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

Hall 1987.

Methods RCT
Participants Country: United Kingdom
 Diagnostic tool: ‘primary anorexia nervosa’; criteria not stated
 No. screened: No detail
 No. randomised: Individual and family: 15; Dietetic advice: 15
 No. started trial: Individual and family, Dietetic advice: no detail
 No. dropped out during intervention: Individual and family: 1; Dietetic advice: 4
 No. dropped out during follow‐up: Individual and family: 0; Dietetic advice: 0
 No. analysed (LOCF): Individual and family: 15; Dietetic advice: 15
 Number analysed (OC): Individual and family: 15; Dietetic advice: 15
 Mean age in years (SD): Individual and family: 19.55; Dietetic advice:19.57
 Age range in years: Total: 13 ‐ 27; Individual and family: 14 ‐ 25; Dietetic advice: 13 ‐ 27
 Gender %: All female
 Subtype: No detail
 Age of onset in years: Individual and family: 17.07 (range 12 ‐ 21); Dietetic advice: 17.53 (range 12 ‐ 25)
 Duration of illness: Total : 6 to 72 months; Individual and family: 29.7 months  (10 had received previous treatment), Dietetic advice: 24.5 months (8 had received previous treatment)
 Baseline weight in kgs: Total : < 85% of MMPW with amenorrhoea; Individual and family: 41.00 (mean 25.35% below ABW); Dietetic advice: 39.54 (mean 28.16% below ABW)
 Baseline BMI: Individual and family: 15.7; Dietetic advice: 15.00
 Baseline eating disorder scale score: Individual and family: mean desired body weight 42.7 kg; Dietetic advice: mean desired body weight 44.2 kg
 Baseline purging: No detail
 Comorbidity: No detail
 Details on living arrangements: No detail
 Family education/employment/income:Total : social classes I ‐ III
 Recruitment strategy: Consecutive referrals to 1 of the study authors; mostly referred by general practitioner
 
 Exclusion criteria: No detail
Interventions Setting of care: Outpatient
 Training/qualification of care provider(s): Unclear: “therapists was trained and experienced in these therapeutic approaches” p. 186, no other statement
 Treatment manual: No: “proportions of individual psychodynamic therapy and family therapy depended on clinical judgment” pg. 186
 Supervision of treatment: No detail
 Adherence to treatment: No detail
 
 Intervention group 1Description: Combined individual and family psychotherapy
 Focus on the role of AN in relationship of the participant with her family and others with efforts made to change those aspects of relationship that stifled participant's development and maintained AN, especially over‐protectedness, conflict avoidance enmeshment and distancing within the family. Broad goals to encourage participant development both within and separately from the family and to promote insight
 Length: 12 sessions
 
 Intervention group 2Description: Dietary advice
 Length: 12 sessions
Outcomes Eating psychopathology
 CCEI (Crown 1979)
 Morgan Russell Assessment Schedule (Morgan 1988)
 Global score calculated from the mean of these
 
 Behavioural indices
 Scores for body weight and menstrual function calculated from CCEI
Notes Included in family therapy vs educational intervention
 Family therapy categorised as other
 Funded by: No detail
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 Low risk Quote: “one year after the assessment interview, all the subjects were interviewed by an assessor who was blind to the treatment allocated” pg. 186
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Numbers of dropouts described. No details on why participants did not complete treatment. ITT analysis undertaken
Selective reporting (reporting bias) High risk Authors report that they collected data on eating disorder psychopathology, but the data are not reported in a format that is useable for analysis. No reporting on eating behaviour outcomes i.e. restricting, purging behaviours
No useable data
Other bias High risk
  1. Family therapy group also includes some individual psychodynamic psychotherapy but no psychodynamic therapy‐alone arm so impossible to draw conclusions about which part of this intervention was the active component

  2. A lot of additional treatment received after end of treatment, particularly in the dietary advice group

  3. Within‐group analysis

  4. Baseline imbalance ‐ slightly longer duration of untreated illness in the treatment group