目的:COVID-19大流行对心理健康产生了有害影响。关于对饮食失调个体的影响的文献正在慢慢出现。虽然加拿大的门诊饮食失调服务试图过渡到虚拟护理,缺乏与该领域最佳虚拟护理相关的指南。因此,我们的加拿大共识小组的目标是制定与为儿童提供虚拟护理有关的临床实践指南,青少年,和患有饮食失调的新兴成年人,以及他们的照顾者,在COVID-19大流行期间及以后。
方法:使用范围审查方法(从2000年到2020年,数据库中的文献和从2010年到2020年的灰色文献),建议的分级,评估,发展,和评估系统,准则的评估,研究和评估工具,以及一个由来自加拿大各地的不同利益相关者组成的小组,我们制定了高质量的治疗指南,专注于对儿童的虚拟干预,青少年,和新兴的成年人有饮食失调,和他们的照顾者。
结果:强烈的建议得到了特别支持,以便在必要时对儿童进行当面医学评估,青少年,和新兴的成年人,寻求公平的群体和边缘化的青年应获得平等的待遇。对于儿童和青少年,对远程保健家庭式治疗(FBT)和在线指导的父母自助FBT的建议薄弱。对于新兴的成年人来说,强烈建议使用基于网络认知行为治疗(CBT)的指导自助。对新兴成年人的弱建议包括基于CBT的团体互联网干预作为治疗辅助手段,基于互联网的复发预防Maudsley成人神经性厌食症治疗模型(MANTRA)指导自助,使用MANTRA预防远程医疗复发,并指导基于CBT的智能手机应用程序作为治疗辅助手段。对于儿童和青少年的照顾者,对虚拟家长餐支持培训的建议较弱,并主持在线护理人员论坛和支持小组。对于新兴成年人的照顾者来说,有指导的父母自助CBT强烈建议,和无指导的照顾者的心理教育自助是弱的建议。
结论:确定了未来工作的几个差距,包括性别的影响,性别,种族,以及儿童虚拟照料的社会经济地位,青少年,和新兴的成年人有饮食失调,以及对更密集服务的研究,比如虚拟日间医院。
OBJECTIVE: The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care,
guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian
Consensus Panel was to develop clinical practice
guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond.
METHODS: Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of
Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment
guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers.
RESULTS: Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended.
CONCLUSIONS: Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.