Department of Psychiatry, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Ann Palliat Med. 2022 Jul;11(7):2451-2463. doi: 10.21037/apm-22-605.
The drug control of symptoms is for now the main clinical treatment of schizophrenia, but patients' varying condition and poor compliance can also fluctuate the therapeutic effect. Personalized nursing with a quantitative evaluation strategy (PNQES) may help improve the compliance and symptoms, but there are controversies over the outcomes reported in each specific study; the meta-analysis method aims to resolve the controversies over studies, thus, we conducted this study to pooling the results of controlled clinical studies, and to systematically evaluate the effects of this nursing model.
The PubMed, Medline, Embase, China National Knowledge Infrastructure, and Wanfang databases were selected and searched for relevant articles for PNQES comparing to usual care. The inclusion criteria were established according to the Participants, Interventions, Comparisons, Outcomes, and Study (PICOS) framework. The Cochrane risk of bias 2.0 tool was used to evaluate the risk of bias of the included articles. The symptom scores, treatment compliance rate, quality of life, and social function indicators of the patients after nursing were quantitatively analyzed with effect sizes of mean difference (MD) or standard mean difference (SMD).
The 11 included articles comprised a total of 1,251 patients with experimental group 625 and control group 626. Of all the 11 articles, only 1 had a "low" risk of bias, while the other articles had "some concern of risk;" none of the articles had a "high" risk of bias. The meta-analysis showed that patients who received PNQES had a significantly lower Positive and Negative Syndrome Scale (PANSS) total score after care than patients who received routine care [MD =-9.95, 95% confidence interval (CI): -14.35, -5.55; P<0.00001]. Further, the treatment compliance rate of patients who received PNQES was significantly higher (odds ratio =4.44, 95% CI: 2.17, 9.09; P<0.0001), as was the quality of life (standard MD =2.40, 95% CI: 1.46, 3.34; P<0.00001). Further, the social function deficit score was significantly lower (MD =-2.25, 95% CI: -3.75, -0.76; P=0.003). Subgroup and regression analyses showed that patient age, initial PANSS score, and the quantitative method of disease severity were not the sources of heterogeneity. Different intervention approaches applied may have been the source of heterogeneity.
The application of PNQES is helpful for improving patients' symptoms and disease outcomes, treatment compliance, social function, and quality of life. It is suggested to be generalized in clinical application.
目前，控制症状是精神分裂症的主要临床治疗方法，但患者病情的变化和较差的依从性也会影响治疗效果。个性化护理与定量评估策略（PNQES）可能有助于提高依从性和改善症状，但每种特定研究报告的结果存在争议；荟萃分析方法旨在解决研究中的争议，因此，我们进行了这项研究，以汇总对照临床试验的结果，并系统地评估这种护理模式的效果。
检索 PubMed、Medline、Embase、中国知网和万方数据库，纳入 PNQES 与常规护理比较的相关文献。根据参与者、干预措施、比较、结局和研究（PICOS）框架制定纳入标准。使用 Cochrane 偏倚风险 2.0 工具评估纳入文章的偏倚风险。采用均数差（MD）或标准均数差（SMD）对护理后患者的症状评分、治疗依从率、生活质量和社会功能指标进行定量分析。
纳入的 11 篇文章共纳入 1251 例患者，实验组 625 例，对照组 626 例。11 篇文章中，仅有 1 篇文章的偏倚风险为“低”，其余文章的偏倚风险均为“存在一定程度的担忧”；没有一篇文章的偏倚风险为“高”。荟萃分析显示，接受 PNQES 护理的患者护理后的阳性和阴性综合征量表（PANSS）总分明显低于接受常规护理的患者[MD=-9.95，95%置信区间（CI）：-14.35，-5.55；P<0.00001]。进一步分析发现，接受 PNQES 护理的患者治疗依从率明显更高（比值比=4.44，95%CI：2.17，9.09；P<0.0001），生活质量也明显更高（标准 MD=2.40，95%CI：1.46，3.34；P<0.00001）。进一步分析发现，社会功能缺陷评分明显较低（MD=-2.25，95%CI：-3.75，-0.76；P=0.003）。亚组和回归分析显示，患者年龄、初始 PANSS 评分和疾病严重程度的定量方法不是异质性的来源。不同的干预方法可能是异质性的来源。
应用 PNQES 有助于改善患者的症状和疾病结局、治疗依从性、社会功能和生活质量。建议在临床应用中推广。
