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Cover of Challenges in Synthesizing and Interpreting the Evidence From a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Challenges in Synthesizing and Interpreting the Evidence From a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults

Evidence Syntheses/Technology Assessments, No. 94

Investigators: , MD, MCR, , MD, MPH, , MD, MPH, , PhD, , MPH, , MS, and , MD, PhD.

Author Information
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 12-05169-EF-1

Structured Abstract

Purpose:

1) To summarize the results of a systematic review of multifactorial assessment and management interventions to prevent functional decline in older adults for the U.S. Preventive Services Task Force and 2) to describe the methodological challenges in synthesizing and interpreting the review’s findings.

Data Sources:

We used two existing systematic reviews to identify trials published through January 2005 and then searched MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature from 2004 through June 3, 2010. We supplemented searches with suggestions from experts and citations from other publications.

Study Selection:

Two investigators independently reviewed 5,553 abstracts and 208 articles against a set of a priori inclusion and quality criteria. Discrepancies were resolved by consensus. In total, we included 70 fair- to good-quality trials.

Data Extraction:

One investigator abstracted data into evidence tables and a second reviewer checked these data. Activities of daily living (ADLs), instrumental activities of daily living (IADLs), falls, hospitalizations, and mortality were combined using a random effects model; institutionalizations were combined using a fixed effects model. We grouped trials based on the purpose of the trial and country in which the trial was conducted after an extensive investigation of important population, setting, and intervention characteristics.

Data Synthesis:

A subset of rigorous randomized, controlled trials suggests that outpatient multifactorial assessment and management interventions have a statistically significant, albeit small, beneficial effect on measures of functional ability, such as ADL and IADL. However, we were unable to determine the clinical significance of this effect and the overall net benefit of these types of interventions due to heterogeneity amongst studies, including: older adults studied, the broad spectrum and multifactorial nature of interventions evaluated, the suboptimal and inconsistent use of outcomes measured, and the inconsistent and inadequate reporting of data that might allow comparison of populations, interventions, and outcomes across studies.

Conclusions:

This review process illustrated the complexities encountered when synthesizing and interpreting the evidence in geriatric research and methods around reviewing complex interventions and multiple interrelated health outcomes. Based on the methodological challenges of this review, we offer suggestions to researchers on the design, reporting, and analysis of trials that would help address these challenges and allow for better interpretation of evidence in the future.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA-290-2007-10057-I, Task Order No. 3, Prepared by: Oregon Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest2,

Suggested citation:

Lin JS, Whitlock EP, Eckstrom E, Fu R, Perdue LA, Beil TL, Leipzig RM. Challenges in Synthesizing and Interpreting the Evidence From a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults. Evidence Synthesis No. 94. AHRQ Publication No. 12-05169-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; October 2012.

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliation or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850; www​.ahrq.gov

2

3800 North Interstate Avenue, Portland, OR 97227

Bookshelf ID: NBK114219PMID: 23193611

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