A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability – the TOuCAN trial

Gowers, Simon; Clark, Andrew; Roberts, Christopher; Byford, Sarah; Barrett, Barbara; Griffiths, Alison; Edwards, Vanessa; Bryan, Claudine; Smethurst, Nicola; Rowlands, Laura; Roots, Peter

doi:10.3310/hta14150

Cited by 90 publications

(110 citation statements)

References 191 publications

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“…Descriptive data for the 71 60,70,71,92,115-117, 120,134,136 There were relatively few studies focusing on post-traumatic stress disorder (PTSD) (n = 2), 86,128 self-harm (n = 4) 72,74,78,137 and generic mental health problems (i.e. interventions designed for any mental health problem; n = 3).…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

“…51,107,133 There were no studies on psychosis. Most (31/71) of the studies concerned interventions that could be classified as treatments (see Chapter 1, Intervention levels), [48][49][50][51][52]55,65,66,70,71,74,77,78,81,[83][84][85][86]91,[94][95][96][97][98][101][102][103][104]106,111,112,[121][122][123][124][125][126][127][129][130][131]133,135,139 with the remainder focusing equally on indicated (n = 11), 53,58,59,…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

“…Sixteen of the interventions were individual child/young person or individual family interventions; 48,65,[69][70][71]74,[83][84][85][86][87][95][96][97][98]111,[121][122][123][124][125][126][127][129][130][131]133,135 the remainder were group interventions or group interventions with occasional individual sessions. Of those studies where a delivery location was given, most of the interventions (33/71) took place in a school setting, 39,[45][46][47]49,50,53,[57][58][59][60]62,63,65,73,82,[90][91][92][93][94]…”

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

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Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Pryjmachuk

Elvey

Kirk

et al. 2014

Health Services and Delivery Research

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BackgroundThe mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health.ObjectivesTo identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision.DesignTwo inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study.SettingGlobal (systematic reviews); England and Wales (mapping exercise and case study).Participants (case study)Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites.Main outcome measures (meta-analysis)A measure of CYP’s mental health symptomatology.Data sources (literature reviews)MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC).Review methodsTitles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review.ResultsSixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support.ConclusionsMental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes.Future workFuture work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness.Study registrationPROSPERO number (for the effectiveness review) CRD42012001981.FundingThe NIHR Health Services and Delivery Research programme.

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Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

Section: Description Of the Included Effectiveness Studiesmentioning

confidence: 99%

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Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Pryjmachuk

Elvey

Kirk

et al. 2014

Health Services and Delivery Research

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“…Ausführliche Beschreibungen der erforderlichen somatischen Massnahmen beim Ernährungs-aufbau bei schwerer Anorexia nervosa sowie das Management der somatischen Komplikationen bei Bulimia nervosa finden sich bei Mehler et al [71,72] spätere Behandlungen entscheidend verschlechtern kann. Studien konnten die Überlegenheit von stationären Behandlungen gegenüber ambulanten Settings nicht nachweisen [73,74]. Die Möglichkeiten für teilstationäre Behandlungen sind bis heute in der Schweiz noch begrenzt.…”

Section: Management Somatischer Komplikationenunclassified

Anorexia nervosa, Bulimia nervosa und andere Essstörungen bei Kindern und Jugendlichen

2013

Swiss Arch Neurol Psychiatr

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Summary Anorexia nervosa, bulimia nervosa and other eating disorders in childhood and a dolescence. Review and recommendations on diagnosis and treatment.The diagnosis and treatment of eating disorders in childhood and adolescence demands specific knowledge of the particular features of symptomatology and approaches in this age group. The diagnostic criteria in the handbooks are only conditionally valid in young patients and their application must be adapted to the patient's age. Clinically relevant atypical eating disorders have a prevalence similar to the classic forms of anorexia nervosa or bulimia n ervosa. High rates of comorbidity exist, in particular with anxiety states and also depression. Monitoring of concomitant somatic symptoms is indispensable. Early detection and treatment improve prognosis. Treatment is multidisciplinary and multimodal. Transdiagnostic approaches take into account the high migration rate of eating disorder diagnoses. There is evidence for the efficacy of family-based therapy in adolescents with anorexia nervosa. In i ndividual psychotherapy motivational treatment, and in bulimia nervosa cognitive behavioural therapy, are in the forefront. Fluoxetine has proved e ffective in the treatment of binge eating in bulimia nervosa.Key words: eating disorders in children and adolescents; eating disoder; child; a dolescent; treatment; review; anorexia nervosa; bulimia nervosa Einleitung Trotz Fortschritten in der Behandlung ist die Anorexia n ervosa als bekannteste und am meisten gefürchtete Essstörung immer noch eine der Erkrankungen des Kindesund Jugendalters mit der höchsten Todesrate [1,2]. Die E rkenntnisse zur Wirksamkeit der Behandlungsmethoden bei Essstörungen wachsen, sind aber immer noch unzureichend. Die Anorexia nervosa nimmt häufig in der frühen oder mittleren Pubertät ihren Anfang, die Bulimia nervosa eher in der späteren Adoleszenz oder im jungen Erwachsenenalter. Behandelnde Fachärzte dieser Altersgruppe sollten daher über Früherkennung und Behandlung von Essstörun-gen bei jungen Menschen gut informiert sein.

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“…354,372 This compared the costs and outcomes of inpatient treatment, specialist outpatient treatment and TAU and found that specialist outpatient treatment had a higher probability of being cost-effective (up to approximately 60%). One limitation of this study was that only 65% of patients adhered to the allocated treatment.…”

mentioning

confidence: 99%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability – the TOuCAN trial

Abstract: NRR number (National Research Register) N0484056615; Current Controlled Trials ISRCTN39345394.

Cited by 90 publications

References 191 publications

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Anorexia nervosa, Bulimia nervosa und andere Essstörungen bei Kindern und Jugendlichen

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

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