Effectiveness of vocational interventions for gaining paid work for people living with mild to moderate mental health conditions: Systematic review and meta-analysis

Objectives: To evaluate the effectiveness of vocational interventions to help people living with mild to moderate mental health conditions gain paid work. Methods: Systematic review of international, peer-reviewed literature. Development of the prepublished protocol and search strategy was done in consultation with stakeholder reference groups consisting of people with lived experience of long-term conditions, advocates and clinicians. We searched academic databases MEDLINE, EMBASE, PsychINFO, AMED, CINAHL, Proquest Dissertations and Theses database, and Business Source Complete for controlled trials comparing a specific vocational intervention against a control intervention or usual care, published between 1 January 2004 and 1 August 2019. Two authors independently screened search results, extracted data and appraised studies using the Cochrane risk of bias tool. Results: Eleven studies met inclusion criteria. Seven studies investigated Individual Placement and Support (IPS) modified for people who were not in intensive mental health treatment services. These studies occurred settings such as community vocational rehabilitation services, a housing programme and community mental health services. The studies provided very low quality evidence that people who receive IPS-style vocational rehabilitation are more likely to gain competitive employment than people who receive usual care (risk ratio 1.70, 95% CI 1.23 to 2.34, seven studies, 1611 participants). The remaining four studies considered cognitive behavioural therapy or specific vocational rehabilitation interventions designed to fit a unique context. There was insufficient evidence from these studies to draw conclusions regarding the effectiveness of non-IPS forms of vocational rehabilitation for people with mild to moderate mental health conditions. Discussion: The meta-analysis showed a clear intervention effect but low precision, and more high-quality studies are needed in this field. There is currently very low quality evidence that IPS-style intervention results in more participants in competitive employment compared with &lsquo;usual care&rsquo; control groups in populations with mild to moderate mental health conditions.</jats:sec

Goal setting and strategies to enhance goal pursuit in adult rehabilitation: summary of a Cochrane systematic review and meta-analysis

This is the author proof version of an article accepted for publication in European Journal of Physical and Rehabilitation Medicine 2016.Final version available from the publisher.This paper is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 7, Art. No.: CD009727, DOI: 10.1002/14651858 (see www.thecochranelibrary.com for information?Article first published online: January 15, 2016.INTRODUCTION: Goal setting is considered an essential part of rehabilitation, but approaches to goal setting vary with no consensus regarding the best approach. The aim of this systematic review and meta-analysis was to assess the effects of goal setting and strategies to enhance the pursuit of goals on improving outcomes in adult rehabilitation. EVIDENCE ACQUISITION: We searched CENTRAL, MEDLINE, EMBASE, four other databases and three trial registries for randomized control trials (RCTs), cluster RCTs, or quasi-RCTs published before December 2013. Two reviewers independently screened all search results, then critically appraised and extracted data on all included studies. We identified 39 trials, which differed in clinical context, participant populations, research question related to goal use, and outcomes measured. Eighteen studies compared goal setting, with or without strategies to enhance goal pursuit, to no goal setting. EVIDENCE SYNTHESIS: These 18 studies provided very low-quality evidence for a moderate effect size that any type of goal setting is better than no goal setting for improving health-related quality of life or self-reported emotional status (N.=446, standard mean difference [SMD]=0.53, 95% confidence interval [CI]: 0.17 to 0.88), and very low-quality evidence of a large effect size for self-efficacy (N.=108, SMD=1.07, 95% CI: 0.64 to 1.49). Fourteen studies compared a structured approach to goal setting to “usual care” goal setting, where some goals may have been set but no structured approach was followed. These studies provided very low-quality evidence for a small effect size that more structured goal setting results in higher patient self-efficacy (N.=134, SMD=0.37, 95% CI: 0.02 to 0.71). No conclusive evidence was found to support the notion that goal setting, or structured goal setting in comparison to “usual care” goal setting, changes outcomes for patients for measures of participation, activity, or engagement in rehabilitation programs. CONCLUSIONS: This review found a large and increasing amount of research being conducted on goal setting in rehabilitation. However, problems with study design and diversity in methods used means the quality of evidence to support estimated effect sizes is poor. Further research is highly likely to change reported estimates of effect size arising from goal setting in rehabilitation.SD’s position at the University of Exeter Medical School is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health

Rehabilitation goals of people with spinal cord injuries can be classified against the International Classification of Functioning, Disability and Health Core Set for spinal cord injuries

Objectives: To establish whether inter-professional rehabilitation goals from people with non-traumatic spinal cord injury (SCI) can be classified against the International Classification of Functioning, Disability and Health (ICF) SCI Comprehensive and Brief Core Sets early postacute situation. Setting: Neurological rehabilitation unit. Methods: Rehabilitation goals of 119 patients with mainly incomplete and non-traumatic SCIs were classified against the ICF SCI Core Sets following established linking rules. Results: A total of 119 patients generated 1509 goals with a mean (and s.d.) of 10.5 (9.1) goals per patient during the course of their inpatient rehabilitation stay. Classifying the 1509 rehabilitation goals against the Comprehensive ICF Core Set generated 2909 ICF codes. Only 69 goals (4.6%) were classified as ‘not definable (ND)’. Classifying the 1509 goals against the Brief ICF Core Set generated 2076 ICF codes. However, 751(49.8%) of these goals were classified as ‘ND’. In the majority of goals (95.7%), the ICF code description was not comprehensive enough to fully express the goals set in rehabilitation. In particular, the notion of quality of movement or specificity and measurability aspects of a goal (usually described with the criteria and acronyms SMART) could not be expressed through the ICF codes. Conclusion: Inter-professional rehabilitation goals can be broadly described by the ICF Comprehensive Core Set for SCI but not the Brief Core Set

Using shared goal setting to improve access and equity : a mixed methods study of the Good Goals intervention in children's occupational therapy

Peer reviewedPublisher PD

Patient preferences for asthma management: a qualitative study

Objective: Preference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients’ attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences. / Design: A qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups. / Setting: Three locations within the greater Wellington area in New Zealand. / Participants: Twenty-seven adults with self-reported doctor’s diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta2-agonist, who had used any inhaled asthma medication within the last month. / Results: Four key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management. / Conclusions: This study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective. / Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN12619000601134)