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. 2019 May 1;2019(5):CD004780. doi: 10.1002/14651858.CD004780.pub4

Geist 2000.

Methods RCT
Participants Country: Canada
 Diagnostic tool: DSM‐IV; but current weight < 90% IBW and self‐imposed food restriction
 No. screened: 120
 No. randomised: Total: 25; Family therapy: 12; Family Group Psychoeducation: 13
 No. started trial: No detail
 No. dropped out during intervention: No detail
 No. dropped out during follow‐up: No detail
 No. analysed (unclear if Observed Case or LOCF): Total: 25; Family therapy: 12; Family group psychoeducation: 13
 Mean age in years (SD): Family therapy: 14.3 (1.5); Family group psychoeducation: 14.9 (1.7)
 Age range: Total: 12 ‐ 17.3
 Gender %: Total: 0% male: 100% female
 Subtype: No detail
 Age of onset: No detail
 Duration of illness: No detail
 Baseline weight in kgs (SD): Family therapy: 41.1 (7.0); Family group psychoeducation: 41.1 (6.3)
 Baseline BMI: No detail
 Baseline eating disorder scale score (EDI drive for thinness): Family therapy: 11.1 (5.8); Family group psychoeducation: 13.7 (6.2)
 Baseline eating disorder scale score (EDI body dissatisfaction): Family therapy: 9.1 (6.6); Family group psychoeducation: 11.0 (5.0)
 Baseline eating disorder scale score (EDI bulimia): Family therapy: 1.2 (1.3); Family group psychoeducation: 1.9 (1.6)
 Baseline purging: No detail
 Comorbidity: No detail
 Details on living arrangements: No detail
 Family education/employment/income: No detail
 Recruitment strategy: “Assessed and admitted to the inpatient program”
Exclusion criteria:

  1. < 12 years

  2. > 17.4 years

  3. Males

  4. Chronic medical illness

  5. Considered an immediate suicide risk

  6. Presented with psychotic features

  7. Were unavailable over the study period

  8. Were receiving individual or family therapy in the community

  9. Could not communicate in English

  10. States that 6 were excluded due to having had a previous admission so appears to be a population of first hospital admission

  11. Abstract states “newly diagnosed”
Interventions Setting of care: Initially inpatients at screening ‐ once medically stable and met their weight goals ‐ discharged to outpatient clinic for remainder of therapy
 Training/qualification of care provider(s): Family therapy: 2 social workers, 1 psychiatrist ‐ with 4 to 10 years experience with family therapy and AN; Family Group Psychoeducation: 2 dieticians, occupational therapist and psychiatric nurse ‐ with 2 to 6 years experience working with adolescent with eating disorders
 Treatment manual: No detail
 Supervision of treatment: No detail
 Adherence to treatment: No detail
 
 Intervention group 1
 Description: Family therapy
 In the context of standard medical and psychosocial intervention, the main objective of family work was to facilitate the young person with AN to take an active role in the management of the disorder, support weight restoration and normalisation of eating behaviour through direct and open communication within the family. Attempts were made to distinguish the eating disorder symptoms from normal adolescent behaviour and expected parent‐adolescent conflict with efforts made to support the development of adolescent autonomy and maturation with an accommodating family
 Length: 4 months
Intervention group 2
 Description: Family psychoeducation
 Education to support attitudinal and behaviour change for both the family and young person with AN
 Length: 4 months
Outcomes Eating psychopathology
 EDI‐2 (Garner 1991)
 DICA (Welner 1987)
 Behavioural indices
 BMI
 Menstruation
 General Psychopathology
 Depression CDI (Kovacs 1992)
 SCL‐90‐R (Derogatis 1992)
 Family Functioning
Family functioning (Skinner 1991)
Notes Included in family therapy vs educational intervention
 Family therapy categorised as other
 Funded by: Physician Services Inc, grant # NIF94‐606
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk No detail
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 No detail
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Quote: “not all parents completed the general or dyadic measures of the FAM‐II” ‐ results not analysed; no other statement as to why the data were missing. Unclear if ITT analysis undertaken
Selective reporting (reporting bias) Low risk Nothing noted
Other bias Unclear risk Small trial