Table 1 Characteristics of studies...

Table 1

Characteristics of studies included in mixed methods systematic review of text-based telehealth interventions in eating disorder management, January 2000–May 2021

Author, year	Country	Study design	OTIs type	OTIs use	Diagnosis	ED-relevant measures	Treatment phase	Sample size	Results
Robinson and Serfaty, 2001 [49]	UK	Single-arm trial	Email	Stand-alone	BN, BED, EDNOS	BITE BDI	Treatment; email therapy	23	There was a significant reduction in scores of depression, of bulimic symptoms and severity (paired t-test, p < 0.05)
Yager 2001 [52]	USA	Case report	Email	Adjunct	AN	Not mentioned	Treatment; contact, monitor	4 cases	There was reasonably good biopsychosocial recovery, including significant improvements in weight gain, eating a wider variety of food and reduction of sleepiness, sluggishness and confusion
Bauer et al., 2003 [55]	Germany	Single-arm trial	Text-messaging	Stand-alone	BN	Informal short evaluation questionnaires	Aftercare; symptom report and tailored feedback	30	There was relief from BN-related symptoms. However, the body satisfaction of one patient remained low
Yager 2003 [53]	USA	Case report	Email	Adjunct	AN	Not mentioned	Treatment; food record, communication	3 cases	There was an increase in frequency and amount of contact between patients and clinicians and email assisted face-to-face sessions
Robinson et al., 2006 [58]	UK	Single-arm trial	Text-messaging	Stand-alone	BN	SEED	Aftercare; symptom report and tailored feedback	21	There was no significant symptom change in terms of the bulimic symptoms
Robinson and Serfaty 2008 [46]	UK	RCT eBT, SDW v.s. waiting list control	Email	Stand-alone	BN, BED, EDNOS	QEDD BDI BITE	Treatment; email bulimia therapy, self-directed writing	97	Email was significantly superior to waiting list control on scores of QEDD (p < 0.05). However, depression and bulimia symptoms on scores of BDI and BITE showed no significant change
Shapiro et al., 2010 [57]	USA	Single-arm trial	Text-messaging	Stand-alone	BN	SCID eating disorders Modules EDI Binge-Purge questionnaire NEQ BDI	Aftercare; symptom report and tailored feedback	31	There were significant reductions on scores of BDI, EDI and NEQ at both post-treatment (week 12; p < 0.05) and follow-up (week 24; p < 0.05)
Gulec et al., 2011 [59]	Germany	Single-arm trial	Email & online chat group & online individual chat	Adjunct	BN, EDNOS	Not mentioned	Aftercare; monitor and feedback	22	^an/a
Bauer et al., 2012 [56]	Germany	RCT Text-messaging v.s. TAU	Text-messaging	Stand-alone	BN, EDNOS	LIFE with an extended session on eating disorders PSRs	Aftercare; symptom report and tailored feedback	165	There was a significant difference in remission rates in both the intent-to-treat analysis (p = 0.05) and the completer analysis (p = 0.06). Remission rates between the intervention and control groups were not significantly different among patients who used outpatient treatment (p = 0.51). For participants who utilized outpatient treatment, the intervention group had a higher remission rate as compared with the control group (p = 0.046)
Moessner and Bauer 2012 [54]	Germany	Descriptive study	Email	Stand-alone	EDs	A set of online questionnaires, which assessed satisfaction, acceptance and service utilization; SEED	Treatment; counseling via email	238	Among patients who were utilizing other forms of service, 39% indicated that they would never engage in additional care without this online counseling service. Thus, it was concluded that online service facilitated access to routine care for underserved individuals
ter Huurne et al., 2013 [50]	Netherlands	Single-arm trial	Webpage	Stand-alone	EDNOS; BN purging BN nonpurging	EDE- BAT MAP-HSS DASS-21 EQ-5D VAS DSM-IV-TR	Treatment Asynchronous and intensive personalized communication between the patient and the therapist	165	Eating disorder psychopathology significantly improved (p < .001); significant improvements in body dissatisfaction, quality of life, mental and physical health. Almost all treatment effects were sustained at the 6-week and 6-month follow-up measurements
Gulec et al., 2014 [60]	Hungary	RCT EDINA v.s. WLC	Online chat group &email	Adjunct	BN or related EDNOS	EDE-Q DASS-21	Aftercare; group chat sessions; symptom-monitoring; feedback	95	There was a statistically significant main effect of time on EDE-Q score (F = 15.814, p < 0.001). None of the time×group interactions reached significance with regard to the DASS-21 scores
Shingleton et al., 2016 [51]	USA	Single-case alternating treatment design	Text-messaging	Adjunct	An, BN	EDE SCID-I RMQ EDE-Q Daily food records Medical Safety Questions	Treatment; daily reminder, symptom and food report, feedback	12	Text-messaging did not impact eating behaviors. Text messages had mixed effects on motivation to change dietary restraint. The effects were moderated by weight status
Wagner et al., 2016 [47]	Germany	RCT Webpage v.s. waiting list control	Webpage	Adjunct to an online self-help program	BED	EDE-Q BDI SCL-90-R, anxiety subscale	Treatment; counseling via text	139	The treatment group had significantly reduced symptoms of all eating psychopathology outcomes relative to those on the waiting list (p < 0.001). This reduction was sustained one year after treatment
Zerwas et al., 2017 [48]	USA	RCT OTIs v.s. face-to-face	Online chat group	Adjunct	BN	EDE SCID-I/P BDI BAI EDQOL SF-6D	Treatment	179	The percentage of abstinent participants increased in both groups. At the end of treatment, CBT4BN was inferior to CBTF2F. However, by the 12-month follow-up, CBT4BN was no longer inferior

Author, year	Country	Study design	OTIs type	OTIs use	Diagnosis	ED-relevant measures	Treatment phase	Sample size	Results
Robinson and Serfaty, 2001 [49]	UK	Single-arm trial	Email	Stand-alone	BN, BED, EDNOS	BITEBDI	Treatment; email therapy	23	There was a significant reduction in scores of depression, of bulimic symptoms and severity (paired t-test, p < 0.05)
Yager2001 [52]	USA	Case report	Email	Adjunct	AN	Not mentioned	Treatment; contact, monitor	4 cases	There was reasonably good biopsychosocial recovery, including significant improvements in weight gain, eating a wider variety of food and reduction of sleepiness, sluggishness and confusion
Bauer et al.,2003 [55]	Germany	Single-arm trial	Text-messaging	Stand-alone	BN	Informal short evaluation questionnaires	Aftercare; symptom report and tailored feedback	30	There was relief from BN-related symptoms. However, the body satisfaction of one patient remained low
Yager2003 [53]	USA	Case report	Email	Adjunct	AN	Not mentioned	Treatment; food record, communication	3 cases	There was an increase in frequency and amount of contact between patients and clinicians and email assisted face-to-face sessions
Robinson et al.,2006 [58]	UK	Single-arm trial	Text-messaging	Stand-alone	BN	SEED	Aftercare; symptom report and tailored feedback	21	There was no significant symptom change in terms of the bulimic symptoms
Robinson and Serfaty 2008 [46]	UK	RCTeBT, SDW v.s. waiting list control	Email	Stand-alone	BN, BED, EDNOS	QEDDBDIBITE	Treatment; email bulimia therapy, self-directed writing	97	Email was significantly superior to waiting list control on scores of QEDD (p < 0.05). However, depression and bulimia symptoms on scores of BDI and BITE showed no significant change
Shapiro et al.,2010 [57]	USA	Single-arm trial	Text-messaging	Stand-alone	BN	SCID eating disorders ModulesEDIBinge-Purge questionnaireNEQBDI	Aftercare; symptom report and tailored feedback	31	There were significant reductions on scores of BDI, EDI and NEQ at both post-treatment (week 12; p < 0.05) and follow-up (week 24; p < 0.05)
Gulec et al.,2011 [59]	Germany	Single-arm trial	Email & online chat group & online individual chat	Adjunct	BN, EDNOS	Not mentioned	Aftercare; monitor and feedback	22	^an/a
Bauer et al.,2012 [56]	Germany	RCTText-messaging v.s. TAU	Text-messaging	Stand-alone	BN, EDNOS	LIFE with an extended session on eating disordersPSRs	Aftercare; symptom report and tailored feedback	165	There was a significant difference in remission rates in both the intent-to-treat analysis (p = 0.05) and the completer analysis (p = 0.06). Remission rates between the intervention and control groups were not significantly different among patients who used outpatient treatment (p = 0.51). For participants who utilized outpatient treatment, the intervention group had a higher remission rate as compared with the control group (p = 0.046)
Moessner and Bauer2012 [54]	Germany	Descriptive study	Email	Stand-alone	EDs	A set of online questionnaires, which assessed satisfaction, acceptance and service utilization; SEED	Treatment; counseling via email	238	Among patients who were utilizing other forms of service, 39% indicated that they would never engage in additional care without this online counseling service. Thus, it was concluded that online service facilitated access to routine care for underserved individuals
ter Huurne et al.,2013 [50]	Netherlands	Single-arm trial	Webpage	Stand-alone	EDNOS; BN purgingBN nonpurging	EDE-BATMAP-HSSDASS-21EQ-5D VASDSM-IV-TR	TreatmentAsynchronous and intensive personalized communication between the patient and the therapist	165	Eating disorder psychopathology significantly improved (p < .001); significant improvements in body dissatisfaction, quality of life, mental and physical health. Almost all treatment effects were sustained at the 6-week and 6-month follow-up measurements
Gulec et al.,2014 [60]	Hungary	RCTEDINA v.s. WLC	Online chat group &email	Adjunct	BN or related EDNOS	EDE-QDASS-21	Aftercare; group chat sessions; symptom-monitoring; feedback	95	There was a statistically significant main effect of time on EDE-Q score (F = 15.814, p < 0.001). None of the time×group interactions reached significance with regard to the DASS-21 scores
Shingleton et al.,2016 [51]	USA	Single-case alternating treatment design	Text-messaging	Adjunct	An, BN	EDESCID-IRMQEDE-QDaily food recordsMedical Safety Questions	Treatment; daily reminder, symptom and food report, feedback	12	Text-messaging did not impact eating behaviors. Text messages had mixed effects on motivation to change dietary restraint. The effects were moderated by weight status
Wagner et al.,2016 [47]	Germany	RCTWebpage v.s. waiting list control	Webpage	Adjunct to an online self-help program	BED	EDE-QBDISCL-90-R, anxiety subscale	Treatment; counseling via text	139	The treatment group had significantly reduced symptoms of all eating psychopathology outcomes relative to those on the waiting list (p < 0.001). This reduction was sustained one year after treatment
Zerwas et al.,2017 [48]	USA	RCTOTIs v.s. face-to-face	Online chat group	Adjunct	BN	EDESCID-I/PBDIBAIEDQOLSF-6D	Treatment	179	The percentage of abstinent participants increased in both groups. At the end of treatment, CBT4BN was inferior to CBTF2F. However, by the 12-month follow-up, CBT4BN was no longer inferior

^aNote(s): This was a feasibility and acceptability study. Hence, no effectiveness was examined; Abbreviations: AN = Anorexia Nervosa; BN = Bulimia Nervosa; BED = Binge Eating Disorder; EDs = Eating Disorders; EDNOS = Eating Disorder Not Otherwise Specified; RCT = Randomized Control Trial; OTIs = Online Text-based Interventions; BITE = Bulimia Investigatory Test Edinburgh; BDI = Beck Depression Inventory; SEED = Short Evaluation of Eating Disorders; QEDD = Diagnosis of eating disorder on the questionnaire for eating disorders; SCID = Structured Clinical Interview for DSM-IV; EDI = Eating Disorders Inventory-II; NEQ = Night Eating Questionnaire; LIFE = Longitudinal Interval Follow-Up Evaluation; PSRs = Psychiatric status ratings; EDE = Eating Disorder Examination; BAT = Body Attitude Test; MAP-HSS = Maudsley Additional Profile Health Symptom Scale; DASS-21 = Depression Anxiety Stress Scale-21 items; EQ-5D VAS = EuroQol- 5 Dimension;DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders; EDE-Q = Eating Disorder Examination Questionnaire; RMQ = Readiness and Motivation Questionnaire; SCL-90-R = Symptom Checklist-90 revised; BAI = Beck Anxiety Inventory; EDQOL = Eating Disorders Quality of Life Questionnaire; SF-6D = Short Form Health State Classification

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