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Results for 'systematic reviews'

Results 1 - 10 of 32

Are acceptance and mindfulness‐based interventions ‘value for money’? Evidence from a systematic literature review

DUARTE Rui, et al
2019

Objectives: Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions. Methods: Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database's inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines. Results: Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made. Conclusion: This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: systematic review and meta-analysis

HUGHES Katie J., et al
2019

Background: exercise therapy is highly recommended for falls prevention in older adults; however, poor exercise adherence may limit treatment effectiveness. Objective: to assess the effectiveness of interventions to improve exercise adherence for community-dwelling adults (aged over 65 years), at risk of falling. Methods: eight databases were searched to identify randomised/quasi-randomised trials. The Capability, Opportunity, Motivation model of behaviour (COM-B) was used to categorise the identified adherence interventions. Studies with similar interventions that provided adherence outcome data per group were analysed to establish pooled intervention effect. Protocol registration with Propsero: (CRD42016033677). Results: of the 20 trials included (n = 4419), five provided data per group for adherence outcome. Meta-analysis of four studies (n = 482), containing interventions exploring the way exercise is delivered, demonstrated significantly better adherence in the intervention group (n = 166 experimental, n = 161 control Fixed effects model (FEM), SMD = 0.48 95% CI [0.26–0.70] P < 0.0001 I2 = 0%, very low GRADE evidence). Within this limited evidence base, interventions using telecommunication and the integration of exercise into activities of daily living appear most promising when delivering exercise at home. Meta-analysis to explore the effect that these interventions to improve adherence had on balance (n = 166 experimental, n = 161 control Random-effects model (REM), SMD = 0.82, 95% CI [−1.20–2.84] P = 0.43 I2 = 52%) and gait (n = 59 experimental, n = 56 control REM, SMD = 0.29, 95% CI [−1.62–2.20] P = 0.77 I2= 48%), found no statistically significant effect. Conclusions: adherence to exercise can be positively influenced; however, insufficient data exists to support any single intervention that also achieves effective outcomes for balance and gait.

Systematic review of community business related approaches to health and social care

McCLEAN Stuart, et al
2019

This systematic review identifies evidence in relation to the impact of community business-related approaches to health and social care on outcomes for its users. In particular, the report asks how effective community businesses are in delivering outcomes for their users. In recent years community businesses which are rooted in a local area and led by the local community have emerged in the wider health and social care market to address factors in local communities that may benefit or harm health and wellbeing. The report demonstrates that the available evidence of varying quality and more research is needed. However, it found that community businesses related approaches such as ‘men’s sheds’ initiatives, village models for older people and community farms impact on a range of health and wellbeing outcomes, These include outcomes for social connectedness, self-esteem, physical health, mental wellbeing and quality of life. It concludes that community businesses deliver benefits for users that could be at least as effective as traditional models of health and social care but more research is needed to provide robust and evidence-based comparisons.

A systematic review to investigate dramatherapy group work with working age adults who have a mental health problem

BOURNE Jane, ANDERSEN-WARREN Madeline, HACKETT Simon
2018

This study investigated the effects of dramatherapy group work with adults between the ages of 18 and 65 years, who have mental health problems. A systematic review was undertaken using a meta-ethnography to synthesise the existing relevant research. Database searches identified 111 records, from which 12 were included in the review. There was a combined total of n = 194 participants from eleven of the studies; plus one study that did not give exact participant numbers. The included studies were either qualitative or mixed method, with a variety of designs: case studies, interviews, focus groups, observations, questionnaires, evaluations, and use of a variety of measurement tools. There was a range of populations, including: adults with intellectual disabilities, adult offenders, community service users, and in-patients. Participants were from a number of different settings. Overall findings were encouraging and included; improvements in social interaction, improved self- awareness, empowerment and social interaction. No negative effects were reported.

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: a systematic review

LOOMAN Wilhelmina Mijntje, HUIJSMAN Robbert, FABBRICOTTI Isabelle Natalina
2019

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

Economic evaluations of falls prevention programs for older adults: a systematic review

OLIJ Branko F., et al
2018

Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.

Occupational therapy fall prevention interventions for community-dwelling older adults: a systematic review

ELLIOTT Sharon, LELAND Natalie E.
2018

Objective: Accidental falls among community-dwelling older adults are preventable and increase the risk of morbidity, hospitalization, and institutionalization. We updated and broadened a 2008 systematic review examining the evidence for the effectiveness of fall prevention interventions in improving fall-related outcomes, occupational performance, quality of life, and health care facility readmissions for community-dwelling older adults., Method: Literature published from 2008 to 2015 from five electronic databases was searched and analysed, Results: Fifty articles met the inclusion criteria and were critically appraised and synthesized-37 provided Level I; 5, Level II; and 8, Level III evidence. Analysis was organized into four intervention themes: single component, multicomponent, multifactorial, and population based. Mixed evidence was found for single-component and multifactorial interventions, strong evidence was found for multicomponent interventions, and moderate evidence was found for population-based interventions., Conclusion: These findings can inform the delivery and integration of fall prevention interventions from acute care to community discharge.

Tackling loneliness: briefing

WHAT WORKS CENTRE FOR WELLBEING
2018

Based on a systematic review of evidence reviews, this briefing summarises the evidence on what works in alleviating loneliness in people aged 55 years and older. A total of 364 reviews were identified and 28 were included in the final review. The review found there is a need for greater clarity on the concept of loneliness and how it differs from social isolation, for both researchers and practitioners. Other key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. Suggestions are made on how to improve the evidence-based on interventions for loneliness. The briefing also provides a case study of Community Webs, a project to reduce loneliness and social isolation of patients presenting to GP practices by mobilising community assets.

An overview of reviews: the effectiveness of interventions to address loneliness at all stages of the life-course

VICTOR Christina, et al
2018

This systematic review of reviews examines the effectiveness of interventions to alleviate loneliness. Searches retrieved 364 evidence reviews for screening. The final review provides a synthesis of 14 reviews and 14 reports identified from the grey literature, focused on assessing interventions to alleviate loneliness. The material included is International and from within the UK. All published and grey literature studies included focus on older people. Key findings show that there is no one-size fits-all approach to alleviating loneliness in older population groups and that tailored approaches are more likely to reduce loneliness. A number of different approaches are being used to alleviate loneliness in older adults. These include: leisure activities; therapies; social and community interventions; educational approaches; befriending; and system-wide activities, such as changing the cultures of care. There was no evidence of approaches doing any harm, however there was a suggestion that some technology-based approaches are not suitable for everyone and could reinforce a sense of social isolation. A wide variety of loneliness measures were used, and the concept of loneliness was not clearly defined, with the terms loneliness and social isolation often used interchangeably. The results from controlled study designs in community settings and care homes showed no effect of interventions on loneliness. However, the review notes that loneliness is seldom reported as a primary outcome in the published literature. The review makes a number of recommendations for policy.

Strategies employed by older people to manage loneliness: systematic review of qualitative studies and model development

KHARICHA Kalpa, et al
2018

Objectives: To (i) systematically identify and review strategies employed by community dwelling lonely older people to manage their loneliness and (ii) develop a model for managing loneliness. Methods: A narrative synthesis review of English-language qualitative evidence, following Economic and Social Research Council guidance. Seven electronic databases were searched (1990–January 2017). The narrative synthesis included tabulation, thematic analysis, and conceptual model development. All co-authors assessed eligibility of final papers and reached a consensus on analytic themes. Results: From 3,043 records, 11 studies were eligible including a total of 502 older people. Strategies employed to manage loneliness can be described by a model with two overarching dimensions, one related to the context of coping (alone or with/in reference to others), the other related to strategy type (prevention/action or acceptance/endurance of loneliness). The dynamic and subjective nature of loneliness is reflected in the variety of coping mechanisms, drawing on individual coping styles and highlighting considerable efforts in managing time, contacting others, and keeping loneliness hidden. Cognitive strategies were used to re-frame negative feelings, to make them more manageable or to shift the focus from the present or themselves. Few unsuccessful strategies were described. Conclusion: Strategies to manage loneliness vary from prevention/action through to acceptance and endurance. There are distinct preferences to cope alone or involve others; only those in the latter category are likely to engage with services and social activities. Older people who deal with their loneliness privately may find it difficult to articulate an inability to cope.

Results 1 - 10 of 32

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