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Medina-Aedo M, Segura-Carrillo C, Torralba-Martinez E, Buitrago-García D, Solà I, Pardo-Hernandez H, Bonfill X. Randomized controlled trials in nursing conducted by Latin American research teams: A scoping review. J Nurs Scholarsh 2024; 56:331-340. [PMID: 37965861 DOI: 10.1111/jnu.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/16/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) are the cornerstone of systematic reviews and other evidence synthesis. RCT identification remains challenging because of limitations in their indexation in major databases and potential language bias. Scientific production in Latin American nursing is steadily increasing, but little is known about its design or main features. We aimed to identify the extent of evidence from RCTs in nursing conducted by Latin American research teams and evaluate their main characteristics, including potential risk of bias. DESIGN Scoping review with risk of bias assessment. METHODS We conducted a scoping review including a comprehensive electronic search in five relevant databases. We completed a descriptive data analysis and a risk of bias assessment of eligible studies using Cochrane's guidance. RESULTS We identified 1784 references of which 47 were RCTs published in 40 journals. Twenty (42.6%) RCTs were published in journals in English. Chronic diseases were the most common health conditions studied (29.7%). Fifteen (31.9%) RCTs had a high risk of bias. Thirty (75%) journals were included in the Journal Citation Report (JCR) catalog and 5 (16.7%) were journals classified under nursing category. Twenty-one (52.5%) journals explicitly required CONSORT checklist recommendations for RCTs reporting. CONCLUSION Publication of RCTs in nursing by Latin American authors has increased. Most journals where RCTs are published are in English and not specific to nursing. Searches in journals of other disciplines may be necessary to facilitate identification of RCTs in nursing. CONSORT statements need to be actively promoted to facilitate rigorous methodology and reporting of RCTs. CLINICAL RELEVANCE STATEMENT This study highlights the need for an increased research focus on RCTs in nursing in Latin America, and the importance of enhancing the reporting quality of these studies to support evidence-based nursing practice.
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Affiliation(s)
- Melixa Medina-Aedo
- Department of Paediatrics Obstetrics & Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristian Segura-Carrillo
- Departamento de Trabajo Social, Universidad de Concepción, Concepción, Chile
- Universitat Autònoma Barcelona, Barcelona, Spain
| | - Elena Torralba-Martinez
- Department of Paediatrics Obstetrics & Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana Buitrago-García
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Hospital Universitario Mayor Mederi, Bogotá, Colombia
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB SantPau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB SantPau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB SantPau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona, Barcelona, Spain
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Mitterfellner R, D'Cunha NM, Isbel S. Occupation-Based Interventions to Improve Occupational Performance Among Older Adults Living in Long-Term Care: A Systematic Review. Am J Occup Ther 2024; 78:7801205140. [PMID: 38231082 DOI: 10.5014/ajot.2024.050441] [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: 01/18/2024] Open
Abstract
IMPORTANCE Evidence for the positive effects of occupation-based interventions on occupational performance is increasing; however, little is known about the impacts of occupation-based interventions on older adults living in long-term care. OBJECTIVE To consolidate the evidence on the effectiveness of occupation-based interventions for improving occupational performance among older adults living in long-term care. DATA SOURCES MEDLINE, CINAHL, PsycINFO, SCOPUS, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from journal-database inception to February 2023. STUDY SELECTION AND DATA COLLECTION This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles were peer-reviewed studies published in English that evaluated occupation-based interventions for older adults living in long-term care and used validated tools to measure occupational performance. FINDINGS Seventeen articles, with 2,974 participants, were identified. The reviewed studies included 6 Level 1b randomized controlled trials, 5 Level 2b studies of various study designs, and 5 Level 3b studies with quasi-experimental designs. Across studies, heterogeneous measures were used to assess occupational performance. All studies implemented client-centered, occupation-based interventions designed and/or delivered by occupational therapists. Interventions were tailored to residents' goals, interests, or abilities to improve occupational performance and participation, and inconsistent effects were reported. CONCLUSIONS AND RELEVANCE Moderate evidence supports the use of occupation-based interventions tailored to individual residents and incorporation of physical activities for improving the occupational performance of older adults living in long-term care. Currently, evidence for care partner involvement and multilevel occupation-based interventions is limited. Plain-Language Summary: This study adds to the evidence base indicating that occupation-based interventions have the potential to promote the occupational performance of older adults living in long-term care. High-quality randomized controlled trials with longer term follow-up and assessment of clinically meaningful outcomes are critical for developing the evidence base in this practice setting.
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Affiliation(s)
- Rachael Mitterfellner
- Rachael Mitterfellner, MOT, BMedSc, is Occupational Therapist, Canberra Health Services, and Professional Associate, Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia. At the time of this research, Mitterfellner was Postgraduate Research Student, School of Exercise and Rehabilitation Sciences, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Nathan M D'Cunha
- Nathan M. D'Cunha, PhD(Health), BHumNutr(Hons), is Assistant Professor, Human Nutrition, School of Exercise and Rehabilitation Sciences, Faculty of Health, and Theme Lead (Dementia and Cognition), Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Stephen Isbel
- Stephen Isbel, HScD, MOT, MHA, BAppSc(OT), GCTE, is Professor, Occupational Therapy, School of Exercise and Rehabilitation Sciences, Faculty of Health, and Theme Lead (Innovative Care Models), Centre for Ageing Research and Translation, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia;
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Poupin P, Caille A, Gana W, Fougère B, Giraudeau B. Cluster randomized trials in nursing homes should better be planned as open-cohort than as closed-cohort. J Clin Epidemiol 2023; 161:1-7. [PMID: 37364621 DOI: 10.1016/j.jclinepi.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Two designs are frequently used in cluster randomized trials in nursing homes: closed cohort and open cohort. The former design includes residents at the beginning of the trial and then follows them. In the latter design, participants are enrolled at the beginning of the trial or although it is ongoing; at dates of assessment, all residents present in the nursing home are assessed. The open-cohort design is much less used than the closed-cohort design, but it offers several advantages such as less exposure to individual attrition. Objective was to assess whether an open-cohort design could have been feasible in trials with a closed-cohort design. STUDY DESIGN AND SETTING Twenty-two closed-cohort trials in nursing homes. RESULTS An open-cohort design was considered a relevant alternative for 20 trials. For 16 trials, a resident newly admitted could not opt out of the intervention, and for all trials, the resident could benefit from an intervention effect if it existed. For two trials, newly admitted residents could not benefit from the intervention effect, if it existed. CONCLUSION The open-cohort design is well-adapted for most of the interventions assessed in nursing homes by means of a cluster randomized trial and should be considered more often.
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Affiliation(s)
- Pierre Poupin
- INSERM, SPHERE, U1246, Tours University, Nantes University, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France.
| | - Agnès Caille
- INSERM, SPHERE, U1246, Tours University, Nantes University, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France
| | - Wassim Gana
- Division of Geriatric Medicine, Tours University Medical Center, Tours, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Medical Center, Tours, France; Education, Ethics, Health (EA 7505), Tours University, Tours, France
| | - Bruno Giraudeau
- INSERM, SPHERE, U1246, Tours University, Nantes University, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France
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Medina‐Aedo M, Torralba‐Martinez E, Segura‐Carrillo C, Buitrago‐García D, Solà I, Pardo‐Hernández H, Bonfill X. Finding and evaluating randomised controlled trials in nursing conducted by Spanish research teams: A scoping review. Health Info Libr J 2022; 39:312-322. [DOI: 10.1111/hir.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 06/30/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Melixa Medina‐Aedo
- Department of Paediatrics Obstetrics & Gynaecology and Preventive Medicine and Public Health at the Universitat Autònoma de Barcelona Barcelona Spain
| | - Elena Torralba‐Martinez
- Department of Paediatrics Obstetrics & Gynaecology and Preventive Medicine and Public Health at the Universitat Autònoma de Barcelona Barcelona Spain
| | | | - Diana Buitrago‐García
- Institute of Social and Preventive Medicine University of Bern Bern Switzerland
- Programa de Epidemiología Clínica Fundación Universitaria de Ciencias de la Salud‐FUCS Bogota Colombia
| | - Ivan Solà
- Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB SantPau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona Barcelona Spain
| | - Héctor Pardo‐Hernández
- Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB SantPau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona Barcelona Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre Biomedical Research Institute Sant Pau (IIB SantPau) Barcelona Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma Barcelona Barcelona Spain
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van der Steen JT, Tong WH, Groothuijse J, Ommering BWC. Perceptions and Motivation Regarding Performing Research in Physicians Specializing in Care for Older Adults Involved in a Mandatory Evidence-Based Medicine Training Study: A Mixed-Methods Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:217-224. [PMID: 35300225 PMCID: PMC8922237 DOI: 10.2147/amep.s348735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Evidence underpinning treatment of older persons with complex conditions is often sparse, and involving more early career physicians committed to optimizing care for older adults may help increase a relevant evidence base. We examined perception of and motivation to conduct research in physicians (residents) specializing in care of older adults. SUBJECTS AND METHODS Residents of an academic medical centre in the Netherlands enrolled in a 3-year training programme. The programme includes a mandatory evidence-based medicine (EBM) training study on pain and discomfort in cognitively impaired nursing home patients, in which residents perform their research over the 3-year duration of the programme. We employed a mixed-methods design with survey and qualitative interviews (December 2019-April 2020). The survey included validated scales with agreement response options rated 1-7. Qualitative interviews were underpinned by interpretative phenomenological analysis. RESULTS Of 38 invited residents, 23 (15 females) participated. The mean score on perceptions of research was 4.1 (SD 0.8); on intrinsic motivation 4.8 (SD 1.0); on extrinsic motivation 4.3, with a higher SD of 1.4. Eight interviews also showed diversity in the extent to which residents felt equipped to conduct the mandatory EBM training study, and research more generally, which was related to previous experiences performing research. The residents generally did not anticipate conducting research themselves despite recognizing the benefits of training in research. CONCLUSION Perceptions and motivation of the residents specializing in care of older people to conduct research, although considered relevant to their practice, were not very positive. The study results in recommendations to motivate physicians in geriatrics training to conduct research, eg through personalized boosting of self-efficacy. This is crucial to motivate future physicians to contribute to research relevant to older people in more ways than just delivering data for research conceived by (non-clinical) researchers.
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Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands
| | - Wing H Tong
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands
- Argos Zorggroep “DrieMaasStede”, Center for Specialized Geriatric Care, Schiedam, the Netherlands
| | - Janneke Groothuijse
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands
| | - Belinda W C Ommering
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, the Netherlands
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Ouslander JG, Reyes B, Yang Z, Engstrom G, Tappen R, Newman D, Huckfeldt PJ. Nursing home performance in a trial to reduce hospitalizations: Implications for future trials. J Am Geriatr Soc 2021; 69:2316-2326. [PMID: 34018181 DOI: 10.1111/jgs.17231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. DESIGN Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. PARTICIPANTS Seventy-one NHs that completed the 12-month trial INTERVENTION: Implementation included distance-learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. MEASUREMENTS Primary outcomes included all-cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30-days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. RESULTS The 18 high-performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low-performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30-day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. CONCLUSION Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high-quality medical care and support of the medical director.
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Affiliation(s)
- Joseph G Ouslander
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA.,Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Bernardo Reyes
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Zhiyou Yang
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gabriella Engstrom
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Peter J Huckfeldt
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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