Many studies were of low quality, lacking rigorous methodology, adequate sample size, randomisation and controls, presenting a risk of bias, which means that the results must be interpreted with caution. Lastly, the majority of studies in this systematic review used the 8-item eHEALS to assess eHL levels after interventions. This is consistent with previous systematic reviews, which suggest that eHEALS is a favoured scale because of its short length, ease of administration and simple questions 25. Of the studies included in this review, only one 48 adopted a more recent scale, choosing the eHLQ which takes into account people’s interactions with digital health services and different stakeholders 18, 63. Thus, the use of eHEALS by most studies considered may not have fully reflected current eHealth Literacy skills due to its outdated nature.
Systematic review
No evidence of global inconsistency was suggested for any endpoint, while a minor deviation detected in the local tests of inconsistency for the complications outcome downgraded certainty ratings for one comparison. To reduce trial level risk of bias, trialists will need to focus on improving blinding of personnel and participants, while ensuring outcome data are complete. Designs need to be adequately powered to detect meaningful differences in outcomes, particularly health related quality of life and physical recovery.
- The first trial has finished enrolling patients and results are expected to be published in March of 2025.
- It is also important to consider whether appropriate analyses were conducted (that is, for cluster design, analyses of sample size, power, and effect size should be performed on clusters – as the unit of randomisation – rather than individuals).
- While sex differences in pre-ICU and ICU care may have contributed to the higher mortality observed in women, early withdrawal of life-sustaining therapy (WLST) could also play a role, particularly in OHCA patients, where women consistently showed higher mortality rates from the first day of ICU admission onwards.
- The responses were categorized as Yes/No/don’t know, depending on the nature and scope of the question.The questionnaire was validated using Lawshe’s technique for content validation 30.
- As noted in a recent systematic review and meta-analysis by Kim et al., which aimed to determine whether an individual’s level of eHL affects actual health-related behaviour, eHL may mediate the process by which health-related information drives health-related behavior change 56.
- A qualitative method of data collection where participant’s views are elicited via verbal interviews.
Cohort studies
First and more generally, in line with previous systematic reviews and meta-analyses 17, 24, our findings supported the effectiveness of eHL interventions, as participants showed a mean increase in eHEALS scores of over five points following the eHL interventions and over three points higher when compared to usual care. This demonstrated that such interventions are an effective strategy for increasing knowledge, comfort, and perceived ability to locate, evaluate, and apply electronic health information to health problems across different population groups. In addition, compared to previous studies, we further investigated the potential influence of age and eHL at baseline on the effectiveness of eHL interventions. While no significant association was observed for age, we found that interventions were more effective for participants with lower eHL at baseline.
Quality appraisal of interrupted time series
However, previous studies have highlighted that sober house unjustified early WLST after cardiac arrest is common, with women being particularly at risk 12, 29. In contrast, the absence of significant LOS differences in IHCA non-survivors and a more equalized risk of ICU mortality between sexes suggests a more standardized ICU care in this subgroup, potentially minimizing sex-related variability. While early WLST cannot be entirely excluded as a contributing factor to the higher early ICU mortality observed in women, the shorter ICU LOS in female survivors indicates that factors beyond early WLST, such as differences in ICU care pathways or treatment escalation decisions, may influence outcomes, particularly in OHCA patients. Indeed, sex differences in the provision of ICU treatments were more pronounced in the OHCA subgroup.
- These are trials where participants (or clusters) are randomly allocated to receive either intervention or control.
- Face validity was done by pre-testing the questionnaire among three pharmacists, three nurses and three medical doctors at KSH, Unayzah.
- Design Systematic review with network and component network meta-analyses of randomised controlled trials.
- Pre-post designs allow researchers to examine changes within the same individuals or groups over extended periods of time.
- The participants then arrived in the same groups of five on the same day for exercise testing occurring between 12.30 and 17.00 h.
While sex differences in pre-ICU and ICU care may have contributed to the higher mortality observed in women, early withdrawal of life-sustaining therapy (WLST) could also play a role, particularly in OHCA patients, where women consistently showed higher mortality rates from the first day of ICU admission onwards. The shorter ICU LOS observed in female OHCA non-survivors compared to male OHCA non-survivors may suggest earlier withdrawal of life-sustaining therapy (WLST) in women. Current guidelines recommend postponing prognostication and WLST for at least 72 h after cardiac arrest 28.
Other Trials to Consider
However, it cannot be ruled out that something else might have caused the change, such as unexpected life events or improved access to treatment or social support. A range of routinely collected administrative and clinically generated healthcare data could be used to evaluate the impact of interventions to improve care. However, there is a lack of guidance as to where relevant routine data can be found or accessed and how they can be linked to other data.
Pimrapat Gebert performed the formal statistical analysis of the data provided by the Swiss Society of Intensive Care Medicine and the Federal Statistics Office. Simon A. Amacher, Tobias Zimmermann, Pimrapat Gebert, Pascale Grzonka, Sebastian Berger, Martin Lohri, Valentina Tröster, Ketina Arslani, Hamid Merdji, Catherine Gebhard, Sabina Hunziker, Raoul Sutter, Martin Siegemund and Caroline E. Gebhard interpreted the data, revised the final manuscript and substantially contributed to the inaugural draft. A systematic review can be defined as a summary of the literature that uses explicit and systematic methods to identify, appraise and summarise the literature according to predetermined criteria. If this description is not present, it is not possible to make a thorough evaluation of the quality of the review. These are trials where participants (or clusters) are allocated to receive either intervention or control (or comparison intervention) but https://www.inkl.com/news/sober-house-rules-a-comprehensive-overview the allocation is not randomised – an approach often called a controlled before-and-after (CBA) study. A specific type of interview study (see interview study) where a group of people (usually 6–12) is interviewed by 1 or more facilitators or interviewers.
Pre-Post Study: Definition, Advantages, and Drawbacks
The findings showed, on average, minor differences between treatment comparisons in mean age and the proportion of enrolled women, mainly for comparisons with smaller numbers of studies (appendix 14). In cases where evidence showed intransitivity, we downgraded CINeMA certainty ratings in the indirectness domain (appendix 8). We also noted some variability in observed risk of complications and central values of length of stay, health related quality of life, and physical recovery in the usual care group (appendix 14, along with results of prespecified control group risk (or mean) network meta-regressions mentioned later). Statistical heterogeneity was substantial for length of stay, health related quality of life, and physical recovery; however, none of our a priori specified effect modifiers meaningfully explained this variability. Small study effects may have been present for exercise, nutrition, plus psychosocial and isolated nutritional prehabilitation for complications and length of stay outcomes; isolated exercise for health related quality of life; and exercise, nutrition, plus psychosocial prehabilitation for physical recovery. For all outcomes, prediction intervals suggested that estimated effects may not always be reliably replicated in different clinical scenarios, reflecting potential heterogeneity in treatment response (appendices 15, 16, 17, and 18 for details).
However, multicentre trials that are appropriately powered for high priority outcomes and that have a low risk of bias are required to have greater certainty in prehabilitation’s efficacy. Equally remarkable is the reduction in severe falls estimated from claims data, showing that only 12 home visits are needed to prevent one severe fall. Several systematic reviews have explored the cost-effectiveness of FPPs using cost per quality-adjusted life-year (QALY) gained 30, cost per fall prevented 31, or both 13 Our estimated ICER of 1296 USD per fall prevented is at the lower bound of the 31 economic evaluations of FPPs in the latter review. This is also well below the willingness-to-pay threshold of 5,000 Canadian dollars per fall prevented, as determined in a recent study 32. In this context, it must be remembered that our result relates solely to falls requiring medical treatment, and not to all falls incurred. Firstly, no consultation costs with the family doctor, physio-or occupational therapist were included.