Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.
Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy.
Front Public Health. 2023 Aug 15;11:1215617. doi: 10.3389/fpubh.2023.1215617. eCollection 2023.
The identification of interventions for rehabilitation and related evidence is a crucial step in the development of World Health Organization's (WHO) Package of Interventions for Rehabilitation (PIR). Interventions for rehabilitation may be particularly relevant in schizophrenia, as this condition is associated with a high risk of disability, poor functioning, and lack of autonomy. Aiming to collect evidence for the WHO PIR, we conducted a systematic review of Clinical Practice Guidelines (CPG) on interventions for rehabilitation of schizophrenia.
Methods for the systematic identification and critical appraisal of CPG were developed by WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of WHO's guideline review committee secretariat. The Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II) was used to evaluate the methodological quality of identified CPG.
After full text screening, nine CPG were identified, for a total of 130 recommendations. Three were excluded because their total AGREE-II scores were below cut-off. Six CPG were approved by the Technical Working Group and included for data extraction. Only one CPG with specific focus on rehabilitation of schizophrenia was retrieved. Other CPG were general, including some recommendations on rehabilitation. Some CPG gave no indications on the assessment of rehabilitation needs. Discrepancies were detectable, with different CPG emphasizing different domains. Most recommendations addressed "symptoms of schizophrenia," while "community and social life" was targeted by few recommendations. International CPG were often conceptualized for high-income countries, and CPG accounting for their implementation in lower income contexts were scarce. Quality of evidence was high/moderate for 41.54% ( = 54) of the recommendations, and very low only in two cases (1.52%). = 45 (34.62%) were based on experts' opinion.
The concepts of recovery and rehabilitation in schizophrenia are relatively new in medical sciences and somewhat ill-defined. An unbalanced distribution in the domains addressed by available CPG is therefore understandable. However, the need for more focus in some areas of rehabilitation is obvious. More clarity is also required regarding which interventions should be prioritized and which are more feasible for global implementation in the rehabilitation of schizophrenia.
确定康复干预措施及其相关证据是制定世界卫生组织（WHO）康复干预措施包（PIR）的关键步骤。康复干预措施在精神分裂症中可能特别重要，因为这种疾病与残疾、功能不良和缺乏自主性的高风险相关。为了为 WHO PIR 收集证据，我们对精神分裂症康复干预措施的临床实践指南（CPG）进行了系统回顾。
WHO 康复计划和 Cochrane 康复在 WHO 指南审查委员会秘书处的指导下制定了系统识别和关键评估 CPG 的方法。使用评估研究和评价工具（AGREE II）评估确定的 CPG 的方法学质量。
经过全文筛选，确定了 9 项 CPG，共 130 项建议。其中 3 项因总 AGREE-II 评分低于临界值而被排除。6 项 CPG 通过技术工作组批准并纳入数据提取。仅检索到一份专门针对精神分裂症康复的 CPG。其他 CPG 是一般性的，包括一些康复建议。一些 CPG 没有说明康复需求的评估。存在差异，不同的 CPG 强调不同的领域。大多数建议针对“精神分裂症症状”，而少数建议针对“社区和社会生活”。国际 CPG 通常是为高收入国家制定的，而很少有 CPG 考虑在低收入环境中的实施。41.54%（=54）的建议证据质量较高/中等，仅在两种情况下质量非常低（=2）。45 项（34.62%）建议基于专家意见。
精神分裂症中康复和康复的概念在医学科学中相对较新，有些定义不明确。因此，现有 CPG 涵盖的领域分布不平衡是可以理解的。然而，明显需要更加关注康复的某些领域。还需要更清楚地确定哪些干预措施应优先考虑，以及哪些干预措施在精神分裂症康复方面更适合全球实施。
