Long-term clinical and cost-effectiveness of a therapist-supported online remote behavioural intervention for tics in children and adolescents: extended 12-and 18-month follow-up of a single-blind randomised controlled trial

被引：11

作者：

Hollis, Chris ^{[1
,2
,3
,4
]}

Hall, Charlotte L. ^{[1
,2
,3
]}

Khan, Kareem ^{[1
,3
]}

Jones, Rebecca ^{[5
]}

Marston, Louise ^{[6
]}

Le Novere, Marie ^{[6
]}

Hunter, Rachael ^{[6
]}

Andren, Per ^{[7
,8
]}

Bennett, Sophie D.

Brown, Beverley J. ^{[1
]}

Chamberlain, Liam R. ^{[1
]}

Davies, E. Bethan ^{[1
,3
]}

Evans, Amber ^{[9
,10
]}

Kouzoupi, Natalia ^{[9
,10
]}

McKenzie, Caitlin ^{[1
]}

Sanderson, Charlotte ^{[9
,10
]}

Heyman, Isobel ^{[9
,10
]}

Kilgariff, Joseph ^{[4
]}

Glazebrook, Cristine ^{[3
]}

Mataix-Cols, David ^{[7
,8
]}

Serlachius, Eva ^{[7
,8
]}

Murray, Elizabeth ^{[6
]}

Murphy, Tara ^{[9
,10
]}

机构：

[1] Univ Nottingham, Inst Mental Hlth, Sch Med, NIHR MindTech MedTech Cooperat, Nottingham, England

[2] Univ Nottingham, Inst Mental Hlth, NIHR Nottingham Biomed Res Ctr, Nottingham, England

[3] Univ Nottingham, Queens Med Ctr, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England

[4] Nottinghamshire Healthcare NHS Fdn Trust, Queens Med Ctr, Dept Child & Adolescent Psychiat, South Block,Level E, Nottingham, England

[5] UCL, Div Psychiat & Priment CTU, London, England

[6] UCL, Res Dept Primary Care & Populat Hlth & Priment CTU, London, England

[7] Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden

[8] Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden

[9] UCL Great Ormond St Inst Child Hlth ICH, London, England

[10] Great Ormond St Hosp Children NHS Fdn Trust, Psychol & Mental Hlth Serv, London, England

来源：

JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY | 2023年 / 64卷 / 06期

关键词：

Tic disorders; randomised controlled trial; long-term follow-up; exposure and response prevention; digital intervention; QUALITY-OF-LIFE; TOURETTE; QUESTIONNAIRE; SEVERITY; SCALE;

D O I：

10.1111/jcpp.13756

中图分类号：

B844 [发展心理学（人类心理学）];

学科分类号：

040202 ;

摘要：

BackgroundLittle is known about the long-term effectiveness of behavioural therapy for tics. We aimed to assess the long-term clinical and cost-effectiveness of online therapist-supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation. MethodsORBIT (online remote behavioural intervention for tics) was a two-arm (1:1 ratio), superiority, single-blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self-referral. This study was a naturalistic follow-up of participants at 12- and 18-month postrandomisation. Participants were permitted to use alternative treatments recommended by their clinician. The key outcome was the Yale Global Tic Severity Scale Total Tic Severity Score (YGTSS-TTSS). A full economic evaluation was conducted. Registrations are ISRCTN (ISRCTN70758207); (NCT03483493). ResultsTwo hundred and twenty-four participants were enrolled: 112 to ERP and 112 to psychoeducation. The sample was predominately male (177; 79%) and of white ethnicity (195; 87%). The ERP intervention reduced baseline YGTSS-TTSS by 2.64 points (95% CI: -4.48 to -0.79) with an effect size of -0.36 (95% CI: -0.61 to -0.11) after 12 months and by 2.01 points (95% CI: -3.86 to -0.15) with an effect size of -0.27 (95% CI -0.52 to -0.02) after 18 months, compared with psychoeducation. Very few participants (<10%) started new tic treatment during follow-up. The cost difference in ERP compared with psychoeducation was 304.94 pound (-139.41 to 749.29). At 18 months, the cost per QALY gained was 16,708 pound for ERP compared with psychoeducation. ConclusionsRemotely delivered online ERP is a clinical and cost-effective intervention with durable benefits extending for up to 18 months. This represents an efficient public mental health approach to increase access to behavioural therapy and improve outcomes for tics.

引用

页码：941 / 951

页数：11

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