Summary of findings 5. Cognitive behavioural therapy as compared with standard medical care.
| Cognitive behavioural therapy compared with standard medical care for conversion disorder | ||||||
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Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatient Intervention: cognitive behavioural therapy Comparison: standard medical care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Standard medical care | Cognitive behavioural therapy | |||||
|
Reduction in physical signs Reduction in monthly seizure frequency as assessed by a daily self‐reported seizure diary End of treatment |
Study population | RR 1.56 (0.39 to 6.19) | 16 (1 study) | ⊕⊝⊝⊝ Very lowa,b | Cognitive behavioural therapy may have little or no effect on reducing physical signs at end of treatment. | |
| 286 per 1000 | 446 per 1000 (174 less to 1484 more) | |||||
|
Reduction in physical signs Monthly seizure frequency as assessed by a daily self‐reported seizure diary (lower is better) End of treatment |
The mean reduction in physical signs in the control group was 6.75 |
MD –4.75 lower (18.73 lower to 9.23 higher) |
— | 61 (1 study) | ⊕⊕⊝⊝ Lowb | Cognitive behavioural therapy may have little or no effect on reducing physical signs at end of treatment. |
|
Reduction in physical sign Seizure freedom as assessed by a daily self‐reported seizure diary End of treatment |
Study population | RR 2.33 (0.30 to 17.88) | 16 (1 study) | ⊕⊝⊝⊝ Very lowa,b | Cognitive behavioural therapy may have little or no effect on reducing physical signs at end of treatment. | |
| 143 per 1000 | 333 per 1000 (100 less to 2414 more) | |||||
|
Level of functioning As measured by the GAF (range 0–100) scale and the WSAS scale (0–40) (lower is better) End of treatment |
— |
SMD 0.44 higher (1.69 lower to 2.57 higher) I2 = 91% |
— | 74 (2 studies) | ⊕⊝⊝⊝ Very lowa,c,d | Cognitive behavioural therapy may have little or no effect on level of functioning at end of treatment. |
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Quality of life As assessed by QOLIE31 (higher is better) Range: 15–97 End of treatment |
The mean quality of life in the control group was 9.7 |
MD 11.20 higher (7.98 lower to 30.38 higher) |
— | 16 (1 study) | ⊕⊝⊝⊝ Very lowa,b | Cognitive behavioural therapy may have little or no effect on quality of life at end of treatment. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; GAF: global assessment of functioning; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; QOLIE31: quality of life in epilepsy inventory; RR: Risk Ratio; SMD: standardised mean difference; WSAS: work and social adjustment scale. | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aDowngraded one level due to high risk of bias. bDowngraded two levels due to imprecision (wide confidence intervals; 1 study with few participants). cDowngraded one level due to imprecision (wide confidence intervals). dDowngraded one level due to inconsistency (I2 = 91%).