School of Psychology, Australian Catholic University, Melbourne, VIC, Australia.
South Eastern Sydney Local Health District, Sydney, NSW, Australia.
Disabil Rehabil. 2019 Dec;41(24):2927-2939. doi: 10.1080/09638288.2018.1482505. Epub 2018 Jul 6.
: With appropriate mental health rehabilitation, schizophrenia is increasingly associated with reports of recovery and stability. However, there is little empirical evidence evaluating the efficacy of services delivering this care. This study evaluated the effectiveness of rehabilitation for improving psychosocial function in consumers with schizophrenia.: An electronic database of standardized assessment instruments mandated and maintained by the health service was retrospectively reviewed to extract ratings of psychosocial function, daily living skills, and mood state from consecutive admissions to an inpatient rehabilitation service. Outcomes were compared at admission, discharge, and one-year follow-up to identify statistically significant change. Individual reliable and clinically significant change was also assessed by comparison with a normative group of clients functioning independently in the community.: From admission to discharge the rehabilitation group made statistically significant gains in psychosocial function and daily living skills. Improvements were reliable and clinically significant in one-quarter to one-third of individual consumers. Approximately half sustained their improvements at follow-up, although this represented only a small fraction of the overall cohort. Consumers not demonstrating gains exhibited psychometric floor effects at admission.: Rehabilitation can produce statistically and clinically significant immediate improvement in psychosocial function for a sub-set of consumers with elevated scores at admission. The durability of any gains is less clear, and strategies promoting longer-term maintenance are encouraged. Furthermore, currently mandated outcome measures are confounded by issues of sensitivity and reporting compliance, and exploration of alternative instruments for assessing recovery is recommended.Implications for RehabilitationRoutinely collected standardized outcome measures can be used to investigate the effectiveness of mental health rehabilitationIn addition to statistical significance, the clinical significance of outcomes should be evaluated to identify change that is individually meaningfulCurrently mandated outcomes instruments do not adequately evaluate many individuals' recovery journeyMental health service evaluation and quality improvement processes would likely benefit from adoption of recovery-oriented measures.
在适当的心理健康康复治疗下，精神分裂症与越来越多的康复和稳定报告相关。然而，很少有实证研究评估提供这种护理的服务的疗效。本研究评估了康复治疗对改善精神分裂症患者的社会心理功能的有效性：通过回顾性分析由卫生服务部门强制和维护的标准化评估工具的电子数据库，从连续入住住院康复服务的患者中提取社会心理功能、日常生活技能和情绪状态的评分。通过比较入院、出院和一年随访时的结果，确定有统计学意义的变化。通过与在社区中独立生活的具有代表性的客户群体进行比较，还评估了个体的可靠和临床显著变化。：从入院到出院，康复组在社会心理功能和日常生活技能方面取得了统计学上的显著进步。四分之一到三分之一的个体患者的改善是可靠和临床显著的。大约一半的患者在随访时保持了他们的改善，但这只占总体队列的一小部分。没有表现出改善的患者在入院时表现出心理测量的地板效应。：康复治疗可以为一部分入院时得分较高的患者在社会心理功能方面立即产生统计学和临床显著的改善。任何收益的持久性都不太清楚，鼓励采用促进长期维持的策略。此外，目前强制使用的结果测量方法受到敏感性和报告合规性的问题的影响，建议探索替代的评估恢复的工具。：对康复的影响：常规收集的标准化结果测量可以用于研究心理健康康复的有效性。除了统计学意义外，还应评估结果的临床意义，以确定对个体有意义的变化。目前强制使用的结果工具并不能充分评估许多人的康复历程。心理健康服务评估和质量改进过程可能受益于采用以恢复为导向的措施。
