BACKGROUND: The systematic review of economic evaluations plays a critical role in making well-informed decisions about competing healthcare interventions. The quality of these systematic reviews varies due to the lack of internationally recognized methodological evaluation standards.
METHODS: Nine English and Chinese databases including the Cochrane Library, PubMed, EMbase (Ovid), NHS economic evaluation database (NHSEED) (Ovid), Health Technology Assessment (HTA) database, Chinese National Knowledge Infrastructure (CNKI), WangFang, VIP Chinese Science & Technology Periodicals (VIP) and Chinese Biomedical Literature Database (CBM) were searched. Two reviewers independently screened studies and extracted data. The methodological quality of the literature was measured with modified AMSTAR. Data were narrative synthesized.
RESULTS: 165 systematic reviews were included. The overall methodological quality of the literature was moderate according to the AMSTAR scale. In these articles, thirteen quality assessment tools and 32 author self-defined criteria were used. The three most widely used tools were the Drummond checklist (19.4%), the BMJ checklist (15.8%), the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement (12.7%). Others included the Quality of Health Economic Studies (QHES), the Consensus on Health Economic Criteria (CHEC), the checklist of Center for Reviews and Dissemination (CRD), the Philips checklist, the World Health Organization (WHO) checklist, the checklist of Critical Appraisal Skills Program (CASP), the Pediatric Quality Appraisal Questionnaire (PQAQ), the Joanna Briggs Institute (JBI) checklist, Spanish and Chinese guidelines. The quantitative scales used in these literature were the QHES and PQAQ.
CONCLUSIONS: Evidence showed that pharmacoeconomic systematic reviews' methodology remained to be improved, and the quality assessment criteria were gradually unified. Multiple scales can be used in combination to evaluate the quality of economic research in different settings and types.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
INTRODUCTION: Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.
METHODS: An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).
RESULTS: A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.
DISCUSSION: Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.
IMPORTANCIA: Existe un debate acerca de la efectividad de los tratamientos psiquiátricos y si la farmacoterapia o psicoterapia se destinarán, principalmente.
OBJETIVOS: Realizar una revisión sistemática sobre la eficacia de tratamientos farmacológicos y psicoterapias para los principales trastornos psiquiátricos y para comparar la calidad de los ensayos de farmacoterapia y psicoterapia.
Revisión de la evidencia: Se realizaron búsquedas en MEDLINE, EMBASE, PsycINFO, y la Biblioteca Cochrane (abril de 2012, sin límite de tiempo o idioma) para revisiones sistemáticas sobre la farmacoterapia o psicoterapia versus placebo, la farmacoterapia versus psicoterapia, y su combinación vs solos modalidad. Dos revisores seleccionaron de forma independiente los metanálisis y extrajeron los tamaños del efecto de eficacia. Se evaluó la calidad de los ensayos individuales incluidos en la farmacoterapia y la psicoterapia metanálisis con el riesgo Cochrane de herramienta de sesgo.
RESULTADOS: La búsqueda produjo 45.233 resultados. Se incluyeron 61 meta-análisis sobre 21 trastornos psiquiátricos, que contenían 852 ensayos individuales y 137.126 participantes. El tamaño del efecto promedio de los metanálisis fue medio (media, 0,50; IC del 95%, 0,41-0,59). Los tamaños del efecto de las psicoterapias vs placebo tendieron a ser mayores que los de los medicamentos, pero las comparaciones directas, aunque por lo general basado en unos pocos ensayos, no revelaron diferencias consistentes. Ensayos de farmacoterapia individuales eran más propensos a tener muestras de gran tamaño, el cegamiento, los grupos de control y análisis de intención de tratar. Por el contrario, los ensayos de psicoterapia tenían menores tasas de deserción y datos de seguimiento previstas. En los estudios de psicoterapia, en lista de espera diseños mostraron efectos más grandes que hizo comparaciones con placebo.
Conclusiones y relevancia: Muchos tratamientos farmacológicos y psicoterapias son eficaces, pero no hay mucho margen de mejora. Debido a las múltiples diferencias en los métodos utilizados en los ensayos de farmacoterapia y psicoterapia, las comparaciones indirectas de sus tamaños del efecto en comparación con placebo o ningún tratamiento son problemáticas. Comparaciones directas bien diseñados, que son escasos, necesitan financiación pública. Dado que los pacientes a menudo se benefician de ambas formas de terapia, la investigación también debe centrarse en cómo ambas modalidades pueden ser mejor combinan para maximizar la sinergia en lugar de debatir sobre el uso de un tratamiento sobre el otro.
The systematic review of economic evaluations plays a critical role in making well-informed decisions about competing healthcare interventions. The quality of these systematic reviews varies due to the lack of internationally recognized methodological evaluation standards.
METHODS:
Nine English and Chinese databases including the Cochrane Library, PubMed, EMbase (Ovid), NHS economic evaluation database (NHSEED) (Ovid), Health Technology Assessment (HTA) database, Chinese National Knowledge Infrastructure (CNKI), WangFang, VIP Chinese Science & Technology Periodicals (VIP) and Chinese Biomedical Literature Database (CBM) were searched. Two reviewers independently screened studies and extracted data. The methodological quality of the literature was measured with modified AMSTAR. Data were narrative synthesized.
RESULTS:
165 systematic reviews were included. The overall methodological quality of the literature was moderate according to the AMSTAR scale. In these articles, thirteen quality assessment tools and 32 author self-defined criteria were used. The three most widely used tools were the Drummond checklist (19.4%), the BMJ checklist (15.8%), the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement (12.7%). Others included the Quality of Health Economic Studies (QHES), the Consensus on Health Economic Criteria (CHEC), the checklist of Center for Reviews and Dissemination (CRD), the Philips checklist, the World Health Organization (WHO) checklist, the checklist of Critical Appraisal Skills Program (CASP), the Pediatric Quality Appraisal Questionnaire (PQAQ), the Joanna Briggs Institute (JBI) checklist, Spanish and Chinese guidelines. The quantitative scales used in these literature were the QHES and PQAQ.
CONCLUSIONS:
Evidence showed that pharmacoeconomic systematic reviews' methodology remained to be improved, and the quality assessment criteria were gradually unified. Multiple scales can be used in combination to evaluate the quality of economic research in different settings and types.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas
