Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis
Introduction Maintaining independence is a primary goal of community health and care services for older people, but there is currently insufficient guidance about which services to implement. Therefore, we aim to synthesise evidence on the effectiveness of community-based complex interventions to su...
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| Format: | Article |
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BMJ Publishing Group
2021-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/2/e045637.full |
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| author | Ram Bajpai Andrew Clegg Joie Ensor John R F Gladman Anne Forster Ridha Ramiz Thomas F Crocker Richard D. Riley Natalie Lam Magda Jordão Eleftheria Patetsini |
| author_facet | Ram Bajpai Andrew Clegg Joie Ensor John R F Gladman Anne Forster Ridha Ramiz Thomas F Crocker Richard D. Riley Natalie Lam Magda Jordão Eleftheria Patetsini |
| author_sort | Ram Bajpai |
| collection | DOAJ |
| description | Introduction Maintaining independence is a primary goal of community health and care services for older people, but there is currently insufficient guidance about which services to implement. Therefore, we aim to synthesise evidence on the effectiveness of community-based complex interventions to sustain independence for older people, including the effect of frailty, and group interventions to identify the best configurations.Methods and analysis Systematic review and network meta-analysis (NMA). We will include randomised controlled trials (RCTs) and cluster RCTs of community-based complex interventions to sustain independence for older people living at home (mean age ≥65 years), compared with usual care or another complex intervention. We will search MEDLINE (1946 to September 2020), Embase (1947 to September 2020), CINAHL (1981 to September 2020), PsycINFO (1806 to September 2020), CENTRAL and clinical trial registries from inception to September 2020, without date/language restrictions, and scan included papers’ reference lists. Main outcomes were: living at home, activities of daily living (basic/instrumental), home-care services usage, hospitalisation, care home admission, costs and cost effectiveness. Additional outcomes were: health status, depression, loneliness, falls and mortality. Interventions will be coded, summarised and grouped. An NMA using a multivariate random-effects model for each outcome separately will determine the relative effects of different complex interventions. For each outcome, we will produce summary effect estimates for each pair of treatments in the network, with 95% CI, ranking plots and measures, and the borrowing of strength statistic. Inconsistency will be examined using a ‘design-by-treatment interaction’ model. We will assess risk of bias (Cochrane tool V.2) and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation for NMA approach.Ethics and dissemination This research will use aggregated, anonymised, published data. Findings will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. They will be disseminated to policy-makers, commissioners and providers, and via conferences and scientific journals.PROSPERO registration number CRD42019162195. |
| format | Article |
| id | doaj-art-295bf5af249146f3a458b646f2c64b5b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-295bf5af249146f3a458b646f2c64b5b2024-11-17T05:00:08ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2020-045637Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysisRam Bajpai0Andrew Clegg1Joie Ensor2John R F Gladman3Anne Forster4Ridha Ramiz5Thomas F Crocker6Richard D. Riley7Natalie Lam8Magda Jordão9Eleftheria Patetsini10lecturer in biostatisticsAcademic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, Bradford, UKassociate professor in biostatisticsprofessor of the medicine of older peopleAcademic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, Bradford, UKSiTRAN, The University of Sheffield, Sheffield, Sheffield, UKAcademic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, Bradford, UKCentre for Prognosis Research, School of Medicine, Keele University, Keele, UKDepartment of Health Sciences, University of York, York, UKAcademic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, Bradford, UKAcademic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, University of Leeds, Bradford, UKIntroduction Maintaining independence is a primary goal of community health and care services for older people, but there is currently insufficient guidance about which services to implement. Therefore, we aim to synthesise evidence on the effectiveness of community-based complex interventions to sustain independence for older people, including the effect of frailty, and group interventions to identify the best configurations.Methods and analysis Systematic review and network meta-analysis (NMA). We will include randomised controlled trials (RCTs) and cluster RCTs of community-based complex interventions to sustain independence for older people living at home (mean age ≥65 years), compared with usual care or another complex intervention. We will search MEDLINE (1946 to September 2020), Embase (1947 to September 2020), CINAHL (1981 to September 2020), PsycINFO (1806 to September 2020), CENTRAL and clinical trial registries from inception to September 2020, without date/language restrictions, and scan included papers’ reference lists. Main outcomes were: living at home, activities of daily living (basic/instrumental), home-care services usage, hospitalisation, care home admission, costs and cost effectiveness. Additional outcomes were: health status, depression, loneliness, falls and mortality. Interventions will be coded, summarised and grouped. An NMA using a multivariate random-effects model for each outcome separately will determine the relative effects of different complex interventions. For each outcome, we will produce summary effect estimates for each pair of treatments in the network, with 95% CI, ranking plots and measures, and the borrowing of strength statistic. Inconsistency will be examined using a ‘design-by-treatment interaction’ model. We will assess risk of bias (Cochrane tool V.2) and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation for NMA approach.Ethics and dissemination This research will use aggregated, anonymised, published data. Findings will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. They will be disseminated to policy-makers, commissioners and providers, and via conferences and scientific journals.PROSPERO registration number CRD42019162195.https://bmjopen.bmj.com/content/11/2/e045637.full |
| spellingShingle | Ram Bajpai Andrew Clegg Joie Ensor John R F Gladman Anne Forster Ridha Ramiz Thomas F Crocker Richard D. Riley Natalie Lam Magda Jordão Eleftheria Patetsini Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis BMJ Open |
| title | Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis |
| title_full | Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis |
| title_fullStr | Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis |
| title_full_unstemmed | Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis |
| title_short | Community-based complex interventions to sustain independence in older people, stratified by frailty: a protocol for a systematic review and network meta-analysis |
| title_sort | community based complex interventions to sustain independence in older people stratified by frailty a protocol for a systematic review and network meta analysis |
| url | https://bmjopen.bmj.com/content/11/2/e045637.full |
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