A Cochrane review [Abstract] 1 included 7 RCTs with a total of 1113 subjects. They had severe mental illness in 3 trials, while in other studies the mental illness was not defined. The trials used different methods of delivering general physical health advice, but methods were comparable as all fell under the definition of general physical healthcare advice. Standard care was the most common comparator. Length of studies ranged from 6 weeks to 18 months. Only comparison "physical health advice vs. standard care" included more than one study. For measures of quality of life no difference was found in a study (MD Lehman scale 0.00, CI -0.67 to 0.67; n = 54) but found in 2 other trials (Quality of Life Medical Outcomes Scale - mental component MD 3.70, CI 1.76 to 5.64; 2 RCTs, n = 487). There was no difference between groups for the outcome of death (RR 0.98, CI 0.27 to 3.56; 2 RCTs, n = 487). For service use two studies presented favourable results for health advice, uptake of ill-health prevention services was significantly greater in the advice group (MD 36.90, CI 33.07 to 40.73; 1 RCT, n = 363) and service use: one or more primary care visit was significantly higher in the advice group (RR 1.77, CI 1.09 to 2.85; 1 RCT, n = 80). Economic data were equivocal. Attrition was large (>30%) but similar for both groups (RR 1.11, CI 0.92 to 1.35; 6 RCTs, n = 964). Comparisons of one type of physical healthcare advice with another were grossly underpowered and equivocal.
Comment: The quality of the evidence is downgraded by study quality (inadequate allocation concealment, more than 20% loss to follow-up), inconsistency (heterogeneity in patients, interventions and outcomes), and imprecise results (few studies for each comparison).
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