The VADO approach in psychiatric rehabilitation: A randomized controlled trial

Abstract

Objective:This study investigated whether a specific planning and evaluation approach called VADO (Skills Assessment and Definition of Goals) resulted in improved personal and social functioning among patients with chronic schizophrenia.Methods:A total of 85 patients with chronic schizophrenia were randomly allocated to the VADO-based intervention or to routine care; 78 completed the program. Interventions were carried out in nine Italian day treatment or residential rehabilitation facilities. Assessment at the beginning of the study and at the one-year follow-up included the Personal and Social Performance scale (PSP) and Brief Psychiatric Rating Scale Version 4.0 (BPRS). Clinically significant improvement was defined as an increase of at least 10 points on the PSP or a decrease of at least 20 percent on the BPRS total score.Results:At baseline, average PSP scores in the experimental group and in the control group were 33.9±8.1 and 34.0±11.2, respectively. (Possible scores range from 1 to 100, with higher scores indicating better functioning.) At six months, the score improved markedly in the experimental group (40.8±10.9) and minimal change was observed in the control group (35.3±11.6); the difference between groups was significant (difference of 6.9 points compared with 1.3 points; t=2.21, df=81, p<.05). At 12 months, the same trend was observed (difference of 12.0 points compared with 3.5 points), and the difference between groups was both statistically and clinically significant (t=2.99, df=75, p<.01).Conclusions:A statistically and clinically significant improvement in functioning was observed among patients treated with the VADO approach.

Effectively Working on Rehabilitation Goals: 24-Month Outcome of a Randomized Controlled Trial of the Boston Psychiatric Rehabilitation Approach

“…However, the lack of effect on the other secondary outcomes contrasts with earlier findings that reported changes in the areas of housing and quality of life, 19 and improvement in general functioning. 20 A possible explanation is that these studies focused on groups with more severe problems, such as homelessness, whereas in the current study goals were directed at more subtle changes, which may have led to a ceiling effect. It is also possible that for these more subtle changes, goal attainment constitutes a more sensitive outcome than generic measures assessing functioning or quality of life, 44,45 measuring, for instance, subtle improvements in residential conditions other than independent living.…”

“…Shern et al 19 reported that homeless psychiatric patients receiving PR improved on unmet needs, housing status, quality of life, and psychological health. Gigantesco et al 20 observed an improvement in social functioning in patients engaged in a rehabilitation program inspired by PR, compared with the control subjects. However, in an RCT on vocational rehabilitation reported by Rogers et al, 21 PR and control groups displayed similar improvement in work participation.…”

Avaliação do comprometimento funcional na esquizofrenia

“…A escala PsP pode ser usada como um instrumento confiável e de fácil aplicação na mensuração dos resultados obtidos (Gigantesco et al, 2006).…”

Understanding Living Skills: First Steps to Evidence‐based Practice. Lessons Learned from a Practice‐based Journey in the Netherlands

“…Table I summarizes the learning from critically appraising the literature and reviewing the best practices in rehabilitation. The most robust evidence is at the base of the table because these principles are well supported by the empirical evidence (for example, Hamera and Brown, 2000;Gigantesco et al, 2006;Burns et al, 2007). The title for each box, written in italics, is a key principle of living skills training.…”

“…Skills training in relation to task (Appelo, 1992;Brown et al, 2002;Swildens et al, 2003;Woonings, 2003;Gigantesco et al, 2006;Eklund, 2007;van Weeghel, 2010; Landelijke Stuurgroep Multidisciplinaire Richtlijnontwikkeling in de GGZ, 2012)…”