Table_1_Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis.docx

Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults).Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included.Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment.Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge.

背景：本研究旨在对评估神经性厌食症心理治疗方法的文献进行系统综述，并比较其有效性。体重增加被选为主要的结局指标。此外，本研究还旨在比较不同服务级别（住院与门诊）和年龄组（青少年与成人）的治疗效果。方法：本研究利用PubMed、Cochrane图书馆、Web of Science、Cinahl和PsychInfo数据库进行系统文献检索（截至2017年2月）。检索词根据数据库进行了调整，结合了厌食、治疗/疗法和控制试验等不同版本。通过预先定义的纳入和排除标准选择研究。数据由两位独立的编码者使用试点表格提取。对所有随机对照试验（RCTs）进行了网络荟萃分析。为了比较服务级别和年龄组，使用了标准均值变化（SMC）统计量，并纳入了自然主义、非随机研究。结果：共有18项RCTs（成人试验：622名参与者；青少年试验：625名参与者）纳入了网络荟萃分析。对38项研究（1,164名参与者）进行了SMC分析。在青少年干预中，基于家庭的方法占主导地位，而在成人中，个体心理治疗占主导地位。没有特定方法显示出优越性。青少年的体重增加更为迅速，且住院治疗更为有效。结论：已开发出多种专业心理治疗干预措施，可推荐用于神经性厌食症（AN）。然而，应区分成年人和青少年患者，因为两组在考虑的治疗方法以及治疗反应方面存在差异。未来的试验应复制先前的研究发现，并开展多中心试验，以允许进行亚组分析。患者评估应包括可考虑为治疗结果相关调节变量的变量。探索适用于神经性厌食症患者亚组的自适应治疗策略是可取的。识别和解决维持厌食症的因素仍然是一个主要挑战。