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  • Andrén, PerKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)

Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents with Tourette Syndrome : A Randomized Clinical Trial

  • Article/chapterEnglish2022

Publisher, publication year, extent ...

  • 2022-08-15
  • American Medical Association (AMA),2022

Numbers

  • LIBRIS-ID:oai:lup.lub.lu.se:33084e6d-68fd-4e09-80aa-d243558a9166
  • https://lup.lub.lu.se/record/33084e6d-68fd-4e09-80aa-d243558a9166URI
  • https://doi.org/10.1001/jamanetworkopen.2022.25614DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-483877URI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:150515347URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:art swepub-publicationtype
  • Subject category:ref swepub-contenttype

Notes

  • IMPORTANCE: The availability of behavior therapy for individuals with Tourette syndrome (TS) and chronic tic disorder (CTD) is limited.OBJECTIVE: To determine the efficacy and cost-effectiveness of internet-delivered exposure and response prevention (ERP) for children and adolescents with TS or CTD.DESIGN, SETTING, AND PARTICIPANTS: This single-masked, parallel group, superiority randomized clinical trial with nationwide recruitment was conducted at a research clinic in Stockholm, Sweden. Out of 615 individuals assessed for eligibility, 221 participants meeting diagnostic criteria for TS or CTD and aged 9 to 17 years were included in the study. Enrollment began in April 2019 and ended in April 2021. Data were analyzed between October 2021 and March 2022.INTERVENTIONS: Participants were randomized to 10 weeks of therapist-supported internet-delivered ERP for tics (111 participants) or to therapist-supported internet-delivered education for tics (comparator group, 110 participants).MAIN OUTCOMES AND MEASURES: The primary outcome was change in tic severity from baseline to the 3-month follow-up as measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS). YGTSS-TTSS assessors were masked to treatment allocation. Treatment response was operationalized as a score of 1 ("Very much improved") or 2 ("Much improved") on the Clinical Global Impression-Improvement scale.RESULTS: Data loss was minimal, with 216 of 221 participants (97.7%) providing primary outcome data. Among randomized participants (152 [68.8%] boys; mean [SD] age, 12.1 [2.3] years), tic severity improved significantly, with a mean reduction of 6.08 points on the YGTSS-TTSS in the ERP group (mean [SD] at baseline, 22.25 [5.60]; at 3-month follow-up, 16.17 [6.82]) and 5.29 in the comparator (mean [SD] at baseline, 23.01 [5.92]; at 3-month follow-up, 17.72 [7.11]). Intention-to-treat analyses showed that the 2 groups improved similarly over time (interaction effect, -0.53; 95% CI, -1.28 to 0.22; P = .17). Significantly more participants were classified as treatment responders in the ERP group (51 of 108 [47.2%]) than in the comparator group (31 of 108 [28.7%]) at the 3-month follow-up (odds ratio, 2.22; 95% CI, 1.27 to 3.90). ERP resulted in more treatment responders at little additional cost compared with structured education. The incremental cost per quality-adjusted life-year gained was below the Swedish willingness-to-pay threshold, at which ERP had a 66% to 76% probability of being cost-effective.CONCLUSIONS AND RELEVANCE: Both interventions were associated with clinically meaningful improvements in tic severity, but ERP led to higher response rates at little additional cost.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03916055.

Subject headings and genre

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  • Holmsved, MoaKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Ringberg, HeleneStockholms läns sjukvårdsområde,Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Wachtmeister, VeraKarolinska Institutet,Stockholms läns sjukvårdsområde (author)
  • Isomura, KayokoKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Aspvall, KristinaKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Lenhard, FabianKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden. (author)
  • Hall, Charlotte L.University of Nottingham,Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Sch Med, Natl Inst Hlth & Care Res MindTech MedTech Cooper, Inst Mental Hlth,Div Psychiat & Appl Psychol, Innovat Pk,Triumph Rd, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res C, Inst Mental Hlth Mental Hlth & Clin Neurosci, Innovat Pk, Nottingham, England. (author)
  • Davies, E. BethanUniversity of Nottingham,Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Sch Med, Natl Inst Hlth & Care Res MindTech MedTech Cooper, Inst Mental Hlth,Div Psychiat & Appl Psychol, Innovat Pk,Triumph Rd, Nottingham, England. (author)
  • Murphy, TaraUniversity College London,UCL, Great Ormond St Inst Child Hlth, London, England.;Great Ormond St Hosp Children Natl Hlth Serv Fdn, Psychol & Mental Hlth Serv, Great Ormond St, London, England. (author)
  • Hollis, ChrisUniversity of Nottingham,Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Sch Med, Natl Inst Hlth & Care Res MindTech MedTech Cooper, Inst Mental Hlth,Div Psychiat & Appl Psychol, Innovat Pk,Triumph Rd, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res C, Inst Mental Hlth Mental Hlth & Clin Neurosci, Innovat Pk, Nottingham, England. (author)
  • Sampaio, Filipa,PhD,1985-Uppsala universitet,Uppsala University,Socialmedicin/CHAP(Swepub:uu)filsa251 (author)
  • Feldman, Inna,Docent,1951-Uppsala universitet,Uppsala University,Socialmedicin/CHAP(Swepub:uu)ife21721 (author)
  • Bottai, MatteoKarolinska Institutet,Karolinska Institute,Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden. (author)
  • Serlachius, EvaKarolinska Institutet,Karolinska Institute,Lund University,Lunds universitet,Barn- och ungdomspsykiatri,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Innovations in pediatric mental health,Forskargrupper vid Lunds universitet,Child and Adolescent Psychiatry,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Lund Univ, Med Fac, Dept Clin Sci, Child & Adolescent Psychiat, Lund, Sweden.(Swepub:lu)ev1305se (author)
  • Andersson, ErikKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Fernández De La Cruz, LorenaKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Mataix-Cols, DavidKarolinska Institutet,Karolinska Institute,Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (author)
  • Karolinska InstituteKarolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden. (creator_code:org_t)

Related titles

  • In:JAMA Network Open: American Medical Association (AMA)5:82574-3805

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