Effect of personalized nursing based on quantitative evaluation strategies on remission of first-episode schizophrenia comparing to usual care: a systematic review and meta-analysis

Abstract

Background: The drug control of symptoms is for now the main clinical treatment of schizophrenia, but patients' varying condition and poor compliance can also fluctuate the therapeutic effect. Personalized nursing with a quantitative evaluation strategy (PNQES) may help improve the compliance and symptoms, but there are controversies over the outcomes reported in each specific study; the meta-analysis method aims to resolve the controversies over studies, thus, we conducted this study to pooling the results of controlled clinical studies, and to systematically evaluate the effects of this nursing model. Methods: The PubMed, Medline, Embase, China National Knowledge Infrastructure, and Wanfang databases were selected and searched for relevant articles for PNQES comparing to usual care. The inclusion criteria were established according to the Participants, Interventions, Comparisons, Outcomes, and Study (PICOS) framework. The Cochrane risk of bias 2.0 tool was used to evaluate the risk of bias of the included articles. The symptom scores, treatment compliance rate, quality of life, and social function indicators of the patients after nursing were quantitatively analyzed with effect sizes of mean difference (MD) or standard mean difference (SMD).Results: The 11 included articles comprised a total of 1,251 patients with experimental group 625 and control group 626. Of all the 11 articles, only 1 had a "low" risk of bias, while the other articles had "some concern of risk;" none of the articles had a "high" risk of bias. The meta-analysis showed that patients who received PNQES had a significantly lower Positive and Negative Syndrome Scale (PANSS) total score after care than patients who received routine care [MD =−9.95, 95% confidence interval (CI): −14.35, −5.55; P<0.00001]. Further, the treatment compliance rate of patients who received PNQES was significantly higher (odds ratio =4.44, 95% CI: 2.17, 9.09; P<0.0001), as was the quality of life (standard MD =2.40, 95% CI: 1.46, 3.34; P<0.00001). Further, the social function deficit score was significantly lower (MD =−2.25, 95% CI: −3.75, −0.76; P=0.003). Subgroup and regression analyses showed that patient age, initial PANSS score, and the quantitative method of disease severity were not the sources of heterogeneity. Different intervention approaches applied may have been the source of heterogeneity.Discussion: The application of PNQES is helpful for improving patients' symptoms and disease outcomes, treatment compliance, social function, and quality of life. It is suggested to be generalized in clinical application.