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The quality of randomized controlled trials of psychotherapy for eating disorders.

ABSTRACT: OBJECTIVE:We investigated the quality of randomized controlled trials (RCTs) that included direct comparisons of psychotherapy for adults with an eating disorder (ED). METHOD:Thirty-five direct comparison RCTs of psychotherapy for adults diagnosed with an ED were rated using the Randomized Controlled Trials Psychotherapy Quality Rating Scale (RCT-PQRS). RESULTS:The mean total RCT-PQRS score (mean = 28.26; SD = 7.04) was in line with those that were reported for RCTs of psychotherapy for depression and anxiety disorders. Several standards of quality were unfulfilled by over half of the RCTs of treatment for EDs, including therapist supervision while treatment was being provided (62.9% unfulfilled); outcome assessment performed by raters blind to treatment group/condition (54% unfulfilled); and adequate sample size (66% unfulfilled). More recent RCTs were of higher quality, and higher quality was moderately associated with lower effect sizes. CONCLUSIONS:To improve the quality of RCTs of psychotherapy of EDs, we recommend that researchers address the quality criteria listed in the RCT-PQRS. Psychotherapy trials should be registered, have a published protocol, and be reported following the Consolidated Standards of Reporting Trials guidelines. Authors should take into account the quality of the research when using that research to inform ED treatment guidelines.

SUBMITTER: Grenon R

PROVIDER: S-EPMC6877143 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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The quality of randomized controlled trials of psychotherapy for eating disorders.

Grenon Renee R McKenna Alena A Maxwell Hilary H Carlucci Samantha S Brugnera Agostino A Schwartze Dominique D Hammond Nicole N Ivanova Iryna I Mcquaid Nancy N Proulx Genevieve G Tasca Giorgio A GA

International journal of methods in psychiatric research 20180720 3

<h4>Objective</h4>We investigated the quality of randomized controlled trials (RCTs) that included direct comparisons of psychotherapy for adults with an eating disorder (ED).<h4>Method</h4>Thirty-five direct comparison RCTs of psychotherapy for adults diagnosed with an ED were rated using the Randomized Controlled Trials Psychotherapy Quality Rating Scale (RCT-PQRS).<h4>Results</h4>The mean total RCT-PQRS score (mean = 28.26; SD = 7.04) was in line with those that were reported for RCTs of psyc ...[more]

PMID: 30028053

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Project description:PurposeEating disorders are prevalent public health problems associated with broad psychosocial impairments and with elevated rates of psychiatric and medical comorbidities. Critical reviews of the treatment literature for eating disorders indicate that although certain specialized psychological treatments and specific medications show efficacy to varying degrees across the different eating disorders, many patients fail to derive sufficient benefit from existing treatments. This article addresses whether combining psychological and pharmacologic interventions confers any additional benefits for treating eating disorders.MethodsThis study was a critical review of randomized controlled trials (RCTs) testing combined psychological and pharmacologic treatment approaches for eating disorders with a focus on anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED).FindingsFor AN, 3 of the 4 RCTs reported no significant advantage for combining treatments; the fourth reported a statistically significant, albeit clinically modest, advantage. For BN, 10 of the 12 RCTs reported no significant advantage for combining treatments; 2 RCTs found that combining fluoxetine with specific psychological treatments enhanced outcomes relative to medication only but not relative to the psychological treatments only. For BED, of the 12 RCTs, only 2 (both with antiseizure medications) significantly enhanced both binge-eating and weight outcomes, and only 2 (with orlistat, a weight-loss medication) enhanced weight loss but not binge-eating outcomes.ImplicationsDespite the public health significance of eating disorders, the scope of research performed on the utility of combining treatments is limited. To date, the few RCTs testing combined pharmacologic plus psychological treatments for eating disorders have yielded mostly nonsignificant findings. Future RCTs should focus on testing additive benefits of medications with relevant mechanisms of action to available effective psychological interventions. In addition, future RCTs that test additive effects should use adaptive designs, which could inform treatment algorithms to enhance outcomes among both responders and nonresponders to initial interventions.

Project description:Continuous feedback on patient improvement and the therapeutic alliance may reduce the number of dropouts and increase patient outcome. There are, however, only three published randomized trials on the effect of feedback on the treatment of eating disorders, showing inconclusive results, and there are no randomized trials on the effect of feedback in group therapy. Accordingly the current randomized clinical trial, initiated in September 2012 at the outpatient clinic for eating disorders at Stolpegaard Psychotherapy Centre, aims to investigate the impact of continuous feedback on attendance and outcome in group psychotherapy.The hypothesis is that continuous feedback to both patient and therapist on treatment progress and alliance will increase attendance and treatment outcome. The trial is set up using a randomized design with a minimum of 128 patients allocated to either an experimental or control group at a ratio of 1:1. The experimental group will receive standard treatment (systemic and narrative group psychotherapy) with feedback intervention, whereas the control group will receive standard treatment only. The participants are diagnosed with bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified, according to the DSM-IV. In the experimental group feedback to the participants, based on the Outcome Rating Scale (ORS) and the Group Session Rating Scale (GSRS), is actively added to standard treatment. The ORS assesses areas of life functioning known to change as a result of therapeutic intervention. The GSRS assesses key dimensions of effective therapeutic relationships. In the control group, the patients fill out the Outcome Rating Scale only, and feedback is not provided.The primary outcome is the rate of attendance to treatment sessions. The secondary outcome is the severity of eating disorder symptoms. Exploratory outcomes are the level of psychological and social functioning, and suicide or self-harm. This is measured with the ORS, Symptom Check List, WHO-Five Wellbeing Index, Sheehan Disability Scale and a modified version of the Self-Harm Inventory.If the results will confirm the hypothesis, this trial will support feedback as a way to improve group treatment attendance for outpatients with eating disorders.ClinicalTrials.gov identifier: NCT01693237.

Project description:BackgroundGood radiotherapy reporting in clinical trials of prostate radiotherapy is important because it will allow accurate reproducibility of radiotherapy treatment and minimize treatment variations that can affect patient outcomes. The aim of our study is to assess the quality of prostate radiotherapy (RT) treatment reporting in randomized controlled trials in prostate cancer.MethodsWe searched MEDLINE for randomized trials of prostate cancer, published from 1996 to 2016 and included prostate RT as one of the intervention arms. We assessed if the investigators reported the ten criteria adequately in the trial reports: RT dose prescription method; RT dose-planning procedures; organs at risk (OAR) dose constraints; target volume definition, simulation procedures; treatment verification procedures; total RT dose; fractionation schedule; conduct of quality assurance (QA) as well as presence or absence of deviations in RT treatment planning and delivery. We performed multivariate logistic regression to determine the factors that may influence the quality of reporting.ResultsWe found 59 eligible trials. There was significant variability in the quality of reporting. Target volume definition, total RT dose and fractionation schedule were reported adequately in 97% of included trials. OAR constraints, simulation procedures and presence or absence of deviations in RT treatment planning and delivery were reported adequately in 30% of included trials. Twenty-four trials (40%) reported seven criteria or more adequately. Multivariable logistic analysis showed that trials that published their quality assurance results and cooperative group trials were more likely to have adequate quality in reporting in at least seven criteria.ConclusionThere is significant variability in the quality of reporting on prostate radiotherapy treatment in randomized trials of prostate cancer. We need to have consensus guidelines to standardize the reporting of radiotherapy treatment in randomized trials.

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The quality of randomized controlled trials of psychotherapy for eating disorders.

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The quality of randomized controlled trials of psychotherapy for eating disorders.

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