Clinical and cost effectiveness of staff training in the delivery of Positive Behaviour Support (PBS) for adults with intellectual disabilities, autism spectrum disorder and challenging behaviour - randomised trial.

ABSTRACT: BACKGROUND:Although Positive Behaviour Support (PBS) is a widely used intervention for ameliorating challenging behaviour (CB), evidence for its use in adults with intellectual disability (ID) and comorbid autism (ASD) is lacking. We report a planned subsidiary analysis of adults with both ASD and ID who participated in a randomised trial of PBS delivered by health professionals. METHODS:The study was a multicentre, cluster randomised trial conducted in 23 community ID services in England, participants were randomly allocated to either the delivery of PBS (n =?11 clusters) or to treatment as usual (TAU; n =?12). One-hundred and thirteen participants (46% of all participants in the trial) had a diagnosis of ID, autism spectrum disorder and CB (ASD+); (47 allocated to the intervention arm, and 66 to the control). CB (primary outcome) was measured with the Aberrant Behaviour Checklist total score (ABC-CT). Secondary outcomes included mental health status, psychotropic medication use, health and social care costs and quality adjusted life years (QALYs) over 12?months. RESULTS:There were no statistically significant differences in ABC-CT between ASD+ groups randomised to the two arms over 12?months (adjusted mean difference?=?-?2.10, 95% CI: -?11.3 7.13, p =?0.655) or other measures. The mean incremental cost of the intervention per participant was £628 (95% CI -£1004 to £2013). There was a difference of 0.039 (95% CI -?0.028 to 0.103) for QALYs and a cost per QALY gained of £16,080. CONCLUSIONS:Results suggest lack of clinical effectiveness for PBS delivered by specialist ID clinical teams. Further evidence is needed from larger trials, and development of improved interventions. TRIAL REGISTRATION:ClinicalTrials.gov: NCT01680276.

SUBMITTER: Strydom A 

PROVIDER: S-EPMC7158144 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature