Robin 1999.

Methods	RCT
Participants	Country: USA Diagnostic tool:DSM‐IIIR No. screened: “approximately 120 telephone enquiries and scheduled 60 for intake interviews” No. randomised: “41 agreed to participate and 4 dropped out, leaving 37 participants”. Does not say when participants dropped out. BFST: 19, EOIT: 18 No. started trial: No detail No. dropped out during intervention: “41 agreed to participate and 4 dropped out, leaving 37 participants”. Does not say when pp dropped out. 7 dropped out ‐ different numbers for different outcomes No. dropped out during follow‐up: “41 agreed to participate and 4 dropped out, leaving 37 participants”. Does not say when pp dropped out No. analysed: Total: 37 (LOCF) BFST: Different N’s for each measure, EOIT: Different N’s for each measure Mean age in years (SD): BFST: 14.9; EOIT: 13.4 Age range in years: Total: 11 ‐ 20 Gender %: Total: 0 male, 37 female; BFST: 0 male, 19 Female; EOIT: 0 male, 18 Female Subtype: No detail Age of onset: No detail Duration of illness: Total: < 12 months Baseline weight: Total: BFST: 86.5 pounds (39.3 kg); EOIT: 86.8 pounds (39.5 kg) Baseline BMI: Total: BFST: 15.0 (1.4), EOIT: 16.3 (2.8) Baseline eating disorder scale score (EAT): BFST: n = 19 32.6 (SD 15.6); EOIT: n = 16 20.6 (SD 15.6) Baseline purging: BFST: 0; EOIT: 0 Comorbidity: Total: 54% mood disorder, 13% anxiety disorder; BFST: BDI score 19.4 (12.3); EOIT: BDI score 11.3 (10.5) Details on living arrangements: Total: All residing at home with 1 or both parents (34 in 2‐parent homes; 3 in single‐mother households) Family education/employment/income (Socioeconomic Status (Hollingshead Four Factor Scale):, BFST: 47.5 (13.6); EOIT: 47.9 (12.0) Recruitment strategy: Investigator’s practice settings, letters sent to physicians, psychologists, clergy, community agencies and schools, public service announcements/media stories, presentations to schools and clinics by the investigators Exclusion criteria: No detail
Interventions	Setting of care: Outpatient treatment provided. Some participants hospitalised with treatment provided as inpatients (11 in the family group and 5 in the individual group) Training/qualification of care provider(s): Yes: 4 doctoral psychologists, 1 masters social worker Treatment manual: Yes Supervision of treatment: No details Adherence to treatment: Yes: All audiotaped and 40 sessions sampled with checklist Intervention group 1 Description: Behavioral family systems Description in the report similar to family‐based therapy including all 3 phases Length: Average 15.9 months Intervention group 2 Description: Ego‐oriented individual therapy Aimed to build ego strength, autonomy and insight. Parents also met with therapists bimonthly Length: Average 15.9 months
Outcomes	Eating psychopathology EAT (Garner 1979) The body shape questionnaire and the dissatisfaction scale of EDI (Garner 1983) Behavioural indices BMI Percentage who reached/exceeded target weight Menstruation General psychopathology BDI (Beck 1961) Child Behaviour Checklists Internalising Behaviour Problems Score (Achenbach 1991) Global pathology and interpersonal functioning Ego functioning ‐ the ineffectiveness interpersonal distrust and interoceptive awareness scale (Garner 1983). Family functioning General and Eating‐Related Conflict (Robin 1990) Observed family conflict ‐ Interaction Behaviour Code for videotaped interactions (Robin 1989)
Notes	Included in family therapy vs individual psychological intervention Family therapy categorised as family‐based therapy Funded by: National Institute of Mental Health Grant
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Correspondence from author stated "coin tossing" was used
Allocation concealment (selection bias)	Unclear risk	Correspondence from author suggested concealment was not possible, but this was followed by a description of blinding
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	High risk	Correspondence from author stated that this was not possible except for those coding the family interactions.
Incomplete outcome data (attrition bias) All outcomes	High risk	From the text of the paper, data for dropouts not reported or analysed. There appear to be 7 dropouts from the tables but it is unclear from the description of numbers and reasons in the text Correspondence from the author suggested 1 out of 20 dropped out from the family therapy group during intervention and 4 out of 21 dropped out from the individual psychotherapy group. Dropouts by follow‐up reported as 5 out of 20 for the family therapy group and 6 out of 21 from the individual psychotherapy group ITT data not provided nor analysed in paper.
Selective reporting (reporting bias)	High risk	Measures taken and reported in earlier papers (1995; BSQ and EDI BD) not reported in later paper. Family conflict not reported in 1999 paper. 1994 paper mentions body shape questionnaire, EDI and EAT however not reported in the 1999 paper. Authors do report on every measure described in the Methods section in the 1999 paper Report on within‐group changes for many outcomes Authors report that they collected data on dropouts, but the data are not reported in a format that is useable for analysis
Other bias	High risk	(1999 paper) Imbalance at the start of treatment: 11 participants from BFST and 5 participants from EOIT were hospitalised for refeeding. Duration of stay not specified by group, or for all participants Uneven treatment duration ‐ not standardised and not reported for all groups Uneven/inconsistent Ns for most measures with no explanation of why Ns vary across measures Baseline imbalances: mean age in EOIT Group significantly younger; difference in EAT scores and BDI scores with the BFST group in the clinical range on the BDI and the EOIT group not in the clinical range No reporting of between‐group differences Randomised before final assessment for inclusion