TY - JOUR
T1 - Management of Frailty
T2 - A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
AU - Negm, Ahmed M.
AU - Kennedy, Courtney C.
AU - Thabane, Lehana
AU - Veroniki, Areti Angeliki
AU - Adachi, Jonathan D.
AU - Richardson, Julie
AU - Cameron, Ian D.
AU - Giangregorio, Aidan
AU - Petropoulou, Maria
AU - Alsaad, Saad M.
AU - Alzahrani, Jamaan
AU - Maaz, Muhammad
AU - Ahmed, Muhammad M.
AU - Kim, Eileen
AU - Tehfe, Hadi
AU - Dima, Robert
AU - Sabanayagam, Kalyani
AU - Hewston, Patricia
AU - Abu Alrob, Hajar
AU - Papaioannou, Alexandra
N1 - Publisher Copyright:
© 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2019/10
Y1 - 2019/10
N2 - Objective: To analyze and determine the comparative effectiveness of interventions targeting frailty prevention or treatment on frailty as a primary outcome and quality of life, cognition, depression, and adverse events as secondary outcomes. Design: Systematic review and network meta-analysis (NMA). Methods: Data sources—Relevant randomized controlled trials (RCTs) were identified by a systematic search of several electronic databases including MEDLINE, EMBASE, CINAHL, and AMED. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed. Data extraction—All RCTs examining frailty interventions aimed to decrease frailty were included. Comparators were standard care, placebo, or another intervention. Data synthesis—We performed both standard pairwise meta-analysis and Bayesian NMA. Dichotomous outcome data were pooled using the odds ratio effect size, whereas continuous outcome data were pooled using the standardized mean difference (SMD) effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome. The quality of evidence was evaluated using the GRADE approach. Results: A total of 66 RCTs were included after screening of 7090 citations and 749 full-text articles. NMA of frailty outcome (including 21 RCTs, 5262 participants, and 8 interventions) suggested that the physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty (SMD –0.92, 95% confidence interval −1.55, −0.29). According to SUCRA, physical activity intervention and physical activity plus nutritional supplementation were probably the most effective intervention (100% and 71% likelihood, respectively) to reduce frailty. Physical activity was probably the most effective or the second most effective interventions for all included outcomes. Conclusion and implications: Physical activity is one of the most effective frailty interventions. The quality of evidence of the current review is low and very low. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.
AB - Objective: To analyze and determine the comparative effectiveness of interventions targeting frailty prevention or treatment on frailty as a primary outcome and quality of life, cognition, depression, and adverse events as secondary outcomes. Design: Systematic review and network meta-analysis (NMA). Methods: Data sources—Relevant randomized controlled trials (RCTs) were identified by a systematic search of several electronic databases including MEDLINE, EMBASE, CINAHL, and AMED. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed. Data extraction—All RCTs examining frailty interventions aimed to decrease frailty were included. Comparators were standard care, placebo, or another intervention. Data synthesis—We performed both standard pairwise meta-analysis and Bayesian NMA. Dichotomous outcome data were pooled using the odds ratio effect size, whereas continuous outcome data were pooled using the standardized mean difference (SMD) effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome. The quality of evidence was evaluated using the GRADE approach. Results: A total of 66 RCTs were included after screening of 7090 citations and 749 full-text articles. NMA of frailty outcome (including 21 RCTs, 5262 participants, and 8 interventions) suggested that the physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty (SMD –0.92, 95% confidence interval −1.55, −0.29). According to SUCRA, physical activity intervention and physical activity plus nutritional supplementation were probably the most effective intervention (100% and 71% likelihood, respectively) to reduce frailty. Physical activity was probably the most effective or the second most effective interventions for all included outcomes. Conclusion and implications: Physical activity is one of the most effective frailty interventions. The quality of evidence of the current review is low and very low. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.
KW - Frailty
KW - aging
KW - geriatric
KW - intervention
KW - meta-analysis
KW - network
UR - http://www.scopus.com/inward/record.url?scp=85072694302&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2019.08.009
DO - 10.1016/j.jamda.2019.08.009
M3 - Review article
C2 - 31564464
AN - SCOPUS:85072694302
SN - 1525-8610
VL - 20
SP - 1190
EP - 1198
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 10
ER -