AOT vs Standard Care Evidence Profile

DescriptionStudy IdsQuality of included studiesConsistencyDirectnessOther factorsN treatment groupN controlEffect sizeLikelihood of clinically important effectOverall qualityImportance
ACT vs Standard Care
Number lost to follow up
01 Number lost to follow upAberg 1995
Audini 1994
Bond 1988
Bond 1990
Fekete 1998
Hampton 1992
Herinckx 1997
Lehman 1997
Morse 1992
Test 1991
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Strong effect (+1)659582SMD= 0.61 (0.5, 0.75)Very Likely (favours AOT)ModerateCritical
Death
01 Death (all causes)Audini 1994
Bond 1988
Bond 1990
Dekker 2002
Hampton 1992
Test 1991
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Imprecise data (−1)314478RR= 1.08 (0.44, 2.65)InconclusiveLowCritical
02 Death due to suicideDekker 2002SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Imprecise data (−1)5051RR= 5.1 (0.25, 103.6)InconclusiveLowCritical
03 Death due to natural causesDekker 2002SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Imprecise data (−1)5051RR= 0.2 (0.01, 4.14)InconclusiveLowCritical
Admitted to hospital during study
03 Admitted to hospital during studyAudini 1994
Bond 1988
Bond 1990
Lehman 1997
SIGN: 1+ Insufficient details on randomisationSignificant heterogeneity (−1): random effects model used9% bipolar disorder (total dataset); largely non-UK setting (−1)None280251RR (random effcts) = 0.66 (0.44, 0.99)Likely (favours ACT)LowCritical
Arrest during study
01 Arrest during studyBond 1990SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse/imprecise data (−1)4543RR = 2.87 (0.31, 26.51)InconclusiveLow
Imprisonment during study
02 Imprisonment during studyBond 1990
Hampton 1992
Test 1991
SIGN: 1+ Insufficient details on randomisationSignificant heterogeneity (−1): random effects model used9% bipolar disorder (total dataset); largely non-UK setting (−1)Imprecise data (−1)202172RR (random effcts) = 0.81 (0.47, 1.39)InconclusiveVery low
Trouble with the police
03 Police contact (includes arrests)Trouble with the police Bond 1988SIGN: 1+ Insufficient details on randomisationSignificant heterogeneity (−1): random effects model used9% bipolar disorder (total dataset); largely non-UK setting (−1)Imprecise data (−1)7475RR (random effcts) = 0.92 (0.13, 6.54)InconclusiveLow
Not living independently at end of study
07 Not living independently at end of studyBond 1990
Lehman 1997
Test 1991
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)None197165RR (random effcts) = 0.7 (0.48, 1.02)Likely (favours AOT)Moderate
Homeless during or at end of study
08 Homeless during or at end of studyBond 1990
Hampton 1992
Test 1991
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Imprecise data (−1)202172RR (random effcts) = 0.28 (0.04, 1.84)InconclusiveModerate
Mean days per month in stable accommodation
09 Mean days per month in stable accommodationLehman 1997SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)None7775WMD= −4.2 (− 7.06, −1.34)UnlikelyModerate
Unemployed at end of study
10 Unemployed at end of studyBond 1990SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse data (−1)4543RR= 1 (0.91, 1.1)UnlikelyModerate
Mental state at about 12 months
11 Mental state at about 12 monthsAudini 1994
Dekker 2002
Morse 1992
Lehman 1997
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)None165153SMD= −0.13 (− 0.35, 0.09)UnlikelyModerateCritical
Mental state at about 24 months
01 Brief Psychiatric Rating Scale (high score = poor) at about 24 monthsDekker 2002SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse data (−1)3132WMD= 0 (−0.4, 0.4)UnlikelyModerateCritical
Social functioning at about 12 months
13 Social functioning at about 12 monthsAudini 1994
Morse 1992
Jerrell 1995
Dekker 2002
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)None140128SMD= −0.16 (− 0.41, 0.08)UnlikelyModerate
Social function at 24 months
01 GAF at 24 monthsDekker 2002SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse data/imprecise data (−1)3329WMD= −4.8 (− 11.46, 1.86)InconclusiveLow
Satisfaction with care
15 Satisfaction with care (Client Satisfaction Questionnaire, low score = poor)Audini 1994
Morse 1992
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)None6555WMD= −0.56 (− 0.77, −0.36)UnlikelyModerate
Self-esteem
16 Self-esteem (Rosenberg Scale, low score = poor)Morse 1992SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse data (−1)3729WMD= 0.17 (− 0.05, 0.39)UnlikelyLow
Quality of life at 12 months
01 General well-being in Quality of Life Scale, low scores = poor
02 SCL-90 at 12 months
17 Quality of life at 12 monthsLehman 1997
Dekker 2002
SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse data/imprecise data (−1)9785SMD= −0.32 (− 0.61, −0.03)InconclusiveLowCritical
Quality of life at 24 months
01 SCL-90 at 24 months
18 Quality of life at 24 monthsDekker 2002SIGN: 1+ Insufficient details on randomisationN/A9% bipolar disorder (total dataset); largely non-UK setting (−1)Sparse data (−1)3027WMD= 0.1 (− 0.21, 0.41)UnlikelyLowCritical

From: APPENDIX 23, EVIDENCE PROFILES

Cover of Bipolar Disorder
Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care.
NICE Clinical Guidelines, No. 38.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2006.
Copyright © 2006, The British Psychological Society & The Royal College of Psychiatrists.

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