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

03_rehab
Research areas: Rehabilitation and occupational therapy, Psychological & psychiatric interventions

Project team: Inanna Reinsperger

Duration: July 2013 – March 2014
Publication: LBI-HTA Projekt report No. 75: http://eprints.hta.lbg.ac.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