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

Autor:	Andrén P; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Holmsved M; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Ringberg H; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Wachtmeister V; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Isomura K; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Aspvall K; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Lenhard F; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden., Hall CL; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.; National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom.; National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom., Davies EB; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.; National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom., Murphy T; Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.; Psychological and Mental Health Services, Great Ormond Street Hospital for Children National Health Service Foundation Trust, Great Ormond Street, London, United Kingdom., Hollis C; Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.; National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Innovation Park, Triumph Road, Nottingham, United Kingdom.; National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Innovation Park, Nottingham, United Kingdom., Sampaio F; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden., Feldman I; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden., Bottai M; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Serlachius E; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Child and Adolescent Psychiatry, Department of Clinical Sciences, Medical Faculty, Lund University, Lund, Sweden., Andersson E; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Fernández de la Cruz L; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden., Mataix-Cols D; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Aug 01; Vol. 5 (8), pp. e2225614. Date of Electronic Publication: 2022 Aug 01.
DOI:	10.1001/jamanetworkopen.2022.25614
Abstrakt:	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.
Databáze:	MEDLINE
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