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Intervención para las crisis en personas con enfermedades mentales graves

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Referencias

Referencias de los estudios incluidos en esta revisión

Ir a:

Fenton 1979 {published data only}

Fenton FR, Tessier L, Contandriopoulos AP, Nguyen H, Struening EL. A comparative trial of home and hospital psychiatric treatment: financial costs. Canadian Journal of Psychiatry 1982;27:177‐85.
Fenton FR, Tessier L, Struening EL. A comparative trial of home and hospital psychiatric care: one‐year follow‐up. Archives of General Psychiatry 1979;36:1073‐9.
Fenton FR, Tessier L, Struening EL, Smith FA, Benoit C, Contandriopoulos AP. A two‐year follow‐up of a comparative trial of the cost‐effectiveness of home and hospital psychiatric treatment. Canadian Journal of Psychiatry 1984;29:205‐11.
Smith FA, Fenton FR, Benoit C, Barzell E, Tessier L. Home care treatment of acutely ill psychiatric patients. Candian Psychiatric Association Journal 1978;23(2):73‐6.

Hoult 1983 {published data only}

Hoult J. Community care of the acutely mentally ill. British Journal of Psychiatry 1986;149:137‐44.
Hoult J, Reynolds I. Schizophrenia. A comparative trial of community orientated and hospital orientated psychiatric care. Acta Psychiatrica Scandinavica 1984;69:359‐72.
Hoult J, Reynolds I, Charbonneau Powis M, Coles P, Briggs J. A controlled study of psychiatric hospital versus community treatment: the effect on relatives. Australian and New Zealand Journal of Psychiatry 1981;15:323‐8.
Hoult J, Reynolds I, Charbonneau Powis M, Weekes P, Briggs J. Psychiatric hospital versus community treatment: the results of a randomised trial. Australian and New Zealand Journal of Psychiatry 1983;17:160‐7.
Hoult J, Rosen A, Reynolds I. Community orientated treatment compared to psychiatric hospital orientated treatment. Social Science and Medicine 1984;18:1005‐10.
Reynolds I, Hoult JE. The relatives of the mentally ill. A comparative trial of community‐oriented and hospital‐oriented psychiatric care. Journal of Nervous and Mental Diseases 1984;172:480‐9.

Muijen 1992 {published data only}

Knapp M, Beecham J, Koutsogeorgopoulou V, Hallam A, Fenyo A, Marks IM, Connolly J, Audini B, Muijen M. Service use and costs of home‐based versus hospital‐based care for people with serious mental illness. British Journal of Psychiatry 1994;164:195‐203.
Marks I, Connolly J, Muijen M, Audini B, McNamee G, Lawrence R. Home‐based versus hospital‐based care for people with serious mental illness. British Journal of Psychiatry 1994;165:179‐94.
Muijen M, Marks I, Connolly J, Audini B. Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial [see comments]. BMJ 1992;304:749‐54.
Muijen M, Marks IM, Connolly J, Audini B, McNamee G. The daily living programme. Preliminary comparison of community versus hospital‐based treatment for the seriously mentally ill facing emergency admission. British Journal of Psychiatry 1992;160:379‐84.
Simpson CJ, Seager CP, Robertson JA. Home‐based care and standard hospital care for patients with severe mental illness: a randomised controlled trial. British Journal of Psychiatry 1993;162:239‐43.

Pasamanick 1964a {published data only}

Davis AE, Dinitz S, Pasamanick B. The prevention of hospitalization in schizophrenia: five years after an experimental program. American Journal of Orthopsychiatry 1972;42:375‐88.
Pasamanick B, Scarpitti FR, Dinitz S. Schizophrenics in the community: an experimental study in the prevention of hospitalization. New York: Appleton‐Century‐Crofts, 1967.
Pasamanick B, Scarpitti FR, Lefton M, Dinitz S, Wernert JJ, McPheeters H. Home versus hospital care for schizophrenics. Journal of the American Medical Association 1964;187:177‐81.

Stein 1975 {published data only}

Stein L, Test M, Marx AJ. Alternative to the hospital: a controlled study. American Journal of Psychiatry 1975;132:517‐22.
Stein LI, Test MA. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry 1980;37:392‐7.
Test MA, Knoedler W, Allness D, Burke S, Brown R, Wallisch L. Community care of schizophrenia: two‐year findings. Schizophrenia Research: Advances in Neuropsychiatry and Psychopharmacology 1989;3:1‐16.
Test MA, Stein LI. Alternative to mental hospital treatment. III. Social cost. Archives of General Psychiatry 1980;37:409‐12.
Test MA, Stein LI. Training in community living: a follow‐up look at a Gold‐Award program. Hospital and Community Psychiatry 1976;27:193‐4.
Test MA, Stein LI. Training in community living: research design and results. In: Stein LI, Test MA editor(s). Alternatives to Mental Hospital Treatment. New York, USA: Plenum Publishing Corporation, 1978:57‐74.
Weisbrod BA, Test MA, Stein LI. Alternative to mental hospital treatment. II. Economic benefit cost analysis. Archives of General Psychiatry 1980;37:400‐5.

Referencias de los estudios excluidos de esta revisión

Ir a:

Bond 1989 {published data only}

Bond GR, Miller LD, Krumwied RD, Ward RS. Assertive case management in three CMHCs: a controlled study. Hospital and Community Psychiatry 1988;39:411‐8.
Bond GR, Witheridge TF, Wasmer D, Dincin J, McRae SA, Mayes J, Ward RS. A comparison of two crisis housing alternatives to psychiatric hospitalization. Hospital and Community Psychiatry 1989;40:177‐83.

Burns 1993 {published data only}

Burns T, Beadsmoore A, Bhat AV, Oliver A, Mathers C. A controlled trial of home‐based acute psychiatric services. I. Clinical and social outcome [see comments]. British Journal of Psychiatry 1993;163:49‐54.
Burns T, Raftery J. Cost of schizophrenia in a randomized trial of home‐based treatment. Schizophrenia Bulletin 1991;17:407‐10.
Burns T, Raftery J, Beadsmoore A, McGuigan S, Dickson M. A controlled trial of home‐based acute psychiatric services. II. Treatment patterns and costs. British Journal of Psychiatry 1993;163:55‐61.

Bush 1990 {published data only}

Bush CT, Langford MW, Rosen P, Gott W. Operation outreach: intensive case management for severely psychiatrically disabled adults. Hospital and Community Psychiatry 1990;41:647‐9.

Fenton 2000 {published data only}

Fenton WS, Hoch JS, Herrell JM, Mosher L, Dixon L. Cost and cost‐effectiveness of hospital vs residential crisis care for patients who have serious mental illness. Archives of General Psychiatry 2002;59:357‐64.
Fenton WS, Mosher LR. Crisis residential care for patients with serious mental illness. In: Martindale B, Bateman A editor(s). Psychosis: Psychological approaches and their effectiveness. London UK: Gaskell, Royal College of Psychiatrists, 2000:157‐76.

Gater 1997 {published data only}

Gater R, Goldberg D, Jackson G, Jennett N, Lowson K, Ratcliffe J, Saraf T, Warner R. The care of patients with chronic schizophrenia: a comparison between two services. Psychological Medicine 1997;27:1325‐36.

Ghandi 2001 {published data only}

Ghandi N, Tyrer P, Evans K, McGee A, Lamont A, Harrison‐Read P. A randomized controlled trial of community‐oriented and hosptial‐oriented care for discharged psychiatric patients: influence of personality disorder on police contacts. Journal of Personality Disorders 2001;15(1):94‐102.

Harrison 2003 {published data only}

Harrison J, Marshall S, Marshall P, Marshall J, Creed F. Day hospital versus home treatment. Social Psychiatry and Psychiatric Epidemiology 2003;38:541‐6.

Henlegger 1999 {published data only}

Henlegger SW, Rowland MD, Randall J, Ward DM, Pickrel SG, Cunningham PB, Miller SL, Edwards J, Zealberg JJ, Hand LD, Santos AB. Home‐based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of American Academy of Child and Adolescent Psychiatry 1999;38(11):1331‐9.

Herz 2000 {published data only}

Herz MI, Lamberti JS, Mintz J, Scott R, O'Dell SP, McCartan L, Nix G. A program for relapse prevention in schizophrenia: a controlled study. Archives of General Psychiatry 2000;57:277‐83.

Jones 2003 {published data only}

Jones K, Colson PW, Holter MC, Lin S, Valencia E, Susser E, Wyatt RJ. Cost‐ effectiveness of Critical Time Intervention to reduce homelessness among persons with mental illness. Psychiatric Services 2003;54:884‐90.

Kuipers 2004 {published data only}

Kuipers E, Holloway F, Rabe‐Hesketh S, Tennakoon L. An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST). Social Psychiatry and Epidemiology 2004;39:358‐63.

Levenson 1997 {published data only}

Levenson AJ. Acute schizophrenia: an efficacious outpatient treatment approach as an alternative to full‐time hospitalization. Diseases of the Nervous System 1977;38:242‐5.

Linszen 1998 {published data only}

Linszen D, Lenoir M, De Haan L, Dingemans P, Gersons B. Early intervention, untreated psychosis and the course of early schizophrenia. British Journal of Psychiatry 1998;172:84‐9.

Merson 1992 {published data only}

Merson S, Tyrer P, Carlen D, Johnson T. The cost of treatment of psychiatric emergencies: a comparison of hospital and community services. Psychological Medicine 1996;26:727‐34.
Merson S, Tyrer P, Onyett S, Lack S, Birkett P, Lynch S, Johnson T. Early intervention in psychiatric emergencies: a controlled clinical trial [see comments]. Lancet 1992;339:1311‐4.

Metcalfe 2005 {published data only}

Metcalfe C, White IR, Weaver T, Ukoumunne OC, Harvey K, Tattan T, Thompson SG. Intensive case management for severe psychotic illness: is there a general benefit for patients with complex needs? A secondary analysis of the UK700 trial data. Social Pyschiatry and Epidemiology 2005;40:718‐24.

Mosher 1975 {published data only}

Bola JR, Mosher LR. Treatment of acute psychosis without nueroleptics: Two‐year outcomes from the Soteria Project. The Journal of Nervous and Mental Disease 2003;191:219‐29.
Mosher LR, Menn A, Matthew SM. Soteria: evaluation of a home‐based treatment for schizophrenia. American Journal of Orthopsychiatry 1975;45:455‐67.
Mosher LR, Menn AZ. Community residential treatment for schizophrenia: two‐year follow‐up. Hospital and Community Psychiatry 1978;29:715‐23.

Muijen 1994 {published data only}

Audini B, Marks IM, Lawrence R, Connolly J, Watts V. Home‐based versus out‐patient/in‐patient care for people with serious mental illness. Phase II of a controlled study. British Journal of Psychiatry 1994;164:204‐10.
Knapp M, Marks I, Wolstenholme J, Beecham J, Astin J, Audini B, Connolly J, Watts V. Home‐based versus hospital‐based care for serious mental illness. British Journal of Psychiatry 1998;172:506‐12.

Pai 1982 {published data only}

Pai S, Kapur RL. Evaluation of home care treatment for schizophrenic patients. Acta Psychiatrica Scandinavica 1983;67:80‐8.
Pai S, Kapur RL. Impact of treatment intervention on the relationship between dimensions of clinical psychopathology, social dysfunction and burden on the family of psychiatric patients. Psychological Medicine 1982;12:651‐8.
Pai S, Nagarajaiah. Treatment of schizophrenic patients in their homes through a visiting nurse ‐ some issues in the nurse's training. International Journal of Nursing Studies 1982;19:167‐72.
Pai S, Roberts E. Follow‐up study of schizophrenic patients initially treated with home care. British Journal of Psychiatry 1983;143:447‐50.

Pasamanick 1964b {published data only}

Davis AE, Dinitz S, Pasamanick B. The prevention of hospitalization in schizophrenia: five years after an experimental program. American Journal of Orthopsychiatry 1972;42:375‐88.
Pasamanick B, Scarpitti FR, Dinitz S. Schizophrenics in the community:an experimental study in the prevention of hospitalization. New York: Appleton‐Century‐Crofts, 1967.
Pasamanick B, Scarpitti FR, Lefton M, Dinitz S, Wernert JJ, McPheeters H. Home versus hospital care for schizophrenics. Journal of the American Medical Association 1964;187:177‐81.

Polak 1976 {published data only}

Polak PR, Kirby MW. A model to replace psychiatric hospitals. Journal of Nervous and Mental Diseases 1976;162:13‐22.

Rosenheck 1995 {published data only}

Rosenheck R, Neale M, Leaf P, Milstein R, Frisman L. Multisite exeprimental cost study of intensive psychiatric community care. Schizophrenia Bulletin 1995;21(1):129‐40.
Rosenheck RA, Neale MS. Cost‐effectiveness of intensive psychiatric community care for high users of inpatient services. Archives of General Psychiatry 1998;55:459‐65.

Sledge 1996 {published data only}

Sledge WH, Tebes J, Rakfeldt J, Davidson L, Lyons L, Druss B. Day hospital/crisis respite care versus inpatient care. Part I. Clinical outcomes. American Journal of Psychiatry 1996;153:1065‐73.
Sledge WH, Tebes J, Wolff N, Helminiak TW. Day hospital/crisis respite care versus inpatient care. Part II. Service utilization and costs. American Journal of Psychiatry 1996;153:1074‐83.

Taylor 1998 {published data only}

Becker T, Holloway F, McCrone P, Thornicroft G. Evolving service interventions in Nunhead and Norwood: PRiSM Psychosis Study 2. British Journal of Psychiatry 1998;173:371‐5.
Taylor RE, Leese M, Clarkson P, Holloway F, Thornicroft G. Quality of life outcomes for intensive versus standard community mental health services: PRiSM Psychosis Study 9. British Journal of Psychiatry 1998;173:416‐22.

Tyrer 1995 {published data only}

Tyrer P, Morgan J, Van Horn E, Jayakody M, Evans K, Brummell R, White T, Baldwin D, Harrison‐Read P, Johnson T. A randomised controlled study of close monitoring of vulnerable psychiatric patients. Lancet 1995;345:756‐9.

van Minnen 1997 {published data only}

van Minnen A, Hoogduin CA, Broekman TG. Hospital versus outreach treatment of patients with mental retardation and psychiatric disorders: a controlled study. Acta Psychiatrica Scandinavica 1997;95:515‐22.

Referencias de los estudios en espera de evaluación

Ir a:

Mattejat 2001 {published data only}

 

Power 2004 {published data only}

 

Altman 1996

Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313:1200. [CI020600]

Audit Comm 1986

Audit Commission. Making a reality of community care. London: HMSO, 1986.

Begg 1996

Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DFSO. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996;276:637‐9.

Bland 1997

Bland JM, Kerry SM. Statistics notes. Trials randomised in clusters. BMJ 1997;315:600.

Bleuler 1974

Bleuler MJN. The long‐term course of the schizophrenic psychoses. Psychological Medicine 1974;4:244‐54.

Buchan 2001

Buchan IE. StatsDirect Statistical Software.1.9.8 Edition. Cambridge: CamCode, 2001.

Caplan 1964

Caplan GK. Principles of preventive psychiatry. New York: Basic Books, 1964.

Divine 1992

Divine GW, Brown JT, Frazer LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7:623‐9.

Donner 2002

Donner A, Klar N. Issues in the meta‐analysis of cluster randomized trials. Statistics in Medicine 2002;21:2971‐80.

Egger 1997

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34.

Ellison 1974

Ellison D, Rieker P, Marx J. Organisational adaptation to community mental health. In: Roma P editor(s). Sociological perspectives on community mental health. Philadelphia, PA: Davis Company, 1974.

Endicott 1972

Endicott J, Spitzer RL. What! Another rating scale? The Psychiatric Evaluation Form. Journal of Nervous and Mental Disease 1972;154(2):88‐104.

Endicott 1976

Endicott J, Spitzer RL, Fleiss JL, et al. The Global Assessment Scale. Archives of General Psychiatry 1976;33:766‐71.

Finch 1991

Finch SJ, Burgess PM, Herrman HE. The implementation of community‐based crisis services for people with acute psychiatric illness. Australian Journal of Public Health 1991;15:122‐9.

Geller 1995

Geller JL, Fisher WH, McDermeit M. A national survey of mobile crisis services and their evaluation. Psychiatric Services 1995;46:893‐7.

Gulliford 1999

Gulliford MC, Ukoumunne OC, Chinn S. Components of variance and intraclass correlations for the design of community‐based surveys and intervention studies: data from the Health Survey for England 1994. Journal of American Epidemiology 1999;149:876‐83.

Higgins 2003

Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60.

Hoult 1984a

Hoult J, Reynolds I. Schizophrenia: a comparative trial of community‐oriented and hospital‐oriented psychiatric care. Acta Psychiatrica Scandinavica 1984;69:359‐72.

Hoult 1984b

Hoult J, Rosen A, Reynolds I. Community oriented treatment compared to psychiatric hospital oriented treatment. Social Sciences Medicine 1984;11:1005‐10.

Hoult 1986

Hoult J. The community care of the acutely mentally ill. British Journal of Psychiatry 1986;149:137‐44.

Lamb 1979

Lamb RH. Alternatives to acute hospitalization. San Fransico, CA: Jossey‐Bass, 1979.

Langsley 1968

Langsley DG, Pittman FS, Machotka P, Flomenhaft K. Family crisis therapy ‐ results and implications. Family Process 1968;7:145‐58.

Larsen 1979

Larsen DH, Attkison CC, Hargreaves WA. Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning 1979;2:197‐207.

Lindemann 1944

Lindemann E. Symptomatology and management of acute grief. American Journal of Psychiatry 1944;101:141‐8.

Marshall 2000

Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249‐52.

Marshall 2004

Marshall M, Lockwood A. Assertive community treatment for people with severe mental disorders. The Cochrane Library 2004, Issue 2.

McGorry 1996

McGorry PD, Edwards J, Mihalopoulos C, Harrigan SM, et al. EPPIC: An evolving system of early detection and optimal management. Schizophrenia Bulletin 1996;22:305‐26.

Moher 2001

Moher D, Schulz KF, Altman D. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomized trials. JAMA 2001;285:1987‐91.

Overall 1962

Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports 1962;10:799‐812.

Pasamanick 1967

Pasamanick B, Scarpitti F, Dinitz S. Schizophrenics in the community: an experimental study in the prevention of hospitalization. New York: Appleton Century Crofts, 1967.

Querido 1968

Querido A. The shaping of community mental health care. British Journal of Psychiatry 1968;114:293‐302.

Schoenfeld 1986

Schoenfeld P, Halvey J, Hemley‐van der Velden E, Ruhf L. Long term outcome of network therapy. Hospital and Community Psychiatry 1986;37:373‐6.

Stein 1978

Stein LI, Test MA. Alternatives to mental hospital treatment. New York: Plenum Press, 1978.

Test 1978

Test MA, Stein LI. Community treatment of the chronic patient: research overview. Schizophrenia Bulletin 1978;4:350‐64.

Thomas 1970

Thomas CS, Weisman GK. Emergency planning: the practical and theoretical backdrop to an emergency treatment unit. International Journal of Social Psychiatry 1970;16:283‐7.

Ukoumunne 1999

Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area‐wide and organisation‐based interventions in health and health care: a systematic review. Health Technology Assessment 1999;3(5):iii‐92. [MEDLINE: 10982317]

Weisman 1989

Weisman GK. Crisis Intervention. In: Bellack AS editor(s). A clinical guide for the treatment of schizophrenia. New York: Plenum Press, 1989:101‐34.

Weissman 1971

Weissman MM, Paykel ES, Siegel R, et al. The social role performance of depressed women: comparisons with a normal group. American Journal of Orthopsychiatry 1971;41:390‐405.

WHO 1987

World Health Organization. Mental Health Services in Pilot Study Areas. Report on European Study. Copenhagen: World Health Organization, 1987.

Wing 1974

Wing JK, Cooper JE, Sartorius N. Measurement and classification of psychiatric symptoms: an instruction manual for the PSE and Catego program. Cambridge: Cambridge University Press, 1974.

Referencias de otras versiones publicadas de esta revisión

Ir a:

Joy 2000

Joy CB, Adams CE, Rice K. Crisis intervention for people with severe mental illnessees: a Cochrane review. Schizophrenia Research 2000;41(1):230‐1.

Joy 2004

Joy CB, Adams CE, Rice K. Crisis intervention for people with severe mental illnesses. Cochrane Database of Systematic Reviews 2004, Issue 4. [CD001087]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Fenton 1979

Methods

Allocation: randomised.
Blindness: single.
Duration: 12 months.
Raters: independent.

Participants

Diagnosis: schizophrenia 41.9%, psychosis 30.3%, neurosis 27.8% (ICD‐8).
N=162.*
History: in need of psychiatric admission, 40% first admissions.
Sex: 40% M, 60% F.
Age: over 18 yrs, modal range 24‐35 yrs.
Exclusions: organic brain syndrome, alcoholism, drug dependency, violent or suicidal behaviour, non english speaking, non resident of Montreal.

Interventions

1. Home care: assessment & treatment in home environment, multidisciplinary team, 24 hr service, drug treatment, psychotherapy, instruction in living skills. N=78.
2. Standard care: short‐term, intensive care in hospital, normal staffing levels, social work, follow‐up visits after discharge. N=84.

Outcomes

Death.**
Hospital admission: unable to keep to initial protocol.
Readmission.
Leaving the study early (patients).
Staff contact.***
Mental state: PEF.
Economic cost.

Unable to use ‐
Days in hospital: includes index admission.
Leaving the study early (relatives): no indvidual data available for each group.
Family burden: FEF (reported only 2 'significant' items out of 61 analysed).

Notes

* Demographic data on 155 patients only.

** Assumed deaths occured at 6 months.

***Home care: number of visits made by team to families or patients in community. Standard care: number of visits made by patient to OPD.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Hoult 1983

Methods

Allocation: random assignment.
Blindness: single, independent raters.
Duration: 12 months.

Participants

Diagnosis: severe psychosis (PSE), 50.4% schizophrenia (DSM III).
N=120.
History: presenting for admission to psychiatric hospital.
Sex: 45.8% M, 54.2% F.
Age: 15‐65 yrs.
Exclusions: dual diagnosis, organic brain disorder, mental retardation, non resident of local area.

Interventions

1. Home care: multidisciplinary team, 24 hr crisis service, drug treatment, counselling, training in basic living skills, family intervention, support & education, intensive treatment during acute phase. N=60.
2. Standard care: admission (mean of 3 weeks), normal staffing levels, day programmes, discussion groups, arts & crafts, sporting activities, after care by standard community mental health centres. N=60.

Outcomes

Death.
Harm.
Hospital admission: unable to keep to initial prtocol.
Readmissions.
Leaving the study early (patients, relatives‐total).
Mental state.*
Family burden.
Patient satisfaction.
Relative satisfaction (total and sub‐group).

Unable to use ‐
Number of days in hospital: no SD.
Loss (relatives‐sub): not clear how many relatives lived with patients.
Global State: HSRS (no SD).
Mental State: BPRS (no data).
Mental state: PSE (no SD).
Community burden: no data.
Economic cost: no SD.

Notes

* 19 symptoms, rated by relatives. For purposes of this review these were grouped into affective symptoms, psychotic symptoms, behaviour, physical problems, social functioning, substance abuse & most relevant symptom taken from each category for analysis.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Muijen 1992

Methods

Allocation: randomised.
Blindness: single.
Duration: 20 months.
Raters: independent.

Participants

Diagnosis: serious mental illness (PSE), 53% met criteria for schizophrenia.
N=189.
History: in need of immediate hospitalisation.
Sex: 49.7% M, 50.3% F.
Age: 17‐64 yrs, mean ˜35yrs.
Exclusions: dual diagnosis.

Interventions

1. Home care: DLP's home based care, multidisciplinary team, crisis clinics, 24hr answering service, problem solving, home visits & relative support, life skills training, assistance with financial & housing problems. N=92.
2. Standard care: hospital care, normal staffing levels, standard outpatient services, CPN. N=97.

Outcomes

Death.
Hospital admission: unable to keep to initial protocol.*
Readmission.*
Leaving the study early (patients and relatives‐sub**).
Mental state: PSE, BPRS.
Global state: GAS, SAS.
Patient satisfaction: CSQ.
Economic cost.

Unable to use‐
Harm to self: incomplete information, data given refers only to patients who were admitted.
Days in hospital: includes index admission.*
Daily living: DLS (was adapted for use in the SAS by authors)
Relative's satisfaction: RSQ (devised by authors, as yet not peer reviewed).
Service Use: no data for standard care group.

Notes

* After 31 months change in policy meant DLP team lost control of admission & discharges.

** Only relatives living with patient were followed up.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Pasamanick 1964a

Methods

Allocation: randomised.
Blindness: single.
Duration: 24 months.
Raters: not blind.

Participants

Diagnosis: schizophrenia.
N=163.*
History: recently hospitalized or in need of hospitalisation.
Sex: 68% F, 32% M.
Age: mean ˜37 yrs.
Exclusions: homicidal or suicidal tendencies.

Interventions

1. Home‐drug care: home based nurse visits, drug treatment, practical assistance & support for patient & family, multidisciplinary team, 24 hour answering service. N=64.**
2. Home‐placebo care: as above except placebos given instead of prescribed medication. N=45.***
3. Standard care: hospitalisation & medication, normal staffing levels & treatment programmes. N=54.

Outcomes

Hospital admission: unable to keep to initial protocol.
Leaving the study early (patients).

Unable to use‐
Readmission: individual data not presented.
Days in hospital: no SD.
Mental state: IMPS, MSPP, SORR & PHNR (no SD).
Family burden: no data for standard care group.
Role fulfillment: no data for standard care group.
Social activity: no data for standard care group.

Notes

* A second cohort recruited from community centres ‐ only randomised to home‐drug or home‐placebo care ‐ not used in this review.

** Once a patient from the home‐care group was admitted they were no longer treated by the community team, follow‐up interviews still conducted.

*** Not used in this analysis.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear
Stein 1975

Methods

Allocation: randomised.
Blindness: single.
Duration: 14 months.
Raters: indpendent.

Participants

Diagnosis: any severe psychiatric disorder.
N=130.
History: in need of psychiatric hospital admission.
Sex: 55% M, 45% F.
Age: 18‐62 yrs, mean ˜31 yrs.
Exclusions: dual diagnosis.

Interventions

1. Home care: CLP's home based care, multidisciplinary team, 24hr service, drug treatment, coping skills taught, family support given, use of community agencies ‐ for 14 months & then withdrawn. N=65.

2. Standard care: hospitalisation, aim of returning to community as soon as possible, normal staffing levels, standard outpatient follow‐up. N=65.

Outcomes

Death.
Harm.
Hospital admission: unable to keep to initial protocol.*
Leaving the study early (patients).
Community burden.

Unable to use‐
Readmission: no data for home care group.
Days in hospital: includes index admission.
Leaving the study early (relatives): not clear if all relatives followed up or just relatives living with the patient.
Mental state: SCRS (no mean or SD).
Global State: CAF (devised by authors, as yet not peer reviewed ).
Family burden: FBS (devised by authors, as yet not peer reviewed).
Life satisfaction: LSS (no mean or SD).
Self Esteem: SES (no mean or SD).
Economic cost: no SD.

Notes

* At 6 months only 60 people in each group ‐ preliminary report data.

Risk of bias

Bias

Authors' judgement

Support for judgement

Allocation concealment?

Unclear risk

B ‐ Unclear

Abbreviations
1. Diagnostic systems
DSM III: Diagnostic Statistical Manual, version 3
ICD ‐ 8: International Classification of Diseases ‐ 8th Review
PSE: Present State Examination

2.Scales/Forms used to collect data
BPRS: Brief Psychiatric Rating Scale
CAF: Community Adjustment Form
DLS: Daily Living Score
FBS: Family Burden Scale
FEF: Family Evaluation Form
HSRS: Health and Sickness Rating Scale
IMPS: Inpatient Multidimensional Psychiatric Scale
LSS: Life Satisfaction Scale
MSPP: Multidmensional Scale for Rating Psychiatric Patients
PEF: Psychiatric Evaluation Form
PHNR: Public Health Nursing Report
SAS: Social Adjustment Scale
SCRS: Short Clinical Rating Scale
SES: Self Esteem Scale
SORR: SIgnificant Other Rating Report
RSQ: Relative' s Satisfaction Questionnaire

Other
ACT: Assertive Community Treatment
M: Male
F: Female
N: Number
CLP: Community Living Programme
CPN: Community Psychiatric Nurse
DLP: Daily Living Programme
OPD: Outpatient department
relatives‐sub ‐ sub group of relatives actually living with the patient.
SD: Standard deviation
WMD: Weighted mean diffference

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Bond 1989

Allocation: not randomised, parallel case series.

Burns 1993

Allocation: randomised ‐ but 332 allocated yet only 162 entered study.
Participants: anyone presenting for treatment to the mental health services in relevant catchment area, majority not severely ill, only 35% met PSE catego 'psychotic'.

Bush 1990

Allocation: randomised.
Participants: people with severe psychosis + high rate of rehospitalisation ‐ not necessarily in 'crisis' or need of readmission at time of allocation.
Interventions: community intensive outreach versus hospital care.

Fenton 2000

Allocation: randomised.
Participants: people with schizophrenia or other serious psychiatric disorder.
Interventions: crisis care in residential setting versus hospital care.

Gater 1997

Allocation: randomised.
Participants: people with schizophrenia.
Interventions: multi‐disiplinary community team versus hospital care but the community care did not involve an 'out of hours' emergency serivce, this was only provided on the day of referral.

Ghandi 2001

Allocation: randomised.
Paricipants: 55% people with schizophrenia, others with bipolar affect disorder, depressive disorders or other psychiatric conditions.
Interventions: community teams versus standard care but not care for those in crisis.

Harrison 2003

Allocation: not randomised.

Henlegger 1999

Allocation: randomised.
Participants: adolescents (mean age ˜13 years) requiring psychiatric hospitialisation, majority not suffering from schizophrenia.

Herz 2000

Allocation: randomised.
Participants: people with schizophrenia or schizoaffective disorder.
Interventions: intensive community aftercare vs standard community aftercare.

Jones 2003

Allocation: randomised.
Participants: homeless people with severe mental illness.
Interventions: critical time intervention (an adapted form of intensive case management ) versus standard care , not specific to care during a crisis.

Kuipers 2004

Allocation: randomised.
Participants: people with functional psychosis.
Interventions: COAST versus treatment as usual, both interventions were multidisciplinary team‐based community care but COAST included specialised psychological interventions and information geared towards early intervention issues, not specifically crisis intervention.

Levenson 1997

Allocation: randomised.
Participants: people with acute schizophrenia.
Intervention: admission versus 'community care'; non hospitalised group sent home but not treated there ‐ required to attend outpatient clinic daily, treatment not delivered by multidisciplinary team, not available 24 hrs.

Linszen 1998

Allocation: randomised.
Participants: young people with recent onset schizophrenia.
Interventions: family intervention, not crisis intervention.

Merson 1992

Allocation: randomised.
Participants: anyone with a psychiatric disorder referred as a psychiatric emergency from the accident and emercengy department or GP.
Intervention: early intervention service (EIS) designed to treat people as quickly as possible versus standard care; EIS assessment at home and then case managers assigned ‐ not a crisis intervention, not availabe 24 hrs a day.

Metcalfe 2005

Allocation: randomised.
Participants: people with severe psychosis complicated by additional needs.
Interventions: intensive case management (10‐15 cases) versus standard case management (30‐35 cases), not crisis intervention.

Mosher 1975

Allocation: quasi randomisation.
Participants: people with schizophrenia, first admission.
Interventions: treated in a residential home versus hospital care ‐ not managed in their home environment.

Muijen 1994

Allocation: randomised.
Partcipants: people with serious mental illness in home care for 18 months (Phase I of study) ‐ not in acute phase.

Pai 1982

Allocation: quasi randomised.

Pasamanick 1964b

Allocation: randomised.
Participants: people with serious mental illness referred to the study from community centres; not necessarily in a crisis, not allocated to standard care as not in need in of hospitalisation ‐ instead were allocated to home‐drug or home‐placebo group. See included studies table (Pasmanick‐Ohio) for more detail.

Polak 1976

Allocation: randomised.
Participants: people with psychiatric illness requiring hospitalisation in a setting where a crisis ethos was already being practiced.
Intervention: home based care via multidisciplinary team with 24 hrs on call service available vs hospital based care.
Outcomes: demoninators unclear, no usable data.

Rosenheck 1995

Allocation: randomised.
Paticipants: people with shcizophrenia or other serious psychiatric illness.
Intervention: Intensive Psychiatric Community Care (IPCC) versus hospitalization; IPCC form of ACT (Assertive Community Treatment) rather than crisis intervention.

Sledge 1996

Allocation: randomised.
Participants: people in acute phase of psychiatric disorder.
Intervention: partial hospitalisation versus standard hospitalisation ‐ both hospital‐based packages.

Taylor 1998

Allocation: randomised.
Participants: people with psychosis.
Interventions: intensive community care versus standard community care.

Tyrer 1995

Allocation: randomised.
Participants: people who were psychiatrically vulnerable.
Interventions: close supervision by key‐worker versus standard psychiatric follow‐up.

van Minnen 1997

Allocation: randomised.
Participants: people with both "mental retardation and severe mental illness" ‐ not clearly schizophrenia.

Data and analyses

Open in table viewer
Comparison 1. HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE'

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death: 1. Any cause Show forest plot

4

601

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.30, 1.88]
Analysis 1.1
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 1 Death: 1. Any cause.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 1 Death: 1. Any cause.

2 Death: 2. By cause Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.2
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 2 Death: 2. By cause.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 2 Death: 2. By cause.

2.1 natural causes

4

601

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.23, 3.09]

2.2 suicide or death in suspicious circumstances

4

601

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.24, 2.32]

3 Harm to self or others Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.3
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 3 Harm to self or others.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 3 Harm to self or others.

3.1 attempted suicide

2

250

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.87, 2.03]

3.2 homicide

1

189

Risk Ratio (M‐H, Fixed, 95% CI)

3.16 [0.13, 76.63]

4 Hospital use: 1. Unable to keep to initial trial protocol as regards admission Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.4
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 4 Hospital use: 1. Unable to keep to initial trial protocol as regards admission.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 4 Hospital use: 1. Unable to keep to initial trial protocol as regards admission.

4.1 by 6 months

3

427

Risk Ratio (M‐H, Fixed, 95% CI)

61.09 [12.58, 296.63]

4.2 by 12 months

5

713

Risk Ratio (M‐H, Fixed, 95% CI)

65.16 [19.04, 223.06]

4.3 by 20 months

2

306

Risk Ratio (M‐H, Fixed, 95% CI)

94.80 [13.90, 646.37]

4.4 by 24 months

1

118

Risk Ratio (M‐H, Fixed, 95% CI)

39.77 [2.47, 639.78]

5 Hospital use: 2. Unable to avoid repeat admissions Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.5
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 5 Hospital use: 2. Unable to avoid repeat admissions.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 5 Hospital use: 2. Unable to avoid repeat admissions.

5.1 by 12 months

3

465

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.54, 0.97]

5.2 by 20 months

1

188

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.75, 1.60]

6 Hospital use: 3. Home or outpatient visits (data likely to be skewed) Show forest plot

Other data

No numeric data
Analysis 1.6

Study

Interventions

Mean

SD

N

Notes

6 ‐ 12 months

Fenton 1979

Crisis/home group

2.1

3.4

76

Difference favouring home group (two tailed t‐test, p=0.005)

Fenton 1979

Standard care group

6.3

12.3

79

by 12 months

Fenton 1979

Crisis/home group

16.5

11.7

76

No difference between the groups (two tailed t test p>0.05)

Fenton 1979

Standard care group

13.0

19.2

79

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 6 Hospital use: 3. Home or outpatient visits (data likely to be skewed).

6.1 6 ‐ 12 months

Other data

No numeric data

6.2 by 12 months

Other data

No numeric data

7 Leaving the study early (unwilling or unable to provide infomation): 1. Patients Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.7
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 7 Leaving the study early (unwilling or unable to provide infomation): 1. Patients.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 7 Leaving the study early (unwilling or unable to provide infomation): 1. Patients.

7.1 by 3 months

1

162

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.45, 1.25]

7.2 by 6 months

4

599

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.53, 0.94]

7.3 by 12 months

4

594

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.56, 0.98]

7.4 by 20 months

3

475

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.57, 1.08]

8 Leaving the study early (unwilling or unable to provide information) 2. Relatives Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.8
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 8 Leaving the study early (unwilling or unable to provide information) 2. Relatives.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 8 Leaving the study early (unwilling or unable to provide information) 2. Relatives.

8.1 total in study

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.52, 2.28]

8.2 subgroup of those living with patient

1

76

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.43, 1.17]

9 Global state: 1. GAS (endpoint score, range 1‐100, low = poor) (loss in some cases is greater than 30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.9
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 9 Global state: 1. GAS (endpoint score, range 1‐100, low = poor) (loss in some cases is greater than 30%).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 9 Global state: 1. GAS (endpoint score, range 1‐100, low = poor) (loss in some cases is greater than 30%).

9.1 by 6 months

1

129

Mean Difference (IV, Fixed, 95% CI)

5.10 [‐0.86, 11.06]

9.2 by 12 months

1

131

Mean Difference (IV, Fixed, 95% CI)

3.5 [‐3.15, 10.15]

9.3 by 20 months

1

142

Mean Difference (IV, Fixed, 95% CI)

5.70 [‐0.26, 11.66]

10 Global state: 2. SAS (endpoint score, high=poor) (loss in some cases in greater than 30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.10
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 10 Global state: 2. SAS (endpoint score, high=poor) (loss in some cases in greater than 30%).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 10 Global state: 2. SAS (endpoint score, high=poor) (loss in some cases in greater than 30%).

10.1 by 6 months

1

130

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.75, 0.35]

10.2 by 12 months

1

120

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.85, 0.25]

10.3 by 20 months

1

139

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.15, ‐0.05]

11 Global state: 3. GAS scale change data by 3 months (+ve change=good, data likely to be skewed) Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

5.20 [‐1.19, 11.59]
Analysis 1.11
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 11 Global state: 3. GAS scale change data by 3 months (+ve change=good, data likely to be skewed).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 11 Global state: 3. GAS scale change data by 3 months (+ve change=good, data likely to be skewed).

12 Global state: 4. SAS change data by 3 months (‐ve change=good, data likely to be skewed) Show forest plot

1

127

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.31, 0.13]
Analysis 1.12
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 12 Global state: 4. SAS change data by 3 months (‐ve change=good, data likely to be skewed).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 12 Global state: 4. SAS change data by 3 months (‐ve change=good, data likely to be skewed).

13 Mental state ‐ general: 1. Unwell by 12 months Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.40, 1.07]
Analysis 1.13
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 13 Mental state ‐ general: 1. Unwell by 12 months.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 13 Mental state ‐ general: 1. Unwell by 12 months.

14 Mental state ‐ general: 2. BPRS (endpoint score, range 24‐168, high=poor) (loss in standard group >30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.14
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 14 Mental state ‐ general: 2. BPRS (endpoint score, range 24‐168, high=poor) (loss in standard group >30%).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 14 Mental state ‐ general: 2. BPRS (endpoint score, range 24‐168, high=poor) (loss in standard group >30%).

14.1 by 6 months

1

129

Mean Difference (IV, Fixed, 95% CI)

‐2.10 [‐6.40, 2.20]

14.2 by 12 months

1

131

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐6.03, 2.03]

14.3 by 20 months

1

142

Mean Difference (IV, Fixed, 95% CI)

‐4.5 [‐8.68, ‐0.32]

15 Mental state ‐ general: 3. PEF (endpoint score, range 0‐5, high=poor) (loss is greater than 30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.15
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 15 Mental state ‐ general: 3. PEF (endpoint score, range 0‐5, high=poor) (loss is greater than 30%).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 15 Mental state ‐ general: 3. PEF (endpoint score, range 0‐5, high=poor) (loss is greater than 30%).

15.1 by 3 months

1

118

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.22, 0.62]

15.2 by 6 months

1

111

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.42, 0.62]

15.3 by 12 months

1

97

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.84, 0.04]

15.4 by 20 months

1

100

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.47, 0.67]

16 Mental state ‐ general: 4. PSE (endpoint score, high score = poor, data likely to be skewed) Show forest plot

Other data

No numeric data
Analysis 1.16

Study

Interventions

Mean

SD

N

Notes

by 6 months

Muijen 1992

Crisis/home care group

13.5

11.5

67

No difference between groups (ANCOVA, p = not reported).

Muijen 1992

Standard care group

16.5

12.1

61

by 12 months

Muijen 1992

Crisis/home care group

11.8

12.0

64

No difference between groups (ANCOVA, p = not reported).

Muijen 1992

Standard care group

13.8

14.4

64

by 20 months

Muijen 1992

Crisis/home care group

8.2

9.3

72

Result not statistically significant (p=0.09)

Muijen 1992

Standard care group

12.2

15.0

70

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 16 Mental state ‐ general: 4. PSE (endpoint score, high score = poor, data likely to be skewed).

16.1 by 6 months

Other data

No numeric data

16.2 by 12 months

Other data

No numeric data

16.3 by 20 months

Other data

No numeric data

17 Mental state ‐ general: 5. BPRS scale change data by 3 months (‐ve change=good, data likely to be skewed) Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

‐3.5 [‐8.92, 1.92]
Analysis 1.17
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 17 Mental state ‐ general: 5. BPRS scale change data by 3 months (‐ve change=good, data likely to be skewed).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 17 Mental state ‐ general: 5. BPRS scale change data by 3 months (‐ve change=good, data likely to be skewed).

18 Mental state ‐ general: 6. PSE scale change data by 3 months (‐ve change=good, data likely to be skewed). Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

‐2.70 [‐7.69, 2.29]
Analysis 1.18
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 18 Mental state ‐ general: 6. PSE scale change data by 3 months (‐ve change=good, data likely to be skewed)..

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 18 Mental state ‐ general: 6. PSE scale change data by 3 months (‐ve change=good, data likely to be skewed)..

19 Mental state ‐ specific: 1. Unsociable (reported by relatives) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.19
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 19 Mental state ‐ specific: 1. Unsociable (reported by relatives).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 19 Mental state ‐ specific: 1. Unsociable (reported by relatives).

19.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.66, 1.12]

19.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.30, 0.64]

20 Mental state ‐ specific: 2. Aggression (reported by relatives) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.20
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 20 Mental state ‐ specific: 2. Aggression (reported by relatives).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 20 Mental state ‐ specific: 2. Aggression (reported by relatives).

20.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.72, 1.31]

20.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.7 [0.39, 1.25]

21 Mental state ‐ specific: 3. Various problems at 4 months (reported by relatives) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.21
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 21 Mental state ‐ specific: 3. Various problems at 4 months (reported by relatives).

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 21 Mental state ‐ specific: 3. Various problems at 4 months (reported by relatives).

21.1 agitation

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.36, 0.95]

21.2 depression

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.57, 1.13]

21.3 disorientation

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.28, 0.79]

21.4 psychotic behaviour

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.30, 1.11]

21.5 substance abuse

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.33, 1.36]

21.6 withdrawl

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.48, 1.07]

22 Burden ‐ family: 1. Disruption to daily routine Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.22
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 22 Burden ‐ family: 1. Disruption to daily routine.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 22 Burden ‐ family: 1. Disruption to daily routine.

22.1 by 3 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.58, 0.96]

22.2 by 6 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.52, 0.92]

23 Burden ‐ family: 2. Disruption to social life Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.23
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 23 Burden ‐ family: 2. Disruption to social life.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 23 Burden ‐ family: 2. Disruption to social life.

23.1 by 3 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.52, 0.87]

23.2 by 6 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.57, 0.94]

24 Burden ‐ family: 3. Financial strain Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.24
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 24 Burden ‐ family: 3. Financial strain.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 24 Burden ‐ family: 3. Financial strain.

24.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.52, 1.10]

24.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.53, 1.33]

25 Burden ‐ family: 4. Physical illness due to patient's illness Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.25
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 25 Burden ‐ family: 4. Physical illness due to patient's illness.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 25 Burden ‐ family: 4. Physical illness due to patient's illness.

25.1 by 3 months

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.65, 0.95]

25.2 by 6 months

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.55, 0.92]

26 Burden ‐ family: 5. Overall burden is great Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.26
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 26 Burden ‐ family: 5. Overall burden is great.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 26 Burden ‐ family: 5. Overall burden is great.

26.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.41, 0.80]

26.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.20, 0.59]

27 Burden ‐ community: 1. Not employed by 20 months Show forest plot

1

189

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.85, 1.12]
Analysis 1.27
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 27 Burden ‐ community: 1. Not employed by 20 months.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 27 Burden ‐ community: 1. Not employed by 20 months.

28 Burden ‐ community: 2. Various outcomes by 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.28
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 28 Burden ‐ community: 2. Various outcomes by 12 months.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 28 Burden ‐ community: 2. Various outcomes by 12 months.

28.1 at least one arrest

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.46, 1.12]

28.2 at least one use of emergency services

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.43, 1.54]

29 Satisfaction ‐ patient: 1. Various outcomes by 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.29
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 29 Satisfaction ‐ patient: 1. Various outcomes by 12 months.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 29 Satisfaction ‐ patient: 1. Various outcomes by 12 months.

29.1 feels unimproved

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.31, 0.74]

29.2 dissatisfied with treatment received

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.50, 0.88]

29.3 prefered to get other treatment

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.27, 0.77]

29.4 feels less able to cope

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.21, 0.62]

29.5 feels will need more help outside working hours in the future

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.88, 2.48]

30 Satisfaction ‐ patient: 2. Patient not satisitfied with care: Satisfaction Scale (endpoint score, range 0 ‐32, Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only
Analysis 1.30
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 30 Satisfaction ‐ patient: 2. Patient not satisitfied with care: Satisfaction Scale (endpoint score, range 0 ‐32,.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 30 Satisfaction ‐ patient: 2. Patient not satisitfied with care: Satisfaction Scale (endpoint score, range 0 ‐32,.

30.1 by 6 months

1

115

Mean Difference (IV, Fixed, 95% CI)

5.10 [3.16, 7.04]

30.2 by 12 months

1

121

Mean Difference (IV, Fixed, 95% CI)

4.80 [3.11, 6.49]

30.3 by 20 months

1

137

Mean Difference (IV, Fixed, 95% CI)

5.40 [3.91, 6.89]

31 Satisfaction ‐ relatives: 1. Feels patient is not improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.31
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 31 Satisfaction ‐ relatives: 1. Feels patient is not improved.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 31 Satisfaction ‐ relatives: 1. Feels patient is not improved.

31.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.60, 1.04]

31.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.53, 0.97]

32 Satisfaction ‐ relatives: 2. Dissatisfied with treatment received Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.32
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 32 Satisfaction ‐ relatives: 2. Dissatisfied with treatment received.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 32 Satisfaction ‐ relatives: 2. Dissatisfied with treatment received.

32.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.44, 0.89]

32.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.42, 0.78]

32.3 by 12 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.29, 0.72]

33 Satisfaction ‐ relatives: 3. Would have preferred patient to have received other treatment Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.33
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 33 Satisfaction ‐ relatives: 3. Would have preferred patient to have received other treatment.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 33 Satisfaction ‐ relatives: 3. Would have preferred patient to have received other treatment.

33.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [0.63, 2.57]

33.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.49, 2.54]

33.3 by 12 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.43, 1.54]

34 Satisfaction ‐ relatives: 4. Various outcomes by 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only
Analysis 1.34
Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 34 Satisfaction ‐ relatives: 4. Various outcomes by 12 months.

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 34 Satisfaction ‐ relatives: 4. Various outcomes by 12 months.

34.1 feel themselves less able to cope

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.42, 0.78]

34.2 feel themsleves to need more help outside working hours in the future

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.91, 1.60]

35 Economic cost per patient (data likely to be skewed) Show forest plot

Other data

No numeric data
Analysis 1.35

Study

Interventions

Mean

SD

N

Notes

total cost for trial period ‐ as assessed by researchers

Fenton 1979

Crisis/home care group

$1980

$1850

79

Difference favouring home group stated (2 tailed t‐test p<0.001)

Fenton 1979

Standard care group

$3250

$2410

76

total cost for trial period ‐ as assessed by finance department

Fenton 1979

Crisis/home care group

$3230

$5120

79

Difference favouring home group (2 tailed t‐test p=0.001)

Fenton 1979

Standard care group

$6750

$7180

76

per week

Muijen 1992

Crisis/home care group

£196

£97

55

Over 20 month trial period

Muijen 1992

Standard care group

£358

£241

48

Difference favouring home group (p=0.000)

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 35 Economic cost per patient (data likely to be skewed).

35.1 total cost for trial period ‐ as assessed by researchers

Other data

No numeric data

35.2 total cost for trial period ‐ as assessed by finance department

Other data

No numeric data

35.3 per week

Other data

No numeric data

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 1 Death: 1. Any cause.
Figuras y tablas -
Analysis 1.1

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 1 Death: 1. Any cause.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 2 Death: 2. By cause.
Figuras y tablas -
Analysis 1.2

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 2 Death: 2. By cause.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 3 Harm to self or others.
Figuras y tablas -
Analysis 1.3

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 3 Harm to self or others.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 4 Hospital use: 1. Unable to keep to initial trial protocol as regards admission.
Figuras y tablas -
Analysis 1.4

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 4 Hospital use: 1. Unable to keep to initial trial protocol as regards admission.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 5 Hospital use: 2. Unable to avoid repeat admissions.
Figuras y tablas -
Analysis 1.5

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 5 Hospital use: 2. Unable to avoid repeat admissions.

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Study

Interventions

Mean

SD

N

Notes

6 ‐ 12 months

Fenton 1979

Crisis/home group

2.1

3.4

76

Difference favouring home group (two tailed t‐test, p=0.005)

Fenton 1979

Standard care group

6.3

12.3

79

by 12 months

Fenton 1979

Crisis/home group

16.5

11.7

76

No difference between the groups (two tailed t test p>0.05)

Fenton 1979

Standard care group

13.0

19.2

79

Figuras y tablas -
Analysis 1.6

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 6 Hospital use: 3. Home or outpatient visits (data likely to be skewed).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 7 Leaving the study early (unwilling or unable to provide infomation): 1. Patients.
Figuras y tablas -
Analysis 1.7

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 7 Leaving the study early (unwilling or unable to provide infomation): 1. Patients.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 8 Leaving the study early (unwilling or unable to provide information) 2. Relatives.
Figuras y tablas -
Analysis 1.8

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 8 Leaving the study early (unwilling or unable to provide information) 2. Relatives.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 9 Global state: 1. GAS (endpoint score, range 1‐100, low = poor) (loss in some cases is greater than 30%).
Figuras y tablas -
Analysis 1.9

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 9 Global state: 1. GAS (endpoint score, range 1‐100, low = poor) (loss in some cases is greater than 30%).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 10 Global state: 2. SAS (endpoint score, high=poor) (loss in some cases in greater than 30%).
Figuras y tablas -
Analysis 1.10

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 10 Global state: 2. SAS (endpoint score, high=poor) (loss in some cases in greater than 30%).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 11 Global state: 3. GAS scale change data by 3 months (+ve change=good, data likely to be skewed).
Figuras y tablas -
Analysis 1.11

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 11 Global state: 3. GAS scale change data by 3 months (+ve change=good, data likely to be skewed).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 12 Global state: 4. SAS change data by 3 months (‐ve change=good, data likely to be skewed).
Figuras y tablas -
Analysis 1.12

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 12 Global state: 4. SAS change data by 3 months (‐ve change=good, data likely to be skewed).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 13 Mental state ‐ general: 1. Unwell by 12 months.
Figuras y tablas -
Analysis 1.13

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 13 Mental state ‐ general: 1. Unwell by 12 months.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 14 Mental state ‐ general: 2. BPRS (endpoint score, range 24‐168, high=poor) (loss in standard group >30%).
Figuras y tablas -
Analysis 1.14

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 14 Mental state ‐ general: 2. BPRS (endpoint score, range 24‐168, high=poor) (loss in standard group >30%).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 15 Mental state ‐ general: 3. PEF (endpoint score, range 0‐5, high=poor) (loss is greater than 30%).
Figuras y tablas -
Analysis 1.15

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 15 Mental state ‐ general: 3. PEF (endpoint score, range 0‐5, high=poor) (loss is greater than 30%).

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Study

Interventions

Mean

SD

N

Notes

by 6 months

Muijen 1992

Crisis/home care group

13.5

11.5

67

No difference between groups (ANCOVA, p = not reported).

Muijen 1992

Standard care group

16.5

12.1

61

by 12 months

Muijen 1992

Crisis/home care group

11.8

12.0

64

No difference between groups (ANCOVA, p = not reported).

Muijen 1992

Standard care group

13.8

14.4

64

by 20 months

Muijen 1992

Crisis/home care group

8.2

9.3

72

Result not statistically significant (p=0.09)

Muijen 1992

Standard care group

12.2

15.0

70

Figuras y tablas -
Analysis 1.16

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 16 Mental state ‐ general: 4. PSE (endpoint score, high score = poor, data likely to be skewed).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 17 Mental state ‐ general: 5. BPRS scale change data by 3 months (‐ve change=good, data likely to be skewed).
Figuras y tablas -
Analysis 1.17

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 17 Mental state ‐ general: 5. BPRS scale change data by 3 months (‐ve change=good, data likely to be skewed).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 18 Mental state ‐ general: 6. PSE scale change data by 3 months (‐ve change=good, data likely to be skewed)..
Figuras y tablas -
Analysis 1.18

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 18 Mental state ‐ general: 6. PSE scale change data by 3 months (‐ve change=good, data likely to be skewed)..

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 19 Mental state ‐ specific: 1. Unsociable (reported by relatives).
Figuras y tablas -
Analysis 1.19

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 19 Mental state ‐ specific: 1. Unsociable (reported by relatives).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 20 Mental state ‐ specific: 2. Aggression (reported by relatives).
Figuras y tablas -
Analysis 1.20

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 20 Mental state ‐ specific: 2. Aggression (reported by relatives).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 21 Mental state ‐ specific: 3. Various problems at 4 months (reported by relatives).
Figuras y tablas -
Analysis 1.21

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 21 Mental state ‐ specific: 3. Various problems at 4 months (reported by relatives).

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 22 Burden ‐ family: 1. Disruption to daily routine.
Figuras y tablas -
Analysis 1.22

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 22 Burden ‐ family: 1. Disruption to daily routine.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 23 Burden ‐ family: 2. Disruption to social life.
Figuras y tablas -
Analysis 1.23

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 23 Burden ‐ family: 2. Disruption to social life.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 24 Burden ‐ family: 3. Financial strain.
Figuras y tablas -
Analysis 1.24

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 24 Burden ‐ family: 3. Financial strain.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 25 Burden ‐ family: 4. Physical illness due to patient's illness.
Figuras y tablas -
Analysis 1.25

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 25 Burden ‐ family: 4. Physical illness due to patient's illness.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 26 Burden ‐ family: 5. Overall burden is great.
Figuras y tablas -
Analysis 1.26

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 26 Burden ‐ family: 5. Overall burden is great.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 27 Burden ‐ community: 1. Not employed by 20 months.
Figuras y tablas -
Analysis 1.27

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 27 Burden ‐ community: 1. Not employed by 20 months.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 28 Burden ‐ community: 2. Various outcomes by 12 months.
Figuras y tablas -
Analysis 1.28

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 28 Burden ‐ community: 2. Various outcomes by 12 months.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 29 Satisfaction ‐ patient: 1. Various outcomes by 12 months.
Figuras y tablas -
Analysis 1.29

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 29 Satisfaction ‐ patient: 1. Various outcomes by 12 months.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 30 Satisfaction ‐ patient: 2. Patient not satisitfied with care: Satisfaction Scale (endpoint score, range 0 ‐32,.
Figuras y tablas -
Analysis 1.30

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 30 Satisfaction ‐ patient: 2. Patient not satisitfied with care: Satisfaction Scale (endpoint score, range 0 ‐32,.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 31 Satisfaction ‐ relatives: 1. Feels patient is not improved.
Figuras y tablas -
Analysis 1.31

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 31 Satisfaction ‐ relatives: 1. Feels patient is not improved.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 32 Satisfaction ‐ relatives: 2. Dissatisfied with treatment received.
Figuras y tablas -
Analysis 1.32

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 32 Satisfaction ‐ relatives: 2. Dissatisfied with treatment received.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 33 Satisfaction ‐ relatives: 3. Would have preferred patient to have received other treatment.
Figuras y tablas -
Analysis 1.33

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 33 Satisfaction ‐ relatives: 3. Would have preferred patient to have received other treatment.

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Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 34 Satisfaction ‐ relatives: 4. Various outcomes by 12 months.
Figuras y tablas -
Analysis 1.34

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 34 Satisfaction ‐ relatives: 4. Various outcomes by 12 months.

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Study

Interventions

Mean

SD

N

Notes

total cost for trial period ‐ as assessed by researchers

Fenton 1979

Crisis/home care group

$1980

$1850

79

Difference favouring home group stated (2 tailed t‐test p<0.001)

Fenton 1979

Standard care group

$3250

$2410

76

total cost for trial period ‐ as assessed by finance department

Fenton 1979

Crisis/home care group

$3230

$5120

79

Difference favouring home group (2 tailed t‐test p=0.001)

Fenton 1979

Standard care group

$6750

$7180

76

per week

Muijen 1992

Crisis/home care group

£196

£97

55

Over 20 month trial period

Muijen 1992

Standard care group

£358

£241

48

Difference favouring home group (p=0.000)

Figuras y tablas -
Analysis 1.35

Comparison 1 HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE', Outcome 35 Economic cost per patient (data likely to be skewed).

Ir a la figura de la revisión
Table 1. Suggestions for trial design

Methods

Participants

Interventions

Outcomes

Notes

Allocation: randomised, with sequence generation and concealment of allocation clearly described.
Blindness: single.
Duration: 12 months at least.
Raters: independent.

Diagnosis: schizophrenia or related psychoses.
N=300.*
History: in need of psychiatric admission.
Sex: both.
Age: any.

1. Home care: assertive community treatment + crisis team, multidisciplinary, 24 hr service, drug treatment, psychotherapy, instruction in living skills. N=150.
2. Home care: assertive community treatment without crisis team. N=150.

Death.
Serious harm to self and others.
Service outcomes: hospital admission, readmissions.
Leaving the study early.
Global and mental state (CGI, binary outcome).**
Satisfaction: family burden, patient satisfaction, relative satisfaction, staff burden (binary data)
Economic data.

* Size of study with sufficient power to highlight about a 10% difference between groups for primary outcome.
** Primary outcome.

Figuras y tablas -
Table 1. Suggestions for trial design
Ir a la tabla de la revisión
Comparison 1. HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE'

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death: 1. Any cause Show forest plot

4

601

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.30, 1.88]

2 Death: 2. By cause Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 natural causes

4

601

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.23, 3.09]

2.2 suicide or death in suspicious circumstances

4

601

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.24, 2.32]

3 Harm to self or others Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 attempted suicide

2

250

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.87, 2.03]

3.2 homicide

1

189

Risk Ratio (M‐H, Fixed, 95% CI)

3.16 [0.13, 76.63]

4 Hospital use: 1. Unable to keep to initial trial protocol as regards admission Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 by 6 months

3

427

Risk Ratio (M‐H, Fixed, 95% CI)

61.09 [12.58, 296.63]

4.2 by 12 months

5

713

Risk Ratio (M‐H, Fixed, 95% CI)

65.16 [19.04, 223.06]

4.3 by 20 months

2

306

Risk Ratio (M‐H, Fixed, 95% CI)

94.80 [13.90, 646.37]

4.4 by 24 months

1

118

Risk Ratio (M‐H, Fixed, 95% CI)

39.77 [2.47, 639.78]

5 Hospital use: 2. Unable to avoid repeat admissions Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 by 12 months

3

465

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.54, 0.97]

5.2 by 20 months

1

188

Risk Ratio (M‐H, Fixed, 95% CI)

1.10 [0.75, 1.60]

6 Hospital use: 3. Home or outpatient visits (data likely to be skewed) Show forest plot

Other data

No numeric data

6.1 6 ‐ 12 months

Other data

No numeric data

6.2 by 12 months

Other data

No numeric data

7 Leaving the study early (unwilling or unable to provide infomation): 1. Patients Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 by 3 months

1

162

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.45, 1.25]

7.2 by 6 months

4

599

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.53, 0.94]

7.3 by 12 months

4

594

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.56, 0.98]

7.4 by 20 months

3

475

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.57, 1.08]

8 Leaving the study early (unwilling or unable to provide information) 2. Relatives Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 total in study

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.52, 2.28]

8.2 subgroup of those living with patient

1

76

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.43, 1.17]

9 Global state: 1. GAS (endpoint score, range 1‐100, low = poor) (loss in some cases is greater than 30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 by 6 months

1

129

Mean Difference (IV, Fixed, 95% CI)

5.10 [‐0.86, 11.06]

9.2 by 12 months

1

131

Mean Difference (IV, Fixed, 95% CI)

3.5 [‐3.15, 10.15]

9.3 by 20 months

1

142

Mean Difference (IV, Fixed, 95% CI)

5.70 [‐0.26, 11.66]

10 Global state: 2. SAS (endpoint score, high=poor) (loss in some cases in greater than 30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 by 6 months

1

130

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.75, 0.35]

10.2 by 12 months

1

120

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.85, 0.25]

10.3 by 20 months

1

139

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.15, ‐0.05]

11 Global state: 3. GAS scale change data by 3 months (+ve change=good, data likely to be skewed) Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

5.20 [‐1.19, 11.59]

12 Global state: 4. SAS change data by 3 months (‐ve change=good, data likely to be skewed) Show forest plot

1

127

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.31, 0.13]

13 Mental state ‐ general: 1. Unwell by 12 months Show forest plot

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.40, 1.07]

14 Mental state ‐ general: 2. BPRS (endpoint score, range 24‐168, high=poor) (loss in standard group >30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

14.1 by 6 months

1

129

Mean Difference (IV, Fixed, 95% CI)

‐2.10 [‐6.40, 2.20]

14.2 by 12 months

1

131

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐6.03, 2.03]

14.3 by 20 months

1

142

Mean Difference (IV, Fixed, 95% CI)

‐4.5 [‐8.68, ‐0.32]

15 Mental state ‐ general: 3. PEF (endpoint score, range 0‐5, high=poor) (loss is greater than 30%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

15.1 by 3 months

1

118

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.22, 0.62]

15.2 by 6 months

1

111

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.42, 0.62]

15.3 by 12 months

1

97

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.84, 0.04]

15.4 by 20 months

1

100

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.47, 0.67]

16 Mental state ‐ general: 4. PSE (endpoint score, high score = poor, data likely to be skewed) Show forest plot

Other data

No numeric data

16.1 by 6 months

Other data

No numeric data

16.2 by 12 months

Other data

No numeric data

16.3 by 20 months

Other data

No numeric data

17 Mental state ‐ general: 5. BPRS scale change data by 3 months (‐ve change=good, data likely to be skewed) Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

‐3.5 [‐8.92, 1.92]

18 Mental state ‐ general: 6. PSE scale change data by 3 months (‐ve change=good, data likely to be skewed). Show forest plot

1

129

Mean Difference (IV, Fixed, 95% CI)

‐2.70 [‐7.69, 2.29]

19 Mental state ‐ specific: 1. Unsociable (reported by relatives) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

19.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.66, 1.12]

19.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.43 [0.30, 0.64]

20 Mental state ‐ specific: 2. Aggression (reported by relatives) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

20.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.72, 1.31]

20.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.7 [0.39, 1.25]

21 Mental state ‐ specific: 3. Various problems at 4 months (reported by relatives) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

21.1 agitation

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.59 [0.36, 0.95]

21.2 depression

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.57, 1.13]

21.3 disorientation

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.28, 0.79]

21.4 psychotic behaviour

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.30, 1.11]

21.5 substance abuse

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.33, 1.36]

21.6 withdrawl

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.48, 1.07]

22 Burden ‐ family: 1. Disruption to daily routine Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

22.1 by 3 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.58, 0.96]

22.2 by 6 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.52, 0.92]

23 Burden ‐ family: 2. Disruption to social life Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

23.1 by 3 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.52, 0.87]

23.2 by 6 months

2

220

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.57, 0.94]

24 Burden ‐ family: 3. Financial strain Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

24.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.52, 1.10]

24.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.53, 1.33]

25 Burden ‐ family: 4. Physical illness due to patient's illness Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

25.1 by 3 months

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.65, 0.95]

25.2 by 6 months

1

100

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.55, 0.92]

26 Burden ‐ family: 5. Overall burden is great Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

26.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.41, 0.80]

26.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.34 [0.20, 0.59]

27 Burden ‐ community: 1. Not employed by 20 months Show forest plot

1

189

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.85, 1.12]

28 Burden ‐ community: 2. Various outcomes by 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

28.1 at least one arrest

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.46, 1.12]

28.2 at least one use of emergency services

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.43, 1.54]

29 Satisfaction ‐ patient: 1. Various outcomes by 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

29.1 feels unimproved

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.48 [0.31, 0.74]

29.2 dissatisfied with treatment received

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.66 [0.50, 0.88]

29.3 prefered to get other treatment

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.27, 0.77]

29.4 feels less able to cope

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

0.36 [0.21, 0.62]

29.5 feels will need more help outside working hours in the future

1

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [0.88, 2.48]

30 Satisfaction ‐ patient: 2. Patient not satisitfied with care: Satisfaction Scale (endpoint score, range 0 ‐32, Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

30.1 by 6 months

1

115

Mean Difference (IV, Fixed, 95% CI)

5.10 [3.16, 7.04]

30.2 by 12 months

1

121

Mean Difference (IV, Fixed, 95% CI)

4.80 [3.11, 6.49]

30.3 by 20 months

1

137

Mean Difference (IV, Fixed, 95% CI)

5.40 [3.91, 6.89]

31 Satisfaction ‐ relatives: 1. Feels patient is not improved Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

31.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.60, 1.04]

31.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.53, 0.97]

32 Satisfaction ‐ relatives: 2. Dissatisfied with treatment received Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

32.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.63 [0.44, 0.89]

32.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.42, 0.78]

32.3 by 12 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.46 [0.29, 0.72]

33 Satisfaction ‐ relatives: 3. Would have preferred patient to have received other treatment Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

33.1 by 3 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.27 [0.63, 2.57]

33.2 by 6 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.49, 2.54]

33.3 by 12 months

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.81 [0.43, 1.54]

34 Satisfaction ‐ relatives: 4. Various outcomes by 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

34.1 feel themselves less able to cope

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

0.57 [0.42, 0.78]

34.2 feel themsleves to need more help outside working hours in the future

1

120

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.91, 1.60]

35 Economic cost per patient (data likely to be skewed) Show forest plot

Other data

No numeric data

35.1 total cost for trial period ‐ as assessed by researchers

Other data

No numeric data

35.2 total cost for trial period ‐ as assessed by finance department

Other data

No numeric data

35.3 per week

Other data

No numeric data
Figuras y tablas -
Comparison 1. HOME‐BASED CARE + INITIAL CRISIS INTERVENTION vs 'STANDARD CARE'
Ir a la tabla de la revisión