Conducting Systematic Reviews of Intervention Questions III: Synthesizing Data from Intervention Studies Using Meta-Analysis

Greater understanding of the mechanisms (mediators) by which behavioral-change interventions work is critical to developing theory and refining interventions. Although systematic reviews have been advocated as a method for exploring mediators, this is rarely done. One challenge is that intervention researchers typically test only two paths of the mediational model: the effect of the intervention on mediators and on outcomes. The authors addressed this challenge by drawing information not only from intervention studies but also from observational studies that provide data on associations between potential mediators and outcomes. They also reviewed qualitative studies of participants’ perceptions of why and how interventions worked. Using data from intervention ( n = 37) and quantitative observational studies ( n = 55), the authors conducted a meta-analysis of the mediation effects of eight variables. Qualitative findings ( n = 6) contributed to more in-depth explanations for findings. The methods used have potential to contribute to understanding of core mechanisms of behavioral-change interventions.

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Research synthesis: systematic reviews and meta-analysis

Practical Psychiatric Epidemiology ◽

10.1093/med/9780198515517.003.0011 ◽

2003 ◽

pp. 203-218

Author(s):

Joanna Moncrieff

Keyword(s):

Medical Research ◽

Systematic Reviews ◽

Intervention Studies ◽

Meta Analysis ◽

Relevant Literature ◽

Research Synthesis ◽

Potential Contribution ◽

Statistical Process ◽

Fresh Perspective ◽

Objective View

The process of synthesizing data from different studies is known as metaanalysis. The techniques were developed in the social sciences and only recently applied to medical research. There has been intense debate about the validity of the process and its potential contribution to research. In medicine the widest application of research synthesis techniques has been with intervention studies. In particular the Cochrane Collaboration1 has promoted the use of systematic reviews and meta-analysis to evaluate medical treatments. Recently there has been increasing attention paid to meta-analysis with other types of study (Altman 2001). This overview will focus on intervention studies, and, after describing the uses and limitations of research synthesis and the particular issues arising for psychiatric researchers, will illustrate the stages in conducting a systematic review or meta-analysis. Definitions For the purposes of this chapter systematic reviews will be taken as referring to reviews which aim to achieve comprehensive coverage of the relevant literature and meta-analysis refers to the statistical process of combining quantitative data from different studies. The need for research synthesis (1) The exponential increase in medical research over recent decades makes it impossible for doctors to have a comprehensive knowledge of research in every area relevant to their practice. (2) By virtue of bringing a fresh perspective to an area, systematic reviews may be able to reach a more objective view of the evidence. (3) Health economists and policy makers need an overview of research and a reliable estimate of efficacy to facilitate the process of resource allocation. (4) Collation of research in different settings is valuable in order to obtain a picture of the range of action of a particular intervention. (5) Many studies are not large enough to detect small effects that may be clinically useful. Combining data enhances the power of the analysis to detect such effects. (6) Systematic collation of evidence indicates which areas require more research.

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T147. CAN HIGH INTENSITY INTERVAL TRAINING (HIIT) IMPROVE PHYSICAL AND MENTAL HEALTH OUTCOMES? A META-REVIEW OF THE GLOBAL BENEFITS OF HIIT AND FOCUSED SYSTEMATIC REVIEW OF THE EFFECTS OF HIIT IN MENTAL DISORDERS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.707 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S286-S287

Author(s):

Rebecca Martland ◽

Brendon Stubbs ◽

Fiona Gaughran

Keyword(s):

Mental Health ◽

Health Outcomes ◽

Systematic Reviews ◽

Intervention Studies ◽

Meta Analysis ◽

Interval Training ◽

Mental Illnesses ◽

Mental Health Outcomes ◽

Schizophrenia Spectrum Disorders ◽

Physical And Mental Health

Abstract Background High intensity interval training (HIIT) has been shown to improve physical and mental health in healthy individuals and those with physical illnesses, such as cardiovascular and cardiometabolic diseases. Initial work has shown that HIIT may have similar benefits in people experiencing mental illnesses including schizophrenia. Thus, it has been proposed that HIIT may be a promising exercise intervention that has the potential to target the poor health of those with mental illnesses. Despite the rapid interest in HIIT, there is a lack of clarity in the totality of the evidence for which outcomes and under what regimes HIIT is effective and safe, both in populations with and without mental illnesses. Methods A review of the literature was undertaken, comprising a) a meta-review investigating HIIT in all populations and all health outcomes to identify the global health benefits of HIIT; b) a traditional systematic review of all individual interventions of HIIT in all mental disorders (including schizophrenia), to see specifically what has been done in mental health populations. Firstly, major databases were searched for systematic reviews (with/without meta-analyses) of randomised & non-randomised trials that compared HIIT to a control in any human population. Findings were summarised narratively. Secondly, major databases were searched for intervention studies investigating HIIT among people with mental illnesses. Findings were summarised narratively, and a preliminary meta-analysis was undertaken. Results Regarding our first search, 33 systematic reviews (including 25 meta-analyses) were retrieved encompassing healthy subjects and people with physical health complications. Evidence suggested HIIT improved cardiorespiratory fitness (21/23, 91% systematic reviews), arterial compliance and vascular function (3/5, 60% systematic reviews), cardiac function (2/3, 67%), muscle mass (2/3, 67%), quality of life (2/4, 50%) exercise capacity (2/3, 67%) and inflammatory markers (3/5, 60% reviews), versus control. Improvements in muscular structure, anxiety and depression, and blood pressure were seen, compared to pre-training. Additionally, no acute injuries were reported, and mean adherence rates surpassed 80% in most systematic reviews. Regarding our second search, 12 intervention studies, (including 7 RCTs), were included encompassing Major Depressive Disorder, Schizophrenia-Spectrum Disorders, Bipolar Disorder, Substance Use Disorder, Panic Disorder and ADHD. Evidence suggested HIIT improved cardiorespiratory fitness (5/8 intervention studies, 63%), anthropometric variables (3/4, 75%), mental health outcomes (9/12, 75%), cardiovascular fitness (5/9, 56%), physical fitness (1/1, 100%) and motor skills (1/1, 100%), compare to pre-training. The preliminary meta-analysis of pre-post changes found HIIT increased High-Density-Lipoprotein (SMD:0.373 [95%CI 0.18; 0.57], p=0.0002) and possibly reduced general psychopathology (SMD:-1.58 [95%CI -3.35; 0.18], p=0.08) in people with schizophrenia-spectrum disorders. HIIT reduced depression severity (Standardised mean difference (SMD):-1.36 [95%CI-1.63;-1.089], p<0.0001) and possibly improved VO2max (SMD:0.18 [95%CI -0.02; 0.37], p=0.08) in people with depression. No acute injuries were reported, mean adherence to HIIT sessions ranged from 64–94%, and dropout ranged from 0–50%. Discussion HIIT appears to be associated with multiple benefits in healthy subjects and people with physical health complications. HIIT may also improve a range of physical and mental health outcomes among people with mental illnesses including schizophrenia. Nonetheless, high-quality well-powered trials are needed to reaffirm these findings.

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Current Therapy of Diabetic Macular Edema Bevacizumab, Triamcinolone Acetonide, and Laser Photocoagulation

Ophthalmologica Indonesiana ◽

10.35749/journal.v45i1.172 ◽

2019 ◽

Vol 45 (1) ◽

pp. 13

Author(s):

Gladys Kusumowidagdo ◽

Randy Sarayar ◽

Kartika Rahayu ◽

Gitalisa Andayani

Keyword(s):

Macular Edema ◽

Triamcinolone Acetonide ◽

Diabetic Macular Edema ◽

Systematic Reviews ◽

Laser Photocoagulation ◽

Meta Analysis ◽

Intravitreal Bevacizumab ◽

Current Therapy ◽

Intravitreal Triamcinolone ◽

Mesh Terms

Background: Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy (DR). Current gold standard therapy of DME is macular laser photocoagulation (MPC). Growing evidences have shown benefits of intravitreal anti-VEGF agents (i.e bevacizumab) and intravitreal corticosteroids (i.e triamcinolone acetonide). Aim: To compare the visual acuity (VA) improvement of patients with DME, treated with intravitreal bevacizumab (IVB), a combination of IVB and intravitreal triamcinolone (IVB/IVT), and MPC. Method: A comprehensive PubMed® and Cochrane® databases search was conducted on May 4th, 2017 using appropriate keywords (diabetic macular edema, bevacizumab, triamcinolone, and laser photocoagulation using their MeSH terms). Studies were filtered using inclusion criterions (clinical trials, RCT, meta-analysis, systematic review, English, humans, and publication within 10 years) Results: Three studies (2 systematic reviews and 1 RCT) were found suitable. From these results, all studies showed favoring effects of IVB when compared to IVB/IVT combination and MPC in short term period (up to 6 months). However, there was no significant improvement of VA beyond this period in all groups. Conclusion: IVB appears to be superior to IVB/IVT and MPC in improving VA during 6 months follow- up period. Future systematic reviews and meta-analysis are required on the effect of IVB and MPC combination in cases of DME.

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Cinammon (Cinnamomum Spp.) and Type 2 Diabetes Mellitus

Current Topics in Nutraceutical Research ◽

10.37290/ctnr2641-452x.18:247-255 ◽

2019 ◽

Vol 18 (3) ◽

pp. 247-255

Author(s):

Sierra-Puente D. ◽

Abadi-Alfie S. ◽

Arakanchi-Altaled K. ◽

Bogard-Brondo M. ◽

García-Lascurain M. ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Systematic Reviews ◽

Meta Analysis ◽

Fasting Blood Glucose ◽

Tolerance Test ◽

Oral Glucose ◽

Key Aspects

Spices such as cinnamon (Cinnamomum Spp.) have been of interest due to their phytochemical composition that exert hypoglycemic effects with potential for management of type 2 diabetes mellitus (T2DM). We summarize data from 27 manuscripts that include, one book chapter, 3 review articles, 10 randomized controlled trials, 4 systematic reviews with meta-analysis, and 9 preclinical studies. The most frequently used cinnamon variety was Cinnamomum cassia rather than the Cinnamomum zeylanicum, whereas outcomes were defined as fasting blood glucose, glycated hemoglobin, and oral glucose tolerance test. A great variability in methodology such as different doses (from 120 mg to 6 g), duration of intervention, data retrieved and use of different concomitant medication, were found to be key aspects of most of trials and systematic reviews with meta-analysis available to date. Low quality studies have been made in most cases with a lot of heterogeneity clouding significance of results. More research needs to be done in order to yield accurate evidence for evidence-based recommendations. Its use is not currently a reliable nor advisable option for the treatment of T2DM.

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Application of the Subspace-Based Methods in Health Monitoring of Civil Structures: A Systematic Review and Meta-Analysis

Applied Sciences ◽

10.3390/app10103607 ◽

2020 ◽

Vol 10 (10) ◽

pp. 3607

Author(s):

Hoofar Shokravi ◽

Hooman Shokravi ◽

Norhisham Bakhary ◽

Mahshid Heidarrezaei ◽

Seyed Saeid Rahimian Koloor ◽

...

Keyword(s):

System Identification ◽

Systematic Reviews ◽

Health Monitoring ◽

Meta Analysis ◽

Civil Structures ◽

Literature Reviews ◽

Research Gap ◽

Meta Analyses ◽

Subspace System Identification ◽

Insight Into

A large number of research studies in structural health monitoring (SHM) have presented, extended, and used subspace system identification. However, there is a lack of research on systematic literature reviews and surveys of studies in this field. Therefore, the current study is undertaken to systematically review the literature published on the development and application of subspace system identification methods. In this regard, major databases in SHM, including Scopus, Google Scholar, and Web of Science, have been selected and preferred reporting items for systematic reviews and meta-analyses (PRISMA) has been applied to ensure complete and transparent reporting of systematic reviews. Along this line, the presented review addresses the available studies that employed subspace-based techniques in the vibration-based damage detection (VDD) of civil structures. The selected papers in this review were categorized into authors, publication year, name of journal, applied techniques, research objectives, research gap, proposed solutions and models, and findings. This study can assist practitioners and academicians for better condition assessment of structures and to gain insight into the literature.

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Diet and physical activity in pregnancy to prevent gestational diabetes: a protocol for an individual participant data (IPD) meta-analysis on the differential effects of interventions with economic evaluation

BMJ Open ◽

10.1136/bmjopen-2020-048119 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048119

Author(s):

Dyuti Coomar ◽

Jonathan M Hazlehurst ◽

Frances Austin ◽

Charlie Foster ◽

Graham A Hitman ◽

...

Keyword(s):

Physical Activity ◽

Cost Effectiveness ◽

Gestational Diabetes ◽

Systematic Reviews ◽

Meta Analysis ◽

Individual Participant Data ◽

Randomised Trials ◽

Diet And Physical Activity ◽

Individual Participant ◽

In Pregnancy

IntroductionMothers with gestational diabetes mellitus (GDM) are at increased risk of pregnancy-related complications and developing type 2 diabetes after delivery. Diet and physical activity-based interventions may prevent GDM, but variations in populations, interventions and outcomes in primary trials have limited the translation of available evidence into practice. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to assess the differential effects and cost-effectiveness of diet and physical activity-based interventions in preventing GDM and its complications.MethodsThe International Weight Management in Pregnancy Collaborative Network database is a living repository of IPD from randomised trials on diet and physical activity in pregnancy identified through a systematic literature search. We shall update our existing search on MEDLINE, Embase, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database without language restriction to identify relevant trials until March 2021. Primary researchers will be invited to join the Network and share their IPD. Trials including women with GDM at baseline will be excluded. We shall perform a one and two stage random-effect meta-analysis for each intervention type (all interventions, diet-based, physical activity-based and mixed approach) to obtain summary intervention effects on GDM with 95% CIs and summary treatment–covariate interactions. Heterogeneity will be summarised using I2 and tau2 statistics with 95% prediction intervals. Publication and availability bias will be assessed by examining small study effects. Study quality of included trials will be assessed by the Cochrane Risk of Bias tool, and the Grading of Recommendations, Assessment, Development and Evaluations approach will be used to grade the evidence in the results. A model-based economic analysis will be carried out to assess the cost-effectiveness of interventions to prevent GDM and its complications compared with usual care.Ethics and disseminationEthics approval is not required. The study is registered on the International Prospective Register of Systematic Reviews (CRD42020212884). Results will be submitted for publication in peer-reviewed journals.

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Forgiveness Interventions for Older Adults: A Review

Journal of Clinical Medicine ◽

10.3390/jcm10091866 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1866

Author(s):

Javier López ◽

Maria Inés Serrano ◽

Isabel Giménez ◽

Cristina Noriega

Keyword(s):

Older Adults ◽

Intervention Studies ◽

Satisfaction With Life ◽

Meta Analysis ◽

Specific Treatment ◽

Community Dwelling ◽

Group Treatments ◽

Receive Treatment ◽

Community Dwelling Older Adults

A meta-analysis of the efficacy of forgiveness interventions in older adults was conducted. International databases (Medline, PsycINFO, Scopus, Web of Science) were searched for studies published from 1990 to 2020 that attempted to promote forgiveness in older adults. Most intervention studies are group treatments targeted towards community-dwelling older adults. Participants in these studies are mainly women. The intervention objectives and contents vary widely and often criteria are not well-defined. Participants that received forgiveness interventions reported significantly higher levels of forgiveness than participants that did not receive treatment. Additionally, forgiveness interventions resulted in more changes in depression, stress and anger than no intervention conditions. Forgiveness treatment also enhances positive states (satisfaction with life, subjective happiness, and psychological wellbeing). The reported effects are moderate. The specific treatment model (e.g., Enright’s, Worthington’s) and format (e.g., group-based interventions and individually delivered programs) do not differentially predict better outcomes. In conclusion, future intervention studies should include more male participants and utilize a broader range of follow-up periods. Caution must be exercised because of the limited number of studies developed to date; researchers must be cautious when generalizing the results.

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Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000517012 ◽

2021 ◽

pp. 1-14

Author(s):

Kerrie A. Sullivan ◽

Isabella F. Churchill ◽

Danielle A. Hylton ◽

Waël C. Hanna

Keyword(s):

Abdominal Surgery ◽

Systematic Reviews ◽

Meta Analysis ◽

Pulmonary Complications ◽

Adult Patients ◽

Controlled Trials ◽

Upper Abdominal Surgery ◽

Upper Abdominal ◽

Incentive Spirometry ◽

Rehabilitation Strategies

Background: Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled trials (RCTs) and systematic reviews of lower methodological quality. To improve the quality of the research and to account for the effects of IS following thoracic surgery, in addition to cardiac and upper abdominal surgery, we performed a meta-analysis with thorough application of the Grading of Recommendations Assessment, Development and Evaluation scoring system and extensive reference to the Cochrane Handbook for Systematic Reviews of Interventions. Objective: The objective of this study was to determine, with rigorous methodology, whether IS for adult patients (18 years of age or older) undergoing cardiac, thoracic, or upper abdominal surgery significantly reduces30-day post-operative pulmonary complications (PPCs), 30-day mortality, and length of hospital stay (LHS) when compared to other rehabilitation strategies. Methods: The literature was searched using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science for RCTs between the databases’ inception and March 2019. A random-effect model was selected to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Results: Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or upper abdominal surgery were included. By comparing the use of IS to other chest rehabilitation strategies, we found that IS alone did not significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88–1.13) or 30-day mortality (RR = 0.73, 95% CI: 0.42–1.25). Likewise, there was no difference in LHS (mean difference = −0.17,95% CI: −0.65 to 0.30) between IS and the other rehabilitation strategies. None of the included trials significantly impacted the sensitivity analysis and publication bias was not detected. Conclusions: This meta-analysis showed that IS alone likely results in little to no reduction in the number of adult patients with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and upper abdominal surgery.

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