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Online remote behav...
Online remote behavioural intervention for tics in 9- to 17-year-olds : the ORBIT RCT with embedded process and economic evaluation
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- Hollis, Chris (författare)
- University of Nottingham
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- Hall, Charlotte L (författare)
- University of Nottingham
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- Khan, Kareem (författare)
- University of Nottingham
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- Le Novere, Marie (författare)
- University College London
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- Marston, Louise (författare)
- University College London
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- Jones, Rebecca (författare)
- University College London
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- Hunter, Rachael (författare)
- University College London
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- Brown, Beverley J (författare)
- University of Nottingham
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- Sanderson, Charlotte (författare)
- Great Ormond Street Hospital
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- Andrén, Per (författare)
- Karolinska Institutet,Karolinska Institute,Stockholm Regional Council
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- Bennett, Sophie D (författare)
- Great Ormond Street Hospital
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Chamberlain, Liam R (författare)
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Davies, E Bethan (författare)
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Evans, Amber (författare)
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Kouzoupi, Natalia (författare)
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McKenzie, Caitlin (författare)
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Heyman, Isobel (författare)
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Kilgariff, Joseph (författare)
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Glazebrook, Cristine (författare)
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- Mataix-Cols, David (författare)
- Karolinska Institutet,Karolinska Institute,Stockholm Regional Council
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- Serlachius, Eva (författare)
- Karolinska Institutet,Lund University,Lunds universitet,Innovations in pediatric mental health,Forskargrupper vid Lunds universitet,Lund University Research Groups
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Murray, Elizabeth (författare)
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Murphy, Tara (författare)
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(creator_code:org_t)
- 2023
- 2023
- Engelska.
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Ingår i: Health Technology Assessment. - 1366-5278. ; 27:18, s. 1-120
- Relaterad länk:
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http://dx.doi.org/10... (free)
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https://lup.lub.lu.s...
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https://doi.org/10.3...
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http://kipublication...
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Abstract
Ämnesord
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- BACKGROUND: Behavioural therapy for tics is difficult to access, and little is known about its effectiveness when delivered online.OBJECTIVE: To investigate the clinical and cost-effectiveness of an online-delivered, therapist- and parent-supported therapy for young people with tic disorders.DESIGN: Single-blind, parallel-group, randomised controlled trial, with 3-month (primary end point) and 6-month post-randomisation follow-up. Participants were individually randomised (1 : 1), using on online system, with block randomisations, stratified by site. Naturalistic follow-up was conducted at 12 and 18 months post-randomisation when participants were free to access non-trial interventions. A subset of participants participated in a process evaluation.SETTING: Two hospitals (London and Nottingham) in England also accepting referrals from patient identification centres and online self-referrals.PARTICIPANTS: Children aged 9-17 years (1) with Tourette syndrome or chronic tic disorder, (2) with a Yale Global Tic Severity Scale-total tic severity score of 15 or more (or > 10 with only motor or vocal tics) and (3) having not received behavioural therapy for tics in the past 12 months or started/stopped medication for tics within the past 2 months.INTERVENTIONS: Either 10 weeks of online, remotely delivered, therapist-supported exposure and response prevention therapy (intervention group) or online psychoeducation (control).OUTCOME: Primary outcome: Yale Global Tic Severity Scale-total tic severity score 3 months post-randomisation; analysis done in all randomised patients for whom data were available. Secondary outcomes included low mood, anxiety, treatment satisfaction and health resource use. Quality-adjusted life-years are derived from parent-completed quality-of-life measures. All trial staff, statisticians and the chief investigator were masked to group allocation.RESULTS: Two hundred and twenty-four participants were randomised to the intervention (n = 112) or control (n = 112) group. Participants were mostly male (n = 177; 79%), with a mean age of 12 years. At 3 months the estimated mean difference in Yale Global Tic Severity Scale-total tic severity score between the groups adjusted for baseline and site was -2.29 points (95% confidence interval -3.86 to -0.71) in favour of therapy (effect size -0.31, 95% confidence interval -0.52 to -0.10). This effect was sustained throughout to the final follow-up at 18 months (-2.01 points, 95% confidence interval -3.86 to -0.15; effect size -0.27, 95% confidence interval -0.52 to -0.02). At 18 months the mean incremental cost per participant of the intervention compared to the control was £662 (95% confidence interval -£59 to £1384), with a mean incremental quality-adjusted life-year of 0.040 (95% confidence interval -0.004 to 0.083) per participant. The mean incremental cost per quality-adjusted life-year gained was £16,708. The intervention was acceptable and delivered with high fidelity. Parental engagement predicted child engagement and more positive clinical outcomes.HARMS: Two serious, unrelated adverse events occurred in the control group.LIMITATIONS: We cannot separate the effects of digital online delivery and the therapy itself. The sample was predominately white and British, limiting generalisability. The design did not compare to face-to-face services.CONCLUSION: Online, therapist-supported behavioural therapy for young people with tic disorders is clinically and cost-effective in reducing tics, with durable benefits extending up to 18 months.FUTURE WORK: Future work should compare online to face-to-face therapy and explore how to embed the intervention in clinical practice.TRIAL REGISTRATION: This trial is registered as ISRCTN70758207; ClinicalTrials.gov (NCT03483493). The trial is now complete.FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Technology Assessment programme (project number 16/19/02) and will be published in full in Health and Technology Assessment; Vol. 27, No. 18. See the NIHR Journals Library website for further project information.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Health Care Service and Management, Health Policy and Services and Health Economy (hsv//eng)
Nyckelord
- Child
- Humans
- Male
- Adolescent
- Female
- Tics
- Cost-Benefit Analysis
- Single-Blind Method
- Tic Disorders
- Behavior Therapy
- Quality of Life
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Hollis, Chris
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Hall, Charlotte ...
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Khan, Kareem
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Le Novere, Marie
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Marston, Louise
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Jones, Rebecca
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visa fler...
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Hunter, Rachael
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Brown, Beverley ...
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Sanderson, Charl ...
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Andrén, Per
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Bennett, Sophie ...
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Chamberlain, Lia ...
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Davies, E Bethan
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Evans, Amber
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Kouzoupi, Natali ...
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McKenzie, Caitli ...
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Heyman, Isobel
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Kilgariff, Josep ...
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Glazebrook, Cris ...
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Mataix-Cols, Dav ...
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Serlachius, Eva
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Murray, Elizabet ...
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Murphy, Tara
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