Statistical issues in randomised controlled trials: a narrative synthesis

Impact of a Health Education Intervention on the Incidence of Influenza-Like Illnesses (ILI) During Hajj via Smartphone Application

This study was aimed at demonstrating the impact of a health education intervention on reducing the incidence of influenza-like illnesses symptoms among Malaysian Hajj pilgrims. This study utilizes a quasi-experimental study in the evaluation of the impact of the intervention. Participants were recruited during Hajj orientation courses organized by private Hajj companies. Participants from two companies were assigned to an intervention group and control group, respectively. The intervention group received a smartphone-based health education intervention guided by the Health Belief Model (HBM), while the control group received a regular Hajj guide intervention smartphone application before departure to Hajj. Data on the incidence of influenza-like illnesses (ILI) were collected from participants from two Hajj companies before and after returning from Hajj. Data analysis was conducted using SPSS with descriptive analysis, and analytical tests were conducted at 5% significance level. A total of 102 pilgrims completed the study in both intervention and control groups. The incidence of ILI and Non-ILI symptoms were statistically significant when the intervention and control groups (p = 0.049) were compared. In conclusion, health education has an impact on reducing the incidence of ILI and non-ILI among Hajj pilgrims.

Effect of a synthetic feline facial pheromone product on stress during transport in domestic cats: a randomised controlled pilot study

OBJECTIVES

Transport can be a stressful experience for domestic cats. The objective of this study was to evaluate the effect of a new synthetic feline facial pheromone product on relieving stress in domestic cats during short-distance transport.

METHODS

A randomised, blinded, placebo-controlled pilot study was conducted. Prior to baseline screening, cat owners were trained via online meetings in the assessment of stress-related behaviours and overall stress visual analogue scoring. All assessments were completed 30 mins after the start of transport. A total of 150 domestic cats exhibiting stress-related behaviours during baseline screening were recruited and randomly assigned to either the treatment group (n = 75) or the placebo group (n = 75). For the placebo-controlled intervention, the product and placebo, which were identical in appearance, were provided to the treatment and placebo groups, respectively. Fifteen minutes after spraying the carriers with the product or placebo, cat owners were required to take their cat out and complete the same assessments (baseline screening).

RESULTS

After the intervention, the performance of the stress-related behaviours curling, lack of motion and meowing during transport outside the home was significantly reduced in the treatment group compared with the placebo group (P <0.05). When the baseline stress visual analogue scale (VAS) score was >2.94 cm, cats in the treatment group had significantly lower post-intervention stress VAS scores compared with those in the placebo group (P <0.05).

CONCLUSIONS AND RELEVANCE

A synthetic feline facial pheromone product can alleviate short-distance transport-related stress in domestic cats with higher stress scores. This finding will benefit domestic cats during transport outside of the home.

Effects of an e-learning programme on osteopaths' back pain attitudes: a mixed methods feasibility study

BACKGROUND

The biopsychosocial model is recommended in the management of non-specific low back pain but musculoskeletal practitioners can lack skills in assessing and managing patients using a biopsychosocial framework. Educational interventions have produced equivocal results. There is a need for an alternative educational tool to support practitioners' development in the application of biopsychosocial model to manage low back pain.

METHODS

A mixed methods study assessed the feasibility and acceptability of an e-learning programme on the biopsychosocial management of non-specific low back pain for osteopaths with more than 15 years' experience. A sequential explanatory design was conducted, with a feasibility randomised controlled trial and semi-structured interviews explored with thematic analysis.

RESULTS

A total of 45 participants participated in the RCT of which 9 also participated in the interview study. The a-priori sample size was not met (45 instead of 50). The recruitment strategies, randomisation, retention, data collection and outcome measures worked well and were found to be feasible for a main trial. The retention, satisfaction and participants' views of the programme demonstrated a good acceptability of the programme. Data from the semi-structured interviews were organised in three themes, the first two were related to the feasibility and acceptability of the e-learning programme (practical experience of following the course and engagement with the content) and the third relates to the impact of the intervention (perception of the BPS model).

CONCLUSION

A main RCT is feasible and the intervention was received well by the participants. A main RCT is required to assess the effectiveness of the e-learning programme. This work also provided data on aspects so far unreported, including osteopaths' views on continuing professional development, on e-learning as a form of continuing professional development and osteopaths' perceptions and challenges concerning the implementation of the biopsychosocial model in practice.

The role and challenges of cluster randomised trials for global health

Evaluating whether an intervention works when trialled in groups of individuals can pose complex challenges for clinical research. Cluster randomised controlled trials involve the random allocation of groups or clusters of individuals to receive an intervention, and they are commonly used in global health research. In this paper, we describe the potential reasons for the increasing popularity of cluster trials in low-income and middle-income countries. We also draw on key areas of global health research for an assessment of common trial planning practices, and we address their methodological shortcomings and pitfalls. Lastly, we discuss alternative approaches for population-level intervention trials that could be useful for research undertaken in low-income and middle-income countries for situations in which the use of cluster randomisation might not be appropriate.

Some statistical memes which sound correct but aren't quite: Application to the analysis of observational databases used in learning health systems

We consider four memes, correct within the context of randomized trials but requiring modification for the analysis of the observational databases typically associated with learning health systems: (a) the right answer always requires randomization; (b) a bigger database is always a better database; (c) statistical adjustment always works if based on a large enough database; and (d) always make a formal adjustment when testing multiple hypotheses. The rationale for these memes within the context of randomized trials is discussed, and the memes are restated in a fashion that is consistent with learning health systems.

Common Design Concepts in Randomized Controlled Trials

It is a known fact that Randomized Controlled Trials (RCTs) are the gold standard design methods in medical investigations particularly when the aim is comparison of medical therapies or effectiveness of intervention between treatment groups. This design method, once carefully followed, presents the highest level of evidence attainable in the measurement of treatment effect. Oftentimes, researchers confuse concepts related to the design of RCTs and thereby jeopardizing its benefits. Furthermore, in resource-poor settings, a very limited access to educational materials on design, conduct, and reporting of clinical trials exists. This among other reasons explains why most studies in such settings are observational in nature as RCTs are not as popular. This review adopted a narrative synthesis approach to aggregate current knowledge scattered in literatures in respect of selected common design concepts in RCTs so as to elucidate on their meaning and demands. Overall, 25 literatures drawn majorly from the PubMed database including 8 textbook materials were involved in examining the following concepts; Study Population in RCTs Setting, Primary and Secondary Outcome Measures, Single and Multicenter Trials, Pragmatic and Explanatory trials, and Blinding. Appropriate search terms for each of the concepts were entered into the PubMed database and relevant articles accessed. This review article, intended for educational purposes could also serve as a guide, especially for new entrants, in the design of RCTs. It is hoped that this educational material would contribute immensely toward maximizing the benefits of this all-important design method.

Malnutrition: evaluating the effectiveness of supplements

This article explores the effectiveness of oral nutritional supplements through a literature review. A literature search was performed throughout various medical databases and one article was selected for a critical appraisal. The study focused on the use of high-energy, low-volume supplements for people living in care homes who are at risk of malnutrtion or who are already manourished. The methods and conclusions of the study are then scrutinised. This article recommends further research to be carried out into the type and volume of supplements needed and the implementation of evidence-based practice.

Implementing a larviciding efficacy or effectiveness control intervention against malaria vectors: key parameters for success

During the last decade, scale-up of vector control tools such as long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) contributed to the reduction of malaria morbidity and mortality across the continent. Because these first line interventions are now affected by many challenges such as insecticide resistance, change in vector feeding and biting behaviour, outdoor malaria transmission and adaptation of mosquito to polluted environments, the World Health Organization recommends the use of integrated control approaches to improve, control and elimination of malaria. Larviciding is one of these approaches which, if well implemented, could help control malaria in areas where this intervention is suitable. Unfortunately, important knowledge gaps remain in its successful application. The present review summarises key parameters that should be considered when implementing larviciding efficacy or effectiveness trials.

A Randomized Controlled Trial of Family Finding: A Relative Search and Engagement Intervention for Youth Lingering in Foster Care

BACKGROUND

Youth who have experienced foster care are at risk of negative outcomes in adulthood. The family finding model aims to promote more positive outcomes by finding and engaging relatives of children in foster care in order to provide options for legal and emotional permanency.

OBJECTIVES

The present study tested whether family finding, as implemented in North Carolina from 2008 through 2011, improved child welfare outcomes for youth at risk of emancipating foster care without permanency.

RESEARCH DESIGN

A randomized controlled trial evaluation was carried out in nine counties in North Carolina. All children eligible for intervention services between 2008 and 2011 underwent random assignment. Effects were tested with an intent-to-treat design. Outcome data were obtained for all subjects from child welfare administrative data. Additional outcome data for a subset of older youth came from in-person interviews.

SUBJECTS

Subjects included 568 children who were in foster care, were 10-17 years old (at time of referral), had no identified permanent placement resource, and had no plan for reunification.

MEASURES

The confirmatory outcome was moves to more family-like placements, whether through a step-down in foster care placement or discharge from foster care to legal permanency.

RESULTS

No impact on the confirmatory outcome was observed. Findings regarding exploratory impacts are also described; these must be interpreted with caution, given the large number of outcomes compared.

CONCLUSIONS

The evaluation failed to find evidence that family finding improves the outcomes of older youth at risk of emancipation from foster care.

Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial

Background

Adherence to treatment remains the cornerstone of long term viral suppression and successful treatment outcomes among patients receiving Antiretroviral Therapy (ART).

Objective(s)

Evaluate the effectiveness of mobile phone reminders and peer counseling in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia.

Methods

A single-blind, parallel group RCT conducted in Hospital Sungai Buloh, Malaysia in which 242 adult Malaysian patients were randomized to intervention or control groups. Intervention consisted of a reminder module delivered through SMS and telephone call reminders by trained research assistants for 24 consecutive weeks (starting from date of ART initiation), in addition to adherence counseling at every clinic visit. The length of intended follow up for each patient was 6 months. Data on adherence behavior of patients was collected using specialized, pre-validated Adult AIDS Clinical Trial Group (AACTG) adherence questionnaires. Data on weight, clinical symptoms, CD4 count and viral load tests were also collected. Data was analyzed using SPSS version 22 and R software. Repeated measures ANOVA, Friedman’s ANOVA and Multivariate regression models were used to evaluate efficacy of the intervention.

Results

The response rate after 6 months follow up was 93%. There were no significant differences at baseline in gender, employment status, income distribution and residential location of respondents between the intervention and control group. After 6 months follow up, the mean adherence was significantly higher in the intervention group (95.7; 95% CI: 94.39–96.97) as compared to the control group (87.5; 95% CI: 86.14–88.81). The proportion of respondents who had Good (>95%) adherence was significantly higher in the intervention group (92.2%) compared to the control group (54.6%). A significantly lower frequency in missed appointments (14.0% vs 35.5%) (p = 0.001), lower viral load (p = 0.001), higher rise in CD4 count (p = 0.017), lower incidence of tuberculosis (p = 0.001) and OIs (p = 0.001) at 6 months follow up, was observed among patients in the intervention group.

Conclusion

Mobile phone reminders (SMS and telephone call reminders) and peer counseling are effective in improving adherence and treatment outcomes among HIV positive patients on ART in Malaysia. These findings may be of potential benefit for collaborative adherence planning between patients and health care providers at ART commencement.