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Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review

INTRODUCTION: The NICE clinical guidelines on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on the results of randomized controlled trials (RCTs), which may not be studies with a pragmatic design, leading to uncertainty on applicability or recommenda...

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Autores principales: Gastaldon, Chiara, Mosler, Franziska, Toner, Sarah, Tedeschi, Federico, Bird, Victoria Jane, Barbui, Corrado, Priebe, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759154/
https://www.ncbi.nlm.nih.gov/pubmed/31550279
http://dx.doi.org/10.1371/journal.pone.0222891
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author Gastaldon, Chiara
Mosler, Franziska
Toner, Sarah
Tedeschi, Federico
Bird, Victoria Jane
Barbui, Corrado
Priebe, Stefan
author_facet Gastaldon, Chiara
Mosler, Franziska
Toner, Sarah
Tedeschi, Federico
Bird, Victoria Jane
Barbui, Corrado
Priebe, Stefan
author_sort Gastaldon, Chiara
collection PubMed
description INTRODUCTION: The NICE clinical guidelines on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on the results of randomized controlled trials (RCTs), which may not be studies with a pragmatic design, leading to uncertainty on applicability or recommendations to everyday clinical practice. AIM: To assess the level of pragmatism of the evidence used to develop the NICE guideline for psychosocial interventions in psychoses. MATERIAL AND METHODS: We conducted a systematic and critical appraisal of RCTs used to develop the ‘psychological therapy and psychosocial interventions’ section of the NICE guideline on the treatment and management of psychosis and schizophrenia in adults, published in 2014. For each study we assessed pragmatism using the pragmatic–explanatory continuum indicator summary-2 (PRECIS-2) and the Cochrane risk of bias tool. The mean score of PRECIS-2, averaging across nine domains, was calculated to describe the level of pragmatism of each individual study. RESULTS: A total of 143 studies were included in the analysis. Based on the PRECIS-2 tool, 16.8% were explanatory, 33.6% pragmatic, and 49.7% were rated in an intermediate category. Compared to explanatory studies, pragmatic studies showed a lower risk of bias. Additionally, pragmatism did not significantly improve over time, and no associations were found between pragmatism and a number of trial characteristics. However, studies with a UK leading investigator had the highest mean score of pragmatism. Cognitive behavioural therapy (CBT), art therapy, family intervention, psychoeducation, and adherence therapy, showed the higher average pragmatism scores. CONCLUSIONS: Two third of studies used to produce NICE recommendations on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on studies that did not employ a pragmatic design.
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spelling pubmed-67591542019-10-04 Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review Gastaldon, Chiara Mosler, Franziska Toner, Sarah Tedeschi, Federico Bird, Victoria Jane Barbui, Corrado Priebe, Stefan PLoS One Research Article INTRODUCTION: The NICE clinical guidelines on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on the results of randomized controlled trials (RCTs), which may not be studies with a pragmatic design, leading to uncertainty on applicability or recommendations to everyday clinical practice. AIM: To assess the level of pragmatism of the evidence used to develop the NICE guideline for psychosocial interventions in psychoses. MATERIAL AND METHODS: We conducted a systematic and critical appraisal of RCTs used to develop the ‘psychological therapy and psychosocial interventions’ section of the NICE guideline on the treatment and management of psychosis and schizophrenia in adults, published in 2014. For each study we assessed pragmatism using the pragmatic–explanatory continuum indicator summary-2 (PRECIS-2) and the Cochrane risk of bias tool. The mean score of PRECIS-2, averaging across nine domains, was calculated to describe the level of pragmatism of each individual study. RESULTS: A total of 143 studies were included in the analysis. Based on the PRECIS-2 tool, 16.8% were explanatory, 33.6% pragmatic, and 49.7% were rated in an intermediate category. Compared to explanatory studies, pragmatic studies showed a lower risk of bias. Additionally, pragmatism did not significantly improve over time, and no associations were found between pragmatism and a number of trial characteristics. However, studies with a UK leading investigator had the highest mean score of pragmatism. Cognitive behavioural therapy (CBT), art therapy, family intervention, psychoeducation, and adherence therapy, showed the higher average pragmatism scores. CONCLUSIONS: Two third of studies used to produce NICE recommendations on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on studies that did not employ a pragmatic design. Public Library of Science 2019-09-24 /pmc/articles/PMC6759154/ /pubmed/31550279 http://dx.doi.org/10.1371/journal.pone.0222891 Text en © 2019 Gastaldon et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gastaldon, Chiara
Mosler, Franziska
Toner, Sarah
Tedeschi, Federico
Bird, Victoria Jane
Barbui, Corrado
Priebe, Stefan
Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review
title Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review
title_full Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review
title_fullStr Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review
title_full_unstemmed Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review
title_short Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review
title_sort are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the nice guidelines pragmatic? a systematic review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759154/
https://www.ncbi.nlm.nih.gov/pubmed/31550279
http://dx.doi.org/10.1371/journal.pone.0222891
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