Tuesday, June 18, 2024

Digital Self-Management Intervention Fails to Enhance Treatment Outcomes for Anorexia Nervosa

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In the quest to improve post-treatment support for anorexia nervosa patients, a recent study evaluated the efficacy of a digital self-management tool, ECHOMANTRA. The tool, integrated with guided interventions and multifaceted online resources, was designed to complement traditional treatments. Despite the promising digital landscape, the study found no significant advantage in patient outcomes when ECHOMANTRA was added to usual care, sparking questions about the future of digital health solutions in managing complex eating disorders.

Study Design and Methodology

The study employed a pragmatic multicentre randomised controlled trial and economic evaluation to assess ECHOMANTRA. Participants, who were patients diagnosed with anorexia nervosa or atypical anorexia nervosa, were randomly assigned along with their carers to either the ECHOMANTRA plus treatment as usual (TAU) group or the TAU alone group. The digital platform offered a comprehensive workbook, recovery-oriented video content, and facilitated online group sessions for patients and carers.

Randomisation was done on a 1:1 ratio, with stratification based on site and severity of anorexia nervosa, determined by baseline BMI. The primary outcome measured was the level of depression, anxiety, and stress at 12 months, with both primary and secondary outcomes analysed on an intention-to-treat basis.

Results and Interpretation

A total of 371 patient-carer dyads were enrolled between July 2017 and July 2020, with 185 allocated to the ECHOMANTRA + TAU group and 186 to the TAU alone group. The findings revealed no significant differences between the two groups in the primary outcome of patient depression, anxiety, and stress. Similarly, secondary outcomes showed minimal and non-significant differences.

The mean depression, anxiety, and stress scores in the TAU group were 61.7 (SD = 29.4), compared to 58.3 (SD = 26.9) in the ECHOMANTRA + TAU group, with an estimated mean difference of 0.48 points (95% CI -5.36 to 6.33; p = 0.87). This lack of significant findings could be attributed to limited engagement with the intervention materials and changes in usual care practices during the trial period.

User-Usable Inferences

  • Successful integration of digital interventions in healthcare requires high patient engagement with the digital tools provided.
  • Changes in standard care practices can significantly influence the outcomes of supplementary interventions.
  • Careful consideration and continuous monitoring of new digital health solutions are critical before widespread implementation.

The study concluded that the addition of ECHOMANTRA to traditional treatment for anorexia nervosa did not result in improved outcomes for patients. This calls for further research into enhancing patient engagement and adapting digital tools to align more closely with evolving care practices.

Funding for the study was provided by the National Institute for Health Research (NIHR) under its Health Technology Assessment Programme and other associated bodies.

Original Article: EClinicalMedicine. 2024 May 27;73:102645. doi: 10.1016/j.eclinm.2024.102645. eCollection 2024 Jul.

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