scholarly journals Effectiveness of Digital Education on Communication Skills Among Medical Students: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

10.2196/12967 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e12967 ◽  
Author(s):  
Bhone Myint Kyaw ◽  
Pawel Posadzki ◽  
Sophie Paddock ◽  
Josip Car ◽  
James Campbell ◽  
...  
Keyword(s):  
Medical Students ◽  
Communication Skills ◽  
Effect Size ◽  
Meta Analysis ◽  
Traditional Learning ◽  
Digital Education ◽  
Significant Difference ◽  
Small Effect Size ◽  
Quality Evidence

Background Effective communication skills are essential in diagnosis and treatment processes and in building the doctor-patient relationship. Objective Our aim was to evaluate the effectiveness of digital education in medical students for communication skills development. Broadly, we assessed whether digital education could improve the quality of future doctors’ communication skills. Methods We performed a systematic review and searched seven electronic databases and two trial registries for randomized controlled trials (RCTs) and cluster RCTs (cRCTs) published between January 1990 and September 2018. Two reviewers independently screened the citations, extracted data from the included studies, and assessed the risk of bias. We also assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations assessment (GRADE). Results We included 12 studies with 2101 medical students, of which 10 were RCTs and two were cRCTs. The digital education included online modules, virtual patient simulations, and video-assisted oral feedback. The control groups included didactic lectures, oral feedback, standard curriculum, role play, and no intervention as well as less interactive forms of digital education. The overall risk of bias was high, and the quality of evidence ranged from moderate to very low. For skills outcome, meta-analysis of three studies comparing digital education to traditional learning showed no statistically significant difference in postintervention skills scores between the groups (standardized mean difference [SMD]=–0.19; 95% CI –0.9 to 0.52; I2=86%, N=3 studies [304 students]; small effect size; low-quality evidence). Similarly, a meta-analysis of four studies comparing the effectiveness of blended digital education (ie, online or offline digital education plus traditional learning) and traditional learning showed no statistically significant difference in postintervention skills between the groups (SMD=0.15; 95% CI –0.26 to 0.56; I2=86%; N=4 studies [762 students]; small effect size; low-quality evidence). The additional meta-analysis of four studies comparing more interactive and less interactive forms of digital education also showed little or no difference in postintervention skills scores between the two groups (SMD=0.12; 95% CI: –0.09 to 0.33; I2=40%; N=4 studies [893 students]; small effect size; moderate-quality evidence). For knowledge outcome, two studies comparing the effectiveness of blended online digital education and traditional learning reported no difference in postintervention knowledge scores between the groups (SMD=0.18; 95% CI: –0.2 to 0.55; I2=61%; N=2 studies [292 students]; small effect size; low-quality evidence). The findings on attitudes, satisfaction, and patient-related outcomes were limited or mixed. None of the included studies reported adverse outcomes or economic evaluation of the interventions. Conclusions We found low-quality evidence showing that digital education is as effective as traditional learning in medical students’ communication skills training. Blended digital education seems to be at least as effective as and potentially more effective than traditional learning for communication skills and knowledge. We also found no difference in postintervention skills between more and less interactive forms of digital education. There is a need for further research to evaluate the effectiveness of other forms of digital education such as virtual reality, serious gaming, and mobile learning on medical students’ attitude, satisfaction, and patient-related outcomes as well as the adverse effects and cost-effectiveness of digital education.

scholarly journals Effectiveness of Digital Education on Communication Skills Among Medical Students: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

2018 ◽  
Author(s):  
Bhone Myint Kyaw ◽  
Pawel Posadzki ◽  
Sophie Paddock ◽  
Josip Car ◽  
James Campbell ◽  
...  
Keyword(s):  
Medical Students ◽  
Communication Skills ◽  
Effect Size ◽  
Meta Analysis ◽  
Traditional Learning ◽  
Digital Education ◽  
Significant Difference ◽  
Small Effect Size ◽  
Quality Evidence

BACKGROUND Effective communication skills are essential in diagnosis and treatment processes and in building the doctor-patient relationship. OBJECTIVE Our aim was to evaluate the effectiveness of digital education in medical students for communication skills development. Broadly, we assessed whether digital education could improve the quality of future doctors’ communication skills. METHODS We performed a systematic review and searched seven electronic databases and two trial registries for randomized controlled trials (RCTs) and cluster RCTs (cRCTs) published between January 1990 and September 2018. Two reviewers independently screened the citations, extracted data from the included studies, and assessed the risk of bias. We also assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations assessment (GRADE). RESULTS We included 12 studies with 2101 medical students, of which 10 were RCTs and two were cRCTs. The digital education included online modules, virtual patient simulations, and video-assisted oral feedback. The control groups included didactic lectures, oral feedback, standard curriculum, role play, and no intervention as well as less interactive forms of digital education. The overall risk of bias was high, and the quality of evidence ranged from moderate to very low. For skills outcome, meta-analysis of three studies comparing digital education to traditional learning showed no statistically significant difference in postintervention skills scores between the groups (standardized mean difference [SMD]=–0.19; 95% CI –0.9 to 0.52; I2=86%, N=3 studies [304 students]; small effect size; low-quality evidence). Similarly, a meta-analysis of four studies comparing the effectiveness of blended digital education (ie, online or offline digital education plus traditional learning) and traditional learning showed no statistically significant difference in postintervention skills between the groups (SMD=0.15; 95% CI –0.26 to 0.56; I2=86%; N=4 studies [762 students]; small effect size; low-quality evidence). The additional meta-analysis of four studies comparing more interactive and less interactive forms of digital education also showed little or no difference in postintervention skills scores between the two groups (SMD=0.12; 95% CI: –0.09 to 0.33; I2=40%; N=4 studies [893 students]; small effect size; moderate-quality evidence). For knowledge outcome, two studies comparing the effectiveness of blended online digital education and traditional learning reported no difference in postintervention knowledge scores between the groups (SMD=0.18; 95% CI: –0.2 to 0.55; I2=61%; N=2 studies [292 students]; small effect size; low-quality evidence). The findings on attitudes, satisfaction, and patient-related outcomes were limited or mixed. None of the included studies reported adverse outcomes or economic evaluation of the interventions. CONCLUSIONS We found low-quality evidence showing that digital education is as effective as traditional learning in medical students’ communication skills training. Blended digital education seems to be at least as effective as and potentially more effective than traditional learning for communication skills and knowledge. We also found no difference in postintervention skills between more and less interactive forms of digital education. There is a need for further research to evaluate the effectiveness of other forms of digital education such as virtual reality, serious gaming, and mobile learning on medical students’ attitude, satisfaction, and patient-related outcomes as well as the adverse effects and cost-effectiveness of digital education.

scholarly journals Offline Digital Education for Medical Students: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

2019 ◽  
Author(s):  
Bhone Myint Kyaw ◽  
Pawel Posadzki ◽  
Gerard Dunleavy ◽  
Monika Semwal ◽  
Ushashree Divakar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Students ◽  
Adverse Effects ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Traditional Learning ◽  
Digital Education ◽  
Computer Based ◽  
Students Attitudes

BACKGROUND Medical schools in low- and middle-income countries are facing a shortage of staff, limited infrastructure, and restricted access to fast and reliable internet. Offline digital education may be an alternative solution for these issues, allowing medical students to learn at their own time and pace, without the need for a network connection. OBJECTIVE The primary objective of this systematic review was to assess the effectiveness of offline digital education compared with traditional learning or a different form of offline digital education such as CD-ROM or PowerPoint presentations in improving knowledge, skills, attitudes, and satisfaction of medical students. The secondary objective was to assess the cost-effectiveness of offline digital education, changes in its accessibility or availability, and its unintended/adverse effects on students. METHODS We carried out a systematic review of the literature by following the Cochrane methodology. We searched seven major electronic databases from January 1990 to August 2017 for randomized controlled trials (RCTs) or cluster RCTs. Two authors independently screened studies, extracted data, and assessed the risk of bias. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations criteria. RESULTS We included 36 studies with 3325 medical students, of which 33 were RCTs and three were cluster RCTs. The interventions consisted of software programs, CD-ROMs, PowerPoint presentations, computer-based videos, and other computer-based interventions. The pooled estimate of 19 studies (1717 participants) showed no significant difference between offline digital education and traditional learning groups in terms of students’ postintervention knowledge scores (standardized mean difference=0.11, 95% CI –0.11 to 0.32; small effect size; low-quality evidence). Meta-analysis of four studies found that, compared with traditional learning, offline digital education improved medical students’ postintervention skills (standardized mean difference=1.05, 95% CI 0.15-1.95; large effect size; low-quality evidence). We are uncertain about the effects of offline digital education on students’ attitudes and satisfaction due to missing or incomplete outcome data. Only four studies estimated the costs of offline digital education, and none reported changes in accessibility or availability of such education or in the adverse effects. The risk of bias was predominantly high in more than half of the included studies. The overall quality of the evidence was low (for knowledge, skills, attitudes, and satisfaction) due to the study limitations and inconsistency across the studies. CONCLUSIONS Our findings suggest that offline digital education is as effective as traditional learning in terms of medical students’ knowledge and may be more effective than traditional learning in terms of medical students’ skills. However, there is a need to further investigate students’ attitudes and satisfaction with offline digital education as well as its cost-effectiveness, changes in its accessibility or availability, and any resulting unintended/adverse effects.

Electroconvulsive Therapy for Depression: A Review of the Quality of ECT versus Sham ECT Trials and Meta-Analyses

2019 ◽  
Vol 21 (2) ◽  
pp. 64-103 ◽  
Author(s):  
John Read ◽  
Irving Kirsch ◽  
Laura McGrath
Keyword(s):  
Electroconvulsive Therapy ◽  
Effect Size ◽  
Memory Loss ◽  
Severe Depression ◽  
Double Blind ◽  
End Of Treatment ◽  
Significant Difference ◽  
Small Effect Size ◽  
Meta Analyses

BackgroundElectroconvulsive therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT versus simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT versus SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based.MethodsThe meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigor of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review.ResultsThe five meta-analyses include between 1 and 7 of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT.ConclusionsThe quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.

A Meta-Analysis of Online Learning Outcomes and Their Gender Differences

2021 ◽  
Vol 19 (3) ◽  
pp. 33-50
Author(s):  
Zhonggen Yu ◽  
Liheng Yu
Keyword(s):  
Gender Differences ◽  
Online Learning ◽  
Online Education ◽  
Learning Outcomes ◽  
Effect Size ◽  
Meta Analysis ◽  
Interdisciplinary Cooperation ◽  
Traditional Learning ◽  
Emotion Detection ◽  
Small Effect Size

In this COVID-19 pandemic, learners across the world are encouraged to stay at home receiving online education, which has nearly caused various learning outcomes. It is thus necessary to analyze online learning outcomes, as well as their gender differences to provide constructive references for learners, teachers, and technology developers. This study obtained reliable data from various databases using searching techniques. The study also selected the research articles based on inclusion and exclusion criteria. After analyzing the forest and funnel plots drawn via Review Manager 5.3, the study arrived at the conclusion that online learning outcomes were significantly higher than the traditional learning outcomes with a large effect size (d = 1.24), while the gender differences in learning outcomes were not significant with a small effect size (d = -0.03). In the future, experts could make every effort to develop advanced emotion detection applications via interdisciplinary cooperation to improve online learning outcomes.

scholarly journals Quality of life in elderly ICU survivors before the COVID-19 pandemic: a systematic review and meta-analysis of cohort studies

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e045086
Author(s):  
Kevin Ariyo ◽  
Sergio Canestrini ◽  
Anthony S David ◽  
Alex Ruck Keene ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Decision Making ◽  
Cohort Studies ◽  
Effect Size ◽  
Meta Analysis ◽  
Qualitative Synthesis ◽  
Small Effect Size

ObjectivesThe influence of age on intensive care unit (ICU) decision-making is complex, and it is unclear if it is based on expected subjective or objective patient outcomes. To address recent concerns over age-based ICU decision-making, we explored patient-assessed quality of life (QoL) in ICU survivors before the COVID-19 pandemic.DesignA systematic review and meta-analysis of cohort studies published between January 2000 and April 2020, of elderly patients admitted to ICUs.Primary and secondary outcome measuresWe extracted data on self-reported QoL (EQ-5D composite score), demographic and clinical variables. Using a random-effect meta-analysis, we then compared QoL scores at follow-up to scores either before admission, age-matched population controls or younger ICU survivors. We conducted sensitivity analyses to study heterogeneity and bias and a qualitative synthesis of subscores.ResultsWe identified 2536 studies and included 22 for qualitative synthesis and 18 for meta-analysis (n=2326 elderly survivors). Elderly survivors’ QoL was significantly worse than younger ICU survivors, with a small-to-medium effect size (d=0.35 (−0.53 and −0.16)). Elderly survivors’ QoL was also significantly greater when measured slightly before ICU, compared with follow-up, with a small effect size (d=0.26 (−0.44 and −0.08)). Finally, their QoL was also marginally significantly worse than age-matched community controls, also with a small effect size (d=0.21 (−0.43 and 0.00)). Mortality rates and length of follow-up partly explained heterogeneity. Reductions in QoL seemed primarily due to physical health, rather than mental health items.ConclusionsThe results suggest that the proportionality of age as a determinant of ICU resource allocation should be kept under close review and that subjective QoL outcomes should inform person-centred decision -aking in elderly ICU patients.PROSPERO registration numberCRD42020181181.

scholarly journals A meta-analysis of effects of Internet CBT for anxiety disorders: open community versus clinical service recruitment (Preprint)

2018 ◽  
Author(s):  
Geke Romijn ◽  
Neeltje Batelaan ◽  
Robin Kok ◽  
Jeroen Koning ◽  
Anton van Balkom ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Effect Size ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Routine Care ◽  
Clinical Service ◽  
Effect Sizes ◽  
Current Evidence ◽  
Significant Difference ◽  
Small Effect Size

BACKGROUND Ample studies show the high potential of Internet-delivered cognitive behavioural therapy (iCBT) for anxiety disorders. However, evidence for its effectiveness in routine care is scarce. We conducted a meta-analysis to compare results obtained in trials with open recruitment to results obtained in trials with clinical service recruitment and updated previous findings. OBJECTIVE The present study thus aims 1) to update the current evidence on iCBT for anxiety disorders by assessing overall efficacy and 2) to assess whether open recruitment results are comparable to those with recruitment in a routine care context. METHODS Randomised controlled trials were included in which the effects of iCBT for anxiety disorders were compared to wait-list controls (WLC) or face-to-face (f2f) CBT controls. Pooled effect sizes based on anxiety measures (primary outcome), depression and quality of life measures (secondary outcomes) were computed. RESULTS We included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Overall effect size of (1) iCBT versus WLC was g=0.72 (p<.001) and (2) iCBT versus f2f CBT g=0.12 (p=0.11). Subgroup analyses revealed (3) iCBT clinical recruitment studies with WLC as comparator: g=0.29 (p<0.01), while iCBT open recruitment studies with WLC comparators showed a higher significant effect of g=0.76 (p<0.001). (4) Clinical recruitment studies comparing iCBT to f2f CBT revealed a non-significant and small effect size g=0.06 (p=0.51) while open recruitment studies comparing iCBT to f2f CBT showed an effect of g=0.19 (p=0.09). Comparing clinical recruitment trials with open recruitment trials showed a significant difference in effect size (p<.001) based on WLC comparators, and no significant difference (p=0.38) based on f2f CBT comparators. CONCLUSIONS iCBT is effective in samples recruited in routine clinical practice, but effect sizes are smaller than those found in open recruitment trials. More studies with routine care populations are needed to further validate these findings.

Antiplatelet Therapy versus Anticoagulation after Surgical Bioprosthetic Aortic Valve Replacement: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 119 (02) ◽  
pp. 328-339 ◽  
Author(s):  
Kevin An ◽  
Emilie Belley-Cote ◽  
Kevin Um ◽  
Saurabh Gupta ◽  
Graham McClure ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Valve Replacement ◽  
Observational Studies ◽  
Meta Analysis ◽  
Significant Difference ◽  
Quality Evidence

Background The optimal antithrombotic therapy after surgical bioprosthetic aortic valve replacement (BAVR) is uncertain. We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) comparing antiplatelet therapy and anticoagulation in patients with surgical BAVR. Methods We searched Cochrane CENTRAL, MEDLINE and EMBASE from inception to 3 November 2017 for studies evaluating antiplatelet therapy versus anticoagulation early after surgical BAVR. We performed title and abstract screening, full-text review, risk of bias evaluation and data collection independently and in duplicate. We evaluated overall quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, and pooled data using a random effects model. Results We identified 2 RCTs (n = 397) and 5 observational studies (n = 2,012) meeting our eligibility criteria. The mean follow-up for all outcomes was 3 months in RCTs, and 10 months for observational studies. Antiplatelet compared with anticoagulant therapy demonstrated a trend towards fewer major bleeds in RCTs (relative risk [RR], 0.34; 95% confidence interval [CI], 0.11–1.04, p = 0.06, I 2 = 0%, low quality evidence), and significantly fewer major bleeds in observational studies (RR, 0.34; 95% CI, 0.20–0.58, p ≤ 0.0001, I 2 = 0%, very low quality evidence), but stroke, thromboembolism and mortality did not show a significant difference in either RCTs or observational studies. Conclusion Antiplatelet therapy demonstrated reduced bleeding risk with no negative effects on stroke, thromboembolism or mortality compared with anticoagulation therapy after surgical BAVR. Our confidence in the results is reduced by the low quality of the available evidence.

scholarly journals Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1070
Author(s):  
Maike Wolters ◽  
Annkathrin von der Haar ◽  
Ann-Kristin Baalmann ◽  
Maike Wellbrock ◽  
Thomas L. Heise ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Treatment Duration ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Pufa Supplementation ◽  
Depressive Symptomology ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

scholarly journals Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: A systematic review and meta-analysis of observational studies

2021 ◽  
pp. 146531252110272
Author(s):  
Despina Koletsi ◽  
Anna Iliadi ◽  
Theodore Eliades
Keyword(s):  
Effect Size ◽  
Tooth Movement ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Patient Treatment ◽  
Qualitative Synthesis ◽  
Meta Analyses ◽  
Enamel Reduction

Objective: To evaluate all available evidence on the prediction of rotational tooth movements with aligners. Data sources: Seven databases of published and unpublished literature were searched up to 4 August 2020 for eligible studies. Data selection: Studies were deemed eligible if they included evaluation of rotational tooth movement with any type of aligner, through the comparison of software-based and actually achieved data after patient treatment. Data extraction and data synthesis: Data extraction was done independently and in duplicate and risk of bias assessment was performed with the use of the QUADAS-2 tool. Random effects meta-analyses with effect sizes and their 95% confidence intervals (CIs) were performed and the quality of the evidence was assessed through GRADE. Results: Seven articles were included in the qualitative synthesis, of which three contributed to meta-analyses. Overall results revealed a non-accurate prediction of the outcome for the software-based data, irrespective of the use of attachments or interproximal enamel reduction (IPR). Maxillary canines demonstrated the lowest percentage accuracy for rotational tooth movement (three studies: effect size = 47.9%; 95% CI = 27.2–69.5; P < 0.001), although high levels of heterogeneity were identified (I2: 86.9%; P < 0.001). Contrary, mandibular incisors presented the highest percentage accuracy for predicted rotational movement (two studies: effect size = 70.7%; 95% CI = 58.9–82.5; P < 0.001; I2: 0.0%; P = 0.48). Risk of bias was unclear to low overall, while quality of the evidence ranged from low to moderate. Conclusion: Allowing for all identified caveats, prediction of rotational tooth movements with aligner treatment does not appear accurate, especially for canines. Careful selection of patients and malocclusions for aligner treatment decisions remain challenging.

scholarly journals Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Fardowsa Mohamed ◽  
Megna Jeram ◽  
Christin Coomarasamy ◽  
Melanie Lauti ◽  
Don Wilson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Faecal Incontinence ◽  
Meta Analysis ◽  
One Anastomosis Gastric Bypass ◽  
Significant Difference ◽  
Post Bariatric Surgery

Abstract Introduction Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird’s variance estimator were used for meta-analysis. Results Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. Graphical abstract

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