The Efficacy and Effectiveness of Online CBT - Jeroen Ruwaard

5.4. Discussion 99LOCF-ITT may be overly liberal if attrition is unbalanced across experimentalgroups, or if posttest data is carried forward to impute missing follow-up data(Molenberghs et al., 2004). Therefore, we reran analyses using available data only(posttest: n = 83; follow-up: n = 41). In terms of statistical significance, results ofthe ITT analyses and the available data analyses were similar.5.3.4 Abstinence and reliable clinically significant changeAs shown in Table 5.4, participants in the online CBT group were more likely to beabstinent from purging in comparison to control group participants at post-test (OR:7.2; P = .02), and more likely to achieve reliable clinically significant change withrespect to EDE-Q (OR: 4.5; P = .01). At follow-up, differences between the onlineCBT group and the bibliotherapy group were not significant (OR: 1.0 to 1.4; P = .99).5.3.5 Client satisfaction with online CBTParticipants following online CBT completed a post-test evaluation questionnaire (n= 51; including those participants who started treatment at a later time). On a 1to 10 point scale, they rated the overall value of treatment with an average of 7.5(SD = 1.3) and the contact with their therapists with an average of 8.6 (SD = 1.9).Seventy-six percent of the participants indicated they had not missed face-to-facecontact, and 94% stated that they would recommend the treatment to others.5.4 DiscussionAs hypothesised, posttest reductions in bulimic symptoms were substantially greaterwith online CBT, in comparison to bibliotherapy and a waiting list. One year aftertreatment, differences between online CBT and bibliotherapy were no longer significant,due to improvements in the bibliotherapy group. Participants allocated toonline CBT reported large, clinically relevant and stable reductions in bulimic symptoms.Notwithstanding the absence of face-to-face contact, treatment dropout wasacceptable, and client satisfaction was high.Results provide further support for the hypothesis that therapist support is a criticaldeterminant of treatment efficacy and adherence in internet-delivered treatment