Meta-Analysis

. 2023 Jul 24;21(1):269.

doi: 10.1186/s12916-023-02966-9.

Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions

Areti Angeliki Veroniki^{1

2}, Charlene Soobiah^{3

4}, Vera Nincic³, Yonda Lai³, Patricia Rios³, Heather MacDonald³, Paul A Khan³, Marco Ghassemi³, Fatemeh Yazdi³, Ross C Brownson^{5

6}, David A Chambers⁷, Lisa R Dolovich^{8

9}, Annemarie Edwards¹⁰, Paul P Glasziou¹¹, Ian D Graham^{12

13}, Brenda R Hemmelgarn¹⁴, Bev J Holmes¹⁵, Wanrudee Isaranuwatchai³, France Legare^{16

17}, Jessie McGowan¹², Justin Presseau^{12

13}, Janet E Squires^{12

18}, Henry T Stelfox¹⁹, Lisa Strifler³, Trudy Van der Weijden²⁰, Christine Fahim³, Andrea C Tricco^{3

21}, Sharon E Straus^{3

4

22}

Affiliations

¹ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada. areti-angeliki.veroniki@unityhealth.to.
² Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada. areti-angeliki.veroniki@unityhealth.to.
³ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.
⁴ Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada.
⁵ Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
⁶ Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, USA.
⁷ National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA.
⁸ Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada.
⁹ Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON, Canada.
¹⁰ Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON, Canada.
¹¹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia.
¹² School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada.
¹³ The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada.
¹⁴ Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB, 2J2.00, Canada.
¹⁵ The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC, Canada.
¹⁶ Département de Médecine Familiale Et Médecine d'urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC, Canada.
¹⁷ Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC, Canada.
¹⁸ School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
¹⁹ Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
²⁰ Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands.
²¹ Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
²² Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 37488589
PMCID: PMC10367354
DOI: 10.1186/s12916-023-02966-9

Meta-Analysis

Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions

Areti Angeliki Veroniki et al. BMC Med. 2023.

. 2023 Jul 24;21(1):269.

doi: 10.1186/s12916-023-02966-9.

Authors

Affiliations

¹ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada. areti-angeliki.veroniki@unityhealth.to.
² Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada. areti-angeliki.veroniki@unityhealth.to.
³ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.
⁴ Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada.
⁵ Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
⁶ Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, USA.
⁷ National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA.
⁸ Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada.
⁹ Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON, Canada.
¹⁰ Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON, Canada.
¹¹ Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia.
¹² School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada.
¹³ The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada.
¹⁴ Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB, 2J2.00, Canada.
¹⁵ The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC, Canada.
¹⁶ Département de Médecine Familiale Et Médecine d'urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC, Canada.
¹⁷ Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC, Canada.
¹⁸ School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
¹⁹ Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada.
²⁰ Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands.
²¹ Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
²² Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 37488589
PMCID: PMC10367354
DOI: 10.1186/s12916-023-02966-9

Abstract

Background: Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.

Methods: Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.

Eligibility criteria: Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).

Information sources: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020.

Outcome measures: Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate.

Data synthesis: We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.

Results: We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I² = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I² = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I² = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I² = 21%).

Conclusions: KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.

Systematic review registration: PROSPERO CRD42018084810.

Keywords: Chronic disease management; Integrated knowledge translation; Knowledge translation; Older adults; Patient and public involvement; Sustainability.

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Conflict of interest statement

The authors declare that they have no competing interests.

Patient involvement and dissemination

This work involved one patient partner to ensure patient perspectives are integrated in our research question. The patient partner was involved from the outset when defining the research question, and we plan to meet regularly in the update of this review to support dissemination of the results. The research question was developed based on the patient’s concerns and priorities. The patient was not involved in the interpretation of results and writing of the article because she retired at that time and was unable to continue due to personal circumstances. The results will be disseminated to the lay audience through a press release, social media, through the SPOR-EA website and through public presentations.

Transparency declaration

The senior author (SES) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

The corresponding author (SES) has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide license to the publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to (i) publish, reproduce, distribute, display and store the contribution, (ii) translate the contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the contribution, (iii) create any other derivative work(s) based on the contribution, (iv) to exploit all subsidiary rights in the contribution, (v) the inclusion of electronic links from the contribution to third party material wherever it may be located; and (vi) license any third party to do any or all of the above.

Figures

**Fig. 1**
PRISMA flow diagram for identification of eligible studies. Abbreviations: CA conference abstract, KT knowledge translation, mos months, RCT randomised controlled trial. From [19]

**Fig. 2**
Cochrane Effective Practice and Organisation of Care (EPOC) risk of bias summary results (n = 157 RCTs)

**Fig. 3**
Stacked bar plot of knowledge translation (KT) sustainability dimensions

**Fig. 4**
Forest plots for quality of life (a, b, c and d) and care outcomes (e). a Short-Form (SF) Mental Health Survey. b SF Physical Health Survey. c European Quality of Life-5 Dimensions (EQ-5D). d St George’s Respiratory Questionnaire (SGRQ) and Minnesota Living with Heart Failure Questionnaire (MLHFQ). e Quality of care. CI confidence interval, EQ5D European Quality of Life-5 Dimensions, HK Hartung–Knapp–Sidik–Jonkman method, MD mean difference, MLHFQ Minnesota Living with Heart Failure Questionnaire, OR odds ratio, SF Short-Form, SGRQ St George’s Respiratory Questionnaire, UC usual care

See this image and copyright information in PMC

Comment in

Sustainability of knowledge translation interventions: the evidence lacks evidence.
Descatha A, Fadel M. Descatha A, et al. BMC Med. 2023 Aug 25;21(1):325. doi: 10.1186/s12916-023-03022-2. BMC Med. 2023. PMID: 37626386 Free PMC article. No abstract available.

References

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1. Powell BJ, Waltz TJ, Chinman MJ, Damschroder LJ, Smith JL, Matthieu MM, et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci. 2015;10:21. doi: 10.1186/s13012-015-0209-1. - DOI - PMC - PubMed
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Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions

Affiliations

Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous