Summary of findings 1. Avatar Therapy compared to treatment as usual (all short‐term) for schizophrenia or related disorders.
| Avatar Therapy compared to treatment as usual (all short‐term) for schizophrenia or related disorders | ||||||
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Patient or population: schizophrenia or related disorders Setting: Intervention: Avatar Therapy Comparison: treatment as usual (all short‐term) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with treatment as usual (all short‐term) | Risk with Avatar Therapy | |||||
| Mental state*: specific – positive – average endpoint score (PANSS‐P, high = poor) – short term | — | MD 1.93 lower (5.10 lower to 1.24 higher) | — | 19 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | This was the nearest proxy measure for our prestated binary outcome, clinically important change in mental state. |
| Mental state: specific – insight – average attitude to voices score (BAVQ‐R, high = poor) – short term | — | MD 5.97 lower (10.98 lower to 0.96 lower) | — | 19 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | This was the nearest proxy measure for our prestated binary outcome, clinically important change in insight. |
| Global state: relapse (rehospitalised) – short term | 0 per 1000 | 0 per 1000 (0 to 0) | RD 0.0 (–0.2 to 0.2) | 19 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | RD reported as no‐one in either group was hospitalised. |
| Leaving study early: for any reason | 0 per 1000 | 0 per 1000 (0 to 0) | RR 11.27 (0.70 to 181.41) | 26 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | Avatar Therapy likely results in little to no difference for the outcome of 'leaving study early for any reason'. |
| Adverse events – anxiety – after first session – short term | 0 per 1000 | 0 per 1000 (0 to 0) | RR 5.54 (0.34 to 89.80) | 19 (1 RCT) | ⊕⊕⊝⊝ Lowa,c | — |
| Quality of life: average endpoint score (QLESQ‐SF, high = good) – short term | — | MD 9.99 higher (3.89 higher to 16.09 higher) | — | 19 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | This was the nearest proxy measure for our prestated binary outcome, clinically important change in quality of life. |
| Functioning: clinically important change | See comment | See comment | — | (0 studies) | — | No study reported on this important outcome. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BAVQ‐R: Revised Beliefs about Voices Questionnaire; CI: confidence interval; MD: mean difference; PANSS‐P: Positive and Negative Syndrome Scale – Positive; QLESQ‐SF: Quality of Life Enjoyment and Satisfaction Questionnaire‐Short Form; RCT: randomised controlled trial; RD: risk difference; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aRisk of bias: 'serious' (downgraded one level) – poor reporting of randomisation, no substantive discussion of any blinding or consideration of blinding. Authors contacted but limited information available. bIndirectness: 'serious' (downgraded one level) – proxy scale for binary outcome prestated in protocol. cImprecision: 'serious' (downgraded one level) – wide confidence intervals generated by very small study.