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Meta-Analysis
. 2014 Mar 28;2014(3):CD008567.
doi: 10.1002/14651858.CD008567.pub3.

General physical health advice for people with serious mental illness

Graeme Tosh  1 , Andrew V Clifton, Jun Xia, Margueritte M White
Affiliations
Meta-Analysis

General physical health advice for people with serious mental illness

Graeme Tosh et al. Cochrane Database Syst Rev. .

Abstract

Background: There is currently much focus on provision of general physical health advice to people with serious mental illness and there has been increasing pressure for services to take responsibility for providing this.

Objectives: To review the effects of general physical healthcare advice for people with serious mental illness.

Search methods: We searched the Cochrane Schizophrenia Group's Trials Register (last update search October 2012) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO and registries of Clinical Trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register.

Selection criteria: All randomised clinical trials focusing on general physical health advice for people with serious mental illness..

Data collection and analysis: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE.

Main results: Seven studies are now included in this review. For the comparison of physical healthcare advice versus standard care we identified six studies (total n = 964) of limited quality. For measures of quality of life one trial found no difference (n = 54, 1 RCT, MD Lehman scale 0.20, CI -0.47 to 0.87, very low quality of evidence) but another two did for the Quality of Life Medical Outcomes Scale - mental component (n = 487, 2 RCTs, MD 3.70, CI 1.76 to 5.64). There was no difference between groups for the outcome of death (n = 487, 2 RCTs, RR 0.98, CI 0.27 to 3.56, low quality of evidence). For service use two studies presented favourable results for health advice, uptake of ill-health prevention services was significantly greater in the advice group (n = 363, 1 RCT, MD 36.90, CI 33.07 to 40.73) and service use: one or more primary care visit was significantly higher in the advice group (n = 80, 1 RCT, RR 1.77, CI 1.09 to 2.85). Economic data were equivocal. Attrition was large (> 30%) but similar for both groups (n = 964, 6 RCTs, RR 1.11, CI 0.92 to 1.35). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal.

Authors' conclusions: General physical health could lead to people with serious mental illness accessing more health services which, in turn, could mean they see longer-term benefits such as reduced mortality or morbidity. On the other hand, it is possible clinicians are expending much effort, time and financial resources on giving ineffective advice. The main results in this review are based on low or very low quality data. There is some limited and poor quality evidence that the provision of general physical healthcare advice can improve health-related quality of life in the mental component but not the physical component, but this evidence is based on data from one study only. This is an important area for good research reporting outcome of interest to carers and people with serious illnesses as well as researchers and fundholders.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study
2
2
PRISMA search flow diagram ‐ 2009 search
3
3
Study flow diagram ‐ updated 2012
1.1
1.1. Analysis
Comparison 1 PHYSICAL HEALTH ADVICE versus STANDARD CARE, Outcome 1 Physical health behaviour: Moderate or vigorous physical activity (min/week, skewed).
1.2
1.2. Analysis
Comparison 1 PHYSICAL HEALTH ADVICE versus STANDARD CARE, Outcome 2 Quality of life: Average scores ‐ various scales.
1.3
1.3. Analysis
Comparison 1 PHYSICAL HEALTH ADVICE versus STANDARD CARE, Outcome 3 Adverse effects/events: Death.
1.4
1.4. Analysis
Comparison 1 PHYSICAL HEALTH ADVICE versus STANDARD CARE, Outcome 4 Service use: Average percentage uptake of recommended health preventative services (US Preventative Services Task Force guidelines, high = good).
1.5
1.5. Analysis
Comparison 1 PHYSICAL HEALTH ADVICE versus STANDARD CARE, Outcome 5 Service use: One or more primary care visit.
1.7
1.7. Analysis
Comparison 1 PHYSICAL HEALTH ADVICE versus STANDARD CARE, Outcome 7 Leaving the study early.
2.1
2.1. Analysis
Comparison 2 HEALTH EDUCATION versus HEALTH EMPOWERMENT EDUCATION, Outcome 1 Quality of life: Average global score (Lehman Quality of Life scale, high = good).
2.3
2.3. Analysis
Comparison 2 HEALTH EDUCATION versus HEALTH EMPOWERMENT EDUCATION, Outcome 3 Leaving the study early.
3.2
3.2. Analysis
Comparison 3 HEALTHY LIVING STUDY CIRCLE versus AESTHETIC STUDY CIRCLE, Outcome 2 Physical health: 1. Metabolic syndrome ‐ present.
3.3
3.3. Analysis
Comparison 3 HEALTHY LIVING STUDY CIRCLE versus AESTHETIC STUDY CIRCLE, Outcome 3 Physical health: 2. Average score for working capacity ‐ various tests.
See this image and copyright information in PMC

Update of

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