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Meta-Analysis
. 2023 Apr;30(2):167-189.
doi: 10.1007/s12529-022-10092-8. Epub 2022 Apr 28.

Effect of In-Person Delivered Behavioural Interventions in People with Multimorbidity: Systematic Review and Meta-analysis

Alessio Bricca  1   2 , Madalina Jäger  3   4 , Marie Johnston  5 , Graziella Zangger  3   4 , Lasse K Harris  3   4 , Julie Midtgaard  6   7 , Søren T Skou  3   4
Affiliations
Meta-Analysis

Effect of In-Person Delivered Behavioural Interventions in People with Multimorbidity: Systematic Review and Meta-analysis

Alessio Bricca et al. Int J Behav Med. 2023 Apr.

Abstract

Background: To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes.

Methods: Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane 'Risk of Bias Tool' 2.0 and the GRADE assessment to evaluate the overall quality of evidence.

Results: Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI -0.12-0.87) and the effect on weight loss was uncertain (BMI mean difference -0.17, 95% CI -1.1-0.83) at the end-treatment follow-up. Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17-0.42) and physical function (SMD 0.42, 95% CI 0.12-0.73), and moderate improvements were seen for depression symptoms (SMD -0.70, 95% CI -0.97-0.42). Studies using the BCTs 'action planning' and 'social support (practical)' reported greater physical activity and weight loss.

Conclusions: Behavioural interventions targeting lifestyle behaviours may improve health-related quality of life and physical function, and reduce depression, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time.

Keywords: Behavioural therapy; Disability; Function; Health; Multimorbidity; Physical activity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on objectively measured physical activity. SMD, standardised mean difference; 95% CI, 95% confidence interval
Fig. 2
Fig. 2
Effectiveness ratio of BCTs in behavioural randomised controlled trials including people with multimorbidity. Effectiveness ratio (x-axis) = number of times each BCT (y-axis) was used in an effective trial divided by the number of times they were a component of all studies using the BCT; the higher the ratio, the more often the BCT was found effective out of the total number of studies included; x-axis = effectiveness ratio, y-axis = BCTs
Fig. 3
Fig. 3
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on weight loss (body mass index). 95% CI, 95% confidence interval. a,b = two separate study comparisons from the same study
Fig. 4
Fig. 4
Effectiveness ratio of BCTs in behavioural randomised controlled trials including people with multimorbidity. Effectiveness ratio (x-axis) = number of times each BCT (y-axis) was used in an effective trial divided by the number of times they were a component of all studies using the BCT; the higher the ratio, the more often the BCT was found effective out of the total number of studies included; x-axis = effectiveness ratio, y-axis = BCTs
Fig. 5
Fig. 5
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on health-related quality of life. SMD, standardised mean difference; 95% CI, 95% confidence interval. a,b = two separate study comparisons from the same study
Fig. 6
Fig. 6
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on physical function. SMD, standardised mean difference; 95% CI, 95% confidence interval. a,b = two separate study comparisons from the same study
Fig. 7
Fig. 7
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on depression symptoms. SMD, standardised mean difference; 95% CI, 95% confidence interval. a,b = two separate study comparisons from the same study
Fig. 8
Fig. 8
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on physical activity and physical function. SMD, standardised mean difference; 95% CI, 95% confidence interval. a,b = two separate study comparisons from the same study
Fig. 9
Fig. 9
Forest plot for the effect of behavioural interventions compared to a usual care comparator group on health-related quality of life. SMD, standardised mean difference; 95% CI, 95% confidence interval. a,b = two separate study comparisons from the same study
See this image and copyright information in PMC

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