Fall prevention interventions for older community-dwelling adults: systematic reviews on benefits, harms, and patient values and preferences

Abstract Background An estimated 20–30% of community-dwelling Canadian adults aged 65 years or older experience one or more falls each year. Fall-related injuries are a leading cause of hospitalization and can lead to functional independence. Many fall prevention interventions, often based on modifiable risk factors, have been studied. Apart from the magnitude of the benefits and harms from different interventions, the preferences of older adults for different interventions as well as the relative importance they place on the different potential outcomes may influence recommendations by guideline panels. These reviews on benefits and harms of interventions, and on patient values and preferences, will inform the Canadian Task Force on Preventive Health Care to develop recommendations on fall prevention for primary care providers. Methods To review the benefits and harms of fall prevention interventions, we will update a previous systematic review of randomized controlled trials with adaptations to modify the classification of interventions and narrow the scope to community-dwelling older adults and primary-care relevant interventions. Four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Ageline), reference lists, trial registries, and relevant websites will be searched, using limits for randomized trials and date (2016 onwards). We will classify interventions according to the Prevention of Falls Network Europe (ProFANE) Group’s taxonomy. Outcomes include fallers, falls, injurious falls, fractures, hip fractures, institutionalization, health-related quality of life, functional status, and intervention-related adverse effects. For studies not included in the previous review, screening, study selection, data extraction on outcomes, and risk of bias assessments will be independently undertaken by two reviewers with consensus used for final decisions. Where quantitative analysis is suitable, network or pairwise meta-analysis will be conducted using a frequentist approach in Stata. Assessment of the transitivity and coherence of the network meta-analyses will be undertaken. For the reviews on patient preferences and outcome valuation (relative importance of outcomes), we will perform de novo reviews with searches in three databases (MEDLINE, PsycInfo, and CINAHL) and reference lists for cross-sectional, longitudinal quantitative, or qualitative studies published from 2000. Selection, data extraction, and risk of bias assessments suitable for each study design will be performed in duplicate. The analysis will be guided by a narrative synthesis approach, which may include meta-analysis for health-state utilities. We will use the CINeMa approach to a rate the certainty of the evidence for outcomes on intervention effects analyzed using network meta-analysis and the GRADE approach for all other outcomes. Discussion We will describe the flow of literature and characteristics of all studies and present results of all analyses and summary of finding tables. We will compare our findings to others and discuss the limitations of the reviews and the available literature. Systematic review registration This protocol has not been registered.

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The effect of eHealth-based falls prevention programmes on balance in people aged 65 years and over living in the community: protocol for a systematic review of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2019-031200 ◽

2020 ◽

Vol 10 (1) ◽

pp. e031200

Author(s):

Meghan Ambrens ◽

Anne Tiedemann ◽

Kim Delbaere ◽

Stephanie Alley ◽

Corneel Vandelanotte

Keyword(s):

Systematic Review ◽

Fall Prevention ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Community Dwelling ◽

Controlled Trials ◽

Exercise Interventions ◽

Prevention Interventions ◽

Randomised Controlled ◽

Community Dwellers

IntroductionBetween 20% and 28% of community-dwelling older people experience a fall each year. Falls can result in significant personal and socioeconomic costs, and are the leading cause of admission to hospital for an older person in Australia. Exercise interventions that target balance are the most effective for preventing falls in community-dwellers; however, greater accessibility of effective programmes is needed. As technology has become more accessible, its use as a tool for supporting and promoting health and well-being of individuals has been explored. Little is known about the effectiveness of eHealth technologies to deliver fall prevention interventions. This protocol describes a systematic review with meta-analysis that aims to evaluate the effect of eHealth fall prevention interventions compared with usual care control on balance in people aged 65 years and older living in the community.Methods and analysisWe will perform a systematic search of the following electronic databases: MEDLINE, CINAHL Complete, Embase and PsychINFO and citation search of Scopus, Web of Science, PubMed Central, Cochrane Database Central and PEDro for randomised controlled trials that use an eHealth technology to deliver a fall prevention intervention to community-dwellers aged ≥65 years, that are published in English, and include a balance outcome (primary outcome). The screening and selection of articles for review will be undertaken by two independent reviewers. The PEDro scale and Grading of Recommendations, Assessment, Development and Evaluations will be used to assess study quality. The results will be synthesised descriptively, and if sufficient data are available and the studies are not overly heterogeneous, a meta-analysis will be conducted using the random effects model.Ethics and disseminationAs this will be a systematic review, without involvement of human participants, there will be no requirement for ethical approval. The results of this systematic review will be disseminated through peer-reviewed publications, conference presentations and dissemination to policymakers and consumers to maximise health impact.PROSPERO registration numberCRD42018115098.

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Fall Prevention in Adults With Cognitive Impairment: Systematic Review and Meta-Analysis

Innovation in Aging ◽

10.1093/geroni/igab046.2598 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 698-698

Author(s):

Megan Racey ◽

Maureen Markle-Reid ◽

Muhammad Usman Ali ◽

Hélène Gagné ◽

Susan Hunter ◽

...

Keyword(s):

Cognitive Impairment ◽

Fall Prevention ◽

Perceived Risk ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Exercise Interventions ◽

Moderate Cognitive Impairment ◽

Prevention Interventions ◽

Risk Of Falls

Abstract Cognitive impairment increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and there is a lack of evidence for effective fall prevention interventions for community-dwelling cognitively impaired adults. We conducted a systematic review and meta-analysis to investigate the effectiveness of fall prevention interventions in improving falls, perceived risk of falls, gait, balance, and functional mobility. We searched 7 databases for interventions involving community-dwelling adults ≥50 years with mild to moderate cognitive impairment. Reviewers screened citations, extracted data, assessed risk of bias and certainty of evidence (GRADE). We performed a meta-analysis of 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate cognitive impairment from 12 randomized controlled trails (8 exercise interventions, 3 multifactorial, and 1 providing medication). Interventions had medium significant effects on perceived risk of falls (SMD -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and timed up and go test (SMD -0.56 [-0.94, -0.17]) and small significant effects on gait speed and control (SMD 0.26 [0.08, 0.43]) with moderate certainty of evidence. There were no significant effects for falls. Sub-analysis showed that exercise and studies at low risk of bias remained significant for balance and perceived risk of falls. The effect of fall prevention interventions on falls remains unclear; exercise interventions are effective at addressing fall risk factors. However, high quality and longer studies with adequate sample sizes are needed to determine their effectiveness on falls.

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Fall Prevention in Community-Dwelling Adults with Mild to Moderate Cognitive Impairment: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-690152/v1 ◽

2021 ◽

Author(s):

Megan Racey ◽

Maureen Markle-Reid ◽

Donna Fitzpatrick-Lewis ◽

Muhammad Usman Ali ◽

Hélène Gagné ◽

...

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Fear Of Falling ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Functional Mobility ◽

Exercise Interventions ◽

Prevention Interventions ◽

Risk Of Falls

Abstract Background: Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. Methods: We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings.Results: 509 community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [-1.10, -0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [-0.94, -0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls.Conclusion: The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

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Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02641-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Racey ◽

M. Markle-Reid ◽

D. Fitzpatrick-Lewis ◽

M. U. Ali ◽

H. Gagne ◽

...

Keyword(s):

Older Adults ◽

Fall Prevention ◽

Fear Of Falling ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Functional Mobility ◽

Exercise Interventions ◽

Prevention Interventions ◽

Risk Of Falls

Abstract Background Cognitive impairment (CI) increases an individual’s risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2–3 times more than cognitively healthy older adults and 60–80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. Methods We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings. Results Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [− 1.10, − 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [− 0.94, − 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls. Conclusion The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.

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The impact of eHealth group interventions on the mental, behavioural, and physical health of adults: A systematic review protocol

10.21203/rs.3.rs-37015/v2 ◽

2020 ◽

Cited By ~ 1

Author(s):

Cheryl L Currie ◽

Richard Larouche ◽

M. L. Voss ◽

Erin K. Higa ◽

Rae Spiwak ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Physical Health ◽

Meta Analysis ◽

Primary Objective ◽

Risk Of Bias ◽

Community Dwelling ◽

Controlled Trials ◽

Sex And Gender ◽

The Impact

Abstract Background: COVID-19 has resulted in an increased demand for mental health services globally. There is emerging evidence for the efficacy for group eHealth interventions that support population-based mental health and wellbeing, but a systematic review is lacking. The primary objective of this systematic review is to summarize the evidence for eHealth group counselling and coaching programs for adults. A second objective is to assess, within studies selected for our primary objective, the impact of programs that encourage PA on outcomes compared to those that do not.Methods and Design: Randomized controlled trials that assess the impact of eHealth group counselling or coaching programs on mental health, health behaviour, or physical health conditions or concerns among community dwelling adults will be searched in MEDLINE, PsycInfo, CINHAL, and the Central Register of Controlled Trials. The review will be structured using PRISMA guidelines. Studies will be synthesized using the Cochrane Handbook and Synthesis Without Meta-Analysis (SWiM) reporting guideline. Quality will be evaluated using GRADE. Risk of bias will be assessed using the Cochrane Risk of Bias tool with higher quality studies prioritized when drawing conclusions. The role of sex and gender will be considered as well as possible gender biases at all stages of the review.Discussion: This review will examine the effectiveness of eHealth counselling and coaching programs delivered to adults in a group format. Findings will inform the decisions of governments, communities, and health care organizations responding to the COVID-19 pandemic in Canada. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020187551).

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Acupuncture in sham device controlled trials may not be as effective as acupuncture in the real world: a preliminary network meta-analysis of studies of acupuncture for hot flashes in menopausal women

Acupuncture in Medicine ◽

10.1136/acupmed-2018-011671 ◽

2019 ◽

Vol 38 (1) ◽

pp. 37-44 ◽

Cited By ~ 1

Author(s):

Tae-Hun Kim ◽

Myeong Soo Lee ◽

Terje Alraek ◽

Stephen Birch

Keyword(s):

Randomised Controlled Trials ◽

Data Extraction ◽

Meta Analysis ◽

Hot Flashes ◽

Sham Acupuncture ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Randomised Controlled

Background: Randomised controlled trials of acupuncture performed using sham interventions to control for the placebo effect have mostly used two types of sham techniques: techniques with minimal insertion of acupuncture needles with no additional stimulation (shallow needling control) and techniques with sham acupuncture devices that do not penetrate the skin (sham device control). To achieve successful blinding, sham device controlled acupuncture trials also use the acupuncture base unit in the verum acupuncture group, but in the shallow needling control trials this is not necessary for the verum acupuncture treatment. Objective: In this study, we analysed the estimated comparative effectiveness of these two verum acupuncture modalities in studies of acupuncture for menopausal hot flashes that used two types of sham control treatments. Methods: We conducted a network meta-analysis that included randomised controlled trials of acupuncture for hot flashes. Electronic databases, including Medline, Embase, Cochrane Library and AMED, were searched through March 2017. Data were extracted using a predefined data extraction tool by two independent reviewers. The risk of bias was assessed using the Cochrane risk of bias tool for randomised controlled trials. A five-node network meta-analysis was conducted based on the frequentist framework. Results: Eight studies were included in this review. From the network meta-analysis, we found that verum acupuncture in the shallow needling controlled trials was more effective than verum acupuncture in the sham device controlled trials (SMD −7.27, 95% CI−9.11 to −5.43). Significant heterogeneity and inconsistency were not observed among the included studies or the comparisons. Conclusions: From this preliminary analysis, we found that different types of verum acupuncture may have different effect sizes with respect to the severity of menopausal hot flashes.

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Efficacy of pressure ulcer prevention interventions in adult intensive care units: a protocol for a systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026727 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026727 ◽

Cited By ~ 1

Author(s):

Yixiu Du ◽

Fangqin Wu ◽

Sai Lu ◽

Wei Zheng ◽

Huiying Wang ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Intensive Care Units ◽

Best Practice ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Prevention Measures ◽

Prevention Intervention ◽

Prevention Interventions

IntroductionPressure ulcers (PUs) are associated with substantial health burden. Patients in intensive care units (ICUs) are at high risk for developing PU. In the absence of large randomised controlled trials (RCTs) that compare commonly known interventions for preventing PU in ICUs, uncertainty remains around the best practice strategy for PU management in adult ICUs. This study, therefore, aims to identify the most effective interventions and combinations of interventions that prevent PU in adult ICU using systematic review and network meta-analysis (NMA).Methods and analysisWe will search for all published and unpublished RCTs evaluating interventions to prevent PU compared with other PU prevention measures or with usual care in adult ICU. The primary outcomes are the incidence of PUs and PU severity in critically ill patients in ICU. The secondary outcomes include number of PUs per patient and intervention-related harms caused by the prevention intervention or intervention-related harms. All data extraction will be performed by at least two independent reviewers on the basis of a priori developed extraction form. We will evaluate the risk of bias of the included RCTs in accordance with the Cochrane Collaboration’s risk of bias tool, and assess the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. A standard pairwise meta-analysis and a Bayesian NMA will be conducted to compare the efficacy of different PU prevention interventions. A surface under the cumulative ranking curve will be used to rank the probabilities of each prevention intervention for various outcomes.Ethics and disseminationThis study will not require the ethics approval as it is a review based on published studies. The findings of this study will be submitted to a peer-reviewed journal for publication. We anticipate that the results of the study will provide the evidence to inform clinicians and guideline developers on determining the best interventions for the prevention of PU in ICU patients.PROSPERO registration numberCRD42018085562.

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Acupuncture versus sham acupuncture for simple obesity: a systematic review and meta-analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-137221 ◽

2020 ◽

Vol 96 (1134) ◽

pp. 221-227 ◽

Cited By ~ 4

Author(s):

Yu-Mei Zhong ◽

Xiao-Chao Luo ◽

Yang Chen ◽

De-Li Lai ◽

Wen-Ting Lu ◽

...

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Scientific Journal ◽

Sham Acupuncture ◽

Obesity Treatment ◽

Risk Of Bias ◽

Controlled Trials ◽

Cochrane Central Register ◽

China National Knowledge Infrastructure ◽

Simple Obesity

Obesity is a growing chronic health problem worldwide. Studies about acupuncture for obesity treatment are many. But there are some doubts about the effectiveness of acupuncture versus sham acupuncture in treating obesity due to its lack of medical evidence. Therefore, the aim of this study is to assess the efficacy of acupuncture for obesity treatment and provide clinic evidence. Four English databases (PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials) and four Chinese databases (China National Knowledge Infrastructure, Chinese BioMedical Database, Chinese Scientific Journal Database and Wan-Fang Data) were searched from their receptions to August 2019. Randomized controlled trials (RCTs) using the comparison between acupuncture and sham acupuncture to treat simple obesity were included. The primary outcome of body mass index (BMI) would be used to measure the effect of acupuncture on obesity. According to the trial data extraction form based on the Cochrane Handbook, two reviewers separately extracted the data. Risk of bias of the RCTs was assessed by the Cochrane Risk of Bias Tool. The study included 8 RCTs with 403 patients. When compared with sham acupuncture, acupuncture showed obviously effect in BMI reduction (MD=1.0kg/m2, 95% CI=0.6 to 1.4, P<0.001). There was also significant reduction in body weight (MD=1.85kg, 95%CI=0.82 to 2.88, p<0.001), WC (MD=0.97cm, 95%CI=0.24 to 1.71, p=0.01) and body fat mass percentage (MD=1.01, 95%CI=0.25 to 1.77, p<0.05). However, WHR (MD=0.01, 95%CI=0 to 0.03, p>0.05) was not statistically and significantly different between the acupuncture and control groups. Adverse effects were reported in 3 studies. The review suggests that acupuncture is an effective therapy for simple obesity rather than a placebo effect. This potential benefit needs to be further evaluated by longer-term and more rigorous RCTs.

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Management of social isolation and loneliness in community-dwelling older adults: protocol for a network meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2020-042828 ◽

2021 ◽

Vol 11 (7) ◽

pp. e042828

Author(s):

Ahreum Lee ◽

Caitlin McArthur ◽

Areti Angeliki Veroniki ◽

Monika Kastner ◽

George Ioannidis ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Social Isolation ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Community Dwelling ◽

Controlled Trials ◽

Central Registry ◽

Randomised Controlled

IntroductionSocial isolation and loneliness in older adults are significant public health issues. Various interventions such as exercise programmes or social activities are used in the management of social isolation and loneliness in older adults. Network meta-analysis (NMA) provides effect estimates for all comparisons by considering the relative efficacy of multiple intervention alternatives. Therefore, this study will determine the comparative efficacy of intervention to alleviate social isolation and loneliness of older adults in community dwelling by comparing direct and indirect interventions through systematic review and NMA.Methods and analysisWe will include all relevant randomised controlled trials for interventions of social isolation and loneliness in older adults written in English without any limitation of publication date through electronic databases: MEDLINE via OVID, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), PsycINFO and CINAHL. Independent teams of reviewers will screen trial eligibility, collect data, identify duplication and assess risk of bias, by using the Cochrane revised risk of bias tool. The interventions for the management of social isolation and loneliness will be included. The primary outcome is social isolation. The secondary outcomes are loneliness and health-related quality of life. We will conduct an NMA through a Bayesian hierarchical model, by testing assumption (ie, transitivity) for NMA. We will also estimate the ranking probabilities for all interventions at each possible rank for each intervention. For estimation of each intervention efficacy, we will assess the certainty and credibility using the Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationEthics approval will not be obtained for this systematic review as it will be conducted with published papers. The review results will be presented at a field-specific conference and published in a relevant peer-reviewed journal.PROSPERO registration numberCRD42020155789.

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PROGRAM CHARACTERISTICS ASSOCIATED WITH REDUCED FEAR OF FALLING: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RCTS

Innovation in Aging ◽

10.1093/geroni/igz038.070 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S19-S19

Author(s):

Marlot Kruisbrink ◽

Kim Delbaere ◽

Gertrudis Kempen ◽

Rik Crutzen ◽

G A Rixt Zijlstra

Keyword(s):

Older People ◽

Contact Time ◽

Fear Of Falling ◽

Data Extraction ◽

Controlled Trial ◽

Meta Analysis ◽

Community Setting ◽

Risk Of Bias ◽

Community Dwelling ◽

Future Research

Abstract Fear of falling (FOF) is common among older people and can result in activity avoidance and decreased physical functioning. Different types of interventions have demonstrated significant small reductions in FOF. To optimize effect sizes, we sought to identify characteristics of interventions that were associated with a change in FOF. Five scientific databases were searched for articles using randomized controlled trial designs in community-dwelling older people without medical conditions. Data extraction included intervention type, setting, group format, type of supervision, provider, delivery format, duration, number of sessions, contact time, and risk of bias (assessed with the Cochrane Collaboration’s Risk of Bias Tool). After screening of titles, abstracts, and full texts, 55 unique studies – reporting on 68 interventions – were systematically reviewed. The majority of interventions focused on exercise (n=50). Interventions were performed at home (n=21) or in a community setting (n=23), were delivered in a group (n=26) or individual (n=30) format, and were often supervised (n=60) and delivered face-to-face (n=56). Duration ranged from 1 to 52 weeks and total contact time with the provider from 2 to 56 hours. Results of 42 interventions were suitable for meta-analysis. Univariate meta-regressions to evaluate associations between intervention characteristics and intervention effects directly after the intervention yielded no significant results. Due to self-reported outcomes and difficulties with blinding, risk of bias was high in all studies. To conclude, intervention characteristics were not associated with changes in FOF in this study. Possible reasons for an absence of associations and future research directions will be discussed.

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