Effectiveness of Inpatient Care in Reducing Likelihood of Relapsing in Patients with Anorexia Nervosa: A Systematic Review and Meta-analysis

Abstract

Background: Anorexia Nervosa is an eating disorder characterized by a fear of gaining weight and a distorted self-image, with high relapse rates. Objective: The aim of this review is to evaluate the effectiveness of inpatient care in reducing the likelihood of patients relapsing in the future. Data Sources: Seven electronic databases are systematically searched using keywords based on the PICO of the research question. Eligibility Criteria: Randomized controlled trials (RCTs) and quasi-experimental studies that evaluate the effectiveness of inpatient care for patients with anorexia nervosa. Data Extraction: PRIMSA guidelines were followed and the studies are screened by at least two researchers independently. The data will be extracted independently using a standardized data extraction form. The target data includes readmission rates and other measures of anorexia nervosa symptoms, and the interventions administered in inpatient care. Appraisal: The studies are appraised using the Cochrane risk of bias tool and ROBINS-I tool. Synthesis methods: Rate of relapse will be calculated into risk ratio and the standard mean difference will be calculated other outcomes. Meta-analysis using random effects model and inverse variance methods will be used, respectively. Heterogeneity will be examined. Results: Patients received inpatient care had increased risk for readmission and had lower BMI than comparator groups but were less likely to relapse in anorexia nervosa psychopathology and behaviours. There was inconclusive evidence to determine if inpatient care was inferior to other forms of care. Clinical Practice and Implications for Research: Future research should focus on defining relapse consistently and longer follow up periods. More RCTs are needed in eating disorder research and concerning inpatient care. Healthcare teams could 3 consider implementing psychotherapy in inpatient care such as cognitive behavioural therapy and family therapy and focus on addressing psychological aspect of the disorder and not just physiological stabilisation, to reduce likelihood of relapse.