The efficacy of family treatments for adolescent anorexia nervosa in specialist versus non-specialist settings: protocol for a systematic review and meta-analysis

Abstract

Background Anorexia nervosa (AN) is often diagnosed in adolescence, and most evidence-based treatments for AN in young people involve the family. Family therapies for AN are intensive, outpatient treatments that utilise the parents as the primary resource in the young person’s recovery. Research regarding family treatment for AN is often conducted in specialist settings—with relatively little data reporting the translation of this specialised treatment into real-world, non-specialist settings. This systematic review and meta-analysis aims to determine the efficacy of family treatments for adolescents with AN in specialist settings versus non-specialist settings. Methods This systematic review and meta-analysis will be conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Retrospective cohort studies, pilot studies, case series, randomised controlled trials and qualitative investigations that present original data and investigated the efficacy of family treatments for adolescents with AN in either a specialist or non-specialist setting will be included in the review. Data will be extracted by two reviewers and study quality will be assessed. The primary outcome, change in weight, will be used to determine via meta-analysis and, depending on study heterogeneity, subgroup analysis or meta-regression whether there is a statistically significant subgroup difference between specialist and non-specialist treatment settings. The review will also consider changes in eating disorder symptomology and related constructs. Discussion Results from this review will help determine if there is a difference in the efficacy of family treatments for adolescent AN in specialist versus non-specialist treatment settings, primarily in relation to weight recovery. This, in turn, will inform the translation of evidence-based interventions that are generally studied and implemented within specialist centres into the non-specialist health care system.

What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure

“…However painful this may be, it must surely be done. This is not to throw the proverbial baby out with the bathwater – much has been achieved over the past decades including important theory developments and research demonstrating the safety of rapid refeeding without the over-arching nemesis of refeeding syndrome [ 54 ], or undertaking refeeding in the home environment [ 55 ]. But the well-worn assumption that AN is essentially a phobia about body image and that refeeding to a healthy weight constitutes full recovery should be reconsidered.…”