A Systematic Review of the Qualitative Evidence for the Use of Lifestyle Planning in People with Learning Disabilities

Lifestyle planning (LP) for people with learning disabilities is largely supported by qualitative rather than quantitative research. LP is a time-consuming and potentially resource-intensive area of practice which is becoming more prevalent in the UK. We present the first systematic review of the qualitative evidence base for the use of LP in people with learning disabilities. Such evidence concerns the special characteristics of LP and its outcomes in descriptive rather than quantitative terms. Qualitative research is usually aimed at enhancing validity by grounding theory in data collected. Twenty-one studies passed eligibility criteria for inclusion in this review, but only ten provided any outcome data, the others being concerned with process only. A replicable search strategy was employed and the resulting original data sources were critically reviewed with respect to major concepts and categories in the areas of: planning process, choices and preferences, ethics and outcomes. Explicitly person-centred approaches such as essential lifestyle planning are contrasted with more service-led methods such as individual programme planning. There are major methodological limitations in much of the available literature and suggestions for future research to clarify matters are made. The current evidence base suggests that no form of LP has significantly better outcomes than any other form and that it is not clear if LP in general enhances outcomes. Ongoing use of person centred planning in particular is informed by ethical considerations and is evolving in its structure and function.

Cerebral dominance and schizophrenia-spectrum disorders in adults with intellectual disability

Studies of the general population without intellectual disability have suggested an association between atypical handedness and schizophrenia-spectrum disorders (SSDs). Mixed handedness is taken as an index of diminished cerebral dominance or laterality. The present study addressed the question of whether such findings extend to the neurodevelopmentally 'at risk' population of adults with intellectual disability and SSDs compared with appropriate controls. Fourteen patients with a dual diagnosis of intellectual disability and SSD were compared with 14 controls with intellectual disability alone. Assessments of self-reported hand preference and relative hand skill were completed. Self-report of hand preference revealed highly significantly greater mixed-handedness in the SSD group. Furthermore, relative hand skill performance was significantly diminished for the dominant hand. The discrepancy between dominant and non-dominant hand functioning was lower in the SSD group and this association was highly significant. The results of the present study support the usefulness of such detailed laterality assessment in this population. Mixed laterality, over and above that of the population with general intellectual disability and developmental disorder, was associated with SSD. These results are consistent with the neurodevelopmental hypothesis of schizophrenia and its cognitive neuropsychiatric/neuropsychological sequelae.

A systematic review of the evidence base for lifestyle planning in adults with learning disabilities: implications for other disabled populations

OBJECTIVE

To carry out the first systematic review of the evidence base for lifestyle planning (LP) approaches in adults with learning disability/developmental disorder and to discuss implications for other handicapped/disabled groups.

METHOD

Exhaustive review of relevant electronic databases, supplemented by appropriate hand-searching of journals and correspondence with key researchers. We gathered information from any papers reporting clear outcome measures. Quantitative and qualitative aspects of relevant studies are appraised.

RESULTS

There are no randomized controlled trials of lifestyle planning in adults with learning disability/developmental disorder. There was one controlled trial. Five studies, with a total of 108 subjects clearly identified, report on some outcome data.

CONCLUSIONS

There is surprisingly little evidence to support any form of lifestyle planning or lifestyle planning in general in the learning disability population. No statistically significant findings on positive outcomes with good statistical power exist. Limited data are presented to suggest certain desirable features of some methods of lifestyle planning in terms of process or outcome. However, there may be good ethical reasons for pursuing lifestyle planning with certain patient groups. Suggestions are made as to how further research may add to the evidence base for or against effective outcomes in different forms of lifestyle planning.