Padgett D, Mumford E, Hynes M, Carter R
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY.
J Clin Epidemiol. 1988;41(10):1007-30. doi: 10.1016/0895-4356(88)90040-6.
A meta-analysis of the literature of controlled studies of educational and psychosocial interventions in the treatment of diabetes mellitus yielded 93 studies of 7451 patients testing the effects of eight intervention types: (1) didactic education, (2) enhanced education, (3) diet instruction, (4) exercise instruction, (5) self-monitoring instruction, (6) social learning/behavior modification, (7) counseling, and (8) relaxation training. An overall mean effect size (ES) of +0.51 +/- 0.11 was found moderate but significant (P less than 0.05) improvements for all intervention subjects. Physical outcome and knowledge gain were most affected, followed by psychological status and compliance. Diet instruction and social learning interventions showed the strongest (ES = +0.68 +/- 0.58 and ES = +0.57 +/- 0.42, respectively) and relaxation training the weakest (ES = +0.30 +/- 0.74) effects. Associations between study and sample characteristics and mean ES values were explored with type of setting and methodological weaknesses such as single group design and non-random assignment achieving statistical significance. Neither intervention type, number of visits, sex, age, nor type of diabetes were significantly correlated with mean ES values. Implications of these findings for clinical treatment and future research are discussed.
一项关于教育和心理社会干预治疗糖尿病的对照研究文献的荟萃分析，纳入了93项研究，涉及7451名患者，测试了八种干预类型的效果：（1）讲授式教育，（2）强化教育，（3）饮食指导，（4）运动指导，（5）自我监测指导，（6）社会学习/行为改变，（7）咨询，以及（8）放松训练。所有干预对象的总体平均效应量（ES）为+0.51±0.11，发现有中度但显著（P<0.05）的改善。身体结果和知识获取受影响最大，其次是心理状态和依从性。饮食指导和社会学习干预显示出最强的效果（ES分别为+0.68±0.58和ES = +0.57±0.42），而放松训练效果最弱（ES = +0.30±0.74）。研究和样本特征与平均ES值之间的关联，通过研究背景类型和方法学缺陷（如单组设计和非随机分配）进行探索，并达到统计学显著性。干预类型、就诊次数、性别、年龄以及糖尿病类型均与平均ES值无显著相关性。讨论了这些发现对临床治疗和未来研究的意义。
