健康教育对精神分裂症康复效果的系统评价

Rehabilitation Effect of Health Education on Schizophrenia:A Systematic Review

目的评价健康教育辅助治疗精神分裂症的康复效果。方法采用Cochrane系统评价方法,检索Co-chrane图书馆、EMBASE、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普数据库(VIP)等电子数据库。由2名评价者共同评价纳入研究质量,对同质研究进行Meta分析。结果共纳入15个研究,2151例精神分裂症患者。纳入的研究中,7个研究具体交待了随机分配方法,8个研究仅提及随机对照试验,未报告随机序列产生的方法;所有纳入研究均未描述分配隐藏和盲法。按测量指标、干预时间进行亚组分析,健康教育+常规药物治疗在降低复发率:6个月[OR=0.41,95%CI为(0.30,0.56),P<0.00001],12个月[OR=0.31,95%CI为(0.23,0.42),P<0.00001];提高患者服药依从性:8周[OR=3.30,95%CI为(2.47,4.41),P<0.00001],6个月[OR=2.80,95%CI为(1.14,8.91),P=0.03];改善患者症状:8周[WMD=-1.33,95%CI为(-2.38,-0.28),P=0.01],3个月[WMD=-3.42,95%CI为(-4.96,-1.88),P<0.00001],6个月[WMD=-1.55,95%CI为(-2.57,-0.54),P=0.003],12个月[WMD=-5.75,95%CI为(-8.31,-3.19),P<0.0001];改善患者自知力:8周[WMD=4.91,95%CI为(4.09,5.73),P<0.00001],6个月[WMD=2.08,95%CI为(1.56,2.61),P<0.0001],这4个方面均优于单纯常规药物治疗。结论现有研究结果显示,健康教育是一种有效的辅助治疗精神分裂症的干预措施。但纳入研究方法学质量不高,影响结果的强度,期待将来更多高质量的随机双盲对照试验提供高质量的证据。

Objective To assess the effect of health education as a accessory therapy on rehabilitation of the patients with schizophrenia.Methods The Cochrane systematic review was taken,and the dada were retrieved form Cochrane library,EMBASE,CBM,CNKI and VIP.The quality of eligible studies was evaluated by two reviewers independently,and Meta-analysis was conducted on homogenous studies.Results Totally fifteen studies involving 2 151 participants were included.The randomized controlled trials （RCTs） was concretely reported in 7 studies;and only the RCTs was described but without random sequence method in 8 studies,All included studies were inadequate in reporting concealment of allocation and blinding.Meta-analysis among the subgroups was performed according to the indexes and intervention time,which showed that health education combined routine medication could reduce relapse rate：after 6 months [OR=0.41,95%CI：（0.30,0.56）,P〈0.00001],after 12 months [OR=0.31,95%CI：（0.23,0.42）,P〈0.00001];improve medication compliance：after 8 weeks[OR=3.30,95%CI：（2.47,4.41）,P〈0.00001],after 6 months[OR=2.80,95%CI：（1.14,8.91）,P=0.03];alleviate symptoms：after 8weeks[WMD=-1.33,95%CI：（-2.38,-0.28）,P=0.01],after 3 months [WMD=-3.42,95%CI：（-4.96,-1.88）,P〈0.00001],after 6 months [WMD=-1.55,95%CI：（-2.57,-0.54）,P=0.003],after 12 months[WMD=-5.75,95%CI：（-8.31,-3.19）,P〈0.0001];improve insight of patients：after 8 weeks[WMD=4.91,95%CI：（4.09,5.73）,P〈0.00001],after 6 months[WMD=2.08,95%CI：（1.56,2.61）,P〈0.0001].And in all the four respects it was better than routine medication alone.Conclusion Health education is a effective intervention as an accessory therapy for patients with schizophrenia.However because of the lower quality in methodology in the included studies the evidence is not strong enough to judge the result.So more double-blind RCTs are needed.