Measuring Clinical Efficacy Through the Lens of Audit Data in Different Adult Eating Disorder Treatment Programmes

Abstract

Background: Audit data is important in creating a clear picture of clinical reality in clinical services, and evaluating treatment outcomes. This paper explored the data from an audit of a large national eating disorder (ED) service and evaluated the outcome of inpatient and day treatment programmes for patients with anorexia nervosa (AN) with and without autistic traits.Methods: Four hundred and seventy-six patients receiving treatment for AN at inpatient (IP), day-care (DC) and step-up (SU) programmes were assessed at admission and at discharge on the following measures: autistic traits, body-mass-index (BMI), ED symptoms, depression and anxiety symptoms, work and social functioning, and motivation for change. Outcomes were analyzed first at a within-group level based on change in mean scores and then at an individual level based on the clinical significance of improvement in eating disorder symptoms. Outcomes were compared between patients with high autistic traits (HAT) and low autistic traits (LAT) in each programme.Results: The findings suggest that 45.5% of DC and 35.1% of IP patients showed clinically significant changes in ED symptoms following treatment. Co-occurring high autistic traits positively predicted improvement in ED symptoms in IP setting, but was a negative predictor in DC. In IP, more HAT inpatients no longer met the BMI cut-off for AN compared to LAT peers. In terms of general psychopathology, patients with AN and HAT exhibited more severe depression symptoms, anxiety symptoms and social functioning impairment than their LAT peers, and these symptoms stayed clinically severe after treatment.Conclusions: Patients with AN and hight autistic traits are more likely than their peers with low autistic traits to show weight restoration and improvement in ED systems after inpatient treatment. This reverses in DC, with high autistic trait patients less likely to improve after treatment compared to low autistic trait patients. Our results suggest that inpatient treatment with individualized and structured routine care may be an effective model of treatment for patients with AN and high autistic traits.

Autism and anorexia nervosa: longitudinal prediction of eating disorder outcomes

“…The present findings lend further credence to previous work documenting that people with AN who report high levels of autistic traits have more severe psychological presentation (Li et al, 2020;Stewart et al, 2017;Tchanturia et al, 2019). Furthermore, the present findings add to the literature by highlighting that high levels of autistic traits predict poorer psychological outcome in long term.…”

“…Similarly previous studies have documented that autistic traits not associated with BMI, but were strongly associated with psychological symptoms and general level of social functioning, among people with lived experience of AN (Kerr-Gaffney et al, 2020;Tchanturia et al, 2019). A recent examination of clinical audit data showed that AN patients reporting high levels of autistic traits had significantly higher BMI upon admission to inpatient care (Li et al, 2020). The focus on BMI as the measure of recovery, in particular, has been highlighted as less helpful for autistic people with AN, who discuss the psychological elements of recovery as being more difficult for them to manage (Sedgewick et al, 2021).…”

Autism and anorexia nervosa: longitudinal prediction of eating disorder outcomes

“…The present ndings lend further credence to previous work documenting that people with AN who report high levels of autistic traits have more severe psychological presentation (24,25,39). Furthermore, the present ndings add to the literature by highlighting that high levels of autistic traits predict poorer psychological outcome in long term.…”

Sensory wellbeing workshops for inpatient and day-care patients with anorexia nervosa

“…Kinnaird and colleagues demonstrated that patients with EDs, with and without autism spectrum comorbidity, are hypersensitive to smells, touch and noise, and hypersensitivity in different domains could be addressed in their treatment [ 4 – 6 ]. Clinical audit data shows that almost 37% of people with AN treated in inpatient and day-care programmes have high Autism Spectrum Condition (ASC) traits and are therefore likely to experience some sensory differences [ 7 ].…”

“…In the novel clinical pathway for autism and eating disorders, PEACE (Pathway for Eating disorders and Autism developed from Clinical Experience), we have started to measure sensory sensitivities in patients and have developed psychoeducation materials and experiential activities to support sensory wellbeing [ 8 ]. We also found that patients with no autistic traits as well as high autistic traits benefited from the sensory changes made in the dining room evidenced with focus groups [ 9 ]. Based on the research evidence [ 4 , 10 ], we have developed one-off workshops which offer both psychoeducational content and experiential activities to support patients by creating a soothing and helpful sensory toolkit.…”