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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Turner KM, Huntley A, Yardley T, Dawson S, Dawson S. Defining usual care comparators when designing pragmatic trials of complex health interventions: a methodology review. Trials 2024; 25:117. [PMID: 38342896 PMCID: PMC10860249 DOI: 10.1186/s13063-024-07956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Pragmatic trials evaluating complex health interventions often compare them to usual care. This comparator should resemble care as provided in everyday practice. However, usual care can differ for the same condition, between patients and practitioners, across clinical sites and over time. Heterogeneity within a usual care arm can raise methodological and ethical issues. To address these it may be necessary to standardise what usual care entails, although doing so may compromise a trial's external validity. Currently, there is no guidance detailing how researchers should decide the content of their usual care comparators. We conducted a methodology review to summarise current thinking about what should inform this decision. METHODS MEDLINE, Embase, CINAHL and PsycINFO were searched from inception to January 2022. Articles and book chapters that discussed how to identify or develop usual care comparators were included. Experts in the field were also contacted. Reference lists and forward citation searches of included articles were screened. Data were analysed using a narrative synthesis approach. RESULTS One thousand nine hundred thirty records were identified, 1611 titles and abstracts screened, 112 full texts screened, and 16 articles included in the review. Results indicated that the content of a usual care comparator should be informed by the aims of the trial, existing care practices, clinical guidelines, and characteristics of the target population. Its content should also be driven by the trial's requirements to protect participants, inform practice, and be methodologically robust, efficient, feasible and acceptable to stakeholders. When deciding the content of usual care, researchers will need to gather information about these drivers, balance tensions that might occur when responding to different trial objectives, and decide how usual care will be described and monitored in the trial. DISCUSSION When deciding the content of a usual care arm, researchers need to understand the context in which a trial will be implemented and what the trial needs to achieve to address its aim and remain ethical. This is a complex decision-making process and trade-offs might need to be made. It also requires research and engagement with stakeholders, and therefore time and funding during the trial's design phase. TRIAL REGISTRATION PROSPERO CRD42022307324.
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Affiliation(s)
- Katrina M Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Alyson Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tom Yardley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Bennett G, King N, Redfern K, Breese BC. Supervised physical activity and the incidence of gestational diabetes mellitus: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2155043. [PMID: 36514828 DOI: 10.1080/14767058.2022.2155043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) characterized by dysfunction in maintaining glucose homeostasis is recognized as the most common metabolic complication associated with pregnancy leading to adverse clinical outcomes for maternal and fetal health. Although previous analysis of the findings from randomized controlled trials (RCTs) support that regular physical activity reduces the incidence of GDM during pregnancy, less is known about the optimal timing of intervention with respect to trimester stage. OBJECTIVES To examine the interaction between both the timing and volume of supervised physical activity interventions on reducing the incidence of GDM during pregnancy. STUDY DESIGN Electronic databases including CINAHL, Embase, Medline and the Cochrane library were searched for records up to 29 September 2022. Eligibility criteria were RCTs including standard antenatal care + supervised physical activity intervention without dietary modification vs. those receiving standard antenatal care alone in women with no previous diagnosis of GDM, type 1 or type 2 diabetes mellitus. RESULTS Of the 3411 records identified, 20 RCTs comprising 6732 participants were included. It was found that supervised physical activity interventions decreased GDM risk when started within the first trimester (RR: 0.57, 95% CI: 0.41-0.79; p = .001) and by accumulating >600 MET·min·wk-1 of exercise (RR: 0.77, 95% CI: 0.60-0.98; p = .03) compared with standard antenatal care alone. Women with a BMI ≤25 kg/m2 experienced the greatest risk reduction in GDM following supervised exercise training (RR: 0.51, 95% CI: 0.34-0.75; p = .001). CONCLUSION Supervised physical activity reduces the incidence of GDM during pregnancy. It is recommended that pregnant individuals achieve a minimum of 600 MET·min·wk-1 of physical activity during the first trimester in order to reduce their odds of developing GDM. Attaining a healthy pre-pregnancy BMI is also an important determinant for the prevention of GDM with exercise.
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Affiliation(s)
- G Bennett
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - N King
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - K Redfern
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
| | - B C Breese
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, UK
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4
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Kraiss J, Viechtbauer W, Black N, Johnston M, Hartmann‐Boyce J, Eisma M, Javornik N, Bricca A, Michie S, West R, de Bruin M. Estimating the true effectiveness of smoking cessation interventions under variable comparator conditions: A systematic review and meta-regression. Addiction 2023; 118:1835-1850. [PMID: 37132077 PMCID: PMC10952237 DOI: 10.1111/add.16222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND AIMS Behavioural smoking cessation trials have used comparators that vary considerably between trials. Although some previous meta-analyses made attempts to account for variability in comparators, these relied on subsets of trials and incomplete data on comparators. This study aimed to estimate the relative effectiveness of (individual) smoking cessation interventions while accounting for variability in comparators using comprehensive data on experimental and comparator interventions. METHODS A systematic review and meta-regression was conducted including 172 randomised controlled trials with at least 6 months follow-up and biochemically verified smoking cessation. Authors were contacted to obtain unpublished information. This information was coded in terms of active content and attributes of the study population and methods. Meta-regression was used to create a model predicting smoking cessation outcomes. This model was used to re-estimate intervention effects, as if all interventions have been evaluated against the same comparators. Outcome measures included log odds of smoking cessation for the meta-regression models and smoking cessation differences and ratios to compare relative effectiveness. RESULTS The meta-regression model predicted smoking cessation rates well (pseudo R2 = 0.44). Standardising the comparator had substantial impact on conclusions regarding the (relative) effectiveness of trials and types of intervention. Compared with a 'no support comparator', self-help was 1.33 times (95% CI = 1.16-1.49), brief physician advice 1.61 times (95% CI = 1.31-1.90), nurse individual counselling 1.76 times (95% CI = 1.62-1.90), psychologist individual counselling 2.04 times (95% CI = 1.95-2.15) and group psychologist interventions 2.06 times (95% CI = 1.92-2.20) more effective. Notably, more elaborate experimental interventions (e.g. psychologist counselling) were typically compared with more elaborate comparators, masking their effectiveness. CONCLUSIONS Comparator variability and underreporting of comparators obscures the interpretation, comparison and generalisability of behavioural smoking cessation trials. Comparator variability should, therefore, be taken into account when interpreting and synthesising evidence from trials. Otherwise, policymakers, practitioners and researchers may draw incorrect conclusions about the (cost) effectiveness of smoking cessation interventions and their constituent components.
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Affiliation(s)
- Jannis Kraiss
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Department of Psychology, Health, and TechnologyUniversity of TwenteEnschedeThe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Nicola Black
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Marie Johnston
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | | | - Maarten Eisma
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenThe Netherlands
| | - Neza Javornik
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and PhysiotherapyUniversity of Southern DenmarkOdenseDenmark
- Department of Physiotherapy and Occupational Therapy, The Research Unit PROgrezNæstved‐Slagelse‐Ringsted HospitalsSlagelseDenmark
| | - Susan Michie
- Centre for Behaviour ChangeUniversity College LondonLondonUK
| | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Marijn de Bruin
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenThe Netherlands
- Institute of Applied Health Sciences, Health Psychology GroupUniversity of AberdeenAberdeenUK
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Nwosu M, Agyeman WY, Bisht A, Gopinath A, Cheema AH, Chaludiya K, Khalid M, Yu AK. The Effectiveness of Intraosseous Basivertebral Nerve Ablation in the Treatment of Nonradiating Vertebrogenic Pain: A Systematic Review. Cureus 2023; 15:e37114. [PMID: 37034146 PMCID: PMC10075185 DOI: 10.7759/cureus.37114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
Intraosseous basivertebral nerve ablation has shown sustained efficacy in treating chronic axial low back pain (LBP) in patients with type 1 or 2 Modic changes. This systematic review aims to determine the efficacy of intraosseous basivertebral nerve radiofrequency ablation in treating nonradiating axial chronic LBP compared to standard therapy, sham, or without contrast. The population of interest is individuals greater than or equal to 18 years old with chronic nonradiating vertebrogenic pain. The key outcome was the percentage of patients with greater than or equal to 50% pain reduction, greater than or equal to 10-point improvement in function and disability measured by the Oswestry Disability Index (ODI), greater than or equal to two-point pain reduction in the visual analog scale (VAS) or numerical pain rating scale, and a decrease in opioid utilization by 10 morphine milligram equivalents. Three databases, PubMed, MEDLINE, and Google Scholar, were used to retrieve the studies for the review. Two independent reviewers assessed the studies for inclusion using the validated tools for quality appraisal. There were 286 articles in total; however, only 11 publications with extensive data on 413 participants matched the inclusion criteria and were used for this review. At three months, a majority of the participants reported greater than or equal to 10-point improvement in the ODI, a measure of functional and disability improvement on a 10-point scale, and greater than or equal to two-point improvement in the VAS. A good number of patients in the basivertebral nerve ablation (BVNA) arm reported complete pain resolution demonstrating therapy success and the superiority of BVNA over sham and standard treatment. Basivertebral nerve radiofrequency ablation, among other criteria, is a safe and minimally invasive therapy that significantly lowers pain and impairment in individuals with vertebrogenic pain with distinct Modic type 1 and 2 changes at lumbar vertebra three-sacral vertebra one (L3-S1) vertebral levels. Proper patient selection and exact procedural methods are essential to the success of basivertebral nerve neurotomy. The findings of the existing investigations require confirmation by nonindustry-funded, large-scale, high-quality trials using generalizable study participants.
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6
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Amiri S, Hassani-Abharian P, Vaseghi S, Kazemi R, Nasehi M. Effect of RehaCom cognitive rehabilitation software on working memory and processing speed in chronic ischemic stroke patients. Assist Technol 2023; 35:41-47. [PMID: 34033513 DOI: 10.1080/10400435.2021.1934608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Stroke survivors need assistance to overcome cognitive impairments. Working memory (WM) and processing speed (PS) as two critical cognitive functions are disrupted by stroke. The goal of this study was to investigate the effect of RehaCom rehabilitation software on WM and PS in participants with chronic ischemic stroke with hemiplegia (right/left side). Participants were selected among stroke patients who were referred to our special rehabilitation clinic. Fifty participants were assigned to control (n = 25) and experimental (n = 25) groups. The results of the experimental group were compared with the control group before and after the treatment with RehaCom (ten 45-min sessions across five weeks, two sessions per week). The results showed a significant improvement in WM and PS in the experimental group in comparison with the control group after a 5-week training with RehaCom. In conclusion, our findings indicate that treatment with RehaCom software improves WM and PS in chronic ischemic stroke participants with hemiplegia. The exact mechanism of RehaCom is largely unknown and further studies are needed, but its effects on the function of brain regions involved in modulating cognitive functions such as the prefrontal cortex, cingulate cortex, and parietal cortex may be mechanisms of interest.
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Affiliation(s)
- Sanaz Amiri
- Department of Psychology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Peyman Hassani-Abharian
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | - Salar Vaseghi
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Tehran, Iran
- Cognitive and Neuroscience Research Center (CNRC), Amir-Almomenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Rouzbeh Kazemi
- TABASOM Rehabilitation Center for Stroke Patients, Tehran, Iran
| | - Mohammad Nasehi
- Cognitive and Neuroscience Research Center (CNRC), Amir-Almomenin Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Perfect MM, Silva GE, Chin CN, Wheeler MD, Frye SS, Mullins V, Quan SF. Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemp Clin Trials 2023; 124:106929. [PMID: 36441106 DOI: 10.1016/j.cct.2022.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
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Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America.
| | - Graciela E Silva
- College of Nursing, University of Arizona, Tucson, AZ 85721, United States of America
| | - Cindy N Chin
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Mark D Wheeler
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Sara S Frye
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Vicky Mullins
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Stuart F Quan
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, United States of America; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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Leahy TP, Kent S, Sammon C, Groenwold RH, Grieve R, Ramagopalan S, Gomes M. Unmeasured confounding in nonrandomized studies: quantitative bias analysis in health technology assessment. J Comp Eff Res 2022; 11:851-859. [PMID: 35678151 DOI: 10.2217/cer-2022-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Evidence generated from nonrandomized studies (NRS) is increasingly submitted to health technology assessment (HTA) agencies. Unmeasured confounding is a primary concern with this type of evidence, as it may result in biased treatment effect estimates, which has led to much criticism of NRS by HTA agencies. Quantitative bias analyses are a group of methods that have been developed in the epidemiological literature to quantify the impact of unmeasured confounding and adjust effect estimates from NRS. Key considerations for application in HTA proposed in this article reflect the need to balance methodological complexity with ease of application and interpretation, and the need to ensure the methods fit within the existing frameworks used to assess nonrandomized evidence by HTA bodies.
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Affiliation(s)
| | - Seamus Kent
- National Institute for Health & Care Excellence, Manchester, M1 4BT, UK
| | | | - Rolf Hh Groenwold
- Department of Clinical Epidemiology & Department of Biomedical Data Sciences, Leiden University Medical Centre, Einthovenweg 20, Leiden, 2333, The Netherlands
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sreeram Ramagopalan
- Global Access, F. Hoffmann-La Roche, Grenzacherstrasse 124 CH-4070, Basel, Switzerland
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, WC1E 6BT, UK
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Javornik N, Powell DJH, Eisma MC, Johnston M, Campbell MK, Hartmann-Boyce J, Michie S, West R, Black N, de Bruin M. Pragmatic evaluation of methods for retrieving unpublished information on comparator interventions in a systematic review of smoking cessation trials. Psychol Health 2022; 39:1-17. [PMID: 35876093 PMCID: PMC10911680 DOI: 10.1080/08870446.2022.2081688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/23/2022] [Accepted: 04/06/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Reporting of the content and delivery characteristics of comparator interventions in published articles is often incomplete. This study examines the feasibility and validity of two methods for collecting additional information on comparator interventions from trial authors. METHODS & MEASURES In a systematic review of smoking cessation trials (IC-Smoke), all trial authors were asked to send unpublished comparator intervention materials and complete a specially-developed comparator intervention checklist. All published and additionally obtained information from authors were coded for behaviour change techniques (BCTs) and other characteristics (type of comparator, provider, provider training, delivery mode and treatment duration). To assess representativeness, we assessed the amount of additional information obtained from trial authors compared with the amount that was published. We examined known-group and convergent validity of comparator intervention data when using only published or also unpublished information. RESULTS Additional information were obtained from 91/136 (67%) of trial authors. Representativeness, known-group and convergent validity improved substantially based on the data collected by means of the comparator intervention checklist, but not by requesting authors to send any existing comparator materials. CONCLUSIONS Requesting authors for unpublished comparator intervention data, using specially-developed checklists and unpublished materials, substantially improves the quality of data available for systematic reviews.
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Affiliation(s)
- Neža Javornik
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Daniel J. H. Powell
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Marion K. Campbell
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences and National Institute of Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Nicola Black
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Technology Addiction Team, Brain and Mind Centre, University of Sydney, Australia
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Mangset M, Kitzmüller G, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne KJ, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation. Trials 2021; 22:850. [PMID: 34838094 PMCID: PMC8627040 DOI: 10.1186/s13063-021-05765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is "usual care." The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants' reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. METHODS Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur's interpretation theory guided the analysis. RESULTS The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants' feelings of control and their ability to cope. Other participants' statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. CONCLUSIONS RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02338869. Registered on October 4, 2014.
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Affiliation(s)
- Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
| | - Gabriele Kitzmüller
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Anne S. Evju
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. Box 385, 8505 Narvik, Norway
| | - Sanne Angel
- Department of Public Health – Research Unit for Nursing and Healthcare, Department of Science in Nursing, Aarhus University, 8000 Aarhus, Denmark
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
| | - Lena Aadal
- Faculty of Health Sciences and Social Care, Molde University College, P.O. Box 2110, NO-6402 Molde, Norway
- Hammel Neurorehabilitation Centre and University Research Clinic, 8450 Hammel, Denmark
- Department of Clinical Medicine, Aarhus University, C, 8000 Aarhus, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
| | | | - Kari J. Kvigne
- Inland Norway University of Applied Sciences, P.B. 400, 2418 Elverum, Norway
- The Faculty of Nursing and Health Sciences, Nord University, P.B. 1490, 8049 Bodø, Norway
| | - Line K. Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Ellen Gabrielsen Hjelle
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Institute of Health and Society and Research Center for Habilitation and Rehabilitation Services and Models (CHARM), University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
| | - Unni Sveen
- Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, P.O. Box 4956, 0424 Oslo, Nydalen Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
| | - Marit Kirkevold
- University of Oslo, P.O. Box 1130, 0318 Oslo, Blindern Norway
- Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, 0130 Oslo, Norway
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11
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Conger A, Schuster NM, Cheng DS, Sperry BP, Joshi AB, Haring RS, Duszynski B, McCormick ZL. The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Neurotomy for the Treatment of Chronic Low Back Pain in Patients with Modic Changes: A Systematic Review. PAIN MEDICINE 2021; 22:1039-1054. [PMID: 33544851 DOI: 10.1093/pm/pnab040] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Determine the effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain with type 1 or 2 Modic changes. DESIGN Systematic review. POPULATION Persons aged ≥18 years with chronic low back pain with type 1 or 2 Modic changes. INTERVENTION Intraosseous basivertebral nerve radiofrequency neurotomy. COMPARISON Sham, placebo procedure, active standard care treatment, or none. OUTCOMES The primary outcome of interest was the proportion of individuals with ≥50% pain reduction. Secondary outcomes included ≥10-point improvement in function as measured by Oswestry Disability Index as well as ≥2-point reduction in pain score on the Visual Analog Scale or Numeric Rating Scale, and decreased use of pain medication. METHODS Three reviewers independently assessed publications before May 15, 2020, in MEDLINE and Embase and the quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation framework. RESULTS Of the 725 publications screened, seven publications with 321 participants were ultimately included. The reported 3-month success rate for ≥50% pain reduction ranged from 45% to 63%. Rates of functional improvement (≥10-point Oswestry Disability Index improvement threshold) ranged from 75% to 93%. For comparison to sham treatment, the relative risk of treatment success defined by ≥50% pain reduction and ≥10-point Oswestry Disability Index improvement was 1.25 (95% confidence interval [CI]: .88-1.77) and 1.38 (95% CI: 1.10-1.73), respectively. For comparison to continued standard care treatment the relative risk of treatment success defined by ≥50% pain reduction and ≥10-point Oswestry Disability Index improvement was 4.16 (95% CI: 2.12-8.14) and 2.32 (95% CI: 1.52-3.55), respectively. CONCLUSIONS There is moderate-quality evidence that suggests this procedure is effective in reducing pain and disability in patients with chronic low back pain who are selected based on type 1 or 2 Modic changes, among other inclusion and exclusion criteria used in the published literature to date. Success of the procedure appears to be dependent on effective targeting of the BVN. Non-industry funded high-quality, large prospective studies are needed to confirm these findings.
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Affiliation(s)
- Aaron Conger
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Nathaniel M Schuster
- Center for Pain Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
| | - David S Cheng
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Beau P Sperry
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Anand B Joshi
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - R Sterling Haring
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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12
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Alyami M, Serlachius A, O'Donovan CE, van der Werf B, Broadbent E. A systematic review of illness perception interventions in type 2 diabetes: Effects on glycaemic control and illness perceptions. Diabet Med 2021; 38:e14495. [PMID: 33306203 DOI: 10.1111/dme.14495] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022]
Abstract
AIMS This systematic review sought to synthesize the evidence regarding the effectiveness of illness perception interventions compared with control conditions at changing illness perceptions and improving glycaemic control in individuals with type 2 diabetes. METHODS Seven electronic databases were searched between October 2018 and May 2020. Randomized controlled trials that tested interventions informed by the Common-Sense Model in adults with type 2 diabetes, and measured illness perceptions and glycaemic control at pre- and post-intervention were included. The Cochrane risk of bias tool was used to assess risk of bias. RESULTS A total of 4095 articles were identified, of which nine randomized control trials (2561 participants) across 12 publications were included in this review. Findings showed that all the illness perception domains were modified in at least one trial, with the exception of cyclical timeline perceptions. Coherence, personal control, treatment control and chronic timeline perceptions were the most frequently modified perceptions. Glycaemic control demonstrated an improvement in the intervention group compared to the control group at 3 and 6 months post-intervention in two trials. Risk of bias assessment showed high risk of bias especially for the blinding of participants and the personnel domain. CONCLUSIONS There is limited evidence that interventions informed by the Common-Sense Model can improve glycaemic control in individuals with type 2 diabetes through changing inaccurate illness perceptions. Recommendations for future research are to tailor intervention content based on baseline perceptions, measure the emotional and causal domains, and involve family members in the intervention. (PROSPERO registration: CRD42019114532).
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Affiliation(s)
- Mohsen Alyami
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Claire E O'Donovan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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13
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Biesecker BB, Lillie SE, Amendola LM, Donohue KE, East KM, Foreman AKM, Gilmore MJ, Greve V, Liangolou B, O'Daniel JM, Odgis JA, Rego S, Rolf B, Scollon S, Suckiel SA, Zepp J, Joseph G. A review and definition of 'usual care' in genetic counseling trials to standardize use in research. J Genet Couns 2021; 30:42-50. [PMID: 33278053 PMCID: PMC7882019 DOI: 10.1002/jgc4.1363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
The descriptor 'usual care' refers to standard or routine care. Yet, no formal definition exists. The need to define what constitutes usual care arises in clinical research. Often one arm in a trial represents usual care in comparison with a novel intervention. Accordingly, usual care in genetic counseling research appears predominantly in randomized controlled trials. Recent standards for reporting genetic counseling research call for standardization, but do not address usual care. We (1) inventoried all seven studies in the Clinical Sequencing Evidence-Generating Consortium (CSER) about how genetic counseling was conceptualized, conducted, and whether a usual care arm was involved; (2) conducted a review of published randomized control trials in genetic counseling, comparing how researchers describe usual care groups; and (3) reviewed existing professionally endorsed definitions and practice descriptions of genetic counseling. We found wide variation in the content and delivery of usual care. Descriptions frequently detailed the content of usual care, most often noting assessment of genetic risk factors, collecting family histories, and offering testing. A minority included addressing psychological concerns or the risks versus benefits of testing. Descriptions of how care was delivered were vague except for mode and type of clinician, which varied. This significant variation, beyond differences expected among subspecialties, reduces the validity and generalizability of genetic counseling research. Ideally, research reflects clinical practice so that evidence generated can be used to improve clinical outcomes. To address this objective, we propose a definition of usual care in genetic counseling research that merges common elements from the National Society of Genetic Counselors' practice definition, the Reciprocal Engagement Model, and the Accreditation Council for Genetic Counselors' practice-based competencies. Promoting consistent execution of usual care in the design of genetic counseling trials can lead to more consistency in representing clinical care and facilitate the generation of evidence to improve it.
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Affiliation(s)
- Barbara B Biesecker
- Genomics, Bioinformatics and Translation, RTI International, Washington, DC, USA
| | - Sarah E Lillie
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Laura M Amendola
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Katherine E Donohue
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kelly M East
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics, Kaiser Permanente - Center for Health Research, Portland, OR, USA
| | - Veronica Greve
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | | | - Jacqueline A Odgis
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shannon Rego
- Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Bradley Rolf
- Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Sarah Scollon
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sabrina A Suckiel
- Institute for Genomic Health, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamilyn Zepp
- Department of Translational and Applied Genomics, Kaiser Permanente - Center for Health Research, Portland, OR, USA
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California, San Francisco, CA, USA
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14
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Petersen B, Vesper I, Pachwald B, Dagenbach N, Buck S, Waldenmaier D, Heinemann L. Diabetes management intervention studies: lessons learned from two studies. Trials 2021; 22:61. [PMID: 33461624 PMCID: PMC7812736 DOI: 10.1186/s13063-020-05017-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Several clinical studies investigated improvements of patient outcomes due to diabetes management interventions. However, chronic disease management is intricate with complex multifactorial behavior patterns. Such studies thus have to be well designed in order to allocate all observed effects to the defined intervention and to exclude effects of other confounders as well as possible. This article aims to provide challenges in interpreting diabetes management intervention studies and suggests approaches for optimizing study implementation and for avoiding pitfalls based on current experiences. Main body Lessons from the STeP and ProValue studies demonstrated the difficulty in medical device studies that rely on behavioral changes in intervention group patients. To successfully engage patients, priority should be given to health care professionals being engaged, operational support in technical issues being available, and adherence being assessed in detail. Another difficulty is to avoid contamination of the control group with the intervention; therefore, strict allocation concealment should be maintained. However, randomization and blinding are not always possible. A limited effect size due to improvements regarding clinical endpoints in the control group is often caused by the Hawthorne effect. Improvements in the control group can also be caused with increased attention paid to the subjects. In order to reduce improvements in the control group, it is essential to identify the specific reasons and adjust study procedures accordingly. A pilot phase is indispensable for this. Another option is to include a third study arm to control for enhanced standard of care and study effects. Furthermore, retrospective data collection could be a feasible option. Adaptive study designs might reduce the necessity of a separate pilot study and combine the exploratory and confirmatory stages of an investigation in one single study. Conclusion There are several aspects to consider in medical device studies when using interventions that rely on changes in behavior to achieve an effective implementation and significant study results. Improvements in the control group may reduce effect sizes and limit statistical significance; therefore, alternatives to the traditional randomized controlled trials may be considered.
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Affiliation(s)
| | | | | | | | - Sina Buck
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Strasse 8/2, 89081, Ulm, Germany.
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Strasse 8/2, 89081, Ulm, Germany
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15
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Is your standard, my standard? Why control arm reporting matters in pediatric clinical trials. Pediatr Res 2020; 88:544-545. [PMID: 32428927 DOI: 10.1038/s41390-020-0974-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/09/2022]
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16
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Black N, Eisma MC, Viechtbauer W, Johnston M, West R, Hartmann‐Boyce J, Michie S, de Bruin M. Variability and effectiveness of comparator group interventions in smoking cessation trials: a systematic review and meta-analysis. Addiction 2020; 115:1607-1617. [PMID: 32043675 PMCID: PMC7496125 DOI: 10.1111/add.14969] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/08/2019] [Accepted: 01/10/2020] [Indexed: 12/22/2022]
Abstract
AIMS To examine variability and effectiveness of interventions provided to comparator (control) groups in smoking cessation trials. METHODS Systematic review with meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for smoking cessation, with or without stop-smoking medication. We searched the Cochrane Tobacco Addiction Group Specialized Register for RCTs with objective outcomes measured at ≥ 6 months. Study authors were contacted to obtain comprehensive descriptions of their comparator interventions. Meta-regression analyses examined the relationships of smoking cessation rates with stop-smoking medication and behavior change techniques. RESULTS One hundred and four of 142 eligible comparator groups (n = 23 706) had complete data and were included in analyses. There was considerable variability in the number of behavior change techniques delivered [mean = 15.97, standard deviation (SD) = 13.54, range = 0-45] and the provision of smoking cessation medication (43% of groups received medication) throughout and within categories of comparator groups (e.g. usual care, brief advice). Higher smoking cessation rates were predicted by provision of medication [B = 0.334, 95% confidence interval (CI) = 0.030-0.638, P = 0.031] and number of behavior change techniques included (B = 0.020, 95% CI = 0.008-0.032, P < 0.001). Modelled cessation rates in comparator groups that received the most intensive support were 15 percentage points higher than those that received the least (23 versus 8%). CONCLUSIONS Interventions delivered to comparator groups in smoking cessation randomized controlled trials vary considerably in content, and cessation rates are strongly predicted by stop-smoking medication and number of behavior change techniques delivered.
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Affiliation(s)
- Nicola Black
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyNSWAustralia
| | - Maarten C. Eisma
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- Department of Clinical Psychology and Experimental PsychopathologyUniversity of GroningenGroningenthe Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtthe Netherlands
| | - Marie Johnston
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
| | - Robert West
- Department of Behavioral Science and HealthUniversity College LondonLondonUK
| | | | - Susan Michie
- Centre for behavior ChangeUniversity College LondonGower StreetLondonWC1E 6BTUK
| | - Marijn de Bruin
- Health Psychology Group, Institute of Applied Health SciencesUniversity of Aberdeen, Health Sciences Building, ForesterhillAberdeenUK
- Radboud University Medical CenterRadboud Institute for Health Sciences, IQ HealthcareNijmegenthe Netherlands
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17
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Young HM, Miyamoto S, Tang-Feldman Y, Dharmar M, Balsbaugh T, Greenwood D. Defining Usual Care in Clinical Trials. Res Gerontol Nurs 2019; 13:125-129. [PMID: 31834414 DOI: 10.3928/19404921-20191127-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/06/2019] [Indexed: 12/24/2022]
Abstract
Pragmatic trials occur within the complexity of real-world care delivery, and when effective, contribute to more rapid translation into practice because of their greater generalizability. Research with older adults is complex when participants have chronic conditions and multiple comorbidities. Often pragmatic trials introduce a novel intervention and try to determine whether it offers a benefit beyond the usual or routine care provided. Researchers commonly focus attention on describing the intervention, yet the comparator condition of usual or routine care can be anything but standard, reducing the effect size of the intervention and introducing threats to the overall validity of the study. The current article describes clinical trial guidelines, then illustrates the complexity of characterizing usual care for interventions addressing type 2 diabetes. The authors provide recommendations for improving description of usual care and discuss implications for gerontological nursing research. [Research in Gerontological Nursing, 13(3), 125-129.].
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Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P, Morris TA, Etherington A, Shiers D, Barnard K, Swaby L, Edwardson C, Carey ME, Davies MJ, Dickens CM, Doherty Y, French P, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Siddiqi N, Wright S, Waller G, Gaughran F, Barnett J, Northern A. Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT. Health Technol Assess 2019; 22:1-160. [PMID: 30499443 DOI: 10.3310/hta22650] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING Ten community mental health trusts in England. PARTICIPANTS People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION Current Controlled Trials ISRCTN19447796. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | | | - David Saxon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tiyi A Morris
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Katharine Barnard
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
| | - Lizzie Swaby
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Marian E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK.,Psychological Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn E Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Sridevi Kalidindi
- Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Richard Laugharne
- Research and Innovation, Cornwall Partnership NHS Foundation Trust, Redruth, UK
| | | | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Stephen Wright
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Glenn Waller
- Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK.,Department of Psychology, University of Sheffield, Sheffield, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Psychosis Unit and Research and Development Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janette Barnett
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
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Herrmann A, Hall A, Zdenkowski N, Sanson-Fisher R. Heading in a new direction? Recommendations for future research on patient decision aids. PATIENT EDUCATION AND COUNSELING 2019; 102:1029-1034. [PMID: 30528874 DOI: 10.1016/j.pec.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/30/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
Decision aids can improve a number of patient outcomes, but they are not commonly used in clinical practice. This commentary paper provides suggestions for potential next steps of decision aid research, with the aim to facilitate their implementation. We suggest to further standardise clinically meaningful outcomes and outcome measures that should be used to examine the impact of decision aids. Second, using mediation analysis and active control groups could help tease out and explore variables that influence decision aids' effectiveness to help healthcare providers decide when and how to use them in clinical practice. Third, effectiveness trials should be clearly reported and replicated to investigate under what circumstances decision aids work best. Specific checklists for decision aid trials should be used to ensure that all relevant factors are reported in detail. Addressing the above issues will help identify what specific components of decision aids are effective and should be implemented. We can then move towards conducting implementation trials which help increase the use of decision aids in "real-world" healthcare.
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Affiliation(s)
- Anne Herrmann
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights NSW 2305, Australia.
| | - Alix Hall
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights NSW 2305, Australia.
| | - Nicholas Zdenkowski
- Department of Medical Oncology, Calvary Mater Newcastle, Edith St & Platt St, Waratah NSW 2298, Australia.
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan NSW 2308, Australia; Hunter Medical Research Institute, Lot 1, Kookaburra Circuit, New Lambton Heights NSW 2305, Australia.
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20
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Lim NLY, Shorey S. Effectiveness of technology-based educational interventions on the empowerment related outcomes of children and young adults with cancer: A quantitative systematic review. J Adv Nurs 2019; 75:2072-2084. [PMID: 30740758 DOI: 10.1111/jan.13974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/10/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023]
Abstract
AIM To determine the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. DESIGN Quantitative systematic review. DATA SOURCES Six electronic databases, including PubMed, Cochrane Library, EMBASE, CINAHL, Scopus, and PsycINFO, were searched to identify eligible randomized controlled trials from each database's point of inception to December 2017. Grey literature was also searched from ProQuest and MedNar. REVIEW METHODS A narrative summary of the results was undertaken owing to the small number of eligible studies and high heterogeneity across the studies. RESULTS Five studies were included in the review. Five empowerment-related outcomes under the domain "patient states" were identified at differing time points of 3-month postintervention, immediate postintervention, and during treatment: (a) self-efficacy; (b) cancer knowledge; (c) health locus of control; (d) emotional well-being; and (e) quality of life. At 3-month postintervention, health locus of control was found to be significant in two studies and self-efficacy and cancer knowledge were found to be significant in one study. No difference in quality of life was found. At immediate postintervention, a beneficial indication was observed. During treatment, no statistical significance was found regarding the effectiveness of a technological-based cognitive behavioural package. CONCLUSION Weak evidences led to inconclusive findings on the effectiveness of technological-based educational interventions on the empowerment-related outcomes of children and young adults with cancer. Future research will benefit from well-designed clinical trials that use a common outcome measurement to provide more information regarding the effectiveness of such interventions.
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Affiliation(s)
- Natalie L Y Lim
- Nursing Division, KK Women's and Children's Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Yong Loo Lin School of Medicine, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
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Yu AM, Balasubramanaiam B, Offringa M, Kelly LE. Reporting of interventions and "standard of care" control arms in pediatric clinical trials: a quantitative analysis. Pediatr Res 2018; 84:393-398. [PMID: 29899384 DOI: 10.1038/s41390-018-0019-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/01/2018] [Accepted: 04/01/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND In pediatric medicine, the usual treatment received by children ("standard of care") varies across centers. Evaluations of new treatments often compare to the existing "standard of care" to determine if a treatment is more effective, has a better safety profile, or costs less. The objective of our study was to evaluate intervention and "standard of care" control arms reported in published pediatric clinical trials. METHODS Pediatric clinical trials, published in 2014, reporting the use of a "standard of care" control arm were included. Duplicate assessment of reporting completeness was done using the 12-item TIDieR (Template for Intervention Description and Replication) checklist for both the "standard of care" control arms and intervention arms within the same published study. RESULTS Following screening, 214 pediatric trials in diverse therapeutic areas were included. Several different terms were used to describe "standard of care." There was a significant difference between the mean reported TIDieR checklist items of "standard of care" control arms (5.81 (SD 2.13) and intervention arms (8.45 (SD 1.39, p < 0.0001). CONCLUSIONS Reporting of intervention and "standard of care" control arms in pediatric clinical trials should be improved as current "standard of care" reporting deficiencies limit reproducibility of research and may ultimately contribute to research waste.
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Affiliation(s)
- Ashley M Yu
- Doctor of Medicine Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, Clinical Trials Platform, George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
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Aycock DM, Hayat MJ, Helvig A, Dunbar SB, Clark PC. Essential considerations in developing attention control groups in behavioral research. Res Nurs Health 2018; 41:320-328. [PMID: 29906317 DOI: 10.1002/nur.21870] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/08/2018] [Indexed: 12/17/2022]
Abstract
Attention control groups strengthen randomized controlled trials of behavioral interventions, but researchers need to give careful consideration to the attention control activities. A comparative effectiveness research framework provides an ideal opportunity for an attention control group as a supplement to standard care, so participants potentially receive benefit regardless of group assignment. The anticipated benefit of the control condition must be independent of the study outcome. Resources needed for attention control activities need to be carefully considered and ethical considerations carefully weighed. In this paper we address nine considerations for the design and implementation of attention control groups: (1) ensure attention control activities are not associated with the outcome; (2) avoid contamination of the intervention or control group; (3) design comparable control and intervention activities; (4) ensure researcher training to adequately administer both treatment arms; (5) design control activities to be interesting and acceptable to participants; (6) evaluate attention control activities; (7) consider additional resources needed to implement attention control activities; (8) quantifying the effects of attention control and intervention groups; and (9) ethical considerations with attention control groups. Examples from the literature and ongoing research are presented. Careful planning for the attention control group is as important as for the intervention group. Researchers can use the considerations presented here to assist in planning for the best attention control group for their study.
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Affiliation(s)
- Dawn M Aycock
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia
| | - Matthew J Hayat
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia.,School of Public Health, Georgia State University, Atlanta, Georgia
| | - Ashley Helvig
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia
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23
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Molloy GJ, Noone C, Caldwell D, Welton NJ, Newell J. Network meta-analysis in health psychology and behavioural medicine: a primer. Health Psychol Rev 2018; 12:254-270. [DOI: 10.1080/17437199.2018.1457449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- G. J. Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
| | - C. Noone
- School of Psychology, National University of Ireland, Galway, Ireland
| | - D. Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - N. J. Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J. Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Ireland
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24
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Leenen LAM, Wijnen BFM, Kessels AGH, Chan H, de Kinderen RJA, Evers SMAA, van Heugten CM, Majoie MHJM. Effectiveness of a multicomponent self-management intervention for adults with epilepsy (ZMILE study): A randomized controlled trial. Epilepsy Behav 2018; 80:259-265. [PMID: 29449140 DOI: 10.1016/j.yebeh.2018.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the ZMILE study was to compare the effectiveness of a multicomponent self-management intervention (MCI) with care as usual (CAU) in adult patients with epilepsy (PWE) over a six-month period. METHODS Participants (PWE & relative) were randomized into intervention or CAU groups. Self-report questionnaires were used to measure disease-specific self-efficacy as the primary outcome measure and general self-efficacy, adherence, seizure severity, emotional functioning, quality of life, proactive coping, and side-effects of antiepileptic drugs (AED) as secondary outcome measures. Instruments used at baseline and during a six-month follow-up period were the following: disease-specific self-efficacy (Epilepsy Self-Efficacy Scale [ESES], General Self-Efficacy Scale [GSES]); adherence (Medication Adherence Scale [MARS] and Medication Event Monitoring System [MEMS]); seizure severity (National Hospital Seizure Severity Scale [NHS3]); emotional well-being (Hospital Anxiety and Depression Scale [HADS]); quality of life (Quality of Life in Epilepsy [QOLIE-31P]); proactive coping (Utrecht Proactive Coping Competence [UPCC]); and side-effects of antiepileptic drugs [SIDAED]. Multilevel analyses were performed, and baseline differences were corrected by inclusion of covariates in the analyses. RESULTS In total, 102 PWE were included in the study, 52 of whom were in the intervention group. On the SIDAED and on three of the quality of life subscales QOLIE-31P, a significant difference was found (p<0.05) in the intervention group. Self-efficacy, however, showed no significant differences between the MCI and the CAU groups. None of the other outcome measures showed any significant difference between the two groups. SIGNIFICANCE Although we found no statistically significant difference in the primary outcome measure, disease-specific self-efficacy, this MCI could prove promising, since we found improvement in some domains of quality of life in epilepsy scale and a decrease in AED side-effects in the MCI group compared with the CAU group.
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Affiliation(s)
- Loes A M Leenen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Ben F M Wijnen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Alfons G H Kessels
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - HoiYau Chan
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - Reina J A de Kinderen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Silvia M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology and Neurosciences: Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
| | - Marian H J M Majoie
- Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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Clery P, Stahl D, Ismail K, Treasure J, Kan C. Systematic review and meta-analysis of the efficacy of interventions for people with Type 1 diabetes mellitus and disordered eating. Diabet Med 2017; 34:1667-1675. [PMID: 28887815 DOI: 10.1111/dme.13509] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Abstract
AIM To examine the types of interventions currently available for people with Type 1 diabetes mellitus and their effectiveness. BACKGROUND The prevalence of disordered eating in people with Type 1 diabetes mellitus is twice that in their counterparts without diabetes, and is associated with worse biomedical outcomes and greater mortality. METHODS Medline, Embase, PsycINFO, the Cochrane Library, PubMed and OpenGrey databases were searched up to August 2016 to identify studies on interventions in people with Type 1 diabetes-associated disordered eating. For the systematic review, intervention components were identified and their effectiveness was examined. For the meta-analysis, the pooled effect sizes of glycaemic control (HbA1c ) between pre- and post-treatment in treatment and comparison groups were calculated using a random effects model. RESULTS Of 91 abstracts reviewed, six studies met the inclusion criteria, of which three had appropriate data for the meta-analysis (n = 118). The pooled effect size was -0.21 95% CI (-0.58 to 0.16; where negative values represent an improvement in HbA1c levels), indicating no statistically significant improvement in the treatment group compared with comparison group. Inpatient therapy appeared to be the most effective treatment, and this had multiple components including cognitive behavioural therapy, psychoeducation and family therapy. CONCLUSION Limited or no improvement in glycaemic control and disordered eating symptoms was observed in people with Type 1 diabetes-associated disordered eating who were receiving currently available interventions. The present review suggests that developing an intensive intervention with a joint focus on both disordered eating and diabetes management is needed for this complex patient group.
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Affiliation(s)
- P Clery
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Stahl
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Ismail
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C Kan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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26
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van Beugen S, Ferwerda M, Spillekom-van Koulil S, Smit JV, Zeeuwen-Franssen MEJ, Kroft EBM, de Jong EMGJ, Otero ME, Donders ART, van de Kerkhof PCM, van Middendorp H, Evers AWM. Tailored Therapist-Guided Internet-Based Cognitive Behavioral Treatment for Psoriasis: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:297-307. [PMID: 27508937 DOI: 10.1159/000447267] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/28/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patients with somatic conditions, such as psoriasis, frequently suffer from high burden of their disease in daily life and might benefit from internet-based cognitive behavioral therapy (ICBT) tailored to their adjustment problems. The aim of this multicenter randomized controlled trial was to examine the effects of therapist-guided, individually tailored ICBT in a clinical sample of patients with psoriasis. METHODS A total of 131 patients with psoriasis, who were screened for a psychological risk profile, were randomized to either care as usual (CAU, n = 66) or ICBT in addition to CAU (n = 65). Participants filled out standardized self-report questionnaires assessing physical and psychological functioning and impact on daily activities at baseline, posttreatment assessment, and 6-month follow-up. RESULTS In covariate-controlled linear mixed-model analyses, significantly larger improvements in ICBT compared to CAU were found in the primary outcomes physical functioning (p = 0.03, d = 0.36) and impact on daily activities (p = 0.04, d = 0.35), but not in psychological functioning (p = 0.32), up to 6 months after treatment compared to baseline. In explorative analyses, the working alliance measured at the beginning of ICBT treatment predicted improved physical (p = 0.02) and psychological (p < 0.001) outcomes. CONCLUSIONS Results underline the promise of therapist-guided, individually tailored ICBT to improve physical functioning and reduce the impact of psoriasis on daily activities in patients with a psychological risk profile. Establishing a good therapeutic relationship early on may be an important factor that influences treatment outcomes in personalized ICBT interventions. Further research is needed to evaluate ICBT effectiveness in additional samples and to explore its underlying mechanisms.
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Affiliation(s)
- Sylvia van Beugen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Charalampopoulos D, Hesketh KR, Amin R, Paes VM, Viner RM, Stephenson T. Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis. PLoS One 2017; 12:e0179685. [PMID: 28665946 PMCID: PMC5493302 DOI: 10.1371/journal.pone.0179685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
Aims To synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS. Methods We searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated. Results Ten eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children’s self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified. Conclusions There is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease. Systematic review registration PROSPERO CRD42015010701
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Affiliation(s)
- Dimitrios Charalampopoulos
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- * E-mail:
| | - Kathryn R. Hesketh
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rakesh Amin
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Veena Mazarello Paes
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Russell M. Viner
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Swaby L, Hind D, Gossage-Worrall R, Shiers D, Mitchell J, Holt RIG. Adherence to NICE guidance on lifestyle advice for people with schizophrenia: a survey. BJPsych Bull 2017; 41:137-144. [PMID: 28584649 PMCID: PMC5451646 DOI: 10.1192/pb.bp.116.054304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims and method The STEPWISE trial (STructured lifestyle Education for People WIth SchizophrEnia, schizoaffective disorder and first episode psychosis) is currently evaluating a lifestyle education programme in addition to usual care. However, it is difficult to define what constitutes 'usual care'. We aimed to define 'usual care' for lifestyle management in people with schizophrenia, schizoaffective disorder and first-episode psychosis in STEPWISE study sites. Ten National Health Service (NHS) mental health trusts participated in a bespoke survey based on the National Institute for Health and Care Excellence (NICE) guidance. Results Eight trusts reported offering lifestyle education programmes and nine offered smoking cessation support. Reported recording of biomedical measures varied. Clinical implications Although recommended by NICE, lifestyle education programmes are not consistently offered across UK NHS mental health trusts. This highlights missed opportunities to improve the physical health of people with psychotic illness. Our survey benchmarks 'usual care' for the STEPWISE study, against which changes can be measured. Furthermore, future studies will be able to identify whether any progress in clinical practice has been made towards achieving the NICE recommendations.
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Affiliation(s)
| | | | | | - David Shiers
- Greater Manchester West Mental Health NHS Foundation Trust
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Pinnock H, Parke HL, Panagioti M, Daines L, Pearce G, Epiphaniou E, Bower P, Sheikh A, Griffiths CJ, Taylor SJC. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med 2017; 15:64. [PMID: 28302126 PMCID: PMC5356253 DOI: 10.1186/s12916-017-0823-7] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Supported self-management has been recommended by asthma guidelines for three decades; improving current suboptimal implementation will require commitment from professionals, patients and healthcare organisations. The Practical Systematic Review of Self-Management Support (PRISMS) meta-review and Reducing Care Utilisation through Self-management Interventions (RECURSIVE) health economic review were commissioned to provide a systematic overview of supported self-management to inform implementation. We sought to investigate if supported asthma self-management reduces use of healthcare resources and improves asthma control; for which target groups it works; and which components and contextual factors contribute to effectiveness. Finally, we investigated the costs to healthcare services of providing supported self-management. METHODS We undertook a meta-review (systematic overview) of systematic reviews updated with randomised controlled trials (RCTs) published since the review search dates, and health economic meta-analysis of RCTs. Twelve electronic databases were searched in 2012 (updated in 2015; pre-publication update January 2017) for systematic reviews reporting RCTs (and update RCTs) evaluating supported asthma self-management. We assessed the quality of included studies and undertook a meta-analysis and narrative synthesis. RESULTS A total of 27 systematic reviews (n = 244 RCTs) and 13 update RCTs revealed that supported self-management can reduce hospitalisations, accident and emergency attendances and unscheduled consultations, and improve markers of control and quality of life for people with asthma across a range of cultural, demographic and healthcare settings. Core components are patient education, provision of an action plan and regular professional review. Self-management is most effective when delivered in the context of proactive long-term condition management. The total cost (n = 24 RCTs) of providing self-management support is offset by a reduction in hospitalisations and accident and emergency visits (standard mean difference 0.13, 95% confidence interval -0.09 to 0.34). CONCLUSIONS Evidence from a total of 270 RCTs confirms that supported self-management for asthma can reduce unscheduled care and improve asthma control, can be delivered effectively for diverse demographic and cultural groups, is applicable in a broad range of clinical settings, and does not significantly increase total healthcare costs. Informed by this comprehensive synthesis of the literature, clinicians, patient-interest groups, policy-makers and providers of healthcare services should prioritise provision of supported self-management for people with asthma as a core component of routine care. SYSTEMATIC REVIEW REGISTRATION RECURSIVE: PROSPERO CRD42012002694 ; PRISMS: PROSPERO does not register meta-reviews.
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Affiliation(s)
- Hilary Pinnock
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Hannah L. Parke
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Luke Daines
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Gemma Pearce
- Centre for Technology Enabled Health Research (CTEHR), Coventry University, Coventry, UK
| | - Eleni Epiphaniou
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Chris J. Griffiths
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Ramchandani N, Johnson K, Cullen K, Hamm T, Bisordi J, Sullivan-Bolyai S. CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation. DIABETES EDUCATOR 2016; 43:97-104. [DOI: 10.1177/0145721716676893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.
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Affiliation(s)
- Neesha Ramchandani
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Kim Johnson
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Karen Cullen
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Terri Hamm
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Jean Bisordi
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Susan Sullivan-Bolyai
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
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de Bruin M, Viechtbauer W, Eisma MC, Hartmann-Boyce J, West R, Bull E, Michie S, Johnston M. Identifying effective behavioural components of Intervention and Comparison group support provided in SMOKing cEssation (IC-SMOKE) interventions: a systematic review protocol. Syst Rev 2016; 5:77. [PMID: 27146038 PMCID: PMC4857384 DOI: 10.1186/s13643-016-0253-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systematic reviews of behaviour change interventions for smoking cessation vary in scope, quality, and applicability. The current review aims to generate more accurate and useful findings by (1) a detailed analysis of intervention elements that change behaviour (i.e. behaviour change techniques (BCTs)) and potential moderators of behaviour change (i.e. other intervention and sample characteristics) and (2) assessing and controlling for variability in support provided to comparison groups in smoking cessation trials. METHODS A systematic review will be conducted of randomized controlled trials of behaviour change interventions for smoking cessation in adults (with or without pharmacological support), with a minimum follow-up of 6 months, published after 1995. Eligible articles will be identified through the Cochrane Tobacco Addiction Group Specialized Register. Study authors will be asked for detailed descriptions of smoking cessation support provided to intervention and comparison groups. All data will be independently coded by two researchers. The BCT taxonomy v1 (tailored to smoking cessation interventions) and template for intervention description and replication criteria will be used to code intervention characteristics. Data collection will further include sample and trial characteristics and outcome data (smoking cessation rates). Multilevel mixed-effects meta-regression models will be used to examine which BCTs and/or BCT clusters delivered to intervention and comparison groups explain smoking cessation rates in treatment arms (and effect sizes) and what key moderators of behaviour change are. Predicted effect sizes of each intervention will be computed assuming all interventions are compared against comparison groups receiving the same levels of behavioural support (i.e. low, medium, and high levels). Multi-disciplinary advisory board members (policymakers, health care providers, and (ex-)smokers) will provide strategic input throughout the project to ensure the review's applicability to policy and practice. DISCUSSION By capturing BCTs in intervention and comparison groups, this systematic review will provide more accurate estimates of the effectiveness of smoking cessation interventions, the most promising BCTs and/or BCT clusters associated with smoking cessation rates in intervention and comparison arms, and important moderators of behaviour change. The results could set new standards for conducting meta-analyses of behaviour change interventions and improve research, service delivery, and training in the area of smoking cessation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015025251.
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Affiliation(s)
- Marijn de Bruin
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Maarten C Eisma
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Robert West
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, England
| | - Eleanor Bull
- NHS Grampian Public Health Directorate, Aberdeen, Scotland
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, England
| | - Marie Johnston
- Aberdeen Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
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Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Chordiya P, Dhakal S, Vandermeer B, Hartling L, Nuspl M, Featherstone R, Dryden DM. Behavioral Programs for Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163:836-47. [PMID: 26414020 DOI: 10.7326/m15-1399] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Whether behavioral approaches for self-management programs benefit individuals with type 1 diabetes mellitus is unclear. PURPOSE To determine the effects of behavioral programs for patients with type 1 diabetes on behavioral, clinical, and health outcomes and to investigate factors that might moderate effect. DATA SOURCES 6 electronic databases (1993 to June 2015), trial registries and conference proceedings (2011 to 2014), and reference lists. STUDY SELECTION 36 prospective, controlled studies involving participants of any age group that compared behavioral programs with usual care, active controls, or other programs. DATA EXTRACTION One reviewer extracted and another verified data. Two reviewers assessed quality and strength of evidence (SOE). DATA SYNTHESIS Moderate SOE showed reduction in glycated hemoglobin (HbA1c) at 6 months after the intervention compared with usual care (mean difference, -0.29 [95% CI, -0.45 to -0.13] percentage points) and compared with active controls (-0.44 [CI, -0.69 to -0.19] percentage points). At the end of the intervention and 12-month follow-up or longer, there were no statistically significant differences in HbA1c (low SOE) for comparisons with usual care or active control. Compared with usual care, generic quality of life at program completion did not differ (moderate SOE). Other outcomes had low or insufficient SOE. Adults appeared to benefit more for glycemic control at program completion (-0.28 [CI, -0.57 to 0.01] percentage points) than did youth (-0.12 [CI, -0.43 to 0.19] percentage points). Program intensity appeared not to influence effectiveness; some individual delivery appears beneficial. LIMITATIONS All studies had medium or high risk of bias. There was scarce evidence for many outcomes. CONCLUSION Behavioral programs for type 1 diabetes offer some benefit for glycemic control, at least at short-term follow-up, but improvement for other outcomes has not been shown. (PROSPERO registration number: CRD42014010515). PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. (PROSPERD registration number: CRD42014010515).
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Affiliation(s)
- Jennifer Pillay
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Marni J. Armstrong
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Lois E. Donovan
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Ronald J. Sigal
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Pritam Chordiya
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Sanjaya Dhakal
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Ben Vandermeer
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Lisa Hartling
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Megan Nuspl
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Robin Featherstone
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
| | - Donna M. Dryden
- From the University of Alberta, Edmonton, and Alberta Health Services and University of Calgary, Calgary, Alberta, Canada
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Prestwich A, Webb TL, Conner M. Using theory to develop and test interventions to promote changes in health behaviour: evidence, issues, and recommendations. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2015.02.011] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cardi V, Ambwani S, Crosby R, Macdonald P, Todd G, Park J, Moss S, Schmidt U, Treasure J. Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial. Trials 2015; 16:165. [PMID: 25885697 PMCID: PMC4435653 DOI: 10.1186/s13063-015-0701-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background We describe the theoretical rationale and protocol for Self-Help And Recovery guide for Eating Disorders (SHARED), a trial investigating whether a guided self-care intervention (Recovery MANTRA) is a useful addition to treatment as usual for individuals with anorexia nervosa. Recovery MANTRA, a 6-week self-care intervention supplemented by peer mentorship, is a module extension of the Maudsley Model of Treatment for Adults with Anorexia Nervosa and targets the maintenance factors identified by the cognitive-interpersonal model of the illness. Methods Patients accessing outpatient services for anorexia nervosa are randomized to either treatment as usual or treatment as usual plus Recovery MANTRA. Outcome variables include change in body weight at the end of the intervention (primary) and changes in body weight and eating disorder symptoms at immediate and extended follow-up (6-months; secondary). Change is also assessed for the domains identified by the theoretical model, including motivation, hope, confidence to change, positive mood, cognitive flexibility, therapeutic alliance and social adjustment. Feedback from peer mentors is gathered to understand the impact on their own well-being of providing guidance. Discussion Results from this exploratory investigation will determine whether a larger clinical trial is justifiable and feasible for this affordable intervention, which has potential for high reach and scalability. Trial registration ClinicalTrials.gov NCT02336841.
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Affiliation(s)
- Valentina Cardi
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Suman Ambwani
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA.
| | - Ross Crosby
- Neuropsychiatric Research Institute, 700 First Ave. South, Fargo, ND, 58103, USA.
| | - Pamela Macdonald
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Gill Todd
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Jinhong Park
- Department of Psychology, Carleton College, 1 N. College St., Northfield, MN, 55057, USA.
| | - Sara Moss
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Janet Treasure
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
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McCambridge J. From question-behaviour effects in trials to the social psychology of research participation. Psychol Health 2015; 30:72-84. [PMID: 25146179 DOI: 10.1080/08870446.2014.953527] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The 'question-behaviour effect' (QBE) has attracted much recent attention within health psychology, where it has also been referred to as the 'mere measurement' effect. There are other conceptualisations of similar phenomena in related disciplines. This paper explores the implications of the QBE for the safety of inferences about intervention effectiveness within the context of randomised controlled trials evaluating health behaviour change interventions. It draws attention to poorly understood mechanisms by which bias is introduced with conventional thinking about trial design and analysis. The threat to valid inference on intervention effectiveness posed by the QBE applies even when its effects are small and regardless of the specific content of the QBE. The nature of the resulting bias does not fit well within existing bias classification schemes, such as that proposed by the Cochrane Collaboration. The QBE is one possible consequence of research participation and it is suggested that the social psychology of research participation is very much underdeveloped. Possible future directions for health psychology research in this area are considered.
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Affiliation(s)
- Jim McCambridge
- a Faculty of Public Health & Policy , London School of Hygiene & Tropical Medicine , London , UK
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36
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de Bruin M. Risk of bias in randomised controlled trials of health behaviour change interventions: evidence, practices and challenges. Psychol Health 2015; 30:1-7. [PMID: 25223823 DOI: 10.1080/08870446.2014.960653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bishop FL, Fenge-Davies AL, Kirby S, Geraghty AWA. Context effects and behaviour change techniques in randomised trials: a systematic review using the example of trials to increase adherence to physical activity in musculoskeletal pain. Psychol Health 2015; 30:104-21. [PMID: 25109300 DOI: 10.1080/08870446.2014.953529] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe and explore the effects of contextual and behaviour change technique (BCT) content of control and target interventions in clinical trials. DESIGN Review and meta-analysis of 42 trials from a Cochrane review of physical activity in chronic musculoskeletal pain. MAIN OUTCOME MEASURES Two researchers coded descriptions of target and control interventions for (a) 93 BCTs and (b) whether target and control interventions shared each of five contextual features (practitioners' characteristics, patient-practitioner relationship, intervention credibility, superficial treatment characteristics e.g. delivery modality, and environment). Quality of study reporting was assessed. Effect sizes for adherence to physical activity and class attendance were computed (Cohen's d) and analysed separately. RESULTS For physical activity outcomes, after controlling for reporting quality, larger effect sizes were associated with target and control interventions using different modalities (β = -.34, p = .030), target and control interventions involving equivalent patient-practitioner relationship (β = .40, p = .002), and target interventions having more unique BCTs (i.e. more BCTs not also in the control) (β = .008, p = .030). There were no significant effect moderators for class attendance outcomes. CONCLUSION Contents of control conditions can influence effect sizes and should be considered carefully in trial design and systematic reviews.
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Affiliation(s)
- Felicity L Bishop
- a Faculty of Social and Human Sciences, Centre for Applications of Health Psychology , University of Southampton , Southampton , UK
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Crutzen R, Viechtbauer W, Spigt M, Kotz D. Differential attrition in health behaviour change trials: a systematic review and meta-analysis. Psychol Health 2015; 30:122-34. [PMID: 25109224 DOI: 10.1080/08870446.2014.953526] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Attrition is a common problem in health behaviour change (HBC) trials. When the degree of attrition differs between treatment conditions, then this is called differential attrition and is regarded as a major threat to internal validity. The primary research question of this study was: how often and to what degree does differential attrition occur in HBC trials? DESIGN A systematic review and meta-analysis of a random selection of HBC trials (k = 60). We meta-analysed the relative attrition rates using a random-effects model and examined the relationship between the relative attrition rates and the potential moderators: the amount of human contact in delivery and the intensity of the intervention/control condition, the type of control condition, and the follow-up intensity and duration. MAIN OUTCOME MEASURES Relative attrition rates. RESULTS The average attrition rate was 18% (SD = .15; M = .15) in the intervention and 17% (SD = .13; M = .13) in the control conditions. The estimated average relative attrition rate was 1.10 (95% CI: 1.01-1.20, p = .02), suggesting an overall higher attrition rate of 10% in the intervention conditions. This relative attrition rate was not related to any of the potential moderators. CONCLUSION There is indication of a slightly higher amount of attrition on average in the intervention conditions of HBC trials.
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Affiliation(s)
- Rik Crutzen
- a CAPHRI School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
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Johnson BT, Low RE, MacDonald HV. Panning for the gold in health research: incorporating studies' methodological quality in meta-analysis. Psychol Health 2014; 30:135-52. [PMID: 25137094 DOI: 10.1080/08870446.2014.953533] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systematic reviews now routinely assess methodological quality to gauge the validity of the included studies and of the synthesis as a whole. Although trends from higher quality studies should be clearer, it is uncertain how often meta-analyses incorporate methodological quality in models of study results either as predictors, or, more interestingly, in interactions with theoretical moderators. OBJECTIVE AND METHODS We survey 200 meta-analyses in three health promotion domains to examine when and how meta-analyses incorporate methodological quality. RESULTS Although methodological quality assessments commonly appear in contemporary meta-analyses (usually as scales), they are rarely incorporated in analyses, and still more rarely analysed in interaction with theoretical determinants of the success of health promotions. The few meta-analyses (2.5%) that did include such an interaction analysis showed that moderator results remained significant in higher quality studies or were present only among higher quality studies. We describe how to model quality interactively with theoretically derived moderators and discuss strengths and weaknesses of this approach and in relation to current meta-analytic practice. CONCLUSIONS In large literatures exhibiting heterogeneous effects, meta-analyses can incorporate methodological quality and generate conclusions that enable greater confidence not only about the substantive phenomenon but also about the role that methodological quality itself plays.
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Affiliation(s)
- Blair T Johnson
- a Department of Psychology, Center for Health, Intervention, & Prevention , University of Connecticut , Storrs , CT , USA
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Evers SMAA, Hiligsmann M, Adarkwah CC. Risk of bias in trial-based economic evaluations: identification of sources and bias-reducing strategies. Psychol Health 2014; 30:52-71. [PMID: 25141273 DOI: 10.1080/08870446.2014.953532] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The objectives of this article are first to give an overview of the risks of bias in trial-based economic evaluations and, second, to identify how key sources for bias can be revealed and overcome (i.e. what bias-reducing strategies might be employed) in future trial-based economic evaluations in the field of health psychology. DESIGN Narrative review discussing sources of bias in trial-based economic evaluations and bias-reducing strategies. RESULTS We identified 11 biases and assigned them to a particular trial phase. A distinction is made between pre-trial biases, biases during the trial and biases that are relevant after the actual trial. All potential forms of bias are discussed in detail and strategies are shown to detect and overcome these biases. CONCLUSION In order to avoid bias in trial-based economic evaluations, one has to be aware of all the possible forms of bias. All stakeholders have to examine trial-based economic evaluations in a rigorous and stringent manner. This article can be helpful in this examination as it gives an overview of the possible biases which researchers should take into account.
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Affiliation(s)
- Silvia M A A Evers
- a Department of Health Services Research , CAPHRI School of Public Health and Primary Care, Maastricht University , Maastricht , The Netherlands
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de Bruin M, McCambridge J, Prins JM. Reducing the risk of bias in health behaviour change trials: improving trial design, reporting or bias assessment criteria? A review and case study. Psychol Health 2014; 30:8-34. [PMID: 25112431 DOI: 10.1080/08870446.2014.953531] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It has been suggested that randomised controlled trials (RCTs) of health behaviour change (HBC) interventions are less rigorously designed than - for example- drug trials. This study presents an approach to clarifying whether this is due to poor trial design, incomplete trial reporting and/or the inappropriateness of commonly applied risk of bias assessment criteria. DESIGN First, a framework of key sources of bias and common strategies for reducing bias risk is developed based on a literature review. Second, we describe the design of a multi-site RCT evaluating the cost-effectiveness of an HIV-treatment adherence intervention (case study). The choices made by the multidisciplinary team trying to minimise the risk of bias are compared against the risk of bias framework. MAIN OUTCOME MEASURES Implementation of common strategies for reducing the risk of bias in the case study; alternative or additional strategies applied; a justification for each deviation from the risk of bias framework. RESULTS Most of the common strategies for reducing the risk of bias could be implemented. Alternative strategies were developed for minimising the risk of performance bias and contamination. Several additional, domain-specific risk of bias strategies were implemented. CONCLUSIONS The literature provides useful guidance for reducing the risk of bias in HBC trials. Yet, the case study suggests that HBC trial designers may face specific challenges that require alternative/additional measures for reducing the risk of bias. Using the risk of bias justification table (RATIONALE) could lead to better-designed HBC trials, more comprehensive trial reports and the data necessary for evaluating the appropriateness of commonly applied risk of bias assessment criteria to HBC trials.
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Affiliation(s)
- Marijn de Bruin
- a Aberdeen Health Psychology Group , Institute of Applied Health Sciences, University of Aberdeen , Aberdeen , UK
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