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Personal assistance for adults (19-64) with both physical and intellectual impairments

  • Review
  • Intervention

Authors


Abstract

Background

There is a high incidence of impairments among working age adults, and their prevalence is increasing in the West. Many countries offer personal assistance in the form of individualised support for people living in the community by a paid assistant other than a healthcare professional for at least 20 hours per week.

Objectives

To assess the effectiveness of personal assistance for adults with physical and intellectual impairments, and the impacts of personal assistance on others, compared to other interventions.

Search methods

Electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Dissertation Abstracts International and a variety of specialist Swedish databases were searched from 1980 to June 2005; reference lists were checked; 345 experts, organisations, government bodies and charities were contacted in an attempt to locate relevant research.

Selection criteria

Adults (19-64) with permanent physical and intellectual impairments living in the community who require assistance to perform tasks of daily living (e.g., bathing and eating) and participate in normal activities. Controlled studies of personal assistance in which participants were prospectively assigned to study groups and in which control group outcomes were measured concurrently with intervention group outcomes were included.

Data collection and analysis

Titles and abstracts were examined by two reviewers. Outcome data were extracted. Because no two studies made the same comparison, studies were not combined for meta-analyses. Studies were assessed for bias. Results and potential sources of bias are presented for included studies.

Main results

Two studies involving 1002 participants compared personal assistance versus usual care. Whilst personal assistance was generally preferred over other services, some people prefer other services. Personal assistance may have some benefits for some recipients and may benefit caregivers. Paid assistance probably substitutes for informal care and may cost government more than alternatives; however, some evidence suggests it may reduce costs. The total costs to recipients and society are unknown.

Authors' conclusions

Research in this field is limited. Personal assistance is expensive and difficult to organise, especially in places that do not already have services in place, but its total cost relative to other services is unknown. When implementing new programmes, recipients could be randomly assigned to different forms of assistance (e.g. organised by individual users versus organised through a cooperative). While advocates may support personal assistance for myriad reasons, this review demonstrates that further studies are required to determine which models of assistance are most effective and efficient for particular people.

摘要

背景

對於有身體與智能障礙的成人 (19 – 64歲) 之個人化協助

在具生產力年齡層的成人,障礙的發生率是高的,在西方的盛行率也在提高中。許多國家對社區生活照顧的個案於個人化的協助方面,除了提供健康專業人員之照顧外,尚提供每週至少20小時之需付費協助者。

目標

對有身體及智能障礙的成人,評估個人協助的效果,以及個人協助對其他人的影響,並與其他種類的介入方法做比較。

搜尋策略

電子資料庫,包括CENTRAL、MEDLINE、EMBASE、CINAHL、PsycINFO、ERIC、Dissertation Abstracts International和其他多種專業的瑞典資料庫,從1980年至2005年六月;檢驗參考文獻名單;並連絡共345名專業人士、組織、政府機關以得知相關研究。

選擇標準

住在社區中有永久身體與智能障礙,需生活起居協助 (例如,盥洗和進食) 與可正常活動的參與者 (19至64歲) 。事前控制分配受試者至試驗組或控制組並且要同時檢測試驗組與控制組的結果。

資料收集與分析

標題和摘要由兩位回顧者檢驗。結果資料被提取出來。因為沒有任兩篇試驗做相同的比較,所以無法合併進行後設分析。試驗的誤差被評估。在所選擇的試驗中結果與可能發生誤差的來源都有呈現。

主要結論

共兩篇試驗,包括1002位受試者,比較個人化協助與一般的照護。雖然一般來說,比起其他服務,個人化協助較為被偏好,仍有某些人比較喜歡其他種類服務。個人化協助可能有某些益處,對於某些接受者與照護者來說。付費的協助者可能可以取代正式的照護,但比起其他種類照護,可能造成政府更多花費;然而,某些證據顯示,花費有可能減少。對於接受者與社會的總花費未知。

作者結論

這個領域的研究是侷限的。個人化的協助是昂貴的,而且組織上有困難,特別對那些尚未準備好提供這類服務的地方而言。但是相對比較其他種類服務的花費是未知的。當施行新的計畫時,接受者可以被隨機分配到不同形式的協助 (例如,以個人使用者或合作方式來組織) 。雖然擁護者會以大量的理由來支持個人化協助,這篇回顧顯示,仍需要進一步的試驗,來決定哪一種協助模式對某類族群,是最有效果也最有效率的。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

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

總結

個人化的協助,在這裡被定義為,對有障礙的人,每星期至少20個小時的付費協助。這篇回顧探討個人化協助和其他任何形式的協助,對於同時有身體及智能障礙的成人,效果的比較。文獻的搜尋找出兩篇文獻,符合選擇條件,包括1002位受試者。他們建議,個人化協助比起其他服務,可能較被偏好。然而,仍有某些人比較偏好其他照護模式。這篇回顧顯示,個人化協助可能對某些接受者和照護者有一些益處。付費的照護可能可以取代正式的照護,但比起其他選擇要帶來政府更多花費。然而,對於接受者與社會的總花費是未知的。

Plain language summary

Personal assistance for adults (19-64) with both physical and intellectual impairments

Personal assistance is here defined as paid support of at least 20 hours per week for people with impairments. This review investigated the effectiveness of personal assistance versus any other form of care for adults with both physical and intellectual impairments. A literature search identified 2 studies that met the inclusion criteria, which included 1002 participants. They suggested that personal assistance may be preferred over other services; however, some people prefer other models of care. This review indicates that personal assistance may have some benefits for some recipients and their informal caregivers. Paid assistance might substitute for informal care and cost government more than alternative arrangements; however, the relative total costs to recipients and society are unknown.

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