Systematic review and meta-analysis of attrition within digital health interventions for people with multiple sclerosis (Preprint)

2021 ◽  
Author(s):  
William Bevens
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Digital Health ◽  
Meta Analysis ◽  
Health Interventions ◽  
Attrition Rates ◽  
Participant Engagement ◽  
Randomised Controlled ◽  
And Control ◽  
Insight Into

BACKGROUND Digital health interventions (DHI) have revolutionised the management of multiple sclerosis (MS). It is now understood that the technological elements that comprise DHIs can influence participant engagement and that people with MS (PwMS) can experience significant barriers to remaining enrolled in DHIs related to the use of these elements. It is essential to explore the influence of technological elements in mitigating attrition after allocation. OBJECTIVE We examined the study design and technological elements of documented DHIs targeted at PwMS and how these correlated with attrition among participants of randomised-controlled trials (RCTs). METHODS We conducted a systematic review and meta-analysis of RCTs (n=17) describing digital technologies for health interventions for PwMS. We analysed attrition of included studies using a random-effects model and meta-regression to measure the association between potential moderators. RESULTS There were no measured differences in attrition between intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 10.6% and 11.2% respectively. CONCLUSIONS Ultimately, this paper provides insight into the technological composition of DHIs and will aid in the design of future studies in this area.

scholarly journals The effectiveness of telemedicine interventions to address maternal depression: A systematic review and meta-analysis

2018 ◽  
Vol 24 (10) ◽  
pp. 639-650 ◽  
Author(s):  
Uthara Nair ◽  
Nigel R Armfield ◽  
Mark D Chatfield ◽  
Sisira Edirippulige
Keyword(s):  
Systematic Review ◽  
Maternal Depression ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Health Concern ◽  
Cochrane Library ◽  
Post Intervention ◽  
Attrition Rates ◽  
Cognitive Behavioural ◽  
Randomised Controlled

Introduction Maternal depression (MD), is an overarching term for depression affecting pregnant women and mothers for up to 12 months postpartum. Because MD may have chronic and long-lasting effects, it is an important public health concern. The extent to which telemedicine may be an effective way to provide services to sufferers of MD is unknown, therefore, this review aimed to assess the available evidence. Methods We conducted a search of The Cochrane Library, PubMed/MEDLINE, PsycINFO, and EMBASE for relevant randomised controlled trials published between 2000 and 2018; we then conducted a systematic review and meta-analysis. Results We identified 10 studies for inclusion. Therapeutic strategies involved cognitive behavioural therapy (CBT), behavioural activation and other psychoeducation. Eight trials reported significant improvement in depression scores post-intervention; four studies that conducted post-intervention follow-up found that these improvements continued. However, high attrition rates and lack of blinding were common problems. Discussion This review found limited evidence supporting the delivery of CBT for the treatment of MD and anxiety using telemedicine. However, most of the evidence only studied improvements in postpartum depression, indicating that use of telemedicine to provide MD intervention is still small and an under-researched area.

P5307A consumer-direct digital health intervention for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) randomised controlled trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Redfern ◽  
T Usherwood ◽  
G Coorey ◽  
J Mulley ◽  
A Scaria ◽  
...  
Keyword(s):  
Digital Health ◽  
Controlled Trial ◽  
Health Interventions ◽  
Control Group ◽  
Physically Active ◽  
Ehealth Literacy ◽  
Health Strategy ◽  
Randomised Controlled ◽  
And Control

Abstract Background Digital health interventions linked to electronic health records offer patients an innovative approach to support cardiovascular disease (CVD) risk management. Purpose Test the effectiveness of a consumer-directed digital health strategy on medication adherence and cardiovascular health outcomes in patients presenting to primary care who are at moderate to high risk of CVD. Methods Randomised controlled trial (RCT) with 12 month follow-up. Intervention group received an interactive digital health strategy for CVD management. The intervention was integrated with patient's electronic health record to enable automated population of risk factor and medication data (Figure). Control group received usual care. Primary outcome was the proportion of patients taking guideline-recommended BP and cholesterol-lowering medications on at least 80% of days (administrative data). Secondary outcomes included mean SBP, LDL-cholesterol, BMI and proportion meeting risk targets for physical activity, achieving smoking cessation, quality of life (EQ5D) and ehealth literacy (eHEALS). Results Intervention (n=486) and control (n=448) groups were well matched at baseline (Table). Mean age of participants was 67±8.1 years, 77% were male, 41% had existing CVD. At 12 months, there was no significant difference between the groups for medication days covered or mean cholesterol and BP (Table). However, there were significantly more patients in the intervention than control group who were physically active and had high ehealth literacy (Table). Table 1. Primary and Secondary Outcomes Baseline 12 months Outcome Control (n=448) Intervention (n=486) Control (n=431) Intervention (n=460) p value* Taking BP and cholesterol medication on ≥80% of days, % 29.7 28.9 29.9 32.8 0.485 SBP (mmHg), mean±SD 139.0±16.6 137.3±15.9 136.3±16.1 136.4±17.6 0.921 LDL (mmol/L), mean±SD 2.6±1.0 2.6±1.0 2.5±0.9 2.4±1.0 0.240 BMI (kg/m2), mean±SD 29.7±5.1 29.9±5.7 29.4±5.0 29.7±5.7 0.508 Proportion achieving BP and LDL target, % 11.2 12.3 11.7 16.5 0.065 Physically active, % 84.0 85.4 79.7 87.0 0.016 Current smoker, % 12.9 13.0 12.0 8.1 0.087 eHEALS, mean±SD 27.0±6.4 27.0±6.4 26.4±7.5 28.3±6.3 0.002 *Comparing intervention and control at 12 month follow-up. Conclusions The integrated digital health strategy did not significantly impact on days of medication covered however, patients in the intervention had higher physical activity and ehealth literacy. The RCT highlights the importance of conducting robust research if we are to understand the potential value of digital health interventions. Acknowledgement/Funding This work was supported by a Project Grant from the National Health and Medical Research Council of Australia

scholarly journals Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Vol 90 (9) ◽  
pp. 1051-1058 ◽  
Author(s):  
Robert Simpson ◽  
Sharon Simpson ◽  
Nitish Ramparsad ◽  
Margaret Lawrence ◽  
Jo Booth ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Treatment Options ◽  
Well Being ◽  
Controlled Trials ◽  
Medical Subject Headings ◽  
Randomised Controlled ◽  
Mental Well Being

ObjectiveImpairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS.MethodsSystematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD).ResultsTwelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28–0.53), p<0.01, I2=28%; against active comparators only (three studies) SMD was 0.17 (0.01–0.32), p<0.05, I2 =0%. Only three adverse events were reported.ConclusionsMBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness.PROSPERO registration numberCRD42018093171.

Interferon-beta injection in multiple sclerosis patients is related to the induction of headache and flu-like pain symptoms: a systematic review and meta-analysis of randomised controlled trials

2021 ◽  
Vol 19 ◽  
Author(s):  
Leonardo Gomes Pereira ◽  
Gabriela Trevisan ◽  
Patrícia Rodrigues ◽  
Fernanda Tibolla Viero ◽  
Julia Maria Frare ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Adverse Effects ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
First Choice ◽  
Pain Symptoms ◽  
Randomised Controlled ◽  
Multiple Sclerosis Patients

: Multiple sclerosis (MS) is a chronic neurodegenerative, inflammatory and autoimmune disease characterised by the demyelination of the central nervous system. One of the main approaches to treating MS is the use of disease-modifying therapies (DMTs). Among the DMTs are interferons (IFNs), which are cytokines responsible for controlling the activity of the immune system, exerting immunomodulatory, antiviral, and antiproliferative activities. IFN-beta (IFN-β) is the first-choice drug used to treat relapsing-remitting MS. However, the administration of IFN-β causes numerous painful adverse effects, resulting in lower adherence to the treatment. Therefore, this study aimed to investigate the headache and flu-like pain symptoms observed after IFNβ injection in MS patients using a systematic review and meta-analysis of randomised controlled trials. The search of research databases identified 2370 articles. Nine articles were included (three involving IFNβ-1b and six involving IFNβ-1a). All studies included in the meta-analysis had a low risk of bias. Headache and flu-like pain symptoms frequency increased in MS patients treated with IFN-β. Thus, the adverse effects of headache and flu-like pain symptoms appear to be linked to IFN-β treatment in MS. The protocol of the study was registered in the Prospective International Registry of Systematic Reviews.

scholarly journals Digital Health Interventions for the Prevention of Cardiovascular Disease: A Systematic Review and Meta-analysis

2015 ◽  
Vol 90 (4) ◽  
pp. 469-480 ◽  
Author(s):  
R. Jay Widmer ◽  
Nerissa M. Collins ◽  
C. Scott Collins ◽  
Colin P. West ◽  
Lilach O. Lerman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Digital Health ◽  
Meta Analysis ◽  
Health Interventions ◽  
Prevention Of Cardiovascular Disease

scholarly journals Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis

2019 ◽  
Vol 21 (1) ◽  
pp. e298 ◽  
Author(s):  
Alline M Beleigoli ◽  
Andre Q Andrade ◽  
Alexandre G Cançado ◽  
Matheus NL Paulo ◽  
Maria De Fátima H Diniz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Digital Health ◽  
Meta Analysis ◽  
Health Interventions ◽  
Obese Adults ◽  
Web Based ◽  
Lifestyle Habit

scholarly journals Age at menarche and risk of multiple sclerosis (MS): a systematic review and meta-analysis

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amirreza Azimi ◽  
Sara Hanaei ◽  
Mohammad Ali Sahraian ◽  
Mehdi Mohammadifar ◽  
Sreeram V. Ramagopalan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Odds Ratio ◽  
Case Reports ◽  
Meta Analysis ◽  
Final Analysis ◽  
Age At Menarche ◽  
Significant Heterogeneity ◽  
Control Groups ◽  
And Control

Abstract Background Some studies have looked at the age at menarche and risk of Multiple Sclerosis (MS).We aimed to conduct a systematic review and meta-analysis to estimate a pooled odds ratio of developing MS by increasing age at menarche. Methods We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Ovid, google scholar and gray literature (references of references, congress abstracts) up to 10th April 2019. Results The literature search found 312 articles. After eliminating duplicates, reviews, case reports and trials, 18 articles remained. Three articles were ultimately included in the final analysis. Two studies were from Iran, and one from Canada. The pooled odds ratio (OR) for increasing 1 year of age at menarche was 0.88 (95% CI:0.82-0.94), with no significant heterogeneity (I2 = 49%, p = 0.1). Mean age at menarche was significantly different between case and control groups (mean difference = − 0.22, 95% CI = -0.42,-0.02). Conclusion The result of this systematic review showed that the risk of MS decreases by increasing age at menarche.

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