Table 54.

Multimodal day treatment be used in 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
Weight Gain From Admission to Discharge (assessed with: BMI/%TGW/Wt), EDI-3, EAT-26, Motivation, successful completion (%)
2	Case Series	very serious a	serious b	not serious	serious c	all plausible residual confounding would reduce the demonstrated effect	Admission to DTP could occur from inpatient setting or outpatient setting based on clinical judgment of need for this level of care. Weight related outcomes reported in various ways. One study reported admission and discharge BMI with a change from 16.5 (SD 1.5) to 17.1 (SD 1.9). Two studies reported %TGW at admission and discharge. One reported an increase in weight from 81.6 to 84.2%TGW. The other study reported weight change separately for patients above and below 85%TGW at admission. For those < 85%TGW at admission, TGW rose from 81.5 to 88.3%, in those > 85%TGW at admission %TGW rose from 88.0 to 92.2%.. Mean LOS varied between 70 to 92 days.	⨁◯◯◯ VERY LOW	CRITICAL
		very serious a	not serious	not serious	serious c	all plausible residual confounding would reduce the demonstrated effect	One study - 26 patients in study, remained in DTP for mean LOS of 10 weeks. Eighty-five % of patients were referred to DTP from outpatient setting, remainder from inpatient program. Only criterion from admission to DTP vs inpatient was medical stability. EDI-3 scores for Drive for Thinness and Perfectionism improved significantly with Drive for Thinness changing from 13.81 (SD 9.08) to 10.08 (SD 8.32) and Perfectionism changing from 8.96 (6.79) to 8.19 (SD 6.87), signifying a small effect size (0.43 and 0.11 respectively). Body dissatisfaction and maturity fears did not change significantly during course of DTP.	⨁◯◯◯ VERY LOW	IMPORTANT
		very serious	not serious	not serious	serious c	all plausible residual confounding would reduce the demonstrated effect	One study - 26 patients in study, remained in DTP for mean LOS of 10 weeks. EAT-26 scores decreased from 28.08 (SD 20.61) at admission to 22.19 (SD 19.34) at discharge which signifies a small effect size (ie 0.30).	⨁◯◯◯ VERY LOW	IMPORTANT
		very serious a	not serious	not serious	serious c	all plausible residual confounding would reduce the demonstrated effect	One study - 26 patients in study, remained in DTP for mean LOS of 10 weeks. ANSOCQ score changed from 53.48 (SD 20.42) to 65.63 (SD 21.27) signifying no change in “stage” (patients remained in “preparation phase” throughout).	⨁◯◯◯ VERY LOW	IMPORTANT
		very serious a	serious b	not serious	not serious	none	Two studies reported on “% completing” the DTP, including 53 patients with AN. Definition of “successful completion” was based on a combination of symptom change, weight gain and progression in program (vs leaving AMA or need for admission to inpatient unit). Mean LOS ranged from 11.6 to 15.3 weeks. “Successful Completion” rates in these studies were 30 to 50%. One study examined whether completion rate varied between those that started at greater than or less that 85%TGW, and reported that there was no difference based on this factor.	⨁◯◯◯ VERY LOW	CRITICAL
Weight
1	Case report	very serious a	serious b	not serious	serious c	all plausible residual confounding would reduce the demonstrated effect	The case report described a weight change from 87lbs to 101 lbs. over the DTP admission	⨁◯◯◯ VERY LOW	CRITICAL

Explanations

^a Observational study, no comparison/control

^bVarying BMI/TGW at admission to various programs, programs provided differing levels/hours of support and results on this outcome varied

^cConfidence intervals wider than actual effect in some studies

Bibliography:

Case series - Ngo 2014 [256], Goldstein 2011 [255]

Case reports – Garner 2002 [254]