Effectiveness and sustainability of inpatient psychiatric rehabilitation for adults: systematic review

Research areas: Rehabilitation and occupational therapy, Psychological & psychiatric interventions

Duration: July 2013 – March 2014
Publication: LBI-HTA Projekt report No. 75: https://eprints.aihta.at/1025/

Suggested by: Austrian federal pension fund
Language: German

Background:
According to the Austrian rehabilitation plan¹ possible indications for psychiatric rehabilitation are schizophrenia; affective disorders; neurotic, stress-related and somatoform disorders; behavioural syndromes associated with physiological disturbances and physical factors as well as disorders of adult personality and behaviour. Target groups of psychiatric rehabilitation  are patients, which did not reach sufficient stabilisation during an acute care hospitalisation, have been in sick-leave often or long-term due to a mental disorder, are at risk of incapacity of work or invalidity due to a mental disorder and patients which made an applications for a disability/invalidity  pension

Aim of the project:
Aim of the project is to provide a systematic analysis of literature on sustainability of effects of psychiatric rehabilitation for patients defined in the PICO scheme in an observation period of at least 12 months after discharge from inpatient rehabilitation.

Research questions:
Can (positive) effects in defined outcomes (see PICO) of inpatient psychiatric rehabilitation still be observed at  least 12 months after rehabilitation compared to patients who did not attend a psychiatric rehabilitation programme?

Inclusion crteria (PICO):

Population	Adults (>18 years) with the following main diagnoses (ICD-10): Schizophrenia, schizotypal and delusional disorders (F2) Mood [affective] disorders (F3) Neurotic, stress-related and somatoform disorders (F4) Behavioural syndromes associated with physiological disturbances and physical factors (F5) Disorders of adult personality and behaviour (F6)
Intervention, Setting	Inpatient psychiatric or psychosomatic rehabilitation programmes
Control	Any, e.g.: no rehabilitation therapy as usual, routine care psychiatric or psychosomatic rehabilitation programmes other than “inpatient” (e.g. outpatient or day-clinic phase II rehabilitation) other inpatient rehabilitation measures (e.g. inpatient psychotherapy, inpatient vocational rehabilitation)
Outcome (effectiveness (I-V), safety (VI))	I. (psychiatric/ psychosomatic) rehospitalisation rate Frequency and duration of sickness absence Re-integration into the labour market / inability to work; retirement II: Patient satisfaction Motivation for therapy III. general health and wellbeing/health problems (e.g.: general state of health, attainment of therapeutic goals, etc.) IV. Assessment of/ changes in Physical/ somatic symptoms Mental symptoms Functional ability Quality of life Self-efficacy Cognitive ability Social skills V. Mortality VI. Unintended effects resulting from intervention
Observation points/ period	T0 (admission, start of rehabilitation), T1 (discharge, end of rehabilitation), T2 time of catamnesis (at least 12 months after T1)/ at least 12 months from discharge
Types of studies	uncontrolled and controlled prospective studies;  systematic reviews, meta-analyses, HTA reports
Publication period	2000-2013
Language	German/ English
Type of publication	published journal article and research reports

Exclusion criteria:
Population:

• children and adolescents (up to 18 years)
• (majority of) patients with other main diagnosis than  F2-F6

Intervention:

• inpatient psychiatric/ psychosomatic acute care
• drug rehabilitation

Observation period

• <12 months

Types of studies

• retrospective studies
• case-reports
• case-series
• studies with less than 50 patients

Types of publication

• unpublished documents
• abstracts, posters, comments, letters
• books

Methods

• Scoping with PVA/ national experts

Systematic Review based on published documents
Systematic literature search:

• Medline, Embase, The Cochrane Library, others
• Handsearch in references (as appropriate via Scopus), internet- search, contact with experts

Time schedule/ milestones:
July 2013: Scoping
August-September 2013: systematic literature search, non-systematic hand search, literature selection
October-November 2013: data extraction, drafting of report
December 2013: internal and external review, publication

Reference
¹ Rehabilitationsplan 2012, available at http://www.hauptverband.at/mediaDB/910004_Rehabilitationsplan_2012.pdf