NIHR MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
NIHR Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, UK.
J Child Psychol Psychiatry. 2023 Jun;64(6):941-951. doi: 10.1111/jcpp.13756. Epub 2023 Jan 17.
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.
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).
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.
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.
对于抽动症的行为疗法的长期疗效知之甚少。我们旨在评估在线治疗师支持的暴露和反应预防（ERP）疗法在治疗开始后 12 个月和 18 个月时对抽动症的长期临床和成本效益。
ORBIT（在线远程行为干预抽动症）是一项两臂（1:1 比例）、优效性、单盲、多中心随机对照试验，比较了在线 ERP 治疗抽动症与在线心理教育。该试验在英格兰的两个儿童和青少年心理健康服务中心进行。参与者是从这两个地点招募的，也从英格兰的其他诊所或自我推荐招募的。本研究是参与者在随机分组后 12-18 个月的自然随访。参与者可以使用其临床医生推荐的替代疗法。主要结局是耶鲁总体抽动严重程度量表总抽动严重程度评分（YGTSS-TTSS）。进行了全面的经济评估。注册信息为 ISRCTN（ISRCTN70758207）；ClinicalTrials.gov（NCT03483493）。
共有 224 名参与者入组：112 名接受 ERP 治疗，112 名接受心理教育。样本主要为男性（177；79%）和白人（195；87%）。ERP 干预将基线 YGTSS-TTSS 降低了 2.64 分（95%CI：-4.48 至-0.79），效应量为-0.36（95%CI：-0.61 至-0.11），12 个月后，ERP 干预将基线 YGTSS-TTSS 降低了 2.01 分（95%CI：-3.86 至-0.15），效应量为-0.27（95%CI：-0.52 至-0.02），与心理教育相比。在随访期间，很少有参与者（<10%）开始新的抽动治疗。与心理教育相比，ERP 的成本差异为 304.94 英镑（-139.41 至 749.29）。在 18 个月时，ERP 治疗的每增加一个质量调整生命年的成本为 16708 英镑，而心理教育为 16708 英镑。
远程提供的在线 ERP 是一种具有临床和成本效益的干预措施，其益处可持续长达 18 个月。这代表了一种有效的公共精神卫生方法，可以增加对行为疗法的获取，并改善抽动症的治疗效果。
