Effects of feedback-assisted treatment on post-treatment outcome for eating disordered inpatients: A follow-up study

Figures & data

Table 1. Simon et al. (2013) sample demographics

	All participants	TAU	Fb
N	133	64	69
Age
M	25.51	25.17	25.83
SD	7.67	6.79	8.44
Range	17–54	18–54	17–48
Gender
Females	133 (100%)	64 (100%)	69 (100%)
Ethnicity
White	123 (92.48%)	58 (90.63%)	65 (94.2%)
Black	2 (1.5%)	1 (1.56%)	1 (1.45%)
Latino	1 (.75%)	1 (1.56%)	0 (0%)
Asian	4 (3.01%)	2 (3.12%)	2 (2.9%)
Mixed	3 (2.26%)	2 (3.12%)	1 (1.45%)
Marital status
Single	94 (70.68%)	44 (68.75%)	50 (72.46%)
Engaged	1 (.75%)	0 (0.0%)	1 (1.45%)
Married	28 (21.05%)	17 (26.56%)	11 (15.94%)
Divorced	8 (6.0%)	3 (4.69%)	5 (7.25%)
Other	2 (1.5%)	0 (0.0%)	2 (2.90%)
Employment
Employed	54 (40.6%)	28 (43.75%)	26 (37.69%)
Unemployed	79 (59.4%)	36 (56.25%)	43 (62.31%)
Duration of disorder (in years)
Mean	10.93	10.44	11.38
SD	7.5	6.63	8.24
Range	1–35	1–35	1–33

Table 2. Current sample demographics

	All participants	TAU	Fb
N	53	27	26
Age
M	30	28.92	32.77
SD	7.71	3.85	10.02
Range	21–53	24–39	21–53
Gender
Females	53 (100%)	27 (100%)	26 (100%)
Ethnicity
White	48 (90.57%)	24 (88.88%)	24 (92.30%)
Black	1 (1.89%)	1 (3.70%)	0 (0.0%)
Latino	1 (1.89%)	1 (3.70%)	0 (0%)
Asian	3 (5.66%)	1 (3.70%)	2 (7.69%)
Mixed	0 (0.0%)	0 (0.0%)	0 (0.0%)
Marital Status
Single	40 (75.47%)	21 (77.77%)	19 (73.08%)
Engaged	0 (0.0%)	0 (0.0%)	0 (0.0%)
Married	3 (5.66%)	1 (3.70%)	2 (7.69%)
Divorced	1 (1.78%)	0 (0.0%)	1 (1.78%)
Other	9 (16.98%)	5 (18.52%)	4 (15.38%)
Employment
Employed	20 (37.74%)	6 (22.22%)	12 (46.15%)
Unemployed	33 (62.26%)	21 (77.77%)	14 (53.84%)
Duration of disorder (in years)
Mean	17.06	15.15	18.96
SD	7.87	4.98	9.69
Range	6–39	7–29	6–39

Figure 1. Mean OQ-45 scores for each treatment group across time excluding outliers.

Table 3. One-way ANCOVA^a

Treatment conditions	Μ^b	SD	F	P
Treatment as usual	−4.19	32.34	.25	.62
Feedback	+3.56	25.25

^a Dependent variable is change between post-treatment and follow-up OQ-45 scores and covariates used were pre-treatment OQ-45 score, restricting behaviors, and group therapy.

^b Mean change in OQ-45 points.

Table 4. Outcome results by treatment group measured by OQ-45 with outliers omitted

	Post	Follow-up	Change	Post to follow-up	Follow-up to follow-up
Feedback group (n = 23)
M	71.35	74.91	+3.56^a
SD	25.79	32.34
d				−0.12^b	−0.15^c
Treatment as usual (n = 26)
M	74.27	70.73	−4.19
SD	20.21	25.25
d				0.16	−0.15^c

^a This number is positive because the feedback group increased their total score.

^b This effect size is reflected as a negative because it means the Fb group’s OQ-45 scores experienced change in a negative direction i.e. they became worse.

^c Comparison between TAU and feedback change scores at follow-up; this effect size comparing both groups at follow-up is negative, which signifies that the TAU group was functioning slightly better at follow-up than Fb group.

Table 5. Percentage of patients meeting clinically significant change, reliable change, reliably worsened, or unchanged criteria on the OQ-45 from pre-treatment to follow-up

Outcome classification	Treatment as usual n (%)	Feedback n (%)
Reliably worsened^a	2 (7)	3 (12)
Unchanged^b	6 (22)	5 (22)
Reliably improved^c	9 (33)	8 (35)
Clinically significant change (recovered)^d	9 (35)	7 (30)

^a Worsened by at least 14 points on the OQ-45 from pre-treatment to follow-up.

^b Improved less than 14 points or worsened by less than 14 points on the OQ-45.

^c Improved by at least 14 points on the OQ-45 but did not pass the cut-off between dysfunctional and functional populations.

^d Improved by at least 14 points on the OQ-45 and passed the cut-off between dysfunctional and functional populations; TAU N = 26; Feedback N = 23 (excluded outliers).

Table 6. Percentage of patients meeting clinically significant change, reliable change, reliably worsened, or unchanged criteria on the OQ-45 from post-treatment to follow-up

Outcome classification	Treatment as usual n (%)	Feedback n (%)
Reliably worsened^a	7 (27)	9 (39)
Unchanged^b	9 (35)	5 (22)
Reliably improved^c	2 (8)	3 (13)
Clinically significant change (recovered)^d	8 (31)	6 (26)

^a Worsened by at least 14 points on the OQ-45 from pre-treatment to follow-up.

^b Improved less than 14 points or worsened by less than 14 points on the OQ-45.

^c Improved by at least 14 points on the OQ-45 but did not pass the cut-off between dysfunctional and functional populations.

^d Improved by at least 14 points on the OQ-45 and passed the cut-off between dysfunctional and functional populations; TAU N = 26; Feedback N = 23 (excluded outliers).

Table 7. Movement toward normal BMI category from pre-treatment to post-treatment

	ALL^a	AN^b	BN^c	EDNOS^d
Started outside normal
TAU & Fb	31/53 (58.5)	22/31 (70.9)	4/31 (12.9)	5/31 (16.1)
TAU	14/31 (45.2)	10/14 (71.4)	2/14 (14.3)	2/14 (14.3)
Fb	17/31 (54.8)	12/17 (70.6)	2/17 (11.8)	3/17 (17.6)
Moved toward normal
TAU & Fb	28/31 (90.3)	22/22 (100)	4/4 (100)	2/5 (40)
TAU	13/14 (92.9)	10/10 (100)	2/2 (100)	1/2 (50)
Fb	15/17 (88.2)	12/12 (100)	2/2 (100)	1/3 (33.3)
Reached normal
TAU & Fb	27/31 (87.1)	21/22 (95.5)	4/4 (100)	2/5 (40)
TAU	13/14 (92.9)	10/10 (100)	2/2 (100)	1/2 (50)
Fb	14/17 (82.4)	11/12 (91.7)	2/2 (100)	1/3 (33.3)

^a ALL, all participants.

^b AN, anorexia nervosa.

^c BN, bulimia.

^d EDNOS, eating disorder not otherwise specified.

Table 8. Movement toward normal BMI category from pre-treatment to follow-up

	ALL^a	AN^b	BN^c	EDNOS^d
Started outside normal
TAU & Fb	31/53 (58.5)	22/31 (70.9)	4/31 (12.9)	5/31 (16.1)
TAU	14/31 (45.2)	10/14 (71.4)	2/14 (14.3)	2/14 (14.3)
Fb	17/31 (54.8)	12/17 (70.6)	2/17 (11.8)	3/17 (17.6)
Moved toward normal
TAU & Fb	17/25 (68)	15/18 (83.3)	1/3 (33.3)	1/4 (25)
TAU	7/12 (58.3)	6/8 (75)	1/2 (50)	0/2 (0)
Fb	10/13 (76.9)	9/10 (90)	0/1 (0)	1/2 (50)
Reached normal
TAU & Fb	12/31 (38.7)	10/22 (45.5)	1/4 (25)	1/5 (20)
TAU	7/14 (50)	6/10 (60)	1/2 (50)	0/2 (0)
Fb	5/17 (29.4)	4/12 (33.3)	0/2 (0)	1/3 (33.3)

^a ALL, all participants.

^b AN, anorexia nervosa.

^c BN, bulimia.

^d EDNOS, eating disorder not otherwise specified.

Table 9. Movement toward normal BMI category from post-treatment to follow-up

	ALL^a	AN^b	BN^c	EDNOS^d
Normal at post-treatment
TAU & Fb	36/42 (85.7)	17/18 (94.4)	14/15 (93.3)	5/9 (55.5)
TAU	19/21 (90.5)	8/8 (100)	9/9 (100)	2/4 (50)
Fb	17/21 (80.9)	9/10 (90)	5/6 (83.3)	3/5 (60)
Deteriorated at follow-up
TAU & Fb	14/42 (33.3)	7/18 (38.9)	3/15 (20)	4/9 (44.4)
TAU	6/21 (28.6)	2/8 (25)	1/9 (11.1)	3/4 (75)
Fb	8/21 (38.1)	5/10 (50)	2/6 (33.3)	1/5 (20)
Improved at follow-up
TAU & Fb	2/42 (4.8)	0/18 (0)	0/15 (0)	2/9 (22.2)
TAU	1/21 (4.8)	0/8 (0)	0/9 (0)	1/4 (25)
Fb	1/21 (4.8)	0/10 (0)	0/6 (0)	1/5 (20)
Maintained BMI
TAU & Fb	26/42 (61.9)	11/18 (61.1)	12/15 (80)	3/9 (33.3)
TAU	14/21 (66.7)	6/8 (75)	8/9 (88.9)	0/4 (0)
Fb	12/21 (57.1)	5/10 (50)	4/6 (66.7)	3/5 (60)

^a ALL, all participants.

^b AN, anorexia nervosa.

^c BN, bulimia.

^d EDNOS, eating disorder not otherwise specified.

Table 10. Percentage of eating disordered behavior across treatment conditions

Endorsement rating	Bingeing (%)	Purging (%)	Restricting (%)	Laxatives (%)
0 (Never)	32 (60.4)	29 (54.7)	12 (22.6)	47 (88.7)
1 (Rarely)	9 (16.9)	9 (16.9)	12 (22.6)	1 (1.8)
2 (Once per week)	6 (11.3)	4 (7.5)	8 (15.1)	0
3 (Several times per week)	4 (7.5)	6 (11.3)	13 (24.5)	2 (3.7)
4 (Several times per day)	2 (3.8)	5 (9.4)	9 (16.9)	3 (5.7)

Table 11. OQ-45 and eating behavior frequencies

Outcome classification	Frequency of eating behavior
	0^a	1^b	2^c	3^d	4^e	Total
Reliably worsened^f	3 (6%)	3 (6%)	0 (0%)	8 (15%)	6 (11%)	20 (38%)
Unchanged^g	2 (4%)	2 (4%)	4 (8%)	2 (4%)	6 (11%)	16 (30%)
Reliably improved^h	0 (0%)	1 (2%)	0 (0%)	1 (2%)	1 (2%)	3 (6%)
Recovered^i	5 (9%)	5 (9%)	4 (8%)	0 (0%)	0 (0%)	14 (26%)
Total	10 (19%)	11 (21%)	8 (15%)	11 (21%)	13 (25%)	53 (100%)

^a Never.

^b Rarely.

^c Once per week.

^d Several times per week.

^e Several times per day.

^f Worsened by at least 14 points on the OQ-45 from pre-treatment to follow-up.

^g Improved less than 14 points or worsened by less than 14 points on the OQ-45.

^h Improved by at least 14 points on the OQ-45 but did not pass the cut-off between dysfunctional and functional populations.

ⁱ Improved by at least 14 points on the OQ-45 and passed the cut-off between dysfunctional and functional populations.

Table 12. OQ-45 and eating behavior chi-square analysis

Statistic	DF	Value	Probability
Chi-square	12	24.05	0.02
Likelihood ratio chi-square	12	32.44	0.00
Mantel-Haenszel Chi-Square	1	5.92	0.02
Phi Coefficient		0.67
Contingency Coefficient		0.55
Cramer’s V		0.39

Table 13. OQ-45 and BMI classification frequency

BMI classification	OQ-45 classification
	Clinical 1^a	Clinical 2^b	Normal 1^c	Normal 2^d	Total
Extreme^e	0 (0%)	4 (10%)	1 (2%)	0 (0%)	5 (12%)
Moderate^f	2 (5%)	4 (10%)	1 (2%)	1 (2%)	8 (19%)
Normal^g	3 (7%)	8 (19%)	7 (17%)	8 (19%)	26 (62%)
Severe^h	3 (7%)	0 (0%)	0 (0%)	0 (0%)	3 (7%)
Total	8 (19%)	16 (38%)	9 (21%)	9 (21%)	42 (100%)

^a OQ-45 scores from 64 to 77.

^b OQ-45 scores of 78 and above.

^c OQ-45 scores from 50 to 63.

^d OQ-45 scores of 49 or below.

^e Extreme classification includes BMI categories of starvation, obese class III, and obese class II.

^f Moderate classification includes BMI categories of underweight and overweight.

^g Normal classification includes the BMI category of normal.

^h Severe classification includes BMI classifications of severely underweight and obese class I.

Table 14. OQ-45 and BMI classification chi-square analysis

Statistic	DF	Value	Probability
Chi-square	9	20.69	0.01
Likelihood ratio chi-square	9	19.41	0.02
Mantel-Haenszel chi-square	1	0.02	0.88
Phi coefficient		0.70
Contingency coefficient		0.57
Cramer’s V		0.40

Table 15. OQ-45 and BMI change frequency

OQ-45 change	BMI change
	Improved	No change	Worsened	Total
Unchanged	1 (2%)	8 (19%)	3 (7%)	12 (29%)
Reliable worsening	1 (2%)	6 (14%)	8 (19%)	15 (36%)
Reliable improvement	0 (0%)	12 (29%)	3 (7%)	15 (36%)
Total	2 (5%)	26 (62%)	14 (33%)	42 (100%)

Table 16. OQ-45 and BMI change chi-square analysis

Statistic	DF	Value	Probability
Chi-square	4	6.0	0.19
Likelihood ratio chi-square	4	6.62	0.16
Mantel-Haenszel chi-square	1	0.002	0.96
Phi coefficient		0.38
Contingency coefficient		0.35
Cramer’s V		0.27

Table 17. Mean distress levels and standard errors based on number of contacts

Number of contacts	n (%)	Mean follow-up OQ-45 score	Standard error
1	38 (71.7)	67.9	4.1
2	6 (11.3)	62.0	10.2
3	9 (16.9)	88.7	8.3

Simon, W., Lambert, M. J., Busath, G., Vazquez, A., Berkeljon, A., Hyer, K., … Berrett, M. (2013). Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: A randomized controlled study. Psychotherapy Research, 23, 287–300. doi:10.1080/10503307.2013.787497

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