Table 51.
Cognitive remediation therapy during inpatient treatment be used for the treatment of 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 CRT Measures of Weight), change in EBRS, change in EDE-Q | |||||||||
| 3 |
Case/control Case Series |
very serious a | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | Three studies reported on addition of CRT to multimodal inpatient treatment. One study described change in weight between patients who received 10 sessions of CRT over 10 weeks vs those who received TAU in a quasi-experimental design (n = 24 in each group). Both groups gained weight at a similar rate (change from mean BMI% of 2.2 to 5.7 over 10 weeks in CRT group vs mean BMI% 5.5 to 7.6 over 10 weeks in TAU group). The other studies reported on patients (total 79 patients) who received either 4 or 10 sessions of CRT provided as once weekly sessions. In all 3 studies patients gained weight. Given the design of these studies it is not possible to determine whether CRT had an impact on weight above and beyond what would have been expected by inpatient treatment alone. |
⨁◯◯◯ VERY LOW |
CRITICAL |
| very serious b | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study included description of 2 patients who received 10 sessions of CRT over 10 weeks in addition to multimodal inpatient treatment. EBRS scores decreased slight for both patients from 26 to 22 and 29 to 26 at end of 10 weeks. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| very serious a | not serious | not serious | serious d | all plausible residual confounding would reduce the demonstrated effect | One study, including 125 hospitalized patients. Received either group (n = 55) or individual (n = 70) CRT. Only those patients receiving individual CRT completed the EDE-Q. pre-post. Patients receiving individual CRT did not experience a change in their EDE-Q global score over the course of the 10 weeks where they received CRT. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| very serious a | not serious | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study, comprising 70 hospitalized patients who received multimodal inpatient treatment along with 10 individual sessions of CRT over 10 weeks. Patients completed the MSCARED before and after the course of CRT. There was a statistically significant shift in motivation noted (p < 0.001), where at initiation of CRT % of patients in each stages of change category were as follows: pre-contemplation 18.6%, contemplation 38.6%, preparation 28.6%, action 11.4%, maintenance 2.9%. At the end of CRT % of patients in each stage of change were: pre-contemplation 0%, contemplation 4.3%, preparation 31.4%, action 42.9%, maintenance 21.4%, Due to the design of this study it is not possible to differentiate the effect of inpatient treatment alone from inpatient treatment + CRT. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| very serious b | serious c | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study included description of 2 patients who received 10 sessions of CRT over 10 weeks in addition to multimodal inpatient treatment. Scores on EAT decreased for one patient (30 to 16) and increased in the other patient (35 to 36). |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
| Weight, EAT-26 | |||||||||
| 2 | Case reports | very serious b | serious c | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | One study involved 7 adolescentsinpatients with AN using group CRT. Weight improved as did motivation. |
⨁◯◯◯ VERY LOW |
IMPORTANT |
| very serious b | serious c | not serious | not serious | all plausible residual confounding would reduce the demonstrated effect | Another study is a single case report describing improvement on the EAT-26 after 10 sessions of CRT with an inpatient with AN. |
⨁◯◯◯ VERY LOW |
IMPORTANT | ||
Explanations
aNot all studies had comparison group and were receiving inpatient treatment which could account for some of the differences observed/reported
bCase report design, no comparison/control
cDiffering results between the 2 reports likely secondary to individual differences
dWide confidence intervals, overlapping with with the size of the effect noted
Bibliography:
Case control - Herbrich 2017 [244], Harrison 2018 [246]
Case series – Asch 2014 [243]