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Meta-Analysis
. 2020 Nov;53(11):1761-1773.
doi: 10.1002/eat.23373. Epub 2020 Aug 28.

Relationship between eating disorder duration and treatment outcome: Systematic review and meta-analysis

Marcela Radunz  1 , Ella Keegan  1 , Ivana Osenk  1 , Tracey D Wade  1
Affiliations
Meta-Analysis

Relationship between eating disorder duration and treatment outcome: Systematic review and meta-analysis

Marcela Radunz et al. Int J Eat Disord. 2020 Nov.

Abstract
in English, French

Objective: This systematic review and meta-analysis examine the contribution of duration to treatment outcome for eating disorders.

Method: Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta-analyses, aimed at increasing homogeneity, were conducted.

Results: First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r = .05, 95% CI: -.03:.13), with high heterogeneity. Second, we conducted three sub-group analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from .02-.08), with low to medium heterogeneity. Third, two stand-alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of .23/-.06, respectively. High levels of heterogeneity were present.

Discussion: Duration did not influence treatment outcome across any of our meta-analyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology.

Antecedentes: Esta revisión sistemática y metaanálisis examinan la contribución de la duración al resultado del tratamiento para los trastornos de la conducta alimentaria. MÉTODOS: Se identificaron estudios (n = 31) que examinaron las asociaciones (r) entre la duración y 45 diferentes resultados. No fue posible extraer r para siete estudios (nueve resultados) y se extrajo r para 36 resultados en 24 estudios (2349 participantes). Los indicadores del resultado del tratamiento fueron heterogéneos y, por lo tanto, se realizaron una serie de diferentes metaanálisis, destinados a aumentar la homogeneidad.

Resultados: Primero, examinamos el tamaño del efecto promedio para un resultado primario relacionado con el trastorno de la conducta alimentaria de cada uno de los 24 estudios. No hubo asociación entre la duración y el resultado del tratamiento (r = .05, IC del 95%: −.03: .13), con alta heterogeneidad. En segundo lugar, realizamos tres análisis de subgrupos para explorar posibles fuentes de heterogeneidad (diagnóstico: anorexia nerviosa versus bulimia nerviosa; naturaleza del resultado: binario versus continuo; o tipo de resultado: indicador binario de recuperación, psicopatología del trastorno alimentario, aumento de peso). No hubo moderación significativa o asociaciones entre la duración y el resultado (rango de .02−.08), con heterogeneidad baja a media. En tercer lugar, dos análisis independientes examinaron los resultados relacionados con el aumento de peso (n = 8) y la psicopatología del trastorno de la conducta alimentaria (n = 5), con una rs no significativa de 0,23/−0,06 respectivamente. Se presentaron altos niveles de heterogeneidad.

Conclusiones: La duración no influyó en el resultado del tratamiento en ninguno de nuestros metaanálisis. El aumento de la homogeneidad y el poder permitirá calcular estimaciones más estables del impacto de la duración en el resultado; con este fin, los estudios de tratamiento futuros deben incluir resultados relacionados con el aumento de peso (anorexia nerviosa) y mejoras en la psicopatología de los trastornos de la conducta alimentaria.

Keywords: anorexia nervosa; bulimia nervosa; duration; severe and enduring; treatment outcome.

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