본 연구는 뇌졸중 환자 대상 심리사회적 개입 연구의 현황 및 특성을 확인하고 개입의 전반적인 효과크기를 확인하였다. 2019년 10월까지 국내외 학술지에 게재된 61편의 연구를 대상으로 체계적 문헌고찰을 진행하였다. 그 중 37편을 대상으로 메타분석을 수행하였고, 개입 효과크기가 개입 유형, 형태 및 환경, 통제 집단 유형, 결과 지표 종류, 연구 설계, 비뚤림 위험에 따라 달라지는지 확인하기 위해 하위집단분석을 수행하였다. 뇌졸중 환자 대상 심리사회적 개입은 주로 심리치료, 심리사회교육, 지지치료, 결합치료였으며, 병원 장면(i.e., 외래, 입원)에서 개인이나 집단 개입 형태로 우울, 불안, 삶의 질, 자기효능감에 초점을 맞추었다. 메타분석 결과, 뇌졸중 환자 대상 심리사회적 개입은 작은 효과크기(g = 0.40; 95% CI, 0.31-0.50)를 보였고, 개입 유형 및 환경에 따른 차이가 관찰되었다. 심리치료가 결합치료, 심리사회교육, 지지치료보다 더 효과적이며, 입원 환경에서 제공되는 개입이 외래나 환자 가정, 지역사회에서 제공하는 것보다 효과적이었다. 분석 대상 연구들의 출판 편향 경향으로 Trim-fill 방법으로 효과크기를 교정하였으나 여전히 유의하였다. 본 연구 결과는 심리사회적 개입이 뇌졸중 환자의 디스트레스 개선에 효과적임을 시사한다.
This study reviewed and analyzed the characteristics and overall effect size (ES) of psychosocial interventions for stroke patients. The systematic review included 61 articles published in domestic and international journals up to October 2019, and the meta-analysis analyzed data from 37 articles. The subgroup analysis was conducted to determine the study characteristics (i.e., intervention type, format, and setting, control group, outcome, study design, and level of risk of bias) influencing the intervention effect. The psychosocial interventions for stroke patients were mainly provided in the form of psychotherapy, psychosocial education, supportive therapy, or combined therapy in inpatient or outpatient settings. The interventions were provided in individual or group format focusing on depression, anxiety, quality of life, and self-efficacy. The result of the meta-analysis observed low ES (g = 0.40; 95% CI, 0.31-0.50), and that ES varied depending on the intervention types and settings. The psychotherapy was more effective than other types, and a larger ES was observed in interventions provided in an inpatient setting than outpatient or home settings. The estimated ESs were corrected using the trim-fill method because of possible publication bias, but it remained significant, suggesting that psychosocial interventions are effective in improving distress in stroke patients.
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