Rudkin, A. & Rowe, D.,

1999,

Reviewed by Janet Robertson,
Institute for Health Research,
Lancaster University

Aims of systematic review

The aim was to carry out the first systematic review of the evidence base for lifestyle planning (LP) approaches for adults with learning disabilities and to discuss implications for other disabled groups. LP or person centred approaches are regularly used in services for people with learning disabilities. There is increasing interest in how, and whether, such approaches should be used with other disabled populations.

Methodology / Critical appraisal

This systematic review is a timely examination of the current state of the evidence base concerning lifestyle planning, or person centred planning, for people with learning disabilities. At a time when person centred planning is becoming central to service delivery for people with learning disabilities, this review illustrates that there is surprisingly little evidence to support any form of lifestyle planning for people with learning disabilities. It should be noted that not all of the forms of lifestyle planning included in the review, for example Individual Programme Planning, reflect the type of person centred planning approaches currently being advocated.

Search strategy

The search strategy is well described and all search terms listed in an appendix. A search was carried out for studies producing quantitative or qualitative data in the field of lifestyle planning using the following electronic databases: Medline (1991-1998); PsychLit (journal articles 1974-97, chapters 1987-97); Embase (1989-98) and Cinahl (1982-98). All terms for lifestyle planning approaches (eg personal futures planning, essential lifestyle planning, person centred planning, MAPS) and all terms for learning disability (following the ICD-10 definition of learning disability) were combined in an exhaustive fashion. A search was also carried out on the Cochrane database, as well as hand searching relevant journals and contacting major researchers to indentify unpublished data.

Data extraction

Consensus was reached between the two authors on the eligibility of articles according to whether they included original data regarding lifestyle planning in a learning disabled population. The two authors also reached consensus on the outcome data of articles.

Due to the small number of studies found, and the fact that none of them employed the same outcome measures, it was not possible to perform meta-analysis. Rather, each identified study was described individually.

Inclusion criteria

The inclusion criteria were that the study should produce original quantitative or qualitative data in relation to lifestyle planning with people with learning disabilities.

Reliability

Two reviewers were involved in deciding which articles to include or reject. It is not clear how these decisions were made beyond following inclusion criteria.

Key findings

The review found that there were no randomised controlled trials of any form of lifestyle planning. There was one controlled trial. In total, there were only five studies with a total of 108 subjects which reported any outcome data. These are described in turn in the review.

Factor et al (1996): a controlled trial where person centred planning was received by 42 elderly people with learning disabilities, with a control group of 38 who did not. Client participation was encouraged more in the intervention group but there was no difference in observed client participation. Intervention group clients living at home took on more volunteer activities.

Mount (1987): looks at the difference between traditional individual planning (IPP) and personal futures planning (PFP). Six clients received each approach and follow-up information (mainly qualitative) after one year presented. Forty five independent reviewers rated PFPs as more client centred than IPPs.

Higgins & Richardson (1994): only 4 people were resettled from hospital to community over three years using care management' rather than an expected 40, compared to 430 transfers in seven years using non-person centred traditional resettlement systems. However, more detail is needed from the original study to fully interpret these results.

Shiell et al . (1992): a naturalistic study of resource management in 150 community homes. However, this study is relevant to care management, not person centred planning per se .

Dagnan et al. (1995): an evaluation of joint training for staff and clients in shared action planning. However, outcome data from the study were limited and only half of the 12 clients who participated could clearly remember the training.

Social work practice/ policy implications