 had outpatient hospital treatment and 3 had very regular contact with GP. 6 patients spent almost the entire year in treatment” (pg. 329 Crisp 1991) Length: 'one off' |
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Outcomes |
Eating psychopathology
Morgan Russell Assessment Schedule (Morgan 1988) Behavioural indices Well: weight within 15% MMPW; regular menstruation; normal eating Almost well: weight risen to above 85% of MMPW , menstruation returned (but not necessarily regular); aspects of abnormal eating may remain Significantly better: Weight risen to within 85% or still less but risen by 10%, and/or menstruation absent or sporadic; aspects of abnormal eating may remain No change: Weight less than 85% MMPW and/or increased by < 10% and/or menstruation absent or sporadic; abnormal eating Worse: weight loss has occurred or score lower on the Morgan Russell score; amenorrhoea still present |
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Notes | Included in family therapy vs standard care/treatment as usual Family therapy categorised as other Also included in family therapy vs individual psychological intervention Family therapy categorised as other Funded by: Marks and Spencer plc, St George’s Hospital Special Trustees and Worshipful Company of Grocers | |
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Unclear risk | No detail : Methods paper pg. 446 “ treatment option drawn by random allocation” with no other statement |
Allocation concealment (selection bias) | Unclear risk | No detail |
Blinding of participants and personnel (performance bias) All outcomes | High risk | Therapists and participants cannot be blinded in trials of family‐based therapy |
Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | At 12 months "patients were seen by one of the team uninvolved in the treatment programs and as far as possibly unaware of the treatment allocation" but the methods paper (Gowers) states it was "not possible for the interviewer to be blind to the treatment given" pg. 453 |
Incomplete outcome data (attrition bias) All outcomes | Low risk | All participants were followed up regardless of compliance with treatment. Analysis included all 90 participants who were randomised |
Selective reporting (reporting bias) | High risk |
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Other bias | High risk |
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