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Management of frailty: a protocol of a network meta-analysis of randomized controlled trials

BACKGROUND: Frailty is a common syndrome affecting 5–17% of community-dwelling older adults. Various interventions are used to prevent or treat frailty. Given the diversity of singular and multi-faceted frailty interventions, not all of them have been compared in head-to-head studies. Network meta-a...

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Autores principales: Negm, Ahmed M., Kennedy, Courtney C., Thabane, Lehana, Veroniki, Areti-Angeliki, Adachi, Jonathan D., Richardson, Julie, Cameron, Ian D., Giangregorio, Aidan, Papaioannou, Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499023/
https://www.ncbi.nlm.nih.gov/pubmed/28679416
http://dx.doi.org/10.1186/s13643-017-0522-7
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author Negm, Ahmed M.
Kennedy, Courtney C.
Thabane, Lehana
Veroniki, Areti-Angeliki
Adachi, Jonathan D.
Richardson, Julie
Cameron, Ian D.
Giangregorio, Aidan
Papaioannou, Alexandra
author_facet Negm, Ahmed M.
Kennedy, Courtney C.
Thabane, Lehana
Veroniki, Areti-Angeliki
Adachi, Jonathan D.
Richardson, Julie
Cameron, Ian D.
Giangregorio, Aidan
Papaioannou, Alexandra
author_sort Negm, Ahmed M.
collection PubMed
description BACKGROUND: Frailty is a common syndrome affecting 5–17% of community-dwelling older adults. Various interventions are used to prevent or treat frailty. Given the diversity of singular and multi-faceted frailty interventions, not all of them have been compared in head-to-head studies. Network meta-analyses provide an approach to simultaneous consideration of the relative effectiveness of multiple treatment alternatives. This systematic review and network meta-analysis of RCTs aims to determine the comparative effect of interventions targeting the prevention or treatment of frailty. METHOD: We will identify relevant RCTs, in any language and publication date, by a systematic search of databases including MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Central Registry of Controlled Trials (CENTRAL), HealthSTAR, DARE, PsychINFO, PEDro, SCOPUS, and Scielo. Duplicate title and abstract and full-text screening will be performed. Authors will extract data and assess risk of bias (using the Cochrane Risk of Bias tool) of eligible studies. The review interventions will include (1) physical activity only, (2) physical activity with protein supplementation or other nutritional supplementation, (3) psychosocial intervention, (4) medication management, (5) pharmacotherapy, and (6) multi-faceted intervention (defined as an intervention that combine physical activity and/or nutrition with any of the following: (1) psychosocial intervention, (2) medication management, and (3) pharmacotherapy). Our primary outcome is difference in change of physical frailty from baseline measured by a reliable and valid frailty measure. Secondary outcomes and the assessments are (1) cognition, (2) short physical performance battery, (3) any other physical performance measure, (4) treatment cost, (5) quality of life, and (6) any adverse outcome. We will conduct a network meta-analysis using a Bayesian hierarchical model. We will also estimate the ranking probabilities for all treatments at each possible rank for each intervention and will assess the certainty of the estimates of effect using GRADE approach. DISCUSSION: To the best of our knowledge, this will be the first systematic review and network meta-analysis considering the direct and indirect effect of interventions targeting frailty prevention or treatment. Given the established high prevalence and socio-economic burden of frailty, there is an urgent need for a high-quality systematic review to inform evidence-based management of frailty. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2016 CRD42016037465. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-017-0522-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-54990232017-07-10 Management of frailty: a protocol of a network meta-analysis of randomized controlled trials Negm, Ahmed M. Kennedy, Courtney C. Thabane, Lehana Veroniki, Areti-Angeliki Adachi, Jonathan D. Richardson, Julie Cameron, Ian D. Giangregorio, Aidan Papaioannou, Alexandra Syst Rev Protocol BACKGROUND: Frailty is a common syndrome affecting 5–17% of community-dwelling older adults. Various interventions are used to prevent or treat frailty. Given the diversity of singular and multi-faceted frailty interventions, not all of them have been compared in head-to-head studies. Network meta-analyses provide an approach to simultaneous consideration of the relative effectiveness of multiple treatment alternatives. This systematic review and network meta-analysis of RCTs aims to determine the comparative effect of interventions targeting the prevention or treatment of frailty. METHOD: We will identify relevant RCTs, in any language and publication date, by a systematic search of databases including MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Central Registry of Controlled Trials (CENTRAL), HealthSTAR, DARE, PsychINFO, PEDro, SCOPUS, and Scielo. Duplicate title and abstract and full-text screening will be performed. Authors will extract data and assess risk of bias (using the Cochrane Risk of Bias tool) of eligible studies. The review interventions will include (1) physical activity only, (2) physical activity with protein supplementation or other nutritional supplementation, (3) psychosocial intervention, (4) medication management, (5) pharmacotherapy, and (6) multi-faceted intervention (defined as an intervention that combine physical activity and/or nutrition with any of the following: (1) psychosocial intervention, (2) medication management, and (3) pharmacotherapy). Our primary outcome is difference in change of physical frailty from baseline measured by a reliable and valid frailty measure. Secondary outcomes and the assessments are (1) cognition, (2) short physical performance battery, (3) any other physical performance measure, (4) treatment cost, (5) quality of life, and (6) any adverse outcome. We will conduct a network meta-analysis using a Bayesian hierarchical model. We will also estimate the ranking probabilities for all treatments at each possible rank for each intervention and will assess the certainty of the estimates of effect using GRADE approach. DISCUSSION: To the best of our knowledge, this will be the first systematic review and network meta-analysis considering the direct and indirect effect of interventions targeting frailty prevention or treatment. Given the established high prevalence and socio-economic burden of frailty, there is an urgent need for a high-quality systematic review to inform evidence-based management of frailty. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2016 CRD42016037465. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-017-0522-7) contains supplementary material, which is available to authorized users. BioMed Central 2017-07-05 /pmc/articles/PMC5499023/ /pubmed/28679416 http://dx.doi.org/10.1186/s13643-017-0522-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Protocol
Negm, Ahmed M.
Kennedy, Courtney C.
Thabane, Lehana
Veroniki, Areti-Angeliki
Adachi, Jonathan D.
Richardson, Julie
Cameron, Ian D.
Giangregorio, Aidan
Papaioannou, Alexandra
Management of frailty: a protocol of a network meta-analysis of randomized controlled trials
title Management of frailty: a protocol of a network meta-analysis of randomized controlled trials
title_full Management of frailty: a protocol of a network meta-analysis of randomized controlled trials
title_fullStr Management of frailty: a protocol of a network meta-analysis of randomized controlled trials
title_full_unstemmed Management of frailty: a protocol of a network meta-analysis of randomized controlled trials
title_short Management of frailty: a protocol of a network meta-analysis of randomized controlled trials
title_sort management of frailty: a protocol of a network meta-analysis of randomized controlled trials
topic Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499023/
https://www.ncbi.nlm.nih.gov/pubmed/28679416
http://dx.doi.org/10.1186/s13643-017-0522-7
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