Asunto(s)
Conductas Relacionadas con la Salud , Educación en Salud , Estilo de Vida , Trastornos Psicóticos/psicología , Trastornos Psicóticos/rehabilitación , Esquizofrenia/rehabilitación , Psicología del Esquizofrénico , Servicios de Salud/estadística & datos numéricos , Humanos , Calidad de Vida/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisión de Utilización de RecursosRESUMEN
BACKGROUND: There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this. OBJECTIVES: To assess the effects of general physical health advice as a means of reducing morbidity, mortality and improving or maintaining quality of life in people with serious mental illness. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group Trials Register (November 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. SELECTION CRITERIA: All randomised clinical trials focusing on general physical health advice. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. MAIN RESULTS: For the comparison of physical healthcare advice versus standard care we identified five studies (total n = 884) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.00 CI -0.67 to 0.67) but another did (n = 407, 1 RCT, MD Quality of Life Medical Outcomes Scale - mental component 3.7 CI 1.7 to 5.6). There was no difference between groups for the outcome of death (n = 407, 1 RCT, RR 1.3 CI 0.3 to 6.0), for the outcome of uptake of ill-health prevention services, one study found percentages significantly greater in the advice group (n = 363, 1 RCT, MD 36.9 CI 33.1 to 40.7). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 884, 5 RCTs, RR 1.18 CI 0.97 to 1.43). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal. AUTHORS' CONCLUSIONS: General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer term benefits such as reduced mortality or morbidity. On the other hand it is possible clinicians are expending much effort, time and financial expenditure on giving ineffective advice. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.
Asunto(s)
Promoción de la Salud/métodos , Estado de Salud , Trastornos Mentales/complicaciones , Calidad de Vida , Concienciación , Conductas Relacionadas con la Salud , Humanos , Trastornos Mentales/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Nivel de AtenciónRESUMEN
BACKGROUND: Current guidance suggests that we should monitor the physical health of people with serious mental illness and there has been a significant financial investment over recent years to provide this. OBJECTIVES: To assess the effectiveness of physical health monitoring as a means of reducing morbidity, mortality and reduction in quality of life in people with serious mental illness. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group Trials Register (October 2009) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. SELECTION CRITERIA: All randomised or quasi-randomised clinical trials focusing on physical health monitoring versus standard care or comparing i) self monitoring vs monitoring by health care professional; ii) simple vs complex monitoring; iii) specific vs non-specific checks iv) once only vs regular checks or v) comparison of different guidance. DATA COLLECTION AND ANALYSIS: The authors (GT, AC, SM) independently screened search results and identified three studies as possibly fulfilling the review's criteria. On examination, however, all three were subsequently excluded. MAIN RESULTS: We did not identify any randomised trials which assessed the effectiveness of physical health monitoring in people with serious mental illness. AUTHORS' CONCLUSIONS: There is no evidence from randomised trials to support current guidance and practice. Guidance and practice are based on expert consensus, clinical experience and good intentions rather than high quality evidence.