TY - JOUR
T1 - Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults
T2 - systematic review and meta-analysis of complex interventions
AU - Veroniki, Areti Angeliki
AU - Soobiah, Charlene
AU - Nincic, Vera
AU - Lai, Yonda
AU - Rios, Patricia
AU - MacDonald, Heather
AU - Khan, Paul A.
AU - Ghassemi, Marco
AU - Yazdi, Fatemeh
AU - Brownson, Ross C.
AU - Chambers, David A.
AU - Dolovich, Lisa R.
AU - Edwards, Annemarie
AU - Glasziou, Paul P.
AU - Graham, Ian D.
AU - Hemmelgarn, Brenda R.
AU - Holmes, Bev J.
AU - Isaranuwatchai, Wanrudee
AU - Legare, France
AU - McGowan, Jessie
AU - Presseau, Justin
AU - Squires, Janet E.
AU - Stelfox, Henry T.
AU - Strifler, Lisa
AU - Van der Weijden, Trudy
AU - Fahim, Christine
AU - Tricco, Andrea C.
AU - Straus, Sharon E.
PY - 2023/7/24
Y1 - 2023/7/24
N2 - BackgroundChronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.MethodsDesign: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.Eligibility criteria: Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).Information sources: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020.Outcome measures: Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC).Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. Data synthesis: We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.ResultsWe included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I-2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I-2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I-2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I-2 = 21%).ConclusionsKT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.Systematic review registrationPROSPERO CRD42018084810.
AB - BackgroundChronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.MethodsDesign: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.Eligibility criteria: Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).Information sources: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020.Outcome measures: Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC).Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. Data synthesis: We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.ResultsWe included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I-2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I-2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I-2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I-2 = 21%).ConclusionsKT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.Systematic review registrationPROSPERO CRD42018084810.
KW - Sustainability
KW - Knowledge translation
KW - Chronic disease management
KW - Older adults
KW - Integrated knowledge translation
KW - Patient and public involvement
KW - RANDOMIZED CONTROLLED-TRIAL
KW - OBSTRUCTIVE PULMONARY-DISEASE
KW - DEPRESSION CARE MANAGEMENT
KW - SYSTOLIC BLOOD-PRESSURE
KW - CORONARY-HEART-DISEASE
KW - OF-VETERANS-AFFAIRS
KW - SELF-MANAGEMENT
KW - HEALTH-CARE
KW - QUALITY IMPROVEMENT
KW - ATRIAL-FIBRILLATION
U2 - 10.1186/s12916-023-02966-9
DO - 10.1186/s12916-023-02966-9
M3 - (Systematic) Review article
C2 - 37488589
SN - 1741-7015
VL - 21
JO - BMC Medicine
JF - BMC Medicine
IS - 1
M1 - 269
ER -