Tosh Graeme, Clifton Andrew V, Xia Jun, White Margueritte M
Early Intervention in Psychosis and Community Therapies, Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH), Swallownest Court, Aughton Road, Swallownest, UK, S26 4TH.
Cochrane Database Syst Rev. 2014 Mar 28;2014(3):CD008567. doi: 10.1002/14651858.CD008567.pub3.
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.
To review the effects of general physical healthcare advice for people with serious mental illness.
We searched the Cochrane Schizophrenia Group's Trials Register (last update search October 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and registries of Clinical Trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register.
All randomised clinical trials focusing on general physical health advice for people with serious mental illness..
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 the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE.
Seven studies are now included in this review. For the comparison of physical healthcare advice versus standard care we identified six studies (total n = 964) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.20, CI -0.47 to 0.87, very low quality of evidence) but another two did for the Quality of Life Medical Outcomes Scale - mental component (n = 487, 2 RCTs, MD 3.70, CI 1.76 to 5.64). There was no difference between groups for the outcome of death (n = 487, 2 RCTs, RR 0.98, CI 0.27 to 3.56, low quality of evidence). For service use two studies presented favourable results for health advice, uptake of ill-health prevention services was significantly greater in the advice group (n = 363, 1 RCT, MD 36.90, CI 33.07 to 40.73) and service use: one or more primary care visit was significantly higher in the advice group (n = 80, 1 RCT, RR 1.77, CI 1.09 to 2.85). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 964, 6 RCTs, RR 1.11, CI 0.92 to 1.35). 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 resources on giving ineffective advice. The main results in this review are based on low or very low quality data. There is some limited and poor quality evidence that the provision of general physical healthcare advice can improve health-related quality of life in the mental component but not the physical component, but this evidence is based on data from one study only. 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.
目前，人们非常关注为严重精神疾病患者提供一般身体健康建议，并且服务机构承担提供此类建议的压力也日益增大。
综述为严重精神疾病患者提供一般身体保健建议的效果。
我们检索了Cochrane精神分裂症研究组试验注册库（2012年10月最后一次更新检索），该注册库基于对CINAHL、BIOSIS、AMED、EMBASE、PubMed、MEDLINE、PsycINFO以及临床试验注册库的定期检索。纳入注册库记录时没有语言、日期、文献类型或出版状态限制。
所有聚焦于为严重精神疾病患者提供一般身体健康建议的随机临床试验。
我们独立提取数据。对于二分类结局，我们基于意向性分析计算风险比（RR）及其95%置信区间（CI）。对于连续性数据，我们估计组间均值差（MD）及其95%CI。我们采用固定效应模型进行分析。我们评估纳入研究的偏倚风险，并使用GRADE创建“结果总结”表。
本综述目前纳入了7项研究。对于身体保健建议与标准护理的比较，我们确定了6项质量有限的研究（总计n = 964）。对于生活质量测量，一项试验未发现差异（n = 54，1项随机对照试验，Lehman量表MD 0.20，CI -0.47至0.87，证据质量极低），但另外两项针对生活质量医疗结局量表的心理成分发现有差异（n = 487，2项随机对照试验，MD 3.70，CI 1.76至5.64）。在死亡结局方面，两组之间没有差异（n = 487，2项随机对照试验，RR 0.98，CI 0.27至3.56，证据质量低）。对于服务利用情况，两项研究表明健康建议有良好效果，建议组中不良健康预防服务的接受率显著更高（n = 363，1项随机对照试验，MD 36.90，CI 33.07至40.73），以及服务利用情况：建议组中一次或多次初级保健就诊显著更高（n = 80，1项随机对照试验，RR 1.77，CI 1.09至2.85）。经济数据不明确。失访率很高（> 30%），但两组相似（n = 964，6项随机对照试验，RR 1.11，CI 0.92至1.35）。一种身体保健建议与另一种建议的比较效力严重不足且不明确。
一般身体健康建议可能会使严重精神疾病患者获得更多医疗服务，这反过来可能意味着他们会获得诸如降低死亡率或发病率等长期益处。另一方面，临床医生可能在给出无效建议上花费了大量精力、时间和财力。本综述的主要结果基于低质量或极低质量的数据。有一些有限且质量差的证据表明，提供一般身体保健建议可以改善心理成分而非身体成分的健康相关生活质量，但该证据仅基于一项研究的数据。这是一个重要领域，需要良好的研究来报告护理人员、严重疾病患者以及研究人员和资助者感兴趣的结局。
