Table 43.
Behaviour therapy based inpatient treatment for children and adolescents with anorexia nervosa
| Certainty assessment | Impact | Certainty | Importance | ||||||
|---|---|---|---|---|---|---|---|---|---|
| № of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | |||
| Change in Weight (assessed with: Pre-post measures of weight), Change in EAT scores, EDI Scores | |||||||||
| 4 | Case Series | very serious a | not serious | not serious | serious b | none | Four Case series utilizing a behaviour therapy approach. Total 198 patients. Various approaches to reporting change in weight. One study reported absolute weight change of 1.89 kg (+/− 1.41) over a mean of 23 days in hospital; one study reported a rise from a mean of 65.9%TGW to 87.4%TGW over 11 weeks. One study reported that patients admitted at > 75%TGW all reached 100%of their TGW by discharge, 91% of those admitted at < 75%TGW not requiring NGT feeds reached their TGW by discharge and only 62% of patients admitted at < 75%TGW and requiring NGT feeds reached 100% of their TGW at discharge. This study also noted that those admitted at > 75%TGW had a mean LOS of 20.8 d, those < 75%TGW at admission had a mean LOS of 18.4d and those < 75%TGW and NGT fed had a mean LOS of 32.7d. The final case series reported weight gain under 2 types of behaviour contracts, varying only with regards to the expected rate of weight gain (ie 0.36 kg/q4d vs 0.55 kg/q4d). Those treated under the contract requiring greater weight restoration gained weight at a faster rate (0.09 kg/d, range 0.04–0.4 kg/d vs 0.17 kg/d, range 0.01–0.64 kg/d), thereby attaining a greater weight gain overall during admission (LOS 28 days). Most case series reported weight gain observed while patients were adhering to a behaviour contract. LOS in these studies ranged from 13 days to 6.25 weeks. In all cases patients gained weight (ranging from 0.17 to 0.63 kg/day. |
⨁◯◯◯ VERY LOW |
CRITICAL |
| very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One study measured EAT scores in 24 patients at admission and discharge (mean LOS 11 weeks) and reported a change from total mean EAT of 37.1 at admission to 12.7 at discharge (p = 0.0001). |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One study of 24 patients, mean LOS 11 weeks. Reported a change in EDI score “Drive for Thinness” score of 8.0 at admission to 1.9 at discharge (p = 0.02). Other subscales and total EDI score not reported. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| Change in Weight, Change in EAT score, change in intake, change in rate of purging | |||||||||
| 11 | Case reports | very serious a | not serious | not serious | serious b | none | Case reports all described patients gaining weight in hospital ranging from 0.45 kg/wk. to 4.0 kg/wk. Two case reports did not note the LOS andstated that the patients gained 10 kg total and change in BMI from 13.5 to 16.5 during their admissions. |
⨁◯◯◯ VERY LOW |
CRITICAL |
| very serious a | not serious | not serious | serious c | all plausible residual confounding would reduce the demonstrated effect | One case report describing that EAT scores remained high for the first 7 weeks of treatment and weight restoration (4.5 kg over first 7 weeks) and then dropped (from total score of 60 to 10) over the last 3 weeks of 10 week admission. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| very serious a | not serious | not serious | not serious | strong association | Two case reports describing change in intake measured by kcal/day from admission to discharge. Only one study reported LOS of 39 days. Kcal/day increased from 1600 kcal/d at admission to 3900 kcal/d at discharge in this study. The other study did not report on LOS, but stated that intake increased from 850 kcal/d at admission to 1700 kcal/d at discharge. |
⨁◯◯◯ VERY LOW |
CRITICAL | ||
| very serious a | not serious | not serious | not serious | none | 1 case report describing a decrease in purging after meals from 48% of meals/week to 0% of meals per week. LOS not noted. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
Explanations
aObservational studies with no comparison group or control
bWide confidence intervals in some studies, overlapping with any true effect
cConfidence intervals not noted
Bibliography:
Case series - Collins 1983 [222], Solanto 1994 [227], Steinhausen 1985 [224], Nygaard 1990 [226]
Case reports - Alessi 1989 [225], Blanchet-Collet 2016 [228], Blinder 1970 [215], Boey 1985 [223], Cinciripini 1983 [221], Clark 1981 [220], Garfinkel 1973 [216], Halmi 1975 [217], Leitenberg 1968 [214], Pertschuk 1978 [218], Poole 1978 [219]