Limitations of meta-analyses

Impacts of goal setting on engagement and rehabilitation outcomes following acquired brain injury: a systematic review of reviews

PURPOSE

To appraise and synthesize evidence from previous systematic reviews (SRs) concerning the impacts of goal setting on engagement in the rehabilitation process and on outcomes of participation and occupational performance for individuals with acquired brain injury (ABI).

MATERIALS AND METHODS

Systematic review of SRs following the preferred reporting items for SRs and meta-analysis guidelines. Sixteen full text articles were assessed for eligibility, from which four were included in the review. The Critical Appraisal Skills Programme checklists for SRs was used to rate quality and risk of bias.

RESULTS

Four SRs of moderate to high quality included a variety of methodologies. Evidence of moderate quality showed clients' active participation in goal setting had positive impacts on the client and their engagement in the process. Findings suggested that goal-directed interventions, particularly in outpatient rehabilitation, may improve occupational performance. There was some indication that goal setting may support adherence to therapeutic exercises, but relevance to rehabilitation outcomes was less clear. Findings related to participation outcomes were minimal.

CONCLUSIONS

Goal setting is a complex and multidimensional process. Goal setting may contribute to improved engagement in rehabilitation although few studies explored occupational performance and participation outcomes for individuals with ABI.Implications for rehabilitationActive goal setting may contribute to improved engagement in rehabilitation, however, including individual clients in the goal setting process requires creativity and flexibility on behalf of professionals.A model is presented to promote understanding of the personal and environmental barriers and facilitators that may interact with goal setting approaches to promote engagement in rehabilitation.There is a need for more research exploring impact of active client-centered goal setting on occupational performance and participation outcomes for people with acquired brain injury.

Narratives of children with high-functioning autism spectrum disorder: A meta-analysis

BACKGROUND

The aim of this meta-analysis was to analyze the narrative performance of children and adolescents with high-functioning Autism Spectrum Disorders (ASD) in terms of microstructure, macrostructure and internal state language.

METHOD

A systematic literature search yielded 24 studies that met the predetermined inclusion criteria. Effect sizes for each study were calculated for eight variables and analyzed using a random effects model. Intellectual ability, age and type of narrative were considered as potential moderators.

RESULTS

Results revealed that the children with ASD performed significantly worse than their peers on all the variables considered.

CONCLUSIONS

Findings are discussed taking into account the main explanatory psychological autism theories. Implications for intervention and orientations for future research are suggested.

Comparative efficacy and safety of deferoxamine, deferiprone and deferasirox on severe thalassemia: a meta-analysis of 16 randomized controlled trials

OBJECTIVE

A meta-analysis was conducted to investigate the efficacy and safety of three main iron chelators, namely, deferoxamine (DFO), deferiprone (DFP) and deferasirox (DFX) for thalassemia major (TM) patients.

METHODS

Randomized controlled trials comparing mono-therapy DFO, DFP, DFX and combined DFP with DFO therapy in TM patients from January 1990 to December 2012 were searched and selected. Two independent authors assessed data from extracted randomized trials for efficacy and safety in the measurements of serum ferritin (SF), live iron concentration (LIC), myocardial iron content (MIC), left ventricular ejection fraction (LVEF) and adverse events (AEs).

RESULTS

Sixteen studies were selected. In the comparison of DFP versus DFO treatment groups, a significant difference was revealed on MIC and LVEF (P=0.01 and P=0.007, respectively) but not on SF or LIC level (P=0.65 and P=0.37, respectively). In comparing combined therapy (DFP plus DFO) versus DFO, a significant difference was shown on MIC and LVEF measurements (P<0.00001 and P=0.003, respectively), but not on SF or LIC levels (P=0.93 and P=0.62, respectively). Moreover, the combined DFP with DFO treatment had significantly higher risk than DFO treatment (RR 1.46 with 95%CI 1.04 to 2.04). When comparing DFX with DFO, a significant difference was shown on the SF level (P=0.003), and there was no difference between DFX and DFO in safety evaluation (RR 1.53 with 95%CI 0.31 to 7.49).

CONCLUSION

Findings indicated that the most effective and safe iron chelators remains to be proven, and further large-scale, long-term studies are needed.