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 / Chris HOLLIS in Journal of Child Psychology and Psychiatry, 64-6 (June 2023)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 64-6 (June 2023) . - p.941-951 Titre : 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 Type de document : Texte imprimé et/ou numérique Auteurs : Chris HOLLIS, Auteur ; Charlotte L. HALL, Auteur ; Kareem KHAN, Auteur ; Rebecca JONES, Auteur ; Louise MARSTON, Auteur ; Marie LE NOVERE, Auteur ; Rachael HUNTER, Auteur ; Per ANDRÉN, Auteur ; Sophie D. BENNETT, Auteur ; Beverley J. BROWN, Auteur ; Liam R. CHAMBERLAIN, Auteur ; E. Bethan DAVIES, Auteur ; Amber EVANS, Auteur ; Natalia KOUZOUPI, Auteur ; Caitlin MCKENZIE, Auteur ; Charlotte SANDERSON, Auteur ; Isobel HEYMAN, Auteur ; Joseph KILGARIFF, Auteur ; Cristine GLAZEBROOK, Auteur ; David MATAIX-COLS, Auteur ; Eva SERLACHIUS, Auteur ; Elizabeth MURRAY, Auteur ; Tara MURPHY, Auteur Article en page(s) : p.941-951 Langues : Anglais (eng) Index. décimale : PER Périodiques Résumé : Background Little 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. Methods ORBIT (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); ClinicalTrials.gov (NCT03483493). Results Two 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 (?139.41 to 749.29). At 18?months, the cost per QALY gained was £16,708 for ERP compared with psychoeducation. Conclusions Remotely 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. En ligne : http://dx.doi.org/https://doi.org/10.1111/jcpp.13756 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=504 [article] 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 [Texte imprimé et/ou numérique] / Chris HOLLIS, Auteur ; Charlotte L. HALL, Auteur ; Kareem KHAN, Auteur ; Rebecca JONES, Auteur ; Louise MARSTON, Auteur ; Marie LE NOVERE, Auteur ; Rachael HUNTER, Auteur ; Per ANDRÉN, Auteur ; Sophie D. BENNETT, Auteur ; Beverley J. BROWN, Auteur ; Liam R. CHAMBERLAIN, Auteur ; E. Bethan DAVIES, Auteur ; Amber EVANS, Auteur ; Natalia KOUZOUPI, Auteur ; Caitlin MCKENZIE, Auteur ; Charlotte SANDERSON, Auteur ; Isobel HEYMAN, Auteur ; Joseph KILGARIFF, Auteur ; Cristine GLAZEBROOK, Auteur ; David MATAIX-COLS, Auteur ; Eva SERLACHIUS, Auteur ; Elizabeth MURRAY, Auteur ; Tara MURPHY, Auteur . - p.941-951. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 64-6 (June 2023) . - p.941-951 Index. décimale : PER Périodiques Résumé : Background Little 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. Methods ORBIT (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); ClinicalTrials.gov (NCT03483493). Results Two 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 (?139.41 to 749.29). At 18?months, the cost per QALY gained was £16,708 for ERP compared with psychoeducation. Conclusions Remotely 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. En ligne : http://dx.doi.org/https://doi.org/10.1111/jcpp.13756 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=504

Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review / Craig WHITTINGTON in Journal of Child Psychology and Psychiatry, 57-9 (September 2016)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 57-9 (September 2016) . - p.988-1004 Titre : Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review Type de document : Texte imprimé et/ou numérique Auteurs : Craig WHITTINGTON, Auteur ; Mary PENNANT, Auteur ; Tim KENDALL, Auteur ; Cristine GLAZEBROOK, Auteur ; Penny TRAYNER, Auteur ; Madeleine GROOM, Auteur ; Tammy HEDDERLY, Auteur ; Isobel HEYMAN, Auteur ; Georgina JACKSON, Auteur ; Stephen JACKSON, Auteur ; Tara MURPHY, Auteur ; Hugh RICKARDS, Auteur ; Mary ROBERTSON, Auteur ; Jeremy STERN, Auteur ; Chris HOLLIS, Auteur Article en page(s) : p.988-1004 Langues : Anglais (eng) Mots-clés : Paediatrics  Tourette syndrome  therapy  tics Index. décimale : PER Périodiques Résumé : Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of ?2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = ?0.71; 95% CI ?1.03, ?0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = ?0.64; 95% CI ?0.99, ?0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = ?0.54; 95% CI ?0.92, ?0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = ?0.74; 95% CI ?1.08, ?0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours ?2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when ?2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments. En ligne : http://dx.doi.org/10.1111/jcpp.12556 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=292 [article] Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review [Texte imprimé et/ou numérique] / Craig WHITTINGTON, Auteur ; Mary PENNANT, Auteur ; Tim KENDALL, Auteur ; Cristine GLAZEBROOK, Auteur ; Penny TRAYNER, Auteur ; Madeleine GROOM, Auteur ; Tammy HEDDERLY, Auteur ; Isobel HEYMAN, Auteur ; Georgina JACKSON, Auteur ; Stephen JACKSON, Auteur ; Tara MURPHY, Auteur ; Hugh RICKARDS, Auteur ; Mary ROBERTSON, Auteur ; Jeremy STERN, Auteur ; Chris HOLLIS, Auteur . - p.988-1004. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 57-9 (September 2016) . - p.988-1004 Mots-clés : Paediatrics  Tourette syndrome  therapy  tics Index. décimale : PER Périodiques Résumé : Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of ?2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = ?0.71; 95% CI ?1.03, ?0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = ?0.64; 95% CI ?0.99, ?0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = ?0.54; 95% CI ?0.92, ?0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = ?0.74; 95% CI ?1.08, ?0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours ?2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when ?2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments. En ligne : http://dx.doi.org/10.1111/jcpp.12556 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=292

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