Authors' objectives: The Evidence-Based Practice Group (EBPG) was asked to investigate the advantage, if any, of inpatient versus outpatient programs in treating injured workers diagnosed with post-traumatic stress disorder (PTSD), without any concurrent disorders such as addiction.

Authors' results and conclusions: At present, there seems to be only one published primary study, in the form of a medium size (total n=992) case-control study design (level of evidence 3. Appendix 1), reporting the effectiveness of cognitive processing therapy (CPT), delivered as inpatient versus outpatient, to treat patients diagnosed with PTSD. Although the authors stated that CPT delivered as outpatients might result in fewer symptoms compared to inpatients, it should be noted that potential bias, chance and effect confounding cannot be discounted from the reported outcomes. Further, outcomes were reported for at most 2 weeks post-treatment which is likely a very short timeline for a potentially chronic disease. It should also be noted that in this study, Walter et al treated both inpatient and outpatient as a treatment setting. At present, there is no primary study reporting the efficacy and/or effectiveness of inpatient versus outpatient treatment in PTSD patients.

Authors' recommendations: At present, there seems to be only one published primary study, in the form of a medium size (total n=992) case-control study design (level of evidence 3. Appendix 1), reporting the effectiveness of cognitive processing therapy (CPT), delivered as inpatient versus outpatient, to treat patients diagnosed with PTSD. Although the authors stated that CPT delivered as outpatients might result in fewer symptoms compared to inpatients, it should be noted that potential bias, chance and effect confounding cannot be discounted from the reported outcomes. Further, outcomes were reported for at most 2 weeks post-treatment which is likely a very short timeline for a potentially chronic disease. It should also be noted that in this study, Walter et al treated both inpatient and outpatient as a treatment setting. At present, there is no primary study reporting the efficacy and/or effectiveness of inpatient versus outpatient treatment in PTSD patients.

Authors' methods: We were given an annotated bibliography, sent by an external provider. The annotated bibliography contained four articles that we then retrieved in full and assessed with the objective of developing a literature search strategy, but none provided evidence on the efficacy and/or effectiveness of inpatient versus outpatient options (either as treatment modality or as treatment setting). Given that, we decided to conduct a comprehensive systematic literature review investigating inpatient and outpatient options, as either treatment setting and/or treatment modality, in treating patients with PTSD without any concurrent disorders. Comprehensive and systematic literature searches were done on commercial medical literature databases on November 7 and 8, 2022. No limitations, such as on the language or date of publication, were implemented in any of these searches. A manual search was also conducted on the references of the articles that were retrieved in full. After our search, six primary studies were thought to be relevant. One of the six primary studies retrieved in full, a paper by Walter et al, also sent by the provider, has been discussed previously and will not be discussed further. Further appraisal of the five primary studies demonstrated that none of these studies provided any relevant data to the objective of this systematic review.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2022

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/inpatient-vs-outpatient-pograms-treatment-ptsd?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3Dinpatient%2520versus%2520outpatient%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=inpatient%20versus%20outpatient

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC