# Efficacy of therapist-supported online remote behavioral therapy for tic disorders: a systematic review and meta-analysis

## TL;DR

This study reviews and analyzes the effectiveness of online therapy for tic disorders, finding it to be promising compared to other treatments.

## Contribution

The study provides a meta-analysis confirming the efficacy of therapist-supported online behavioral therapy for tic disorders.

## Key findings

- TSORBT significantly reduced tic severity scores compared to controls.
- TSORBT was as effective as face-to-face therapy but more effective than online psychoeducation.
- Results suggest TSORBT is a viable treatment option for tic disorders.

## Abstract

Recently, several studies about therapist-supported online remote behavioral therapy (TSORBT) have been showed effective for tic disorders (TD). With the increasing adoption of telemedicine, a systematic review of existing evidence is crucial to confirm the efficacy of TSORBT in treating TD.

We aim to assess the efficacy of TSORBT on the treatment of TD.

This review followed PRISMA guidelines. We searched PubMed, Web of Science, Cochrane, and Embase up to September 2024 for clinical trials on TSORBT’s efficacy in TD. Two researchers independently screened studies, focusing on the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS) and other subscores of the YGTSS-motor tic score (YGTSS-MTS), YGTSS-vocal tic score (YGTSS -VTS), YGTSS-impairment score and Parent Tic Questionnaire (PTQ). Risk of bias was assessed using Cochrane RoB 2. Data were analyzed in RevMan 5.4, with outcomes expressed as mean difference (MD) and 95% CI.

In total, 2764 articles were identified for screening. Nine studies involving 1049 participants, with 527 assigned to the TSORBT and 522 to the control were included. TSORBT exhibited potential in addressing YGTSS-TTSS (MD = -2.22, 95% CI: [-3.16, -1.29], P<0.00001), YGTSS-MTS (MD = -2.17, 95% CI: [-3.39, -0.96], P=0.0004), YGTSS-impairment score (MD= -1.69, 95% CI: [-3.26, -0.12], P=0.03) and PTQ score (MD= -6.05, 95% CI: [-8.65, -3.44], P<0.00001);. Subgroup analyses revealed that TSORBT demonstrated nearly the same efficacy as face-to-face BT in addressing YGTSS-TTSS (MD = -0.38, 95% CI: [-3.20, 2.43], P=0.79), but more effective than online psychoeducation (MD = -2.37, 95% CI: [-3.64, -1.10], P = 0.0002).

The current study demonstrates the promising therapeutic efficacy of TSORBT in TD. Further rigorously designed studies, particularly those assessing long-term treatment durability, are warranted to consolidate the evidence base.