Almerie Muhammad Qutayba, Okba Al Marhi Muhammad, Jawoosh Muhammad, Alsabbagh Mohamad, Matar Hosam E, Maayan Nicola, Bergman Hanna
Department of General Surgery, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK, LS9 7TF.
Cochrane Database Syst Rev. 2015 Jun 9;2015(6):CD009006. doi: 10.1002/14651858.CD009006.pub2.
Social skills programmes (SSP) are treatment strategies aimed at enhancing the social performance and reducing the distress and difficulty experienced by people with a diagnosis of schizophrenia and can be incorporated as part of the rehabilitation package for people with schizophrenia.
The primary objective is to investigate the effects of social skills training programmes, compared to standard care, for people with schizophrenia.
We searched the Cochrane Schizophrenia Group's Trials Register (November 2006 and December 2011) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. We inspected references of all identified studies for further trials.A further search for studies has been conducted by the Cochrane Schizophrenia Group in 2015, 37 citations have been found and are currently being assessed by review authors.
We included all relevant randomised controlled trials for social skills programmes versus standard care involving people with serious mental illnesses.
We extracted data independently. For dichotomous data we calculated risk ratios (RRs) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD) and 95% CIs.
We included 13 randomised trials (975 participants). These evaluated social skills programmes versus standard care, or discussion group. We found evidence in favour of social skills programmes compared to standard care on all measures of social functioning. We also found that rates of relapse and rehospitalisation were lower for social skills compared to standard care (relapse: 2 RCTs, n = 263, RR 0.52 CI 0.34 to 0.79, very low quality evidence), (rehospitalisation: 1 RCT, n = 143, RR 0.53 CI 0.30 to 0.93, very low quality evidence) and participants' mental state results (1 RCT, n = 91, MD -4.01 CI -7.52 to -0.50, very low quality evidence) were better in the group receiving social skill programmes. Global state was measured in one trial by numbers not experiencing a clinical improvement, results favoured social skills (1 RCT, n = 67, RR 0.29 CI 0.12 to 0.68, very low quality evidence). Quality of life was also improved in the social skills programme compared to standard care (1 RCT, n = 112, MD -7.60 CI -12.18 to -3.02, very low quality evidence). However, when social skills programmes were compared to a discussion group control, we found no significant differences in the participants social functioning, relapse rates, mental state or quality of life, again the quality of evidence for these outcomes was very low.
AUTHORS' CONCLUSIONS: Compared to standard care, social skills training may improve the social skills of people with schizophrenia and reduce relapse rates, but at present, the evidence is very limited with data rated as very low quality. When social skills training was compared to discussion there was no difference on patients outcomes. Cultural differences might limit the applicability of the current results, as most reported studies were conducted in China. Whether social skills training can improve social functioning of people with schizophrenia in different settings remains unclear and should be investigated in a large multi-centre randomised controlled trial.
社交技能训练项目（SSP）是旨在提高精神分裂症患者的社交表现、减轻其痛苦和困难的治疗策略，可作为精神分裂症患者康复计划的一部分。
主要目的是研究与标准护理相比，社交技能训练项目对精神分裂症患者的影响。
我们检索了Cochrane精神分裂症组试验注册库（2006年11月和2011年12月），该注册库基于对CINAHL、BIOSIS、AMED、EMBASE、PubMed、MEDLINE、PsycINFO的定期检索以及临床试验注册库。我们检查了所有已识别研究的参考文献以寻找更多试验。Cochrane精神分裂症组在2015年进行了进一步的研究检索，发现了37条引用，综述作者目前正在对其进行评估。
我们纳入了所有关于社交技能训练项目与标准护理对比、涉及严重精神疾病患者的相关随机对照试验。
我们独立提取数据。对于二分数据，我们在意向性分析的基础上计算风险比（RRs）及其95%置信区间（CI）。对于连续数据，我们计算平均差（MD）和95%CI。
我们纳入了13项随机试验（975名参与者）。这些试验评估了社交技能训练项目与标准护理或讨论组的对比。我们发现，在所有社交功能测量指标上，与标准护理相比，有证据支持社交技能训练项目。我们还发现，与标准护理相比，社交技能训练组的复发率和再住院率更低（复发：2项随机对照试验，n = 263，RR 0.52，CI 0.34至0.79，极低质量证据），（再住院：1项随机对照试验，n = 143，RR 0.53，CI 0.30至0.来93，极低质量证据），并且接受社交技能训练项目组的参与者精神状态结果更好（1项随机对照试验，n = 91，MD -4.01，CI -7.52至-0.50，极低质量证据）。在一项试验中，通过未经历临床改善的人数来衡量总体状态，结果支持社交技能训练（1项随机对照试验，n = 67，RR 0.29，CI 0.12至0.68，极低质量证据）。与标准护理相比，社交技能训练项目组的生活质量也有所改善（1项随机对照试验，n = 112，MD -7.60，CI -12.18至-3.02，极低质量证据）。然而，当将社交技能训练项目与讨论组对照进行比较时，我们发现参与者的社交功能、复发率、精神状态或生活质量没有显著差异，同样，这些结果的证据质量也非常低。
与标准护理相比，社交技能训练可能会提高精神分裂症患者的社交技能并降低复发率，但目前，证据非常有限，数据质量被评为极低。当将社交技能训练与讨论进行比较时，患者的结果没有差异。文化差异可能会限制当前结果的适用性，因为大多数报告的研究是在中国进行的。社交技能训练在不同环境中是否能改善精神分裂症患者的社交功能仍不清楚，应该通过大型多中心随机对照试验进行研究。
