Buckley L A, Pettit T, Adams C E
Claremont House, Department of Psychotherapy, Off Framlington Place, Newcastle Upon Tyne, UK, NE2 4AA.
Cochrane Database Syst Rev. 2007 Jul 18(3):CD004716. doi: 10.1002/14651858.CD004716.pub3.
Supportive therapy is often used in everyday clinical care and in evaluative studies of other treatments.
To estimate the effects of supportive therapy for people with schizophrenia.
We searched the Cochrane Schizophrenia Group's register of trials (January 2004), supplemented by manual reference searching and contact with authors of relevant reviews or studies.
All randomised trials involving people with schizophrenia and comparing supportive therapy with any other treatment or standard care.
We reliably selected studies, quality rated these and extracted data. For dichotomous data, we estimated the relative risk (RR) fixed effect with 95% confidence intervals (CI). Where possible, we undertook intention-to-treat analyses. For statistically significant results, we calculated the number needed to treat/harm (NNT/H). We estimated heterogeneity (I-square technique) and publication bias.
We included 21 relevant studies. We found no significant differences in the primary outcomes between supportive therapy and standard care. There were, however, significant differences favouring other psychological or psychosocial treatments over supportive therapy. These included hospitalisation rates (3 RCTs, n=241, RR 2.12 CI 1.2 to 3.6, NNT 8) but not relapse rates (5 RCTs, n=270, RR 1.18 CI 0.9 to 1.5). We found that the results for general functioning significantly favoured cognitive behavioural therapy compared with supportive therapy in the short (1 RCT, n=70, WMD -9.50 CI -16.1 to -2.9), medium (1 RCT, n=67, WMD -12.6 CI -19.4 to -5.8) and long term (2 RCTs, n=78, SMD -0.50 CI -1.0 to -0.04), but the clinical significance of these findings based on few data is unclear. Participants were less likely to be satisfied with care if receiving supportive therapy compared with cognitive behavioural treatment (1 RCT, n=45, RR 3.19 CI 1.0 to 10.1, NNT 4 CI 2 to 736). The results for mental state and symptoms were unclear in the comparisons with other therapies. No data were available to assess the impact of supportive therapy on engagement with structured activities.
AUTHORS' CONCLUSIONS: There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.
支持性治疗常用于日常临床护理以及其他治疗方法的评估研究中。
评估支持性治疗对精神分裂症患者的疗效。
我们检索了Cochrane精神分裂症研究组的试验注册库（2004年1月），并通过手工参考文献检索以及与相关综述或研究的作者联系进行补充。
所有涉及精神分裂症患者并将支持性治疗与其他任何治疗或标准护理进行比较的随机试验。
我们可靠地选择研究，对这些研究进行质量评分并提取数据。对于二分数据，我们采用固定效应模型估计相对危险度（RR）及95%置信区间（CI）。在可能的情况下，我们进行意向性分析。对于具有统计学显著性的结果，我们计算治疗所需人数/伤害所需人数（NNT/H）。我们估计异质性（I² 法）和发表偏倚。
我们纳入了21项相关研究。我们发现支持性治疗与标准护理在主要结局方面无显著差异。然而，与支持性治疗相比，其他心理或社会心理治疗有显著优势。这些优势包括住院率（3项随机对照试验，n = 241，RR 2.12，CI 1.2至3.6，NNT 8），但不包括复发率（5项随机对照试验，n = 270，RR 1.18，CI 0.9至1.5）。我们发现，在短期（1项随机对照试验，n = 70，WMD -9.50，CI -16.1至-2.9）、中期（1项随机对照试验，n = 67，WMD -12.6，CI -19.4至-5.8）和长期（2项随机对照试验，n = 78，SMD -0.50，CI -1.0至-0.04），与支持性治疗相比，认知行为疗法在总体功能方面有显著优势，但基于少量数据，这些发现的临床意义尚不清楚。与认知行为治疗相比，如果接受支持性治疗，参与者对护理的满意度较低（1项随机对照试验，n = 45，RR 3.19，CI 1.0至10.1，NNT 4，CI 2至736）。与其他疗法比较时，精神状态和症状的结果尚不清楚。没有数据可用于评估支持性治疗对参与结构化活动的影响。
没有足够的数据来确定支持性治疗与标准护理在结局上的差异。有几个结局，包括住院治疗和总体精神状态，表明其他心理疗法比支持性治疗更具优势，但这些发现基于少数小型研究。未来的研究若将支持性治疗作为主要治疗组而非对照，进行更大规模的试验将有益。
