The adult social care outcomes framework : A systematic review of systematic reviews to support its use and development

ABSTRACT: Overall the evidence base was large; we identified 43 systematic reviews covering hundreds of studies and thousands of participants. Evidence clustered around particular outcomes, interventions and populations. Outcomes The vast majority of evidence is on quality of life and prevention outcomes Evidence on satisfaction with services and safeguarding is severely limited Interventions Physical activity interventions are those most widely evaluated in systematic reviews, followed by occupational therapy interventions No evidence is available on some key social care interventions, e.g. direct payments Populations The majority of evidence concerns people with long-term conditions (e.g. dementia, cancer, stroke) There is much less evidence on older people or people with mental health problems Evidence on learning or physical disabilities is extremely limited. Interventions with evidence of positive effect Evidence of positive impact was found for seven of the 14 social care interventions examined in the included reviews: physical activity, occupational therapy, supported employment, lay/peer support, hip protectors, assistive devices and personal assistance. Evidence on the scale of positive impacts was available for five of these interventions. Larger positive impacts resulted from integrated employment and mental health support and from hip protectors. Both larger and smaller impacts were found across eight physical activity reviews and two occupational therapy reviews. Smaller impacts resulted from a lay-led self-management intervention. Interventions with evidence of harm Two reviews contained evidence that interventions shown to be effective for some populations could potentially cause harm to vulnerable social care recipients. Tai chi, though effective for older people in general, was found to increase the rate of falls among frail older people. Exercise was found to have positive impacts on people exercising for rehabilitation after a period of ill health, but a negative impact on the psychological QoL of people exercising to manage their condition. Interventions not shown to be effective There were seven interventions for which no conclusive positive evidence was found. All available evidence on the following interventions was inconclusive: structured communication, safeguarding training, home hazard assessment. All available evidence on case management and social support interventions showed no evidence of difference between intervention and control groups. Of two reviews on alternative therapies, one found no evidence of difference between groups and another found inconclusive evidence. Inconclusive evidence was also found for some interventions shown to be positive in other reviews: physical activity, occupational therapy, personal assistance, assistive devices, lay/peer support, supported employment. No evidence of difference was found in some reviews for interventions which were found in other reviews to have positive effects: physical activity, assistive devices, lay/peer support, supported employment. On balance, the overall evidence suggests that physical activity interventions and occupational therapy are effective. What are the implications? Implications for policy and practice The greatest portion of evidence included in this review of reviews is about physical activity – evidence suggests that these types of interventions can be effective for people with long-term conditions and non-frail older people and may address both quality of life and delay or reduce the need for social care support. Moreover, although physical activity interventions may typically be regarded as not within the remit of social care, they may be relatively cheap and easy to implement, and therefore worth considering. More complex and perhaps more recognisably social care interventions such as occupational therapy are also supported by the review-level literature. The large and medium effects resulting from integrated mental health and employment services also underscore the value of complex social care interventions. Moreover, the integrated nature of this particular intervention suggests that the current drive in the UK to integrate health and social services (Department of Health 2011) may prove to be successful. Wider evaluation of integrated services is certainly warranted. A last key message for policymakers and practitioners is the need to recognise the influence of contextual factors on the success of social care interventions, in particular the need for safety measures when implementing social care interventions with particularly vulnerable groups. Implications for research The great breadth and extent of evidence contained within this review of reviews is clear. However, assessing the available review-level evidence across the whole of social care also makes clear that there are significant gaps in the evidence examining impact on ASCOF outcomes. There is severely limited evidence on satisfaction with services and safeguarding outcomes in existing systematic reviews There is little use of quality of life measures designed to evaluate the impact of social care interventions included in reviews There is limited review-level evidence on many social care interventions, and none for some key intervention types There is scant evidence on key populations groups – people with physical and learning disabilities There is no review-level evidence on cost-effectiveness. How did we get these results? The research involved identifying and analysing evidence from systematic reviews to answer the following research questions: Which social care interventions can effectively improve outcomes for services users in the four outcome domains set out in the ASCOF: quality of life, prevention, satisfaction and safeguarding? How much impact do effective social care interventions have on ASCOF outcomes?