Impact of isolation on hospitalised patients who are infectious: systematic review with meta-analysis

Purssell, Edward; Gould, Dinah; Chudleigh, Jane

The eligibility criteria for inclusion was that studies should compare quantitative data on psychological or non-psychological outcomes in adult patients who are in infective isolation with those not isolated. Purely symptomatic/disease progression outcomes were not included, neither were those looking at patients isolated due to immunosuppression. Studies not containing comparative data between those isolated and not isolated were also excluded. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Due to the variety of different settings and methods it was deemed that the methodological and clinical heterogeneity was too broad to pool results; apart from those related to anxiety and depression, for which results were pooled using the random-effects model. This model assumes that the observed effect from each study is estimating a related but different true effect, allowing for between-study variation to be calculated in the form of heterogeneity statistics. All calculations and plots were produced using the meta and metafor packages in R. [14] [15] [16] Where raw data were not provided the summary results are given in the text but not the forest plots. All data relevant to the study are included in the article or uploaded as Supplementary File 3. Where it was not possible to pool outcome data because of methodological and clinical heterogeneity, the data from studies are shown as forest plots but without meta-analysis. The forest plots contain results from the studies where sufficient data were given to calculate either the risk ratio or standardised mean difference. A number of studies provided data on those under contact precautions, but no comparative data and so were not included. [44] [45] [46] [47] The data from the comparative studies suggest that although in many cases infective isolation precautions make little difference to psychological outcomes, where it does make a difference this is primarily negative. There were significant declines in mean scores related to control and self-esteem, and in many studies increases in the mean scores for risk of anxiety and depression. However, these findings were not consistent, and some larger studies showed little or no difference between the groups for these outcomes. These are shown in Figures 1 and 2 respectively. For non-psychological outcomes, using a difference in the risk of +/-20% of an event as being a measure of clinical significance it appears there was a trend for less attention to be given to, and for more errors to occur in those who were isolated.