scholarly journals Rationale and Design of Different Self-care Models for Adults With Heart Failure: a Systematic Review and Network Meta-analysis

2021 ◽  
Author(s):  
Mingzhi Hu ◽  
Hengheng Dai ◽  
Kehua Zhou ◽  
Jingjing Zhang ◽  
Ying Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Meta Analysis ◽  
Self Care ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Intervention Model ◽  
Care Intervention ◽  
Credible Intervals

Abstract Background: Active self-care improves quality of life, lowers hospital readmission risks, and decreases mortality from heart failure. Different self-care intervention models for these patients involve a variety of care contributions from healthcare professionals and caregivers, and little is known about which self-care intervention model is the most effective.Methods: We will search the MEDLINE/PubMed, the Cochrane Library, CINAHL, ClinicalTrials.gov, Embase and PsycINFO databases from January, 2000 to April, 2021. The gray literature will also be searched to ensure randomized controlled trials are included as comprehensively as possible. Summary standardized mean differences and 95% credible intervals will be calculated via Bayesian random-effects network meta-analysis. Heterogeneity will be evaluated, and risk of bias will be assessed using the Cochrane Risk of Bias tool.Discussion: This network meta-analysis will analyze outcomes including quality of life, healthcare use, readmission rate, and mortality to identify the most effective intervention model.Impact: We will analyze self-care interventions and determine which is most effective through this meta‐analysis.Registration number: PROSPERO CRD42021253179

scholarly journals Effectiveness of Resilience Interventions on Psychosocial Outcomes for Persons With Neurocognitive Disorders: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Ying Wang ◽  
Iris Chi ◽  
Yuning Zhan ◽  
Wenjang Chen ◽  
Tongtong Li
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Meta Analysis ◽  
Psychosocial Outcomes ◽  
Well Being ◽  
Neurocognitive Disorders ◽  
Risk Of Bias ◽  
Significant Benefit ◽  
Cochrane Library

Background: Neurocognitive disorders, such as mild cognitive impairment (MCI), dementia, and Alzheimer's disease, not only harm people's cognitive function but also lead to negative emotions, poor quality of life (QOL), and unsatisfactory level of well-being. Resilience can be defined as a dynamic and amendable process, which maintains or improves life satisfaction and quick recovery from own dilemma. However, no meta-analysis of randomized controlled trials (RCTs) has thus far examined the effectiveness of resilience interventions among persons with neurocognitive disorders, and the results of RCTs were inconsistent. This systematic review aimed to assess the effectiveness of resilience interventions on psychosocial outcomes among persons with neurocognitive disorders.Methods: Nine electronic Chinese and English databases (the Cochrane Library, PsycINFO, Web of Science, PubMed, Medline, Eric, JSTOR, CNKI, and WANGFANG) were searched through April 2021. Only RCTs were included, and the quality of the included studies was assessed by the Cochrane “Risk of Bias” tool. Meta-analysis was carried out on psychosocial outcomes, and heterogeneity was investigated by subgroup and sensitivity analysis. RevMan 5.4 was used for meta-analysis.Results: Fourteen RCT studies were identified, representing a total of 2,442 participants with neurocognitive disorders. The risk of bias was high or unclear for most included studies in the domains of allocation concealment, blinding participants, and interventionists. Meta-analysis showed that heterogeneity was low or moderate. There were significant differences in favor of resilience interventions compared with control on the outcome of QOL, using the Quality of Life-Alzheimer Disease scale (QOL-AD) [I2 = 36%, standardized mean difference (SMD) = 0.14, 95% CI (0.02, 0.26), p = 0.02], and no significant differences on depression, using the Cornell Scale for Depression in Dementia (CSDD) [I2 = 41%, SMD = −0.14, 95% CI (−0.34, 0.05), p = 0.16], and neuropsychiatric symptoms using the Neuropsychiatric Inventory Questionnaire (NPI-Q) [I2 = 62%, SMD = −0.10, 95% CI (−0.37, −0.16), p ≤ 0.46].Conclusions: Resilience interventions had a significant benefit on QOL but no significant benefit on depression and neuropsychiatric behavioral symptoms. More evidence is needed to answer questions about how to implement resilience interventions and how to evaluate their effectiveness.

Abstract 224: Characterizing Quality of Life Responses and Physical Functioning Improvements to an Integrated Self-care Intervention for Persons With Co-morbid Heart Failure and Diabetes

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Melinda Higgins ◽  
Carolyn Reilly ◽  
Rebecca Gary ◽  
Sandra Dunbar ◽  
Brittany Butts ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Physical Function ◽  
Physical Functioning ◽  
Nyha Class ◽  
Self Care ◽  
Meaningful Change ◽  
Care Intervention ◽  
Eq5d Index

Objectives: In the Quality HF-DM trial, which tested an integrated self-care intervention for persons with heart failure (HF) and diabetes (DM), improved perceived HF and general health-related quality of life (QOL) and physical functioning were observed, but not for DM QOL. However, some participants did improve. This analysis examined the demographic and clinical factors associated with positive and clinically meaningful change in outcomes in response to the intervention to help inform future improvement in targeted interventions. Methods: HF-DM participants (n=134), mean age 57.4 ± 11 years, 66% men, 69% African American, were randomized to usual care (UC) or intervention (INT) with assessments at baseline (BL), 1, 3 and 6 months (M). Intervention included education/counseling focused on HF-DM self-care. Variables (measures, clinically meaningful change between BL-6 M) were: HF QOL (MLHFQ &gt5), general QOL (EQ5D-index &gt0.1; EQ5D-VAS &gt10), DM QOL (ADDQOL, &gt1), physical function (6 Minute Walk Test [6MWT] &gt50 meters). Age, gender, race, education, living arrangements, NYHA class and time with HF and DM were evaluated after adjusting for the INT group using linear and logistic regression to assess for relationship to improvements in outcomes. Results: For general QOL EQ5D index scores, those with less education (high school or less) (p=.024); those with NYHA class 3 or 4 (p=.036); and those with DM longer (p=.011) improved more. For MLWHF scores, whites were more likely than African Americans to improve their MLWHF scores (p=.05). For DM QOL (ADDQOL), 35% of younger participants (&lt=58 yrs.) in the intervention group improved their ADDQOL scores by 1 or more points compared to only 10% of the older participants (&gt58 yrs.) (p=.039). For 6MWT distances, males in INT group more likely to achieve improvement (p=.014), and those with NYHA class 3 or 4 more likely to improve (p=.048). Conclusions: When considering QOL and physical function outcomes in response to an HF-DM self-care intervention, age, education, race, gender, NYHA class, and time with DM were important. The INT improved outcomes in vulnerable groups of lower education, greater HF severity, and longer times with DM. Effects differed by EQ5D, MLWHF and ADDQOL measures highlighting the importance of evaluating multiple general and disease specific QOL dimensions, and the need to consider demographic and clinical risk factors to tailor toward more precise interventions.

scholarly journals Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis

2018 ◽  
Vol 33 (3) ◽  
pp. 395-407 ◽  
Author(s):  
Ewout B Smit ◽  
Hylco Bouwstra ◽  
Cees MPM Hertogh ◽  
Elizabeth M Wattel ◽  
Johannes C van der Wouden
Keyword(s):  
Quality Of Life ◽  
Goal Setting ◽  
Physical Functioning ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Geriatric Rehabilitation ◽  
Randomized Controlled

Objective: To explore the effect of goal-setting on physical functioning, quality of life and duration of rehabilitation in geriatric rehabilitation compared to care as usual. Data sources: Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from initiation to October 2018. Methods: We included randomized controlled trials (RCTs), controlled before–after studies and studies using historic controls of older patients (mean age ⩾55 years) receiving rehabilitation for acquired disabilities. Our primary outcome was physical functioning; secondary outcomes were quality of life and rehabilitation duration. Cochrane guidelines were used to assess the risk of bias of the studies and extract data. Only RCT data were pooled using standardized mean difference (SMD). Results: We included 14 studies consisting of a total of 1915 participants with a mean age ranging from 55 to 83 years. Ten out of the 14 studies had a randomized controlled design, 7 of which could be pooled for the primary outcome. The risk of bias was judged high in several domains in all included studies. The meta-analysis showed no statistically significant differences between goal-setting and care as usual for physical functioning (SMD −0.11 (−0.32 to 0.10)), quality of life (SMD 0.09 (−0.56 to 0.75)) and rehabilitation duration (MD 13.46 days (−2.46 to 29.38)). Conclusion: We found low-quality evidence that goal-setting does not result in better physical functioning compared to care as usual in geriatric rehabilitation. For quality of life and duration of rehabilitation, we could not exclude a clinically relevant effect.

scholarly journals Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e058932
Author(s):  
Abubeker Alebachew Seid ◽  
Setognal Birara Aychiluhm ◽  
Ahmed Adem Mohammed
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Mean Difference ◽  
Cochrane Library ◽  
P Value ◽  
Published Data ◽  
Respiratory Rehabilitation

IntroductionRespiratory rehabilitation is the use of exercise, education, and behavioural interventions to alleviate symptoms and improve quality of life. Recent studies highlight that respiratory rehabilitation is effective and safe for patients with COVID-19. We aim to evaluate the effectiveness and feasibility of respiratory telerehabilitation on patients infected with COVID-19 by conducting a systematic review and meta-analysis.Methods and analysisPubMed, Web of Science, Science Direct, Physiotherapy Evidence Database, Google Scholar and Cochrane Library databases will be searched from inception to the end of November 2021. Randomised controlled trials investigating the effectiveness of telerehabilitation in the management of COVID-19 will be included. The primary outcomes will be functional capacity, cardiopulmonary exercise tests and quality of life. Secondary outcomes will include anxiety/depression level, sleep quality, mortality rate, completion rate, reason for withdrawal, adverse events, service satisfaction, cost-effectiveness and other potential factors. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. Review Manager V.5.4 (Cochrane Collaboration) software will be used for statistical analysis. Heterogeneity will be analysed using I² statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables.Ethics and disseminationEthical approval is not required because this systematic review and meta-analysis is based on previously published data. Final result will be published in peer-reviewed journal and presented at relevant conferences and events.PROSPERO registration numberCRD42021287975.

scholarly journals Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data

BMJ ◽  
2021 ◽  
pp. m4743
Author(s):  
Joshua Z Goldenberg ◽  
Andrew Day ◽  
Grant D Brinkworth ◽  
Junko Sato ◽  
Satoru Yamada ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Carbohydrate ◽  
Remission Of Diabetes

Abstract Objective To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. Design Systematic review and meta-analysis. Data sources Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. Study selection Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. Data extraction Primary outcomes were remission of diabetes (HbA 1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA 1c , fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. Results Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA 1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I 2 =58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA 1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. Conclusions On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. Systematic review registration PROSPERO CRD42020161795.

scholarly journals Effectiveness of Antalgic Therapies in Patients with Vertebral Bone Metastasis: A Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (8) ◽  
pp. 3991
Author(s):  
Antonio Jose Martin-Perez ◽  
María Fernández-González ◽  
Paula Postigo-Martin ◽  
Marc Sampedro Pilegaard ◽  
Carolina Fernández-Lao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Metastasis ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Pharmacological Intervention ◽  
Vertebral Metastasis ◽  
Randomized Controlled Clinical Trials

There is no systematic review that has identified existing studies evaluating the pharmacological and non-pharmacological intervention for pain management in patients with bone metastasis. To fill this gap in the literature, this systematic review with meta-analysis aims to evaluate the effectiveness of different antalgic therapies (pharmacological and non-pharmacological) in the improvement of pain of these patients. To this end, this protocol has been written according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and registered in PROSPERO (CRD42020135762). A systematic search will be carried out in four international databases: Medline (Via PubMed), Web of Science, Cochrane Library and SCOPUS, to select the randomized controlled clinical trials. The Risk of Bias Tool developed by Cochrane will be used to assess the risk of bias and the quality of the identified studies. A narrative synthesis will be used to describe and compare the studies, and after the data extraction, random effects model and a subgroup analyses will be performed according to the type of intervention, if possible. This protocol aims to generate a systematic review that compiles and synthesizes the best and most recent evidence on the treatment of pain derived from vertebral metastasis.

scholarly journals Effects of exercise-based pulmonary rehabilitation on adults with asthma: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhenzhen Feng ◽  
Jiajia Wang ◽  
Yang Xie ◽  
Jiansheng Li
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Life Questionnaire ◽  
Asthma Control Questionnaire ◽  
Clinical Trial Registration ◽  
Domain Scores

Abstract Background Pulmonary rehabilitation (PR) has been proposed as an effective method for many respiratory diseases. However, the effects of exercise-based PR on asthma are currently inconclusive. This review aimed to investigate the effects of exercise-based PR on adults with asthma. Methods The PubMed, Embase, Cochrane Library, Web of Science, International Clinical Trials Registry Platform and ClinicalTrials.gov databases were searched from inception to 31 July 2019 without language restriction. Randomized controlled trials (RCTs) investigating the effects of exercise-based PR on adults with asthma were included. Study selection, data extraction and risk of bias assessment were performed by two investigators independently. Meta-analysis was conducted by RevMan software (version 5.3). Evidence quality was rated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Results Ten literatures from nine studies (n = 418 patients) were identified. Asthma quality of life questionnaire total scores (MD = 0.39, 95% CI: 0.02 to 0.76) improved significantly in the experimental group compared to control group, including activity domain scores (MD = 0.58, 95% CI: 0.21 to 0.94), symptom domain scores (MD = 0.52, 95% CI: 0.19 to 0.85), emotion domain scores (MD = 0.53, 95% CI: − 0.03 to 1.09) and environment domain scores (MD = 0.56, 95% CI: 0.00 to 1.11). Both the 6-min walk distance (MD = 34.09, 95% CI: 2.51 to 65.66) and maximum oxygen uptake (MD = 4.45, 95% CI: 3.32 to 5.58) significantly improved. However, improvements in asthma control questionnaire scores (MD = − 0.25, 95% CI: − 0.51 to 0.02) and asthma symptom-free days (MD = 3.35, 95% CI: − 0.21 to 6.90) were not significant. Moreover, there was no significant improvement (MD = 0.10, 95% CI: − 0.08 to 0.29) in forced expiratory volume in 1 s. Nonetheless, improvements in forced vital capacity (MD = 0.23, 95% CI: 0.08 to 0.38) and peak expiratory flow (MD = 0.39, 95% CI: 0.21 to 0.57) were significant. Conclusions Exercise-based PR may improve quality of life, exercise tolerance and some aspects of pulmonary function in adults with asthma and can be considered a supplementary therapy. RCTs of high quality and large sample sizes are required. Clinical trial registration: The review was registered with PROSPERO (The website is https://www.crd.york.ac.uk/prospero/, and the ID is CRD42019147107).

scholarly journals Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled Trial

2021 ◽  
Vol 11 (2) ◽  
pp. 418-429
Author(s):  
Joana Pereira Sousa ◽  
Hugo Neves ◽  
Miguel Pais-Vieira
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Care Management ◽  
Controlled Trial ◽  
Self Care ◽  
Fluid Restriction ◽  
Symptom Recognition ◽  
Patients With Heart Failure ◽  
Randomised Controlled

Patients with heart failure have difficulty in self-care management, as daily monitoring and recognition of symptoms do not readily trigger an action to avoid hospital admissions. The purpose of this study was to understand the impact of a nurse-led complex intervention on symptom recognition and fluid restriction. A latent growth model was designed to estimate the longitudinal effect of a nursing-led complex intervention on self-care management and quality-of-life changes in patients with heart failure and assessed by a pilot study performed on sixty-three patients (33 control, 30 intervention). Patients in the control group had a higher risk of hospitalisation (IRR 11.36; p < 0.001) and emergency admission (IRR 4.24; p < 0.001) at three-months follow-up. Analysis of the time scores demonstrated that the intervention group had a clear improvement in self-care behaviours (βSlope. Assignment_group = −0.881; p < 0.001) and in the quality of life (βSlope. Assignment_group = 1.739; p < 0.001). This study supports that a nurse-led programme on symptom recognition and fluid restriction can positively impact self-care behaviours and quality of life in patients with heart failure. This randomised controlled trial was retrospectively registered (NCT04892004).

scholarly journals The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-17
Author(s):  
Lu Wang ◽  
Mingmin Xu ◽  
Qianhua Zheng ◽  
Wei Zhang ◽  
Ying Li
Keyword(s):  
Quality Of Life ◽  
Meta Analysis ◽  
Safety Evaluation ◽  
Functional Constipation ◽  
Responder Rate ◽  
Current Evidence ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Increased Risk

Objective. The purpose of this study was to assess the effectiveness and safety of acupuncture for functional constipation (FC). Methods. A rigorous literature search was performed in English (PubMed, Web of Science, the Cochrane Library, and EMBASE) and Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang database, and China Science and Technology Journal (VIP)) electronic databases from their inception to October 2019. Included randomized controlled trials (RCTs) compared acupuncture therapy with sham acupuncture or pharmacological therapies. The outcome measures were evaluated, including the primary outcome of complete spontaneous bowel movement (CSBM) and secondary outcomes of Bristol Stool Form Scale (BSFS), constipation symptoms scores (CSS), responder rate, the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and safety evaluation. Meta-analysis was performed by using RevMan5.3. Results. The merged data of 28 RCTs with 3525 participants indicated that acupuncture may be efficient for FC by increasing CSBMs (p<0.00001; MD = 0.84 [95% CI, 0.65 to 1.03]; I2 = 0%) and improving constipation symptoms (p=0.03; SMD = −0.4 [95% CI, −0.78 to −0.03]; I2 = 74%), stool formation (p<0.00001; MD = 0.24 [95% CI, 0.15 to 0.34]; I2 = 0%), quality of life (p<0.00001; N = 1, MD = −0.33 [95% CI, −0.45 to −0.21]), and responder rates (p=0.02; RR = 2.16; [95% CI, 1.1 to 4.24]; I2 = 69%) compared with the effects of sham treatment. No increased risk of adverse events was observed (p=0.44; RR = 1.18; [95% CI, 0.77 to 1.81]; I2 = 0%). With regard to medication comparisons, the pooled data indicated that acupuncture was more effective in increasing CSBMs (p=0.004; MD = 0.53 [95% CI, 0.17 to 0.88]; I2 = 88%) and improving patients’ quality of life (p<0.00001; SMD = −0.73 [95% CI, −1.02 to −0.44]; I2 = 64%), with high heterogeneity. However, there were no significant differences in responder rate (p=0.12; RR = 1.31; [95% CI, 0.94 to 1.82]; I2 = 53%), BSFS (p=0.5; MD = 0.17 [95% CI, −0.33 to 0.68]; I2 = 93%), or CSS (p=0.05; SMD = −0.62 [95% CI, −1.23 to −0.01]; I2 = 89%). Regarding safety evaluation, acupuncture was safer than medications (p<0.0001; RR = 0.3; [95% CI, 0.18 to 0.52]; I2 = 30%). Conclusions. Current evidence suggests that acupuncture is an efficient and safe treatment for FC. Acupuncture increased stool frequency, improved stool formation, alleviated constipation symptoms, and improved quality of life. However, the evidence quality was relatively low and the relationship between acupuncture and drugs is not clear. More high-quality trials are recommended in the future. PROSPERO registration number: CRD42019143347.

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