Psychosocial interventions for the prevention of disability following traumatic physical injury

  • Review
  • Intervention

Authors


Abstract

Background

Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning.

Objectives

To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury.

Search methods

The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008.

Selection criteria

Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI).

Data collection and analysis

Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data.

Main results

We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients.

Authors' conclusions

This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.

摘要

背景

心理社會介入措施用以預防創傷性身體損傷後的失能

創傷性的身體損傷會造成許多失能的後遺症,包括身體和心理的健康問題及不全的社會功能。

目標

評估心理社會的介入措施對於預防創傷性身體損傷後之身體,心理和社會失能的效果。

搜尋策略

檢索方式不限日期,語言或發表狀況。我們檢索以下的電子資料庫;Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlledtrials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed。我們也審閱所有蒐集文章其參考文獻,並連繫相關研究的作者。最新一次搜尋試驗是在2008年2月。

選擇標準

隨機對照試驗,其研究一種或多種已定義的心理社會介入措施以預防創傷性身體損傷造成的身體失能,心理健康問題或減少社會功能。我們排除創傷性腦損傷(traumatic brain injury (TBI))病患的研究。

資料收集與分析

兩位作者分別審閱搜尋結果的標題和摘要,檢閱可能相關研究的全文,分別評估偏差風險並摘錄資料。

主要結論

我們納入5篇研究共包含756名參與者。3篇研究評估簡易的心理社會治療效果,1篇研究自助手冊的影響,及1篇評估共同照護的效果。不同本質的試驗其包含不同的病患群體,介入措施和結果,意指不可能經由研究將資料有意義的加總。簡易的心理社會治療或教育手冊對於預防失能沒有保護效果的證據。一篇試驗證據顯示,損傷後一個月那些接受共同照護介入措施合併簡易心理教育介入措施者,可以減少創傷後壓力症候群(traumatic stress disorder (PTSD))和憂鬱症狀,然而這項結果並未持續追蹤。整體心理健康狀況是唯一會受到任何介入措施影響的失能結果。3篇試驗顯示心理社會介入措施對於病患的心理健康狀況有不良的影響。

作者結論

有關心理社會介入措施的效果對於預防創傷性身體損傷後的失能,這篇回顧並未提供使人信服的證據。整體來說,我們的研究結果不能被視為支持提供心理社會方面的介入措施以預防因身體損傷造成的失能。然而,這些結論是基於少數不同的試驗其具有小量至適中的樣本數,所以必須謹慎。在這些結果可以被證實之前,需要更多使用較大的樣本數和相似的介入措施及病患群體的研究,以使結果可以加總。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

心理社會介入措施用以預防創傷性身體損傷後的失能:創傷性身體損傷如導因於道路交通事故,跌倒和火災會造成後續高度失能的個人影響。這也許包括導因於初期損傷和後續後遺症造成的身體失能,心理健康問題如憂鬱,焦慮,和創傷後壓力症候群(posttraumatic stress disorder (PTSD))其導因於創傷事件造成的傷害和由此產生的身體及社會問題,社會問題如喪失社會生活與失業。因此,評估介入措施其探究預防這些不良的結果是很重要的。心理社會的預防措施包括心理學治療如人際輔導和認知行為治療(cognitive behavioural therapy (CBT)),和社會介入措施如協助,社會支持和自助諮詢,在損傷後迅速提供這些措施也許有助於預防這些問題。這篇回顧已確知五篇隨機對照試驗,共包含756名參與者,其評估心理社會介入措施以預防創傷性損傷後的失能。研究結果無使人信服的證據以支持這些介入措施的效果。特別是自助手冊和人際治療對於預防失能沒有效果。有些證據顯示較複雜的介入措施包括共同照護可以在短期減少憂鬱症狀和創傷後壓力症候群,而非中期。有來自三篇試驗的證據顯示心理社會介入措施對於心理健康有不良的影響。整體來說,我們的研究結果不能被視為支持提供心理社會方面的介入措施以預防因身體損傷造成的失能。這些結果顯示未來的介入措施應該重視檢視病患不良結果的風險,並僅治療那些有發展後續問題者。然而,這些結論的優點受限於少量的樣本數和有許多變異本質的試驗,這意指他們的結果不能被加總。

Plain language summary

Psychosocial interventions for the prevention of disability following traumatic physical injury

Traumatic physical injury such as that resulting from road traffic accidents, falls and fires can cause high levels of subsequent disability in the person affected. This may include physical disability as a result of the initial injury and subsequent complications, mental health problems such as depression, anxiety and post-traumatic stress disorder (PTSD) as a result of the trauma of the event which caused the injury and the resulting physical and social problems, and social problems such as loss of social life and unemployment. It is therefore important to evaluate interventions which seek to prevent these adverse secondary outcomes. Psychosocial interventions, which include psychological therapies such as interpersonal counselling and cognitive behavioural therapy (CBT), and social interventions such as befriending, social support and self-help advice, delivered soon after the injury, may help to prevent these problems.

This review identified five randomised controlled trials, involving 756 participants, which evaluated psychosocial interventions for the prevention of disability following traumatic injury. No convincing evidence was found supporting the efficacy of these interventions. In particular, self-help booklets and interpersonal therapies had no effect on preventing disability. There was some evidence that a more complex intervention involving collaborative care reduced symptoms of depression and PTSD in the short but not the medium term. There was evidence from three trials that psychosocial interventions had a detrimental effect on mental health. Taken together, our findings cannot be taken as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. These results suggest that future interventions should focus on screening patients at risk of poor outcomes and only treating those who develop subsequent problems. However, the strength of these conclusions is limited by the small size and varied nature of many of the trials, which means that their results cannot be pooled.

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