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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 Nincic  3 , Yonda Lai  3 , Patricia Rios  3 , Heather MacDonald  3 , Paul A Khan  3 , Marco Ghassemi  3 , Fatemeh Yazdi  3 , Ross C Brownson  5   6 , David A Chambers  7 , Lisa R Dolovich  8   9 , Annemarie Edwards  10 , Paul P Glasziou  11 , Ian D Graham  12   13 , Brenda R Hemmelgarn  14 , Bev J Holmes  15 , Wanrudee Isaranuwatchai  3 , France Legare  16   17 , Jessie McGowan  12 , Justin Presseau  12   13 , Janet E Squires  12   18 , Henry T Stelfox  19 , Lisa Strifler  3 , Trudy Van der Weijden  20 , Christine Fahim  3 , Andrea C Tricco  3   21 , Sharon E Straus  3   4   22
Affiliations
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. .

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.

Copyright/license for publication

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
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
Fig. 2
Cochrane Effective Practice and Organisation of Care (EPOC) risk of bias summary results (n = 157 RCTs)
Fig. 3
Fig. 3
Stacked bar plot of knowledge translation (KT) sustainability dimensions
Fig. 4
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
Fig. 4
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
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