综合康复方法（CARe）的效果如何？一项集群随机对照试验。
How effective is the comprehensive approach to rehabilitation (CARe) methodology? A cluster randomized controlled trial.
机构信息
Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.
GGzE Institute for Mental Health Care, PO BOX 909, 5600, AX, Eindhoven, The Netherlands.
出版信息
BMC Psychiatry. 2017 Dec 11;17(1):396. doi: 10.1186/s12888-017-1565-y.
BACKGROUND
The CARe methodology aims to improve the quality of life of people with severe mental illness by supporting them in realizing their goals, handling their vulnerability and improving the quality of their social environment. This study aims to investigate the effectiveness of the CARe methodology for people with severe mental illness on their quality of life, personal recovery, participation, hope, empowerment, self-efficacy beliefs and unmet needs.
METHODS
A cluster Randomized Controlled Trial (RCT) was conducted in 14 teams of three organizations for sheltered and supported housing in the Netherlands. Teams in the intervention group received training in the CARe methodology. Teams in the control group continued working according to care as usual. Questionnaires were filled out at baseline, after 10 months and after 20 months. A total of 263 clients participated in the study.
RESULTS
Quality of life increased in both groups, however, no differences between the intervention and control group were found. Recovery and social functioning did not change over time. Regarding the secondary outcomes, the number of unmet needs decreased in both groups. All intervention teams received the complete training program. The model fidelity at T1 was 53.4% for the intervention group and 33.4% for the control group. At T2 this was 50.6% for the intervention group and 37.2% for the control group.
CONCLUSION
All clients improved in quality of life. However we did not find significant differences between the clients of the both conditions on any outcome measure. Possible explanations of these results are: the difficulty to implement rehabilitation-supporting practice, the content of the methodology and the difficulty to improve the lives of a group of people with longstanding and severe impairments in a relatively short period. More research is needed on how to improve effects of rehabilitation trainings in practice and on outcome level.
TRIAL REGISTRATION
ISRCTN77355880 , retrospectively registered (05/07/2013).
背景
CARe 方法旨在通过支持严重精神疾病患者实现其目标、处理其脆弱性并改善其社会环境，来提高他们的生活质量。本研究旨在调查 CARe 方法对严重精神疾病患者的生活质量、个人康复、参与、希望、赋权、自我效能信念和未满足需求的有效性。
方法
在荷兰的 14 个庇护和支持性住房组织的团队中进行了一项集群随机对照试验 (RCT)。干预组的团队接受了 CARe 方法的培训。对照组的团队继续按照常规护理工作。在基线、10 个月和 20 个月时填写问卷。共有 263 名患者参与了研究。
结果
两组的生活质量都有所提高，但干预组和对照组之间没有发现差异。康复和社会功能随时间没有变化。关于次要结果，两组的未满足需求数量都有所减少。所有干预团队都完成了完整的培训计划。在 T1 时，干预组的模型保真度为 53.4%，对照组为 33.4%。在 T2 时，干预组为 50.6%，对照组为 37.2%。
结论
所有患者的生活质量都有所提高。然而，我们没有发现两组患者在任何结果测量上的显著差异。这些结果的可能解释是：实施康复支持实践的难度、方法的内容以及在相对较短的时间内改善一群长期严重受损的人的生活的难度。需要进一步研究如何在实践和结果水平上提高康复培训的效果。
试验注册
ISRCTN77355880，回顾性注册（2013 年 5 月 7 日）。
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