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. 2024 Aug 19;9(8):e015120.
doi: 10.1136/bmjgh-2024-015120.

Core outcome sets for trials of interventions to prevent and to treat multimorbidity in adults in low and middle-income countries: the COSMOS study

Aishwarya Lakshmi Vidyasagaran  1 , Rubab Ayesha  2   3 , Jan R Boehnke  4   5 , Jamie Kirkham  6   7 , Louise Rose  8 , John R Hurst  9 , Juan Jaime Miranda  10   11 , Rusham Zahra Rana  12 , Rajesh Vedanthan  13 , Mehreen Riaz Faisal  4 , Saima Afaq  14   15 , Gina Agarwal  16 , Carlos Alberto Aguilar-Salinas  17 , Kingsley Akinroye  18 , Rufus Olusola Akinyemi  19 , Syed Rahmat Ali  20 , Rabeea Aman  21 , Cecilia Anza-Ramirez  10 , Koralagamage Kavindu Appuhamy  4 , Se-Sergio Baldew  22 , Corrado Barbui  23 , Sandro Rogerio Rodrigues Batista  24 , María Del Carmen Caamaño  25 , Asiful Haidar Chowdhury  26 , Noemia Teixeira de Siqueira-Filha  4 , Darwin Del Castillo Fernández  10   27 , Laura Downey  28   29 , Oscar Flores-Flores  30   31 , Olga P García  25 , Ana Cristina García-Ulloa  32 , Richard Ig Holt  33 , Rumana Huque  34   35 , Johnblack K Kabukye  36   37 , Sushama Kanan  26 , Humaira Khalid  38 , Kamrun Nahar Koly  39 , Joseph Senyo Kwashie  40 , Naomi S Levitt  41 , Patricio Lopez-Jaramillo  42   43 , Sailesh Mohan  44   45 , Krishna Prasad Muliyala  46 , Qirat Naz  47 , Augustine Nonso Odili  48 , Adewale L Oyeyemi  49   50 , Niels Victor Pacheco-Barrios  10 , Devarsetty Praveen  51 , Marianna Purgato  23 , Dolores Ronquillo  25 , Kamran Siddiqi  4   52 , Rakesh Singh  53 , Phuong Bich Tran  54 , Pervaiz Tufail  55 , Eleonora P Uphoff  56 , Josefien van Olmen  57 , Ruth Verhey  58 , Judy M Wright  59 , Jessica Hanae Zafra-Tanaka  10 , Gerardo A Zavala  4 , Yang William Zhao  28   60 , Najma Siddiqi  4   52 ; COSMOS collaboration
Collaborators, Affiliations

Core outcome sets for trials of interventions to prevent and to treat multimorbidity in adults in low and middle-income countries: the COSMOS study

Aishwarya Lakshmi Vidyasagaran et al. BMJ Glob Health. .

Abstract

Introduction: The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. Core outcome sets (COS) appropriate for the study of multimorbidity in LMICs do not presently exist. These are required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at preventing and treating multimorbidity in adults in LMICs.

Methods: To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals and policymakers) with representation from 33 countries. Consensus meetings were used to reach agreement on the two final COS.

Registration: https://www.comet-initiative.org/Studies/Details/1580.

Results: The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention and 6 treatment outcomes were added from Delphi round 1. Delphi round 2 surveys were completed by 95 of 132 round 1 participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) adverse events, (2) development of new comorbidity, (3) health risk behaviour and (4) quality of life; and four for the treatment COS: (1) adherence to treatment, (2) adverse events, (3) out-of-pocket expenditure and (4) quality of life.

Conclusion: Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to adults in LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs.

Prospero registration number: CRD42020197293.

Keywords: Other study design; Prevention strategies; Treatment.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. (A) Development of COS for trials of interventions to prevent multimorbidity in LMICs. (B) Development of COS for trials of interventions to treat multimorbidity in LMICs. COS, core outcome sets; LMICs, low and middle-income countries.
See this image and copyright information in PMC

Update of

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