title: Nidotherapy for people with schizophrenia.
abstract: BACKGROUND
  Nidotherapy is a therapeutic method that principally aims to modify the environment of people with schizophrenia and other serious mental illnesses, whilst working in conjunction with, or alongside other treatments. Rather than focusing on direct treatments or interventions, the aim is to help the individual identify the need for, and work to effect environmental change with the aim of minimising the impact of any form of mental disorder on the individual and society.
  
  
  OBJECTIVE
  To review the effects of nidotherapy added to standard care, compared with standard care or no treatment for people with schizophrenia or related disorders.
  
  
  METHODS
  We searched the Cochrane Schizophrenia Group Trials Register (December 2011) and supplemented this by contacting relevant study authors, handsearching nidotherapy articles and manually searching reference lists.
  
  
  METHODS
  All randomised controlled trials (RCTs) that compared nidotherapy with standard care or no treatment.
  
  
  METHODS
  We independently selected and quality assessed potential trials. We reliably extracted data. We calculated risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data. Scale data were only extracted from valid scales. For non-skewed continuous endpoint data, we estimated mean difference (MD) between groups. Skewed data have been presented in the Data and analyses as 'other data', with acknowledged means and standard deviations. We assessed risk of bias for the included study and used GRADE to create a 'Summary of findings' table.
  
  
  RESULTS
  We included only one study that compared nidotherapy-enhanced standard care with standard care alone (total 52 participants); this study was classified by its authors as a 'pilot study'. The duration of the included study was 18 months in total. The single study examined the short-term (up to six months) and medium-term (between six and 12 months) effects of nidotherapy-enhanced standard care versus standard care.Nidotherapy-enhanced standard care was favoured over standard care for social functioning in both the short term (n = 50, 1 RCT, MD -2.10, 95% CI -4.66 to 0.46) and medium term (n = 37, 1 RCT, MD -1.70, 95% CI -4.60 to 1.20, Very low quality); however, these results did not reach statistical significance. Results concerning engagement with non-inpatient services favoured the intervention group in both the short term (n = 50, 1 RCT, MD 2.00, 95% CI 0.13 to 3.87) and medium term (n = 37, 1 RCT, MD 1.70, 95% CI -0.09 to 3.49), with statistical significance evident in the short term, but not in the medium term. Results of people leaving the study early favoured the intervention in the short term (n = 52, 1 RCT, RR 0.86, 95% CI 0.06 to 12.98), with slight favour of the control group at medium term (n = 50, 1 RCT, RR 0.99, 95% CI 0.39 to 2.54); again, these results did not reach statistical significance. Results for the adverse effects/events of death (measured by 12 months) favoured the intervention (n = 52, 1 RCT, RR 0.29, 95% CI 0.01 to 6.74, Very low quality) but with no statistical significance. Skewed results were available for mental state, service use, and economic outcomes, and present a mixed picture of the benefits of nidotherapy.
  
  
  CONCLUSIONS
  Further research is needed into the possible benefits or harms of this newly-formulated therapy. Until such research is available, patients, clinicians, managers and policymakers should consider it an experimental approach.
authors.affiliation: Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK. chamberlain_ian@yahoo.co.uk.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Chamberlain
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sampson
mesh_terms: D006801:Humans; D007398:Interpersonal Relations; D026684:Personal Autonomy; D010865:Pilot Projects; D012559:Schizophrenia / Q000628:therapy*; D012917:Social Adjustment; D012931:Social Environment
references.citation: Therapie. 1999 Jul Aug;54(4):405-11
references.pmid: 10667106
references.citation: Stat Med. 2002 Oct 15;21(19):2971-80
references.pmid: 12325113
references.citation: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD000453
references.pmid: 17054130
references.citation: Health Technol Assess. 1999;3(5):iii-92
references.pmid: 10982317
references.citation: Bull Menninger Clin. 1946 May;10:66-70
references.pmid: 20985168
references.citation: Int J Soc Psychiatry. 2010 Jan;56(1):50-9
references.pmid: 19592427
references.citation: J Clin Epidemiol. 2006 Jan;59(1):7-10
references.pmid: 16360555
references.citation: Acta Psychiatr Scand. 2002 Jun;105(6):469-71;discussion 471-2
references.pmid: 12059852
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000270
references.pmid: 17636625
references.citation: Epidemiol Psichiatr Soc. 2009 Apr-Jun;18(2):128-36
references.pmid: 19526744
references.citation: BMJ. 2007 Jan 6;334 Suppl 1:s7
references.pmid: 17204765
references.citation: BMJ. 1996 Nov 9;313(7066):1200
references.pmid: 8916759
references.citation: Psychol Med. 2002 Jul;32(5):855-61
references.pmid: 12171379
references.citation: Cochrane Database Syst Rev. 2010 Oct 06;(10):CD007906
references.pmid: 20927766
references.citation: BMJ. 2003 Sep 6;327(7414):557-60
references.pmid: 12958120
references.citation: Br J Psychiatry. 2005 Oct;187:366-71
references.pmid: 16199797
references.citation: Psychother Psychosom. 2003 Nov-Dec;72(6):350-6
references.pmid: 14526138
references.citation: BMJ. 1997 Sep 6;315(7108):600
references.pmid: 9302962
references.citation: Br J Psychiatry Suppl. 2007 May;49:s75-8
references.pmid: 17470946
references.citation: Schizophr Res. 2005 Nov 15;79(2-3):231-8
references.pmid: 15982856
references.citation: Int J Epidemiol. 2002 Feb;31(1):140-9
references.pmid: 11914310
references.citation: BMJ. 1997 Sep 13;315(7109):629-34
references.pmid: 9310563
references.citation: Int J Soc Psychiatry. 2005 Sep;51(3):265-75
references.pmid: 16252794
references.citation: Br J Psychiatry. 2000 Mar;176:249-52
references.pmid: 10755072
references.citation: Am J Epidemiol. 1999 May 1;149(9):876-83
references.pmid: 10221325
references.citation: J Neurol Neurosurg Psychiatry. 1996 Jun;60(6):604-13
references.pmid: 8648325
references.citation: Schizophr Bull. 2007 Jan;33(1):183-91
references.pmid: 16905632
references.citation: Cochrane Database Syst Rev. 2010 Dec 08;(12):CD000088
references.pmid: 21154340
references.citation: J Gen Intern Med. 1992 Nov-Dec;7(6):623-9
references.pmid: 1453246