Review of Randomized Controlled Trials Using e-Health Interventions for Patients With Eating Disorders

Abstract

Background: In a world of technological advancements, electronic devices and services seem to be a promising way to increase patients' engagement in treatment and to help manage their symptoms. Here, we identified and analyzed the current evidence of RCTs to evaluate the effectiveness and acceptability of e-health interventions in the eating disorder (ED) field. Methods: We screened an initial cluster of 581 papers. In the end, 12 RCTs in clinical ED cohorts were included. Results: Some studies were conceived as stand-alone interventions, while others were presented as add-ons to ED-specific treatments. Studies varied in the type of EDs under investigation and in the e-health intervention applied (with vs. without therapist support vs. blended interventions; smartphone-vs. web-based). Only four studies reported explicit acceptability measures. Out of those, two reported high acceptability, one reported low acceptability, and one reported no significant difference in acceptability between groups. Four studies reported higher effectiveness of the e-health intervention compared to the control condition, e.g., reduction in maladaptive eating behaviors. Regarding control groups, three used a wait list design and nine had another kind of intervention (e.g., faceto-face CBT, or treatment as usual) as control. Discussion: So far, the evidence for acceptability and effectiveness of e-health interventions in EDs is very limited. There is also a lack of studies in older patients, adolescents, men, sexual and ethnic minorities. Shame/stigma is discussed in the context of e-health interventions for EDs. It remains unclear how severity of EDs affects the effectiveness of e-health interventions, how patients can channel the knowledge they acquire from e-health interventions into their actual behaviors, and how such interventions can better fit the needs of the individual patient to increase acceptability and effectiveness.

Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches

“…These approaches have demonstrated promise in the field of psychiatry (eg, depression and anxiety) [ 15 ] and specifically within eating disorders [ 16 , 17 ]. Studies of web-based self-help interventions for eating disorders report moderate acceptability and accessibility [ 18 ], with some evidence suggesting that they may be at least as effective as in-person interventions [ 19 , 20 ]. Despite the potential and realized advantages of digital health interventions, limitations exist.…”

Specialized post-inpatient psychotherapy for sustained recovery in anorexia nervosa via videoconference – study protocol of the randomized controlled SUSTAIN trial

“…Thirdly, our data will contribute to the evidence base on using technology-enhanced dissemination strategies to improve treatment access and continuity of care for ED patients. A recent systematic review summarizing findings from RCTs using e-Health interventions for ED patients concludes that the evidence is still very limited, with no trial reporting on the use of psychotherapy via videoconference [ 53 ].…”

Potential benefits and limitations of machine learning in the field of eating disorders: current research and future directions

“…Human involvement is needed because ML methods are not always transparent (i.e., it is sometimes unclear what predictions were based on), ML predictions can be inaccurate, and ML methods may not capture all of the intricacies of each specific situation [ 79 ]. Further, human involvement is important for therapeutic alliance which can improve treatment outcomes and can reduce higher dropout rates associated with completely remote care [ 81 , 82 ]. However, it is important to note than human decision making in clinical settings can also be negatively impacted by conscious or unconscious biases [ 83 , 84 ], which can lead to inaccurate diagnoses, unhelpful patient-clinician interactions, and inappropriate treatment recommendations.…”