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

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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

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Summary of findings for the main comparison. Monetary reward compared with no monetary reward for schizophrenia
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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]
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Comparison 1. MONETARY REWARD vs NO MONETARY REWARD
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