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首页> 外文OA文献 >Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study):single-blind, cluster-randomised controlled trial
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Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study):single-blind, cluster-randomised controlled trial

机译：旨在提高患者对活动的参与度的心理健康住院康复部门员工培训干预的临床效果（生命活动的康复效果[REAL]研究）：单盲，整群随机对照试验

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BackgroundMental health inpatient rehabilitation services focus on people with complex psychosis who have, for example, treatment-refractory symptoms, cognitive impairment, and severe negative symptoms, which impair functioning and require lengthy admission. Engagement in activities could lead to improvement in negative symptoms and function, but few trials have been done. We aimed to investigate the effectiveness of a staff training intervention to increase patients' engagement in activities.MethodsWe did a single-blind, two-arm, cluster-randomised controlled trial in 40 mental health inpatient rehabilitation units across England. Units were randomly allocated to either a manual-based staff training programme delivered by a small intervention team (intervention group, n=20) or standard care (control group, n=20). The primary outcome was patients' engagement in activities 12 months after randomisation, measured with the time use diary. With this measure, both the degree of engagement in an activity and its complexity are recorded four times a day for a week, rated on a scale of 0–4 for every period (maximum score of 112). Analysis was by intention-to-treat. Random-effects models were used to compare outcomes between study groups. Cost-effectiveness was assessed by combining service costs with the primary outcome. This study is registered with Current Controlled Trials (ISRCTN25898179).FindingsPatients' engagement in activities did not differ between study groups (coefficient 1·44, 95% CI −1·35 to 4·24). An extra £101 was needed to achieve a 1% increase in patients' engagement in activities with the study intervention.InterpretationOur training intervention did not increase patients' engagement in activities after 12 months of follow-up. This failure could be attributable to inadequate implementation of the intervention, a high turnover of patients in the intervention units, competing priorities on staff time, high levels of patients' morbidity, and ceiling effects because of the high quality of standard care delivered. Further studies are needed to identify interventions that can improve outcomes for people with severe and complex psychosis.
机译：背景技术精神病患者住院康复服务的重点是那些患有复杂精神病的人，例如，患有难治性症状，认知障碍和严重的负面症状，这些人会损害功能并需要长期入院。参与活动可能会改善阴性症状和功能，但很少进行试验。我们旨在研究员工培训干预措施以增加患者参与活动的有效性。方法我们在英格兰的40个精神病患者住院康复机构中进行了单盲，两臂，集群随机对照试验。单位被随机分配到一个由小型干预团队（干预组，n = 20）或标准护理（对照组，n = 20）提供的基于手动的员工培训计划。主要结果是患者参与随机分组后12个月的活动，以时间使用日记来衡量。通过这种方法，每周进行一天四次活动的参与程度及其复杂性的记录，每个阶段的评分为0-4（最高分112）。分析是按意向性进行的。随机效应模型用于比较研究组之间的结果。通过将服务成本与主要结果相结合来评估成本效益。本研究已在电流对照试验（ISRCTN25898179）中进行了注册。研究对象患者的活动参与在研究组之间没有差异（系数1·44、95％CI -1·35至4·24）。需要额外的101英镑，以使研究干预活动的患者参与度提高1％。解释我们的培训干预措施在随访12个月后并未增加患者的参与度。这种失败可能归因于干预措施的实施不充分，干预部门患者的离职率高，工作人员时间上竞争激烈的优先事项，患者发病率高以及由于提供的标准护理质量高而产生的上限效应。需要进一步的研究来确定可以改善严重和复杂精神病患者预后的干预措施。

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