comes to scale-derived continuous measures. It is possible to add
data from different but similar scales and perform meta-analysis,
but we feel that this gives spurious authority to weak data. There
are too many assumptions. Scale-derived data are proxy measures,
often not truly continuous and are frequently incomplete. Then to
calculate an effect size estimate and then estimate how that would
relate to one favoured scale is, we suggest, more of an academic
contrivance than of direct clinical value.
Outcomes were mainly physician-oriented. Participant-oriented
outcomes, such as quality of life, satisfaction or days out of hospital
were seldom reported. Participant satisfaction was only reported
in three studies and no studies reported family burden. We would
suggest that future research should focus more on participantoriented
aspects, such as general and social functioning, family
burden and participants acceptability. Policymakers will certainly
want more and better reported economic data.
2. Applicability
Most trials were undertaken in hospital, whereas the majority of
people with schizophrenia are treated in the community. We are
unsure that, in the context of well-functioning community services,
psychoeducation, as a separate package, has a place. This is
the sort of information that would not be difficult to generate.
As many of the included trials are conducted in China, the findings
of this review are applicable to the Chinese population. Nevertheless,
most of the included Chinese trials are also conducted
in hospitals, thus raising the same concern that it may be inappropriate
to apply the results to community based patients.
Quality of the evidence
Overall, the quality of reporting was poor. Most included studies
did not describe how the randomisation was conducted. Blinding
was only used in eight studies and blinding concealment was not
tested. Therefore, there is a moderate risk of overestimating the
estimate of effect. Please refer to Figure 1 for a graphic representation
of the methodological quality of included studies.
Potential biases in the review process
The process of searching for studies was thorough.We strictly followed
the review protocol in the process of study selection, data
extraction and analysis. However, we only worked with published
reports in this review and may be perpetuating a publishing bias.
Many trials included in this update version were from the People’s
republic of China. The quality of some of the Chinese trials
has been called into question (Wu 2006), as many that are stated
to be randomised are not. In this update version, we found two
Chinese trials (Liu 2007; Unclear - Both 2005) conducted at different
places and time periods to have reported exactly the same