Effectiveness, Safety, and Acceptability of Medical Abortion at Home vs. In the Clinic: A Systematic Review and Meta-Analysis in Response to COVID-19

BackgroundIncreased access to home-based medical abortion may offer women a convenient, safe and effective abortion method, reduce burdens on healthcare systems and support social distancing during the COVID-19 pandemic. Home-based medical abortion is defined as any abortion where mifepristone, misoprostol or both medications are taken at home.MethodsA systematic review and meta-analysis of randomised controlled trials (RCTs) and non-randomised studies (NRSs) were conducted. We searched databases from inception to 10 July 2019 and 14 June 2020. Successful abortion was the main outcome of interest. Eligible studies were RCTs and NRSs studies with a concurrent comparison group comparing home versus clinic-based medical abortion. Risk ratios (RRs) and their 95% CIs were calculated. Estimates were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess risk of bias by outcome and to evaluate the overall quality of the evidence.ResultsWe identified 6277 potentially eligible published studies. Nineteen studies (3 RCTs and 16 NRSs) were included with 11 576 women seeking abortion up to 9 weeks gestation. Neither the RCTs nor the NRS found any difference between home-based and clinic-based administration of medical abortion in having a successful abortion (RR 0.99, 95% CI 0.98 to 1.01, I2=0%; RR 0.99, 95% CI 0.97 to 1.01, I2=52%, respectively). The certainty of the evidence for the 16 NRSs was downgraded from low to very low due to high risk of bias and publication bias. The certainty of the evidence for the three RCTs was downgraded from high to moderate by one level for high risk of bias.ConclusionHome-based medical abortion is effective, safe and acceptable to women. This evidence should be used to expand women’s abortion options and ensure access to abortion for women during COVID-19 and beyond.PROSPERO registration numberCRD42020183171.

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Exercise-based games interventions at home in individuals with a neurological disease: A systematic review and meta-analysis

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2019.04.004 ◽

2019 ◽

Vol 62 (5) ◽

pp. 366-378 ◽

Cited By ~ 4

Author(s):

Anaick Perrochon ◽

Benoit Borel ◽

Dan Istrate ◽

Maxence Compagnat ◽

Jean-Christophe Daviet

Keyword(s):

Systematic Review ◽

Neurological Disease ◽

Meta Analysis ◽

At Home

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Simultaneous compared to interval administration of mifepristone and misoprostol for medical abortion up to 10+0 weeks' gestation: a systematic review with meta-analyses

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2019-200448 ◽

2020 ◽

pp. bmjsrh-2019-200448

Author(s):

Mia Schmidt-Hansen ◽

Jonathan Lord ◽

Elise Hasler ◽

Sharon Cameron

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Medical Abortion ◽

Cochrane Library ◽

Published Data ◽

Study Results ◽

Randomised Controlled ◽

Meta Analyses

BackgroundMedical abortion with mifepristone and misoprostol usually involves an interval of 36–48 hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effectiveness of simultaneous compared with interval administration of mifepristone and misoprostol for abortion up to 10+0 weeks’ gestation.MethodsWe searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily, and Epub Ahead-of-Print, In-Process & Other Non-Indexed Citations; and Cochrane Library on 11 December 2019. We included randomised controlled trials (RCTs), published in English from 1985, comparing simultaneous to interval administration of mifepristone and misoprostol for early abortion. Risk of bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs) using the Mantel-Haenszel method were performed. The quality of the evidence was assessed using GRADE.ResultsMeta-analyses of three RCTs (n=1280) showed no differences in ‘ongoing pregnancy’ (RR 1.78, 95% CI 0.38 to 8.36), ‘haemorrhage requiring transfusion or ≥500 mL blood loss’ (RR 0.11, 95% CI 0.01 to 2.03) and ‘incomplete abortion with the need for surgical intervention’ (RR 1.30, 95% CI 0.76 to 2.25) between the interventions. Individual study results showed no difference in patient satisfaction, or ‘need for repeat misoprostol’, although ‘time to onset of bleeding or cramping’ was longer after simultaneous than interval administration. The quality of evidence was very low to moderate.ConclusionThe published data support the use of simultaneous mifepristone and misoprostol for medical abortion up to 9+0 weeks in women who prefer this method of administration.

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Surgical or medical abortion of pregnancies between 13+0 and 23+6 weeks’ gestation? A systematic review and new NICE national guidelines

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2019-200460 ◽

2020 ◽

pp. bmjsrh-2019-200460

Author(s):

Mia Schmidt-Hansen ◽

Patricia A Lohr ◽

Sharon Cameron ◽

Elise Hasler

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Medical Abortion ◽

Cochrane Library ◽

National Guidelines ◽

Cervical Injury ◽

Surgical Methods ◽

Randomised Controlled

BackgroundAbortion in the second trimester may be performed surgically or medically. The objective of this systematic review was to examine the effectiveness, safety and acceptability/satisfaction of surgical compared with medical abortion of pregnancy between 13+0 and 23+6 weeks’ gestation for a new national guideline.MethodsWe searched Embase, Medline and the Cochrane Library on 4 March 2019. We included randomised controlled trials (RCTs; any size) and non-randomised comparative studies with n≥100 in each arm, published in English from 1985. Risk-of-bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs)used the Mantel-Haenszel method. The quality of the evidence was assessed using GRADE.ResultsTwo RCTs (n=140) were included. ‘Incomplete abortion requiring surgical intervention’ was clinically significantly higher with medical than surgical methods (RR=4.58, 95% CI 1.07 to 19.64). ‘Abortion completed by the intended method’ was statistically, but not clinically, significantly lower after medical than surgical methods, but was marked by high between-study heterogeneity (RR=0.88, 95% CI 0.79 to 0.98). To the extent that ‘haemorrhage requiring transfusion/≥500 mL blood loss’, ‘uterine injury’, ‘cervical injury requiring repair’ and ‘infection reported within 1 month of abortion’ were reported, they did not differ significantly between methods. Depending on measurement method, ‘patient satisfaction/acceptability’ was either clinically significantly higher or comparable after surgical than medical methods. The quality of this evidence was limited by low event rates and attrition bias.ConclusionBased on this evidence and consensus, women should be offered the choice of medical or surgical methods of abortion between 13+0 and 23+6 weeks’ gestation, unless not clinically appropriate.

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104: Systematic review and meta-analysis of commercially-available at-home pelvic floor training devices that provide biofeedback for treatment of urinary incontinence

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.12.144 ◽

2020 ◽

Vol 222 (3) ◽

pp. S834

Author(s):

J.F. Pennycuff ◽

C. Wu ◽

C. Iglesia

Keyword(s):

Systematic Review ◽

Urinary Incontinence ◽

Pelvic Floor ◽

Meta Analysis ◽

Pelvic Floor Training ◽

At Home

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Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026308 ◽

2019 ◽

Vol 9 (11) ◽

pp. e026308 ◽

Cited By ~ 10

Author(s):

Sally Bennett ◽

Kate Laver ◽

Sebastian Voigt-Radloff ◽

Lori Letts ◽

Lindy Clemson ◽

...

Keyword(s):

Systematic Review ◽

Occupational Therapy ◽

Psychological Symptoms ◽

Meta Analysis ◽

Family Carers ◽

Moderate Quality ◽

People With Dementia ◽

Behavioural And Psychological Symptoms ◽

Randomised Controlled ◽

At Home

ObjectiveTo determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL.DesignSystematic review and meta-analysis.MethodsEight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data.ResultsFifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD −0.32, 95% CI −0.57 to −0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person with dementia (SMD −0.33, 95% CI −0.58 to −0.07); had less distress with behaviours (SMD −0.23, 95% CI −0.42 to −0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality.ConclusionsFindings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.PROSPERO registration numberCRD42011001166.

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Home treatment for mental health problems: a systematic review

Psychological Medicine ◽

10.1017/s0033291702005299 ◽

2002 ◽

Vol 32 (3) ◽

pp. 383-401 ◽

Cited By ~ 70

Author(s):

J. CATTY ◽

T. BURNS ◽

M. KNAPP ◽

H. WATT ◽

C. WRIGHT ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Health Problems ◽

Meta Analysis ◽

Health Problems ◽

Home Treatment ◽

Randomized Studies ◽

Service Components ◽

And Control ◽

At Home

Background. Concerns have been raised about the scope and generalizability of much community mental health research. In particular, both experimental and control services are poorly characterized.Methods. To review the effectiveness of ‘home treatment’ for mental health problems in terms of hospitalization, we conducted a systematic review, using Cochrane methodology but with a wider remit. Non-randomized studies were included in response to concerns about RCTs’ generalizability. All authors were followed up for data on service components. ‘Home treatment’ was defined broadly for the purposes of the literature search, but included studies were then assessed against service components specifically focused on delivering treatment at home. The study tested components and other features for associations with days in hospital, as well as conducting a conventional meta-analysis of data on days in hospital.Results. We found 91 studies, 18 comparing home to in-patient treatment. Sixty per cent of authors responded to follow-up. The vast majority of the services studied had a ‘home treatment function’ and regularly visited patients at home. The heterogeneity of control services made meta-analysis problematical as did the limited availability of data. There was some evidence that ‘regular’ home visiting and combined responsibility for health and social care were associated with reduced hospitalization. The inclusion of non-randomized studies rarely affected the findings.Conclusions. Evidence concerning the effectiveness of home treatment remains inconclusive. A centrally coordinated research strategy is recommended, with attention to study design. Experimental and control service components should be prospectively recorded and reported to enable meaningful analysis.

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