36P Critical reading of a meta-analysis of clinical trials

Nony, Patrice; Cucherat, Michel; Haugh, Margaret; Fareh, Samir; Boissel, Jean-Pièrre

doi:10.1016/0197-2456(94)90164-3

Cited by 8 publications

(14 citation statements)

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“…Comprehensive searching helped avoid bias related to using easy-to-locate primary research with larger effect sizes. 89,90,96,105 Publication bias was addressed to the extent possible by including both unpublished and published studies. 93 Small-sample studies, which may be underpowered, were included because meta-analyses do not utilize p values for determining effect sizes.…”

Section: Methodsmentioning

confidence: 99%

Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis

Conn

Ruppar

Enriquez

et al. 2016

Research in Social and Administrative Pharmacy

104

135

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Background Inadequate medication adherence is a pervasive, under-recognized cause of poor health outcomes. Many intervention trials designed to improve medication adherence have targeted adults with adherence problems. No previous reviews have synthesized the effectiveness of medication adherence interventions focused on subjects with medication adherence difficulties. Objective This systematic review and meta-analysis synthesized findings from medication adherence intervention studies conducted among adults with medication adherence difficulties. Methods Primary research studies were eligible for inclusion if they tested an intervention designed to increase medication adherence among adults with documented adherence difficulties and reported medication adherence behavior outcomes. Comprehensive search strategies of 13 computerized databases, author and ancestry searches, and hand searches of 57 journals were used to locate eligible primary research. Participant demographics, intervention characteristics, and methodological features were reliably coded from reports along with medication adherence outcomes. Effect sizes for outcomes were calculated as standardized mean differences, and random effects models were used to estimate overall mean effects. Exploratory dichotomous and continuous variable moderator analyses were employed to examine potential associations between medication adherence effect size and sample, intervention, and methodological characteristics. Results Data were extracted from 53 reports of studies involving 8,243 individual primary study participants. The overall standardized mean difference effect size for treatment vs. control subjects was 0.301. For treatment pre- vs. post-intervention comparisons, the overall effect size was 0.533. Significantly larger effect sizes were associated with interventions incorporating prompts to take medications than interventions lacking medication prompts (0.497 vs. 0.234). Larger effect sizes were also found for interventions that linked medication taking with existing habits compared to interventions that did not (0.574 vs. 0.222). Effect sizes were largest among studies that measured adherence by pill counts or electronic event monitoring systems. Analysis of study design features identified several potential risks of bias. Statistically significant publication bias was detected, but adherence effect sizes were not significantly associated with other risks of bias. Conclusions These findings document that interventions targeting individuals with medication adherence problems can have modest but significant effects on medication-taking behavior. The findings support the use of behavioral strategies such as prompts and linking medications to habits to increase medication adherence in adults with adherence challenges. Face-to-face interventions appear to be critical for patients who have experienced past problems with medication adherence.

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Section: Methodsmentioning

confidence: 99%

Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis

Conn

Ruppar

Enriquez

et al. 2016

Research in Social and Administrative Pharmacy

104

135

View full text Add to dashboard Cite

show abstract

“…To avoid introducing bias by including only easy-to-locate studies that may have larger effect sizes, comprehensive search strategies were employed [25, 41, 42]. This strategy permitted identification of eligible unpublished as well as published studies, which minimized inflation of overall effect sizes due to publication bias.…”

Section: Methodsmentioning

confidence: 99%

Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

et al. 2015

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This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

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“…Diverse search strategies were used to limit the bias introduced by narrow searches (Conn, Isamaralai et al, 2003; Nony, Cucherat, Haugh, & Boissell, 1995). A reference librarian performed computerized searches in 11 databases (MEDLINE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts International, PsychInfo, SportDiscus, HealthStar, Clinical Evidence, Scopus, DARE, ABI/Inform, Cumulative Index to Nursing & Allied Health Literature).…”

Section: Methodsmentioning

confidence: 99%

Meta-analysis of Quality-of-Life Outcomes From Physical Activity Interventions

2009

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Background Interventions to increase physical activity among chronically ill adults are intended to improve quality of life as well as reduce disease complications or slow disease progression. Objective This meta-analytic review integrates quality-of-life outcomes from primary research studies testing interventions to increase physical activity among adults with chronic illness. Methods Extensive literature searching strategies were employed to locate published and unpublished primary research testing physical activity interventions. Results were coded for studies that had at least 5 participants with chronic illness. Fixed- and random-effects meta-analytic procedures included moderator analyses. Results Eighty-five samples from 66 reports with 7,291 subjects were synthesized. The mean quality-of-life effect size for two-group comparisons (treatment vs. control) was 0.11 (higher mean quality-of-life scores for treatment subjects than for control subjects). The treatment group pre-post comparison effect size was 0.27 for quality of life. Heterogeneity was modest in two-group comparisons. Most design and sample attributes were unrelated to intervention effects on quality of life. Studies that exclusively used supervised center-based exercise reported larger quality-of-life improvements than studies that included any educational-motivational content. Effect sizes were larger among unpublished and unfunded studies. The effect size for physical activity did not predict the quality-of-life effect size. Discussion Subjects experience improved quality of life from exposure to interventions designed to increase physical activity, despite considerable heterogeneity in the magnitude of the effect. Future primary research should include quality-of-life outcomes so that patterns of relationships among variables can be further explored.

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36P Critical reading of a meta-analysis of clinical trials

Cited by 8 publications

References 0 publications

Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis

Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis

Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

Meta-analysis of Quality-of-Life Outcomes From Physical Activity Interventions

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