Limits...
A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents.

Madden S, Miskovic-Wheatley J, Wallis A, Kohn M, Lock J, Le Grange D, Jo B, Clarke S, Rhodes P, Hay P, Touyz S - Psychol Med (2014)

Bottom Line: There was no significant difference between groups in hospital days following initial admission.There were significantly more total hospital days used and post-protocol FBT sessions in the WR group.Cost savings would result from combining shorter hospitalization with FBT.

View Article: PubMed Central - PubMed

Affiliation: Eating Disorder Service at The Sydney Children's Hospitals Network,Westmead,Australia.

ABSTRACT

Background: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.

Method: We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).

Results: The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.

Conclusions: Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.

No MeSH data available.


Related in: MedlinePlus

Remission indicators at each assessment point.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4301212&req=5

fig02: Remission indicators at each assessment point.

Mentions: Table 3 and Figure 2 show the main analyses of the outcomes. Contrary to our hypothesis, there was no significant difference in hospital days used between groups following the initial admission (22.78 days for the MS group versus 27.51 days for the WR group; group difference = 4.74 days; p > 0.05, Cohen's d = 0.10, based on linear regression analysis). However, this resulted in significantly fewer total hospital days used at the end of the 12-month follow-up in the group randomized to MS (45.20 days for the MS group versus 65.50 days for the WR group; group difference = 20.20 days; p < 0.05, Cohen's d = 0.43, based on linear regression analysis). In addition, there was no significant difference in the rates of readmission between the two groups (36.1% in the MS group versus 33.3% in the WR group, χ21 = 0.00, p = 1.00, n.s.). Of those readmitted, 70.8% were for weight loss and medical instability and 29.2% due to risk of self-harm or suicide. There was no difference between groups regarding the reason for readmission (χ21 = 1.36, p = 0.18, n.s.).Fig. 2.


A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents.

Madden S, Miskovic-Wheatley J, Wallis A, Kohn M, Lock J, Le Grange D, Jo B, Clarke S, Rhodes P, Hay P, Touyz S - Psychol Med (2014)

Remission indicators at each assessment point.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301212&req=5

fig02: Remission indicators at each assessment point.
Mentions: Table 3 and Figure 2 show the main analyses of the outcomes. Contrary to our hypothesis, there was no significant difference in hospital days used between groups following the initial admission (22.78 days for the MS group versus 27.51 days for the WR group; group difference = 4.74 days; p > 0.05, Cohen's d = 0.10, based on linear regression analysis). However, this resulted in significantly fewer total hospital days used at the end of the 12-month follow-up in the group randomized to MS (45.20 days for the MS group versus 65.50 days for the WR group; group difference = 20.20 days; p < 0.05, Cohen's d = 0.43, based on linear regression analysis). In addition, there was no significant difference in the rates of readmission between the two groups (36.1% in the MS group versus 33.3% in the WR group, χ21 = 0.00, p = 1.00, n.s.). Of those readmitted, 70.8% were for weight loss and medical instability and 29.2% due to risk of self-harm or suicide. There was no difference between groups regarding the reason for readmission (χ21 = 1.36, p = 0.18, n.s.).Fig. 2.

Bottom Line: There was no significant difference between groups in hospital days following initial admission.There were significantly more total hospital days used and post-protocol FBT sessions in the WR group.Cost savings would result from combining shorter hospitalization with FBT.

View Article: PubMed Central - PubMed

Affiliation: Eating Disorder Service at The Sydney Children's Hospitals Network,Westmead,Australia.

ABSTRACT

Background: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.

Method: We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).

Results: The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.

Conclusions: Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.

No MeSH data available.


Related in: MedlinePlus