Case management approaches to home support for people with dementia

Cochrane Review, January 2015

This Cocrane Review aims to evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including ‘treatment as usual’, standard community treatment and other non-case management interventions.

The review concludes that there is some evidence that case management is beneficial at improving some outcomes at certain time points, both in the person with dementia and in their carer. However, there was considerable heterogeneity between the interventions, outcomes measured and time points across the 13 included RCTs. There was some evidence from good-quality studies to suggest that admissions to care homes and overall healthcare costs are reduced in the medium term; however, the results at longer points of follow-up were uncertain. There was not enough evidence to clearly assess whether case management could delay institutionalisation in care homes. There were uncertain results in patient depression, functional abilities and cognition. Further work should be undertaken to investigate what components of case management are associated with improvement in outcomes. Increased consistency in measures of outcome would support future meta-analysis.

Click here for more information and to download the paper.

Workplace interventions for reducing sitting at work

The Cochrane Library, 26 January 2015

The number of people working whilst seated at a desk keeps increasing worldwide. As sitting increases, occupational physical strain declines at the same time. This has contributed to increases in cardiovascular disease, obesity and diabetes. Therefore, reducing and breaking up the time that people spend sitting while at work is important for health.

The objectives of this Cochrane Review are to evaluate the effects of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.

The study concludes that at present there is very low quality evidence that sit-stand desks can reduce sitting time at work, but the effects of policy changes and information and counselling are inconsistent. There is a need for high quality cluster-randomised trials to assess the effects of different types of interventions on objectively measured sitting time. There are many ongoing trials that might change these conclusions in the near future.

Click here to read the full paper.

Free online training sessions for the Cochrane Library

January 2015

Wiley, publisher of The Cochrane Library Online, are offering instructor-led online training sessions on how to use The Cochrane Library.

All you need is an internet connection and access to a telephone.  This training is completely free of charge and will be conducted over the telephone and via the internet at your desktop.

The sessions last approximately 1 hour.  Places are strictly limited.  To sign up just click on one of the links below and select “Register”.

Two sessions are scheduled for January:

Thursday, 15th January 2015, 14:30 GMT Time (London, GMT)

 Go to https://wiley-onlinelibrary.webex.com/wiley-onlinelibrary/k2/j.php?MTID=t80181653ccacb3009196715c55ec2883 and register.

Thursday, 22nd January 2015, 12:00 GMT Time (London, GMT)

Go to https://wiley-onlinelibrary.webex.com/wiley-onlinelibrary/k2/j.php?MTID=te7dea7e6df985bd8f3ccd22c1a7b7e27 and register.

Once you have registered, you will receive a confirmation email with instructions for joining the session.

Visit the Wiley training website at: http://wileyonlinelibrary.com/training   

If you have any queries, please send an email to Gavin Stewart at gstewart@wiley.com

 

Compulsory community and involuntary outpatient treatment for people with severe mental disorders

The Cochrane Library, 4 December 2014

This Cochrane Review finds that compulsory community treatment (CCT) results in no significant difference in service use, social functioning or quality of life compared with standard voluntary care. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature.

Click here to download abstract or the full text article.

 

Interventions for improving the adoption of shared decision making by healthcare professionals

Cochrane Reviews, 15 September 2014

Summary

When there are several treatments possible, healthcare professionals can involve patients in the process of making decisions about their care so that the patients can choose care that meets their needs and reflects what is important to them. We call this ‘shared decision making’. Although the results are better when patients are involved, healthcare professionals often do not involve their patients in these decisions. We wanted to know more about what can be done to encourage healthcare professionals to share decision making with their patients. In our review we identified 39 studies that tested what activities work in helping healthcare professionals involve their patients more in the decision-making process. We learned that any such activity was better than none, and that activities for healthcare professionals and patients together worked somewhat better than activities just for patients or just for healthcare professionals. However, given the small number of studies and the differences across the studies, it was difficult to know which activities worked best. This review suggested ways to better evaluate how much healthcare professionals involve patients in healthcare decisions so that we can understand this process better in the future.

Click here to access the full text paper.  You will need to login with your Athens password.

All Lancashire Care staff are able to register for an Athens password.  Please click here to apply for an Athens password.

ABI – Cochrane – Music therapy for Acquired Brain Injury

Cochrane – Music therapy for Acquired Brain Injury, 2010

Reference:  Bradt J, Magee WL, Dileo C, Wheeler BL, McGilloway E. Music therapy for acquired brain injury. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD006787.

Abstract:

BACKGROUND: Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, sensory processing and emotional disturbances. This may severely reduce a survivor’s quality of life. Music therapy has been used in rehabilitation to stimulate brain functions involved in movement, cognition, speech, emotions and sensory perceptions. A systematic review is needed to gauge the efficacy of music therapy as a rehabilitation intervention for people with ABI.

OBJECTIVES: To examine the effects of music therapy with standard care versus standard care alone or standard care combined with other therapies on gait, upper extremity function, communication, mood and emotions, social skills, pain, behavioral outcomes, activities of daily living and adverse events.

SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (February 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (July 2009), EMBASE (August 2009), CINAHL (March 2010), PsycINFO (July 2009), LILACS (August 2009), AMED (August 2009) and Science Citation Index (August 2009). We handsearched music therapy journals and conference proceedings, searched dissertation and specialist music databases, trials and research registers, reference lists, and contacted experts and music therapy associations. There was no language restriction.

SELECTION CRITERIA: Randomized and quasi-randomized controlled trials that compared music therapy interventions and standard care with standard care alone or combined with other therapies for people older than 16 years of age who had acquired brain damage of a non-degenerative nature and were participating in treatment programs offered in hospital, outpatient or community settings.

DATA COLLECTION AND ANALYSIS: Two review authors independently assessed methodological quality and extracted data. We present results using mean differences (using post-test scores) as all outcomes were measured with the same scale.

MAIN RESULTS: We included seven studies (184 participants). The results suggest that rhythmic auditory stimulation (RAS) may be beneficial for improving gait parameters in stroke patients, including gait velocity, cadence, stride length and gait symmetry. These results were based on two studies that received a low risk of bias score. There were insufficient data to examine the effect of music therapy on other outcomes.

AUTHORS’ CONCLUSIONS: RAS may be beneficial for gait improvement in people with stroke. These results are encouraging, but more RCTs are needed before recommendations can be made for clinical practice. More research is needed to examine the effects of music therapy on other outcomes in people with ABI.

Lancashire Care staff can either click on the links above or email: susan.jennings@lancashirecare.nhs.uk

Cochrane – Self-help and guided self-help for eating disorders

Self-help and guided self-help for eating disorders,    Cochrane,  2009

Sarah S J Perkins1, Rebecca RM Murphy2, Ulrike US Schmidt1, Chris Williams3

1Section of Eating Disorders, PO Box 59, Institute of Psychiatry, King’s College London, London, UK. 2Department of Psychiatry, Warneford Hospital, Oxford, UK. 3Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK

Perkins SSJ, Murphy RRM, Schmidt UUS, Williams C. Self-help and guided self-help for eating disorders. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004191. DOI: 10.1002/14651858.CD004191.pub2.

Click on the title above to gain full-text access to the Cochrane review

Abstract:

Anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS) are common and disabling disorders. Many patients experience difficulties accessing specialist psychological treatments. Pure self-help (PSH: self-help material only) or guided self-help (GSH: self-help material with therapist guidance), may bridge this gap.

 

 

Objectives

Main objective:
Evaluate evidence from randomised controlled trials (RCTs) / controlled clinical trials (CCTs) for the efficacy of PSH/GSH with respect to eating disorder symptoms, compared with waiting list or placebo/attention control, other psychological or pharmacological treatments (or combinations/augmentations) in people with eating disorders.

Secondary objective:
Evaluate evidence for the efficacy of PSH/GSH regarding comorbid symptomatology and costs.

Search strategy

CCDANCTR-Studies and CCDANCTR-References were searched in November 2005, other electronic databases were searched, relevant journals and grey literature were checked, and personal approaches were made to authors.

Selection criteria

Published/unpublished RCTs/CCTs evaluating PSH/GSH for any eating disorder.

Data collection and analysis

Data was extracted using a customized spreadsheet. Relative Risks (RR) were calculated from dichotomous data and weighted/standardized mean differences (WMD/SMD) from continuous data, using a random effects model.

Main results

Twelve RCTs and three CCTs were identified, all focusing on BN, BED, EDNOS or combinations of these, in adults, using manual-based PSH/GSH across various settings.

Primary comparisons:
At end of treatment, PSH/GSH did not significantly differ from waiting list in abstinence from bingeing (RR 0.72, 95% CI 0.47 to 1.09), or purging (RR 0.86, 95% CI 0.68 to 1.08), although these treatments produced greater improvement on other eating disorder symptoms, psychiatric symptomatology and interpersonal functioning but not depression.

Compared to other formal psychological therapies, PSH/GSH did not differ significantly at end of treatment or follow-up in improvement on bingeing and purging (RR 0.99, 95% CI 0.75 to 1.31), other eating disorder symptoms, level of interpersonal functioning or depression. There were no significant differences in treatment dropout.

Secondary comparisons:
One small study in BED found that cognitive-behavioural GSH compared to a non-specific control treatment produced significantly greater improvements in abstinence from bingeing and other eating disorder symptoms. Studies comparing PSH with GSH found no significant differences between treatment groups at end of treatment or follow-up. Comparison between different types of PSH/GSH found significant differences on eating disorder symptoms but not on bingeing/purging abstinence rates.

Authors’ conclusions

PSH/GSH may have some utility as a first step in treatment and may have potential as an alternative to formal therapist-delivered psychological therapy. Future research should focus on producing large well-conducted studies of self-help treatments in eating disorders including health economic evaluations, different types and modes of delivering self-help (e.g. computerised versus manual-based) and different populations and settings.

 

Lancashire Care staff can either click on the link above or email: susan.jennings@lancashirecare.nhs.uk