CASP Tool | Carlsson et al. Baseline vs. 9-month follow-up [18] | Carlsson, Olsen, Mortensen & Kastrup 10-year follow-up [20] | Carlsson et al. Baseline vs 9 month vs. 23 month follow-up [17] | Kinzie et al. Baseline vs- 12 month follow-up [28] | Löfvander et al. Baseline, 6- and 12-month follow-up [33] | Stammel et al. Baselinve vs. 7 months vs. 14 months [36] |
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Did the study address a clearly focused issue? | Yes | Yes | Yes | No | Yes | Yes |
Was the cohort recruited in an acceptable way? | No | Yes | Yes | Yes | Yes | Yes |
Was the exposure accurately measured to minimise bias? | Cannot tell – no control group | Cannot tell – no control group | Yes | Cannot tell – no control group | Yes | Cannot tell – no control group |
Was the outcome accurately measured to minimise bias? | Yes | Yes | Yes | Yes | Yes | Yes |
Have the authors identified all important confounding factors? | Yes | Yes | No | Yes | Yes | Yes |
Have they taken account of the confounding factors in the design and/or analysis? | No | No | Cannot tell | Cannot tell | Yes | Yes |
Was the follow up of subjects complete enough? | Yes | Yes | Yes | Yes | Cannot tell | Cannot tell |
What are the results of this study? | After a mean of 8 months of multidisciplinary treatment, mental symptoms and health-related quality of life did not change | The level of emotional distress was high at follow-up. Social relations and unemployment at follow-up were important predictors of mental health symptoms and low health-related quality of life. | Reduction in trauma /depression (baseline > 23 month) means. Minimal differences due to low effect sizes. Intervention not effective. | There were significant changes between means on the WHOQOL physical, mental and environmental domains after 1 year. | New immigrants did not have inferior physical or psychological health, quality-of-life, well-being or social functioning compared with their age- and sex-matched Swedish born pairs during a 1-year follow-up. | Quality of life increased significantly after an average of 14 months of treatment. |
How precise are the results? | Cannot tell | Cannot tell | Cannot tell | Cannot tell | Cannot tell | Good |
Do you believe the results? | Cannot tell | Cannot tell | Yes | No, more information is required | Cannot tell | Yes |
Can the results be applied to the local population? | No | No | No | No | No | No |
Do the results of this study fit with other available evidence? | Yes | Yes | Cannot tell | Cannot tell | No | No |
What are the implications of this study for practice? | When planning health-related and social interventions an increased focus is needed on the present exile situation, e.g., social relations, occupation and resources available in the present situation. | Post migratory factors, such as social relations and occupation, are important for mental health and health-related quality of life. For the clinician dealing with severely traumatized refugees, it is important to be aware of a possible chronic condition. | Long-term follow-ups should be included in randomized trials focusing on the effects of different treatment approaches, including the appropriate length of treatment. | The results can have implications for the treatment of torture survivors. | General screening in unselected settings of refugees and new immigrants seems to be of little value. Clinical consultations in selected cases are to be preferred, adopting a holistic practical approach in patient and family-focused care. | It provides evidence for the efficacy of multidisciplinary treatment, more research needed. |