A review of methods for addressing components of interventions in meta-analysis

Πετροπούλου, Μαρία; Efthimiou, Orestis; Rücker, Gerta; Schwarzer, Guido; Furukawa, Toshi A; Pompoli, Alessandro; Koek, Huiberdina L.; Giovane, Cinzia Del; Rodondi, Nicolas; Mavridis, Dimitris

doi:10.1371/journal.pone.0246631

Cited by 26 publications

(40 citation statements)

References 55 publications

(30 reference statements)

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“…Then, they should aim to evaluate the intervention and implement it, if found effective. In addition, our review, showing that there are some narrative differences between effective and ineffective interventions, paved the way for future research and the next potential step can be to do a meta-analysis, using the methods developed for evaluating effects of individual components in complex interventions ( 81 ), to predict what intervention variables are associated with reductions in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nalbant

Hassanein

Lewis

et al. 2022

Front. Public Health

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ObjectivesThis systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions used for managing hypertension and to compare these characteristics with ineffective interventions.Design and MethodThe JBI and the PRISMA guidelines were followed in this systematic review. RCTs conducted among hypertensive adults were included. RCTs reporting at least one of the major components of yoga (i.e., asana, pranayama, and dhyana and relaxation practices) and comparing them with no intervention or any intervention were eligible. Sixteen databases were searched for published and unpublished studies without any date and language restrictions till March 15, 2021.ResultsThe literature search yielded 13,130 records. 34 RCTs (evaluating 38 yoga interventions) met the inclusion criteria. Overall, included studies had low methodological quality mostly due to inadequate reporting. Yoga reduced SBP and DBP compared to a control intervention (MD −6.49 and −2.78; 95CI% −8.94– −4.04 and −4.11– −1.45, respectively). Eighteen, 14 and 20 interventions were effective in improving SBP, DBP, or either, respectively. 13 out of 20 effective interventions incorporated all the 3 major components of yoga and allocated similar durations to each component whereas ineffective interventions were more focused on the asana and duration of asana practice was longer. The most common duration and frequency of effective interventions were 45 min/session (in 5 interventions), 7 days/week (in 5 interventions), and 12 weeks (in 11 interventions) whereas the most common session frequency was 2 days a week (in 7 interventions) in ineffective interventions. Effective interventions were mostly center-based (in 15 interventions) and supervised (in 16 interventions) and this was similar with ineffective interventions.ConclusionDespite the low quality and heterogeneity of included studies, our findings suggest yoga interventions may effectively manage hypertension. The differences between the effective and ineffective interventions suggest that effective yoga interventions mostly incorporated asana, pranayama, and dhyana and relaxation practices and they had a balance between these three components and included regular practice. They were mostly delivered in a center and under supervision. Future studies should consider developing and evaluating an intervention for managing hypertension using the synthesized findings of the effective interventions in this review.Systematic Review Registration[PROSPERO], identifier [CRD42019139404].

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Section: Discussionmentioning

confidence: 99%

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nalbant

Hassanein

Lewis

et al. 2022

Front. Public Health

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“…Subgroup analyses were run when specific subgroups (such as theoretical orientation of psychological interventions, type of delivery agents, dosage density of intervention and type of population) were reported in more than 4 studies. We used meta-regression analysis [ 31 ] to understand the impact of other therapeutic elements of interventions employed in included studies compared with ‘relaxation techniques’. Meta-regression analysis was run when covariates were reported in more than ten studies [ 32 , 33 ].…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of relaxation techniques ‘as an active ingredient of psychological interventions’ to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis

Hamdani

Zill-e-Huma

Zafar

et al. 2022

Int J Ment Health Syst

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Background Adolescent depression and anxiety are among the leading contributors to health burden worldwide. ‘Relaxation Techniques (RTs)’ are a “set of strategies to improve physiological response to stress” and are frequently cited as an active ingredient of trans-diagnostic, psychosocial interventions for scaling-up care for preventing and treating these conditions in adolescents. However, there is a little evidence on the effectiveness of ‘relaxation techniques’ for this age group. Aim As a part of the Wellcome Trust’s Active Ingredients commission, we did a systematic review and meta-analysis to evaluate the effectiveness of RTs to reduce the symptoms of distress, anxiety and depression in young people, aged 14 to 24 years old, globally. Methods We searched 10 academic databases to include 65 Randomized Controlled Trials (RCTs) of relaxation-based interventions for young people with the symptoms of anxiety and depression. Primary outcomes were reduction in symptoms of distress, anxiety and/or depression. We employed the Cochrane risk of bias tool and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines to assess certainty of outcomes pertaining to anxiety, depression and distress. Standardized mean difference was estimated using effect size. Results The analysis of 65 RCTs with 8009 young people showed that RTs were highly effective in treating anxiety (pooled effect size of (Standardized Mean Difference-SMD) − 0.54 (95% CI − 0.69 to − 0.40); moderately effective in reducing distress (SMD = − 0.48, 95% CI − 0.71 to − 0.24) and had only a weak effect on improving depression in young people (SMD = − 0.28 (95% CI − 0.40% to − 0.15). Face-to-face delivered relaxation techniques yielded higher effect size (SMD = − 0.47, 95% CI − 0.64 to − 0.30) compared to online delivery (SMD = − 0.22, 95% CI − 0.48 to 0.04) for anxiety. Conclusion Most of the included studies were from High Income Countries (HICs) and had a high risk of bias. Further high-quality studies with low risk of bias, especially from low resource settings are needed to evaluate the evidence for effectiveness of RTs as an active ingredient of psychological interventions to reduce the symptoms of distress, anxiety and depression in young people.

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“…Subgroup analyses were run when speci c subgroups (such as theoretical orientation of psychological interventions, type of delivery agents, dosage density of intervention and type of population) were reported in more than 4 studies. We used meta-regression analysis (31) to understand the impact of other therapeutic elements of interventions employed in included studies compared with 'relaxation techniques'. Meta-regression analysis was run when covariates were reported in more than ten studies (32,33).…”

Section: Data Analyses Methodsmentioning

confidence: 99%

Effectiveness of Relaxation Techniques ‘as an Active Ingredient of Psychological Interventions’ to Reduce Distress, Anxiety and Depression in Adolescents: A Systematic Review and Meta-Analysis

Hamdani

Huma

Zafar

et al. 2022

Preprint

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BackgroundAdolescent depression and anxiety are the leading contributors to health burden worldwide. ‘Relaxation Techniques (RTs)’ are a “set of strategies to improve physiological response to stress” and are frequently cited as an active ingredient of trans-diagnostic, psychosocial interventions for scaling-up care for preventing and treating these conditions in adolescents. However, there is a little evidence on the effectiveness of ‘relaxation techniques’ for this age group. AimAs a part of the Wellcome Trust’s Active Ingredients commission, we did a systematic review and meta-analysis to evaluate the effectiveness of RTs to reduce the symptoms of distress, anxiety and depression in adolescents, aged 14 to 24 years old, globally. MethodsWe searched 10 academic databases to include 65 Randomized Controlled Trials (RCTs) of relaxation-based interventions adolescents with the symptoms of anxiety and depression. Primary outcomes were reduction in symptoms of distress, anxiety and/or depression. We employed the Cochrane risk of bias tool and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines to assess certainty of outcomes pertaining to anxiety, depression and distress. Standardized mean difference was estimated using effect size. ResultsThe analysis of 65 RCTs with 8009 adolescents showed that RTs were highly effective in treating anxiety (pooled effect size of (Standardized Mean Difference-SMD) -0.54 (95% CI: -0.69 to -0.40); moderately effective in reducing distress (SMD= -0.48, 95% CI: -0.71 to -0.24) and had only a weak effect on improving depression in adolescents (SMD= -0.28 (95% CI: -0.40% to -0.15). Face-to-face delivered relaxation techniques yielded higher effect size (SMD=-0.47, 95% CI: -0.64 to -0.30) compared to online delivery (SMD=-0.22, 95% CI: -0.48 to 0.04) for anxiety. Conclusion Most of the included studies were from High Income Countries (HICs) and had a high risk of bias. Further high-quality studies with low risk of bias, especially from low resource settings are needed to evaluate the evidence for effectiveness of RTs as an active ingredient of psychological interventions to reduce the symptoms of distress, anxiety and depression in adolescents.

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A review of methods for addressing components of interventions in meta-analysis

Cited by 26 publications

References 55 publications

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effectiveness of relaxation techniques ‘as an active ingredient of psychological interventions’ to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis

Effectiveness of Relaxation Techniques ‘as an Active Ingredient of Psychological Interventions’ to Reduce Distress, Anxiety and Depression in Adolescents: A Systematic Review and Meta-Analysis

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