Behavioral trials in the Arab Gulf States: A scoping review

Abstract

The leading chronic conditions in Arab Gulf States are modifiable by lifestyle change. Available evidence suggests a paucity of experimental studies on these conditions. We aimed to review the published randomized controlled trials on behavioral modification in the Arab Gulf States. Three databases (PubMed, Embase, and Cochrane) were searched for related keywords, and the records were screened for eligible studies; data were abstracted on trial characteristics (e.g. publication year, study population, primary outcome, intervention, control, follow-up, and outcome results), and a quality assessment of the trials was made. A total of 16 trials were eligible; 50% did not provide sample size calculation, and 31% did not designate a primary outcome. A majority of the trials did not explain randomization or allocation concealment (50%), did not blind outcome assessors (69%) or adopt an intention-to-treat analysis (56%); and 82% of trials found a significant intervention effect. More behavioral trials should be conducted overall and specifically for conditions for which there are no trials (e.g. respiratory tract infection and road injury).

Systematic review and pooled analysis of randomized controlled trials in countries of the Gulf Cooperation Council (GCC)

“…This is comparable with the report of Rajab et al 9 in which their studied trials exhibited 54.1% of unclear to high risk of biases combined. On the other hand, the result of blinding of outcome assessment revealed that 25.4% of the analyzed trials exhibited high risk of bias, which is roughly twice as high as the results (13.1%) reported by Rajabet al 9 The result of the current study is relatively in comparable (high and unclear risk combined, 65.3%) with the review of Zhang et al 24 wherein a high rate of RCTs (82.7%) in China provided no information on blinding of either participants or investigators, as well as comparable with the report of Saquib et al 7 in terms of the blinding of outcome assessment. It is evident that inconsistent treatments potentially are provided, participant may behave in a different way, or the outcome is not measured objectively, if the blinding element was violated.…”

“…It is evident that inconsistent treatments potentially are provided, participant may behave in a different way, or the outcome is not measured objectively, if the blinding element was violated. 24,26 The overall risk of bias revealed that 54.4% of the trials was of "high risk" category which is comparable with the result of risk of bias analysis in Saudi Arabian RCTs conducted by Saquib et al 7 Also, both the results of the current study and of Rajab et al 9 revealed that none of the RCTs exhibited "low risk" in the overall assessment. Other studies conducted by Chung et al 14 and Chung and Lee 1 in Korea reported a relatively similar result concerning a very low number to zero RCTs categorized as "low risk" of bias according to CCRBT assessment.…”

“…6 In the Arab Gulf states, the cases of non-communicable diseases and their risk factors were found to have increased over time. 7 This finding suggests the need for experimental research, such as RCTs, to address this alarming concern.…”

The Transcultural Diabetes Nutrition Algorithm: A Middle Eastern Version

“…The benefits of MNT on glycemic control in people with prediabetes and T2D have been well established ( 10 , 12 ), and the cost-effectiveness of MNT has likewise been demonstrated ( 11 ). However, very few trials of lifestyle interventions among people with diabetes have been undertaken in the Gulf States, and those that are available are of questionable quality ( 33 ). Available studies indicate that education and counseling can lead to improved glycemic control (with nutrition counseling) and to weight loss (with physical activity programs) ( 33 ).…”

“…However, very few trials of lifestyle interventions among people with diabetes have been undertaken in the Gulf States, and those that are available are of questionable quality ( 33 ). Available studies indicate that education and counseling can lead to improved glycemic control (with nutrition counseling) and to weight loss (with physical activity programs) ( 33 ).…”