A Cochrane review [Abstract] 1 included 2 studies with a total of 1002 subjects. The effectiveness of personal assistance versus any other form of care for adults with both physical and intellectual impairments was investigated. Personal assistance was defined as paid support of at least 20 hours per week for people with impairments. Meta-analysis was not possible due to substantial differences between the studies. Some evidence was identified that personal assistance recipients may express greater satisfaction and fewer unmet needs than participants receiving other services. However, some people prefer other models of care. Evidence was not found that personal assistance reduces long-term institutional care. One trial found mixed effects on caregivers. In one trial participants in the control group received substantial amount of paid assistance without external intervention. Paid assistance probably substitutes for informal care and may cost government more than alternatives; however, some evidence suggests it may reduce costs. The total costs to recipients and society are unknown.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), by indirectness (short follow-up periods) and by imprecise results (limited study size for each comparison).
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