Effects of Yoga in Pregnancy on Postpartum Depression: A Systematic Review

Context: Postpartum depression is a common condition, which is managed by antidepressants. Antidepressants are generally considered to be safe during breastfeeding, and the probability of exposure to antidepressants through breast milk is low to very low. Due to the beliefs of breastfeeding women that antidepressants may have side effects on infants, complementary and alternative medicine (CAM) is being investigated to play a role in the management of postpartum depression. Yoga is among the complementary therapies that showed preventive effects against depression in some age and disease groups. The aim of this systematic review was to assess the effects of Yoga intervention on healthy pregnant women and its preventive effects on postpartum depression. Methods: Clinical databases, including Scopus, PubMed, Medlib, Web of Science, Psych Info, and Cochrane Library, as well as Google Scholar, were searched using search keywords, including pregnant women, women, maternal period, yoga, mindfulness, postpartum depression, and depression. Clinical trial, case-control, and cohort articles in English language that assessed the effects of Yoga on postpartum depression in healthy women were reviewed. Among the initial 982 identified studies, five studies (271 subjects) were eligible for the review. Due to the high heterogeneity in the studies, meta-analysis was not performed. Results: One study had medium quality, one study had good quality, and three studies had high quality. Yoga intervention included physical and mindfulness exercises and assessed mood and behavior during pregnancy. The intervention duration ranged between 6 and 24 weeks during pregnancy. In the majority of studies, Yoga intervention reduced postpartum depression and other mental disorders. Conclusions: Yoga may be a beneficial and safe choice in the management of postpartum depression in healthy pregnant women.

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Clinical Manifestation and Maternal Complications and Neonatal outcomes in Pregnant Women with COVID 19: An Update a Systematic Review and Meta-analysis

10.21203/rs.3.rs-27383/v1 ◽

2020 ◽

Author(s):

Marzieh Soheili ◽

Ghobad Moradi ◽

Hamid Reza Baradaran ◽

Maryam Soheili ◽

Yousef Moradi

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

English Language ◽

Meta Analysis ◽

Clinical Manifestations ◽

Fetal Distress ◽

Cochrane Library ◽

Maternal Complications ◽

Pooled Prevalence ◽

Co Morbidity

Abstract Background Existing evidence indicates that the risk of obstetric and perinatal outcomes is higher in women with coronavirus infection. outbreaks suggest that pregnant women and their fetuses are particularly susceptible to poor outcomes. However, there is little known about pregnancy related complications and co-morbidity in this group of women. Therefore, this, systematic review and meta-analysis performed in order to find out whether COVID-19 may cause different manifestations and outcomes in antepartum and postpartum period or not.Methods We searched databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid and CINHAL to retrieve all articles reporting the prevalence of maternal and neonatal complications, in addition clinical manifestations, in pregnant women with COVID 19 that published with English language from January to April 2020. Results 11 studies with total 177 pregnant women included in this systematic review.Results show that the pooled prevalence of neonatal mortality, lower birth weight, stillbirth, premature birth, and intrauterine fetal distress in women with COVID 19 were 4% (95% Cl: 1 - 9%), 21% (95% Cl: 11 – 31%), 2% (95% Cl: 1 - 6%), 28% (95% Cl: 12 - 44%), and 15% (95% Cl: 4 - 26%); respectively. Also the pooled prevalence of fever, cough, diarrhea and dyspnea were 56% (95% Cl: 30 - 83%), 30% (95% Cl: 21 - 39%), 9% (95% Cl: 2 - 16%), and 3% (95% Cl: 1 - 6%) in the pregnant women with COVID-19.Conclusion According to this systematic review and meta-analysis, the pregnant women with COVID-19 with or without pneumonia, are at a higher risk of pre-eclampsia, preterm birth, miscarriage and cesarean delivery. Furthermore, the risk of LBW and intrauterine fetal distress seems increased in neonates.

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Remotely delivered interventions to support women with symptoms of anxiety in pregnancy: a mixed methods systematic review of quantitative and qualitative evidence (Preprint)

10.2196/preprints.28093 ◽

2021 ◽

Author(s):

Kerry Evans ◽

Stefan Rennick-Egglestone ◽

Serena Cox ◽

Yvonne Kuipers ◽

Helen Spiby

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Quantitative Data ◽

Meta Analysis ◽

Treatment Options ◽

Social Science Citation Index ◽

Cochrane Library ◽

Access To Treatment ◽

On Line ◽

In Pregnancy

BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low level psychological therapy is recommended as first line treatment options for women with mild to moderate anxiety, with the aim to prevent an escalation of symptoms and provide women with coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support for women in pregnancy and provide a cost-effective, flexible and timely solution. OBJECTIVE To identify and evaluate remotely delivered, digital or on-line interventions to support women with symptoms of anxiety in pregnancy. METHODS A mixed method systematic review following a convergent segregated approach to synthesise the qualitative and quantitative data. The ACM Digital Library, AMED, ASSIA, CRD, CENTRAL, the Cochrane Library, CINAHL, EMBASE, HTA, IEEE Xplore, JBI, Maternity and Infant Care, Medline, PsycINFO and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research including pregnant women which evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women’s views, feedback and opinions were included in the review. RESULTS Three qualitative and 14 were quantitative studies included. Populations included a general antenatal population, and pregnant women with anxiety and depression, fear of childbirth, insomnia and pre-term labour. Interventions included CBT, Problem Solving, Mindfulness and Educational designs. Most interventions were delivered via on-line platforms and 8 included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found for I-CBT and facilitated interventions there was observed beneficial effect in relation to the reduction of anxiety scores (SMD=-0.49; 95% CI=-0.75 to -0.22; SMD=-0.48; 95% CI=-0.75 to -0.22). However, due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesised findings from quantitative and qualitative data found some evidence to suggest that interventions are more effective when women are motivated to maintain regular participation in interventions. Participation may be enhanced by providing regular contact with therapists, targeting interventions for women with anxiety symptoms; providing peer support forums; including components of relaxation and cognitive based skills; and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS There is limited evidence to suggest that pregnant women may benefit from remotely delivered interventions. The synthesised findings highlighted components of interventions which may improve the effectiveness and acceptability of remotely delivered interventions. These include providing women with contact with a therapist, healthcare professional or peer community. Women may be more motivated to complete interventions which are perceived as relevant or tailored to their needs and situations. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.

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Duration of palliative care before death in international routine practice: a systematic review and meta-analysis

BMC Medicine ◽

10.1186/s12916-020-01829-x ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Roberta I. Jordan ◽

Matthew J. Allsop ◽

Yousuf ElMokhallalati ◽

Catriona E. Jackson ◽

Helen L. Edwards ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

English Language ◽

Meta Analysis ◽

Service Evaluation ◽

Research Literature ◽

Cochrane Library ◽

Routine Practice ◽

Middle Income ◽

Palliative Care Services

Abstract Background Early provision of palliative care, at least 3–4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature. Methods We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker’s criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death). Results One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as ‘good’ quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries. Conclusions Duration of palliative care is much shorter than the 3–4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.

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Prevalence of Syphilis among Pregnant Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2019/4562385 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Siraj Hussen ◽

Birkneh Tilahun Tadesse

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Screening Program ◽

Meta Analysis ◽

Relevant Literature ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Forest Plot ◽

Pooled Prevalence ◽

Sub Saharan

Objective. Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design. Systematic review and meta-analysis. Data Sources. Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction. Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results. The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion. This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.

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Iron stores in pregnant women with sickle cell disease: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026497 ◽

2019 ◽

Vol 9 (9) ◽

pp. e026497 ◽

Cited By ~ 2

Author(s):

Desmond Aroke ◽

Benjamin Momo Kadia ◽

Tsi Njim

Keyword(s):

Systematic Review ◽

Sickle Cell Disease ◽

Iron Deficiency ◽

Pregnant Women ◽

Sickle Cell ◽

Iron Deficiency Anaemia ◽

Meta Analysis ◽

Cochrane Library ◽

Cell Disease ◽

Deficiency Anaemia

IntroductionSickle cell disease (SCD) is the most common inherited disease worldwide. The greatest disease burden is seen in sub-Saharan Africa. Early diagnosis and improved care of people living with SCD have led to an increase in the number of women with SCD reaching the reproductive age. Iron deficiency anaemia remains the most common cause of anaemia in pregnancy, affecting 51%–63% of pregnancies in Africa. However, the unavailability of guidelines on supplementation of iron in this pregnant subpopulation often leaves clinicians in a fix. We propose to conduct the first systematic review and possibly a meta-analysis on the prevalence, associated factors and maternal/fetal outcomes of iron deficiency anaemia among pregnant women with SCD.Methods and analysisWe will search the following electronic databases for studies on the iron status of pregnant women with SCD: PubMed, MEDLINE, EMBASE, Google Scholar, African Journals Online, African Index Medicus, Popline and the Cochrane Library. After the selection of eligible studies from the search output, review of full text, data extraction and data synthesis will be performed. Studies obtained from the review shall be evaluated for quality, risk of bias and heterogeneity. Appropriate statistical methods shall be used to pool prevalence estimates for matching studies globally and in subpopulations. This protocol has been reported as per the 2015 guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.Ethics and disseminationThere is no requirement for ethical approval as the proposed study will use published data. The findings of this study will be published in a peer-reviewed journal and will be presented at conferences.Trial registration numberCRD42018109803.

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Adverse effects of ADT on cognitive function and dementia for men with prostate cancer: A meta-analysis and systematic review.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.150 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 150-150 ◽

Cited By ~ 1

Author(s):

Maxine Sun ◽

Alexander Cole ◽

Nawar Hanna ◽

Adam S. Kibel ◽

Toni K. Choueiri ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Cognitive Function ◽

Cognitive Decline ◽

English Language ◽

Meta Analysis ◽

Pooled Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

The Impact

150 Background: Nearly 50% of men diagnosed with prostate cancer may receive treatment with some form of androgen deprivation therapy (ADT). While some side effects of ADT are well acknowledged, the specific impact of ADT on cognitive function is uncertain. Our objective was to perform a systematic review and meta-analysis assessing the impact of ADT on overall cognitive decline, and the risks of Alzheimers, Parkinson’s disease. Methods: Relevant studies were identified through search of English language articles indexed in PubMed Medline, PsycINFO, Cochrane Library and Web of Knowledge/Science. First, we assessed rates of cognitive decline in five cohorts from three studies. Second, we assessed rates of Alzheimer’s or Parkinson disease using three large retrospective studies. A pooled-analysis was conducted using a meta-analysis. Weighted averages were reported as odds ratios (OR) with 95% confidence intervals (CI) using RevMan and a DerSimonian and Laird random-effects model. The heterogeneity test was measured using the Q-Mantel-Haenszel ( P< 0.10 was considered of significant heterogeneity). Results: With respect to overall cognitive decline (defined as scoring 1.5 standard deviations [SD] in two or more objective cognitive tests), patients receiving ADT had higher odds of overall cognitive decline than patients with prostate cancer not treated with ADT or health controls (OR: 2.03, 95% CI: 1.42–2.90). Furthermore, men with a history of ADT for prostate cancer had higher odds of developing Alzheimer’s and Parkinson dementia compared to men with prostate cancer not treated with ADT (OR: 1.32, 95% CI: 1.27–1.37). Conclusions: Men receiving ADT for prostate cancer performed significantly worse on measures of overall cognitive function. Additionally, results from the three large observational trials included suggest men exposed to ADT for prostate cancer have higher rates of Parkinson/Alzheimer’s compared to men without ADT.

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Reporting quality of systematic review abstracts in articles hand and wrist pathology: a review

Australasian Journal of Plastic Surgery ◽

10.34239/ajops.v2n2.141 ◽

2019 ◽

Vol 2 (2) ◽

pp. 50-57

Author(s):

Amanda Yang Shen ◽

Robert S Ware ◽

Tom J O'Donohoe ◽

Jason Wasiak

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

English Language ◽

Meta Analysis ◽

Reporting Quality ◽

Cochrane Library ◽

Annual Basis ◽

Cochrane Reviews ◽

Abstract Reporting

Background: An increasing number of systematic reviews are published on an annual basis. Although perusal of the full text of articles is preferable, abstracts are sometimes relied upon to guide clinical decisions. Despite this, the abstracts of systematic reviews have historically been poorly reported. We evaluated the reporting quality of systematic review abstracts within hand and wrist pathology literature. Methods: We searched MEDLINE®, EMBASE and Cochrane Library from inception to December 2017 for systematic reviews in hand and wrist pathology using the 12-item PRISMA-A checklist to assess abstract reporting quality. Results: A total of 114 abstracts were included. Most related to fracture (38%) or arthritis (17%) management. Forty-seven systematic reviews (41%) included meta-analysis. Mean PRISMA-A score was 3.6/12 with Cochrane reviews having the highest mean score and hand-specific journals having the lowest. Abstracts longer than 300 words (mean difference [MD]: 1.43, 95% CI [0.74, 2.13]; p <0.001) and systematic reviews with meta-analysis (MD: 0.64, 95% CI [0.05, 1.22]; p = 0.034) were associated with higher scores. Unstructured abstracts were associated with lower scores (MD: –0.65, 95% CI [–1.28, –0.02]; p = 0.044). A limitation of this study is the possible exclusion of relevant studies that were not published in the English language. Conclusion: Abstracts of systematic reviews pertaining to hand and wrist pathology have been suboptimally reported as assessed by the PRISMA-A checklist. Improvements in reporting quality could be achieved by endorsement of PRISMA-A guidelines by authors and journals, and reducing constraints on abstract length.

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The relationship between delivery mode and postpartum depression: a systematic review and meta-analysis

10.21203/rs.3.rs-30402/v1 ◽

2020 ◽

Author(s):

Yu-Xin Chen ◽

Pei Zhao ◽

ZhuLiduzi Jiesisibieke ◽

Pei-En Chen ◽

Tao-Hsin Tung ◽

...

Keyword(s):

Systematic Review ◽

Postpartum Depression ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Depression Symptoms ◽

Delivery Mode ◽

Significant Difference ◽

The Relationship

Abstract Background: To assess the relationship between delivery mode and postpartum depression and to examine whether cesarean section (CS) has a higher risk of postpartum depression than vaginal delivery (VD). Methods: We searched the Cochrane Library, PubMed, and EMBASE from inception to 30 April 2019 without language limitations. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreements were resolved by discussion with a third author. We used the Newcastle-Ottawa Scale and GRADE methods to assess the quality of the included studies and evidences. This study had four included cohort studies data and carried out fixed-effect model meta-analysis. Results: The findings demonstrated a significant difference in the risk of postpartum depression between CS and VD. Compared with the control group, the CS group was associated with a higher prevalence of postpartum depression symptoms (Risk Ratio =1.29; 95% CI: 1.11-1.51). Conclusions: The findings supported a relationship between delivery mode and postpartum depression. Particularly, we found that CS is associated with a higher risk of postpartum depression. Therefore, we ought to encourage pregnant women who are without medical indication of CS to select VD.r Trial registration: The protocol of this systematic review was registered in the PROSPERO under the number CRD42019148154.

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Prevalence and predictors of self-medication among university students in Ethiopia: a systematic review and meta-analysis

Journal of Pharmaceutical Policy and Practice ◽

10.1186/s40545-021-00391-y ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Getahun Fetensa ◽

Tadesse Tolossa ◽

Werku Etafa ◽

Ginenus Fekadu

Keyword(s):

Systematic Review ◽

University Students ◽

English Language ◽

Meta Analysis ◽

Cochrane Library ◽

Self Medication ◽

Manual Search ◽

Global Issue ◽

Pooled Prevalence ◽

Unpublished Studies

Abstract Background Self-medication of medicines is a global issue particularly among those with good access and familiarity with medications such as university students. It has a significant impact on drug resistance and medication-related complications. There are limited and inconsistent studies on self-medication practices in Ethiopia. The aim of this systematic review and meta-analysis was to estimate the pooled prevalence of self-medication and its predictors among university students in Ethiopia. Methods A systematic review and meta-analysis was conducted to assess the prevalence and predictors of self-medication among university students in Ethiopia. Published articles from various electronic databases such as Medline, Hinari, Pub Med, Cochrane library, and the Web of Science were accessed. In addition, a manual search was performed including Google Scholar. Searching of articles were searched from January 1st to February 1, 2021. All observational studies conducted among university students in English language were included in the review. Two reviewers independently assessed articles before inclusion in the final review using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) instrument for critical appraisal. The I2 test was used to assess heterogeneity. Since the included studies exhibited high heterogeneity, a random-effects model was used to estimate the pooled prevalence of self-medication. Results We found of 812 published and unpublished studies in our search. Finally, 31 full-text studies were reviewed, and 13 studies fulfilled the inclusion criteria and were included in the final meta-analysis. A total of 5377 study respondents from 13 studies were included in the study. The results of our study revealed that the pooled prevalence of self-medication among university students was 49.41% (95% CI 38.67%, 60.13%). The included studies had a sample size ranging from 250 to 792 with the lowest prevalence (19.87%) of self-medication from the University of Gondar, whereas the highest prevalence (77.01%) was recorded in a study conducted at Arsi University. From the pooled estimation, there was a significant association between self-medication and income (OR = 0.67: 95% CI 0.55–0.80). However, the association between self-medication and year of study and sex of participants was insignificant. Conclusion The pooled prevalence of self-medication among Ethiopian university students was relatively high compared to the current global health problem with an increase in anti-microbial resistance. Health professionals and concerned bodies should pay attention to raising awareness regarding the consequences of using medications without prescription.

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The effectiveness of mHealth interventions on postpartum depression: A systematic review and meta-analysis

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20917816 ◽

2020 ◽

pp. 1357633X2091781

Author(s):

Chuqing Zhou ◽

Hua Hu ◽

Chunyi Wang ◽

Ziyu Zhu ◽

Gengchen Feng ◽

...

Keyword(s):

Systematic Review ◽

Postpartum Depression ◽

Large Scale ◽

Meta Analysis ◽

Clinical Care ◽

Intervention Group ◽

Depression Scale ◽

Clinical Effectiveness ◽

Well Being ◽

Cochrane Library

Introduction Postpartum depression (PPD) is a common psychiatric condition during the postnatal period that negatively impacts the well-being of both the mother and her infant. This study describes a systematic review and preliminary meta-analysis to assess the efficacy of mobile health (mHealth) interventions, which is defined as the use of portable electronic devices to support public health and medical practice, in addressing depressive symptoms among postpartum women. Methods Databases including PubMed, PsycINFO, the Cochrane Library, Embase and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) assessing the effectiveness of mHealth interventions on PPD from database inception to December 2019. Results The initial search identified 754 studies, of which, 11 studies fulfilled the inclusion criteria. These studies evaluated four types of distinct mHealth interventions and involved 2424 participants across six countries. Pooled results demonstrated that compared to the controls, the Edinburgh Postnatal Depression Scale score decreased in the mHealth intervention group (mean difference: –1.09, 95% confidence interval: –1.39 to –0.79). Discussion Our study suggested that mHealth interventions may be a promising tool to complement routine clinical care in the prevention and treatment of PPD, but the clinical effectiveness of mHealth interventions needs to be better established. While most studies focused on telephone-based interventions, recent researches have also suggested the superiority and effectiveness of short messaging service (SMS) and smartphone applications, but the exact efficacy needs further evaluation. Therefore, more high-quality RCTs on app-based and SMS-based interventions are needed before the large-scale roll-out of these interventions in clinical practice.

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