15 Apr Implications for clinical practice, training and treatment
The present review has several strengths, in particular the close attention to RCT control arm type and study quality, the inclusion of post-treatment as well as follow-up findings and the use of two ways of exploring the effect of trauma frequency on treatment https://kissbrides.com/hot-scandinavian-women/ efficacy. Moreover, the present work was conducted in accordance with gold standard guidelines on meta-analysis (i.e. PRISMA guidelines), all steps were carried out by at least two researchers working independently and discrepancies were solved through through discussions until consensus was reached. Last, we adjusted for the fact that dichotomising a continuous variable is always associated with a certain degree of arbitrariness and might blur results. That is, we assessed the potential influence of trauma frequency on efficacy outcomes both dichotomously as well as continuously and results were in line.
Identification and selection of studies
Some limitations also need to be noted. First, some studies had to be excluded from the quantitative analyses as they did not report trauma frequency. Therefore, we strongly encourage authors to report on this important clinical variable. Second, our definition of multiple trauma can be criticised. Our cut-off for being considered a multiple-exposure trial was that at least 50% of participants had suffered multiple trauma exposures. However, we carried out a sensitivity analysis with a more conservative definition of multiple-exposure trial (i.e. at least 90% of participants reporting multiple lifetime trauma exposures) and results and conclusions were very similar (i.e. no differential treatment efficacy between single- versus multiple-exposure trials). Third, it would have been desirable also to focus on other metrics of treatment success beyond standardised mean differences. However, in the field of paediatric PTSD there is no gold standard definition of treatment response or clinically meaningful change.