Effectiveness of interventions to improve antidepressant medication adherence: a systematic review

Non-adherence to antidepressant medications is a significant barrier to the successful treatment of depression in clinical practice. This review aims to systematically assess the effectiveness of interventions for improving antidepressant medication adherence among patients with unipolar depression, and to evaluate the effect of these interventions on depression clinical outcomes. MEDLINE, PsycINFO and EMBASE databases were searched for English-language randomised controlled trials published between January 1990 and December 2010 on interventions to improve antidepressant adherence. The impact of interventions on antidepressant medication adherence (compliance and persistence) and depression clinical outcomes was evaluated. Data concerning the quality of the included studies were also extracted. Twenty-six studies met the inclusion criteria. Interventions were classified as educational, behavioural and multifaceted interventions. A total of 28 interventions were tested, as two studies investigated two interventions each. Sixteen (57%) of the 28 interventions showed significant effects on antidepressant adherence outcomes, whereas 12 (43%) interventions demonstrated significant effects on both antidepressant adherence and depression outcomes. The interventions which showed significant improvement in outcomes were primarily multifaceted and complex, with proactive care management and involvement of mental health specialists. The most commonly used elements of multifaceted interventions included patient educational strategies, telephone follow-up to monitor patients' progress, as well as providing medication support and feedback to primary care providers. Overall, educational interventions alone were ineffective in improving antidepressant medication adherence. In conclusion, improving adherence to antidepressants requires a complex behavioural change and there is some evidence to support behavioural and multifaceted interventions as the most effective in improving antidepressant medication adherence and depression outcomes. More carefully designed and well-conducted studies are needed to clarify the effect of interventions in different patient populations and treatment settings.     

Effectiveness of interventions for secondary Raynaud's phenomenon: a systematic review

Huisstede BM, Hoogvliet P, Paulis WD, van Middelkoop M, Hausman M, Coert JH, Koes BW. Effectiveness of interventions for secondary Raynaud's phenomenon: a systematic review.

Objectives

To present an evidence-based overview of the effectiveness of (non)surgical symptomatic interventions to treat secondary Raynaud's phenomenon (RP).

Data Sources

The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched for relevant systematic reviews and randomized controlled trials (RCTs).

Study Selection

Two reviewers independently applied the inclusion criteria to select potential studies.

Data Extraction

Two reviewers independently extracted data and assessed the methodologic quality.

Data Synthesis

If pooling of data was not possible, a best-evidence synthesis was used to summarize the results. Of the 5 reviews and 19 RCTs included, 1 RCT studied acupuncture and another RCT reported on percutaneous radiofrequency thoracic sympathectomy. All others concentrated on the effectiveness of drugs (oral or intravenous [IV]). It appeared that calcium channel blockers significantly reduce the frequency and severity of Raynaud attacks, and are therefore effective in the treatment of secondary RP. Iloprost (oral and IV) was also found to be effective. Limited evidence was found for atorvastatin. For other traditional and more recently discovered interventions, no clear favorable effects were found.

Conclusions

This review shows that there is clear evidence in favor of calcium channel blockers and iloprost (oral and IV) to treat secondary RP. For all other interventions, only limited, conflicting, or no evidence was found. More high-quality, well-designed RCTs are needed in this field, especially for new interventions based on recent knowledge about the pathophysiology of secondary RP.     

Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review

OBJECTIVE: To systematically review the impact of interventions by community pharmacists on patients' adherence with chronic medication. DATA SOURCES: A MEDLINE search (1966-November 30, 2003) and a review of reference sections were done to identify all pertinent English- and German-language journal articles. Search terms included compliance, adherence, persistence, discontinuation, pharmacist, and intervention. STUDY SELECTION AND DATA EXTRACTION: From each relevant study, the following data were extracted: study design, country, disease, number of patients, patients' age and gender, type of intervention, duration of follow-up, method of measurement of adherence and adherence rate, and data concerning the quality of the included studies. DATA SYNTHESIS: A total of 162 studies were identified, of which 18 matched our inclusion criteria. Twelve were randomized controlled trials and 6 were non-crossover single-group trials. Eight studies showed significant improvement of adherence at one or more time points. Eight studies did not show any effect, 7 of which were randomized controlled trials. In most studies, adherence rates at baseline were high compared with rates reported in the general population. Counseling, monitoring, and education during weekly or monthly appointments showed some effect. However, these same types of interventions showed no effect in other studies. The overall quality of the included studies was low. CONCLUSIONS: Currently, it is impossible to identify an overall successful adherence-improving strategy performed by pharmacists. More well-designed and well-conducted studies on the effectiveness of interventions by a community pharmacist to improve patient adherence to chronic medication need to be performed.     

Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review

Gebremariam L, Hay EM, Koes BW, Huisstede BM. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review.

Objective

To provide an evidence-based overview of the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome.

Data Sources

The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched.

Study Selection

Two reviewers independently selected relevant systematic reviews and randomized controlled trials (RCTs).

Data Extraction

Two reviewers independently extracted data and assessed the methodologic quality.

Data Synthesis

If pooling of data was not possible, a best-evidence synthesis was used to summarize the results.

Results

One review and 5 RCTs reporting on various surgical techniques, and postsurgical interventions were included. Moderate evidence was found in favor of adding platelet-leukocyte gel versus open subacromial decompression. No evidence was found for the superiority of subacromial decompression versus conservative treatment in the short, mid, and long term or in favor of 1 surgical technique when compared with another. Limited evidence was found in favor of early activation after arthroscopic decompression in the short and long term.

Conclusions

This review shows that there is no evidence that surgical treatment is superior to conservative treatment or that1 particular surgical technique is superior to another. Because of possibly lower risks for complications, conservative treatment may be preferred. When choosing for surgery, arthroscopic decompression may be preferred because of the less invasive character of the procedure.     

Effectiveness of transitional care interventions for chronic illnesses: A systematic review of reviews

AimThis systematic review of reviews aims to critically evaluate and synthesize findings from recent systematic reviews to analyze the effectiveness of transitional care interventions in the management of adult patients with chronic illnesses.BackgroundTransitional care interventions have been provided to patients with chronic illnesses for reducing fragmented care and hospital readmissions after discharge. However, the effectiveness of the interventions on outcomes other than hospital readmissions is still unclear.Review methodsThis study used the systematic review of systematic reviews methodology. From five electronic databases, systematic reviews published between January 2011 and December 2020 and those that met the inclusion and exclusion criteria were searched and screened to retrieve recent evidence.ResultsEight systematic reviews that met the inclusion criteria and had high methodological quality were included. All included transitional care interventions aimed to reduce fragmented care and hospital admissions and improve health care outcomes in chronically ill patients. On summarizing and synthesizing the data, four common outcomes—hospital readmissions, quality of life, mortality, and health care cost savings—were retrieved. There was evidence regarding the effectiveness of transitional care on health care cost savings; however, other outcomes showed mixed results.ConclusionsTransitional care interventions are effective for patients with chronic illnesses. It is important to have standardized outcome measures; therefore, it is recommended to fund research and reimbursement of transitional care practices. The findings and implications of this review are important to nurse managers, health care practitioners, researchers, and policymakers.     

Non-pharmacological interventions for breathlessness management in patients with lung cancer: a systematic review

The aim is to review the published scientific literature for studies evaluating non-pharmacological interventions for breathlessness management in patients with lung cancer. The following selection criteria were used to systematically search the literature: studies were to be published research or systematic reviews; they were to be published in English and from 1990 to 2007; the targeted populations were adult patients with dyspnoea/breathlessness associated with lung cancer; and the study reported on the outcomes from use of non-pharmacological strategies for breathlessness. This review retrieved five studies that met all inclusion criteria. All the studies reported the benefits of non-pharmacological interventions in improving breathlessness regardless of differences in clinical contexts, components of programmes and methods for delivery. Analysis of the available evidence suggests that tailored instructions delivered by nurses with sufficient training and supervision may have some benefits over other delivery approaches. Based on the results, non-pharmacological interventions are recommended as effective adjunctive strategies in managing breathlessness for patients with lung cancer. In order to refine such interventions, future research should seek to explore the core components of such approaches that are critical to achieving optimal outcomes, the contexts in which the interventions are most effective, and to evaluate the relative benefits of different methods for delivering such interventions.     

Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis

The family is the primary caregiver for most patients with schizophrenia, and their roles are essential in patients' illness trajectories and outcomes. Due to this, various family interventions for schizophrenia have been developed and applied to the relatives who take care of their family members with schizophrenia. This study examined the effectiveness of existing family interventions for schizophrenia in achieving their target outcomes at both the family and patient levels by utilizing a systematic review and meta-analysis. Combinations of terms were used to search for relevant studies from the databases. Thirty-seven randomized controlled trials that met the inclusion criteria were included in the analysis. Based on the pooled result of the included studies, the programmes significantly improved the targeted outcomes with large effect size. The programmes' impacts on family-related outcomes were higher than those on patients. Among the targeted outcomes, patients' treatment satisfaction and adherence and family caregivers' mental health were the most remarkable outcomes that had improved from the included programmes. Conversely, outcomes related to family relationships, caregiving experiences, perceived social support of family caregivers, and patients' medication use did not see significant improvements. The programmes delivered to individual family units and only to the family caregivers were more effective than those delivered to groups of caregivers and caregivers and patients together, respectively. Programme-focused interventions were more effective than emotion-focused ones. Based on these findings, an in-home visiting nurse programme or advanced technology is suggested when applying family interventions for schizophrenia in practice.     

Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain: a systematic review

Purpose. A systematic review was conducted to evaluate the effectiveness of workplace rehabilitation interventions for injured workers with low back pain (LBP).

Method. MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and AMED (Allied and Complementary Medicine) were searched from 1982 to 2005 for peer-reviewed studies of rehabilitation interventions that were provided at the workplace to workers with musculoskeletal work-related LBP. Methodological quality appraisal and data extraction were conducted by five reviewers.

Results. Of a total of 1,224 articles that were identified by the search, 15 articles, consisting of 10 studies, were of sufficient quality to be included in the review. The best evidence was that clinical interventions with occupational interventions as well as early return to work/modified work interventions were effective in returning workers to work faster, reducing pain and disability, and decreasing the rate of back injuries. Ergonomic interventions also were found to be effective workplace interventions.

Conclusion. The need for further research in this area is necessary to reduce the burden of back pain on employees and their families, employers, and the health care system.     

Healthy living interventions and schizophrenia: a systematic review

AIM: This paper reports a systematic review of the published and grey literature which has investigated the efficacy of healthy living interventions for adults with a diagnosis of schizophrenia or schizo-affective disorder. BACKGROUND: Adults with a diagnosis of schizophrenia or schizo-affective disorder have reduced life expectancy when compared with members of the general population, with approximately 59% of excess mortality resulting from natural causes. METHODS: The review was conducted following guidelines provided by the United Kingdom National Health Service Centre for Reviews and Dissemination, and using the Medline, PsycINFO, CINAHL, Embase, Cochrane Library, National Research Register, and System for Info on Grey Literature databases. RESULTS: Sixteen studies were identified, examining four types of healthy living interventions: smoking cessation (n = 7), weight management (n = 5), exercise (n = 3) and nutritional education (n = 1). The smoking cessation, weight management and exercise studies showed positive outcomes in the main. The quality of the studies, however, was generally poor. Only two had control groups, most recruited small self-selected samples, six did not standardize for diagnosis, external validity was generally poor and no studies followed participants for longer than 6 months. The best quality evidence was produced by the smoking cessation and weight management studies, which were more methodologically robust and demonstrated promising outcomes. CONCLUSIONS: Further research is needed to assist the development of effective interventions to help this client group to adopt and maintain healthier lifestyles. Research and practice development in this area may be an important role for nurses in both hospital and community settings.     

Effectiveness of corticosteroid injections compared with physiotherapeutic interventions for lateral epicondylitis: A systematic review

Objectives

To compare the effectiveness of corticosteroid injections with physiotherapeutic interventions for the treatment of lateral epicondylitis (tennis elbow).

Data sources

The electronic databases AMED, Cinahl, Medline and Embase were searched up to Week 12 2009. In addition, the Cochrane Central Register of Controlled Clinical Trials, the Metaregister of Controlled Clinical Trials and the Physiotherapy Evidence Database (PEDro) were searched up to March 2009.

Review methods

All English-language randomised controlled trials (RCTs) that included participants with a clinical diagnosis of lateral epicondylitis, comparing corticosteroid injections with physiotherapeutic interventions, and used at least one clinically relevant outcome measure were included. The review authors extracted and analysed the data independently, using the PEDro scale to assess the methodological quality of each eligible study.

Results

Five RCTs were identified and included in the review. Four of the studies included the measurement of pain-free grip strength. Standardised mean differences (effect sizes) were calculated for this outcome measure and assessor's rating of severity at 3, 6, 12, 26 and 52 weeks for two of the RCTs. Large effect sizes were demonstrated in favour of corticosteroid injections at short-term follow-up. At intermediate- and long-term follow-up, medium-to-large effect sizes were demonstrated in favour of physiotherapeutic interventions compared with corticosteroid injections. However, at long-term follow-up, the research suggests that there is a small benefit of physiotherapeutic interventions compared with a ‘wait and see’ policy.

Conclusion

Overall, the findings indicated that corticosteroid injections are effective at short-term follow-up, and physiotherapeutic interventions are effective at intermediate- and long-term follow-up. However, due to the limited number of high-quality RCTs and differences in the interventions and outcomes utilised within each of the included studies, any conclusions drawn must be interpreted with caution.