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Incentivos económicos para la esquizofrenia

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Referencias

Referencias de los estudios incluidos en esta revisión

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Thorpe 1962 {published data only}

Thorpe JG. The response of chronic female schizophrenics to monetary incentives. British Journal of Social and Clinical Psychology 1962;1:192‐8.

Referencias de los estudios excluidos de esta revisión

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Dilling 1971 {published data only}

Dilling H, Albrec J, Von Zerssen D. Efficacy of various modes of payment in work therapy of schizophrenics. Proceedings of the 5th World Congress of Psychiatry; 1971 Nov 28‐Dec 4; Mexico City, Mexico. 1971:268‐9.

Hellman 1998 {published data only}

Hellman SG, Kern RS, Neilson LM, Green MF. Monetary reinforcement and Wisconsin card sorting performance in schizophrenia: why show me the money?. Schizophrenia Research 1998;34(1‐2):67‐75.

LaPorte 1997 {published data only}

LaPorte D, Lahti A, Hagerdorn H, Corey T, Tamminga C. Effects of monetary reinforcement on verbal and visuospatial memory in schizophrenic subjects. Schizophrenia Research 1997;24(1, 2):112.

Nugent‐Hirschbeck 1995 {published data only}

Nugent‐Hirschbeck J. In: Sidun N editor(s). Cognitive remediation and monetary feedback to rehabilitate social cognitive deficits in schizophrenia. Chicago School of Professional Psychology, 1995:45. [DISSERTATION: Abstracts (order number) AAC 9616848]

Olfson 1998 {published data only}

Olfson M. Implementing practice guidelines for schizophrenia. Proceedings of the 151st Annual Meeting of the American Psychiatric Association; 1998 May 30 ‐ Jun 4; Toronto, Ontario, Canada. 1998.

Phillips 1964 {published data only}

Phillips JPN. The response of chronic schizophrenics to different frequencies of monetary reward: a pilot study. British Journal of Social and Clinical Psychology 1965;4:116.

Ravensborg 1972 {published data only}

Ravensborg MR. An operant conditioning approach to increasing interpersonal awareness among chronic schizophrenics. Journal of Clinical Psychology 1972;28(3):411‐3.

Summerfelt 1991 {published data only}

Summerfelt AT, Alphs LD, Wagman AMI, Funderburk FR, Hierholzer RM, Strauss ME. Reduction of perseverative errors in patients with schizophrenia using monetary feedback. Journal of Abnormal Psychology 1991;100(4):613‐6.

Wexler 1997 {published data only}

Wexler BE, Hawkins KA, Rounsaville B, Anderson M, Sernyak MJ, Green MF. Normal neurocognitive performance after extended practice in patients with schizophrenia. Schizophrenia Research 1997;26:173‐80.

Referencias adicionales

Ir a:

Altman 1996

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

Arieti 1955

Arieti S. Interpretation of Schizophrenia. New York: Robert Brunner, 1955.

Begg 1996

Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, et al. Improving the quality of randomised controlled trials. The CONSORT statement. JAMA 1996;276:637‐9.

Bland 1997

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

Boissel 1999

Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, Boutitie F, Nony P, Haugh M, Mignot G. The problem oftherapeutic efficacy indices. 3. Comparison of the indices and their use. Therapie 1999;54(4):405‐11.

Crow 1985

Crow TJ. The two‐syndrome concept: origins and current status. Schizophrenia Bulletin 1985;11(3):471‐86. [MEDLINE: 2863873]

Deeks 2000

Deeks JJ. Issues in the selection of a summary statistic for meta‐analyses of binary data. Proceedings of the 8th International Cochrane Colloquium; 2000 Oct 25‐28th; Cape Town, South Africa. 2000.

Divine 1992

Divine GW, Brown JT, Frazier LM. The unit of analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7(6):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;31:629‐34.

Elbourne 2002

Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta‐analyses involving cross‐over trials: methodological issues.. International Journal of Epidemiology 2002;31(1):140‐9.

Goldstein 1986

Goldstein G. The neuropsychology of schizophrenia. In: Grant I, Adams K editor(s). Neuropsychological assessment of neuropsychiatric disorders. New York: Oxford University Press, 1986:147‐71.

Green 1992

Green MF, Statz P, Ganzell S, Vaclav JF. Wisconsin card sorting test performance in schizophrenia: remediation of a stubborn deficit. American Journal of Psychiatry 1992;149:62‐67.

Gulliford 1999

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

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. British Medical Journal 2003;327:557‐60.

Higgins 2008

Higgins JPT, Green S (editors). Cochrane Handbook for systematic reviews of interventions 5.0.1 [updated Sept 2008]. The Cochrane Collaboration, 2008.

Hirsch 2003

Hirsch SR, Weinberger D. Schizophrenia. 2nd Edition. Oxford: Blackwell Science Ltd, 2003.

Kay 1986

Kay SR, Opler LA, Fiszbein A. Positive and negative syndrome scale (PANSS) manual. New York: Multi‐Health Systems Inc, 1986.

Layne 1982

Layne C, Wallace LT. Impaired preferences for praise in schizophrenic adolescents. Journal of Clinical Psychology 1982;38:51‐55.

Leucht 2005

Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean. Schizophrenia Research 2005;70(2‐3):231‐8.

Leucht 2005a

Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of Brief Psychiatric Rating Scale scores. British Journal of Psychiatry 2005;187(4):366‐71.

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.

McMonagle 2000

McMonagle T, Sultana A. Token economy for schizophrenia. Cochrane Database of Systematic Reviews 2000, Issue 3. [DOI: 10.1002/14651858.CD001473]

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;285:1987‐1.

Overall 1962

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

Skinner 1957

Skinner BF. Verbal Behavior. New York: Appleton‐Century‐Crofts, 1957. [0390812951]

Ukoumunne 1999

Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area‐wide and organisation‐based intervention in health and health care: a systematic review. Health Technology Assessment 1999;3(5):1‐75.

Xia 2007

Xia J, Adams CE, Bhagat N, Bhagat V, Bhoopathi P, El‐Sayeh H, Pinfold V, Takriti Y. The Leeds Outcomes Stakeholders Survey (LOSS) Study. Proceedings of the 15th Cochrane Colloquium; 2007 Oct 23‐27; Sao Paulo. 2007.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Ir a:

Thorpe 1962

Methods

Allocation: randomised, no further details.
Blindness: unclear, not stated.
Duration: six week cross over trial ‐ divided into three arms of two week sessions*
Raters: ward sisters used as raters.

Participants

Diagnosis: schizophrenia (Arieti 1955 2nd or 3rd stage).
N=25.
Age: mean ˜ 43 years, range 36 to 50 years.
Sex: all female.
Setting: hospital.
History: chronic, non‐paranoid, mean time in hospital ˜ 20 years, half of the participants had pre‐frontal leucotomomy not less than four years previously.

Interventions

1. Monetary reward: One hour session in the morning assembling plastic dolls, task required considerable manual dexterity, inserting two arms and two legs into appropriate sockets of doll's body. Session repeated for an hour in the afternoon. Paid 3 pence/12 dolls assembled. N=10.

2. No monetary reward: Same work assembling dolls with no monetary reward. N=15.

Outcomes

Target behaviour: average number of dolls produced per day.**
Leaving the study early***

Notes

* Only data from first two week arm of trial used as data after first cross‐over prone to bias.
** All data retrieved from graphs alone.
*** Assumed no loss

Risk of bias

Bias

Authors' judgement

Support for judgement

Adequate sequence generation?

Unclear risk

No description: "the twenty‐five patients were split into five groups of five by a random‐selection technique".

Allocation concealment?

Unclear risk

No description: "these groups were numbered one to five and patients within each group worked together in a small circle".

Blinding?
All outcomes

Low risk

Not practical to blind participants to treatment, unclear if raters blind to allocation: "patients in groups 1 and 4 were informed that they would be working for money and paid according to how many dolls they were able to assemble as a group. Patients in groups 1,2, and 5 were informed that they would be assembling dolls but would not receive any payment".

Incomplete outcome data addressed?
All outcomes

Unclear risk

No description.

Free of selective reporting?

Low risk

All outcomes reported.

Free of other bias?

Low risk

No description of author affiliations given, but thought other biases unlikely.

Characteristics of excluded studies [ordered by study ID]

Ir a:

Study

Reason for exclusion

Dilling 1971

Allocation: unclear.
Participants: people with schizophrenia.
Interventions: various schedules of payment for work.
Outcomes: performance, staff assessment, no numerical data.

Hellman 1998

Allocation: random.
Participants: people with schizophrenia.
Interventions: low (2 cents per correct response) and high (10 cents per correct response) monetary reinforcement and instruction.
Outcomes: performance, no useable numerical data.

LaPorte 1997

Allocation: random.
Participants: people with schizophrenia.
Interventions: two levels of monetary positive or negative reinforcement.
Outcome: performance, no numerical data.

Nugent‐Hirschbeck 1995

Allocation: random.
Participants: people with schizophrenia.
Interventions: monetary reward + memory enhancement vs monetary reward. Investigating effect of memory enhancement not monetary reward has on performance.

Olfson 1998

Allocation: random.
Participants: men with long‐standing schizophrenia.
Interventions: social reward plus monetary coupons vs no social or monetary coupons, not money alone.

Phillips 1964

Allocation: random.
Participants: people with long‐standing schizophrenia
Interventions: monetary reward frequencies for work therapy tasks.
Outcomes: work output, no numerical data.

Ravensborg 1972

Allocation: random.
Participants: men with long‐standing schizophrenia.
Interventions: praise reinforcement alone vs praise and money reinforcement, not money alone.
Outcomes: Interpersonal awareness development and increased ward behaviour.

Summerfelt 1991

Allocation: random.
Participants: people with schizophrenia.
Interventions: monetary reward versus no monetary reward.
Outcomes: no usable data.

Wexler 1997

Allocation: random.
Participants: people with long‐standing schizophrenia.
Interventions: various task difficulties, paid everyone, not allocating monetary rewards.

Data and analyses

Open in table viewer
Comparison 1. MONETARY REWARD vs NO MONETARY REWARD

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Target behaviour: average number of dolls assembled per day Show forest plot

1

25

Mean Difference (IV, Fixed, 95% CI)

‐0.80 [‐1.41, ‐0.19]
Analysis 1.1
Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 1 Target behaviour: average number of dolls assembled per day.

Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 1 Target behaviour: average number of dolls assembled per day.

2 Leaving the study early Show forest plot

1

25

Risk Difference (M‐H, Fixed, 95% CI)

0.0 [‐0.15, 0.15]
Analysis 1.2
Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 2 Leaving the study early.

Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 2 Leaving the study early.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figuras y tablas -
Figure 1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 1 Target behaviour: average number of dolls assembled per day.
Figuras y tablas -
Analysis 1.1

Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 1 Target behaviour: average number of dolls assembled per day.

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Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 2 Leaving the study early.
Figuras y tablas -
Analysis 1.2

Comparison 1 MONETARY REWARD vs NO MONETARY REWARD, Outcome 2 Leaving the study early.

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Table 1. Suggested design of study

Methods

Allocation: randomised, clearly described.
Design: cross‐over.*
Duration: 3 months before first cross‐over.

Participants

Diagnosis: schizophrenia.
N=300.**
Age: any.
Sex: men and women.
History: stable, perhaps with prominent negative symptoms, perhaps attending day units.

Interventions

1. Additional funds: not given every day but intermittently and randomly*** as reward for countering person‐specific negative symptom. N=150.

2. No additional funds. N=150.

Outcomes

Target symptoms: improved/not improved to important extent.
Satisfaction.
Quality of life.
Functioning.

Notes

* in suggesting cross‐over design we are attempting to ensure that everyone is assured of reward.
** study size to clearly illustrate 20% difference between groups in binary outcome.
*** strong positive reinforcer

Figuras y tablas -
Table 1. Suggested design of study
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Summary of findings for the main comparison. Monetary reward compared with no monetary reward for schizophrenia

Monetary reward compared with no monetary reward for schizophrenia

Patient or population: patients with schizophrenia1
Settings: in hospital in UK in 1960s2
Intervention: Monetary reward3
Comparison: no monetary reward

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

no monetary reward

Monetary reward

Target behaviour: average number of dolls assembled per day

The mean Target behaviour: average number of dolls assembled per day in the intervention groups was
0.8 lower
(1.41 to 0.19 lower)

25
(1 study)

⊕⊝⊝⊝
very low4,5,6

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Very chronically ill, not actively psychotic
2 Average stay in hospital ‐ 20 years
3 £0 s0 6d (1/40 th of one pound sterling)
4 Randomisation not well described
5 Work was assembling dolls in hospital workshop
6 Small study, likely others are unpublished or in dissertations only

Figuras y tablas -
Summary of findings for the main comparison. Monetary reward compared with no monetary reward for schizophrenia
Ir a la tabla de la revisión
Comparison 1. MONETARY REWARD vs NO MONETARY REWARD

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Target behaviour: average number of dolls assembled per day Show forest plot

1

25

Mean Difference (IV, Fixed, 95% CI)

‐0.80 [‐1.41, ‐0.19]

2 Leaving the study early Show forest plot

1

25

Risk Difference (M‐H, Fixed, 95% CI)

0.0 [‐0.15, 0.15]
Figuras y tablas -
Comparison 1. MONETARY REWARD vs NO MONETARY REWARD
Ir a la tabla de la revisión