Systematic Reviews and Evidence Synthesis Module Assignment 22-23
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Systematic Reviews and Evidence Synthesis Module Assignment 22-23
Please undertake BOTH tasks described below.
The maximum word limit for both tasks is 2,500 words in total (excluding plots and any plot labels/captions). However, it is likely that fewer words will be more than sufficient for a good assignment – e.g. around 700 words for task 1 and 1,300 words for task 2.
The deadline is 7th February 2023 (14:00 UK time, 18:00 Dubai time). Please submit via canvas (‘Assignment’ tab, ‘Assignment SRES 22-23’).
Please:
- submit both parts of the assignment (Task 1 and Task 2) as a SINGLE DOCUMENT
- make sure the file name and the submitted document contain your STUDENT ID NUMBER.
- DO NOT put your name on your submission
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Task 1 - Meta-analysis (50 marks)
Scenario
You have been undertaking a systematic review on the effectiveness of a weight loss intervention compared to a control. Studies that met the following eligibility criteria were included:
Population
Overweight or obese people aged 18 and over
Intervention
Any type of weight reduction programme (e.g. Weight
Watchers, Slimming World etc.) where participants:
- attend a weekly group session,
- are given advice on weight loss,
- are weighed and
- are encouraged to lose weight.
The intervention must last a minimum of 12 weeks
Comparator
No treatment
OR
One-off general advice given on eating and exercise
Outcome
Weight loss reported as percentage (%) weight loss (achieved between the start of the study and the point of follow-up)
Quality of life
Study design
Any prospective controlled study (including randomised controlled trials and non-randomised controlled studies)
You are about to undertake the analyses in the review. Weight loss can be reported in different ways, but you are focussing only on the outcome of weight loss reported as the proportion of people who have, or have not, lost 5% or more weight (achieved between the start of the study and the point of follow-up). The threshold of 5% or more was chosen as it is considered to be clinically meaningful.
Assignment task
You have been provided with a set of data that has been extracted from 20 studies meeting the inclusion criteria for the systematic review. The dataset shows for each study the proportion of people that have lost 5% or more weight in the intervention and control groups. It also gives some additional information on study design, population ages and length of follow-up of the studies.
Your task is to undertake one or more meta-analyses on the data provided using either STATA or Review Manager software. Before undertaking the task, you should make sure you are familiar with the relevant module sessions. Those of most relevance are: Reporting & publication bias, Approaches to synthesis, Meta-analysis, STATA practical and Review Manager practical.
Please note that you have been allocated a dataset from several available. Your assignment will be marked on the analysis of the dataset you were given. You must indicate the number of the dataset you were given on your assignment submission.
Your meta-analysis plot(s) should be copied and pasted into your assignment in MS Word (please refer to guidance given during the practicals in week 2 on how to do this). Plot(s) should be clearly labelled. Please write short notes to accompany the plot(s).
In looking at the information provided you should decide on the analysis or analyses that you want to undertake and be able to explain why you chose this. In doing this you must first consider any clinical and methodological heterogeneity. As part of your analyses, you should consider and undertake any subgroup analyses that are appropriate, justifying your reasons for doing so.
You should consider the appropriateness of combining data (“pooling”) in a meta-analysis for each analysis, and undertake the meta-analysis where you consider it would be appropriate to do so. You should justify the choice of outcome metric and model for any meta-analyses you do.
If you consider any meta-analyses inappropriate you should indicate why and consider if there are alternative approaches to analyse and present the relevant information.
You should consider whether it is possible to identify potential publication bias in any meta- analyses you undertake, and if so undertake an appropriate analysis.
For each analysis you should present any figure produced and also fully interpret the findings of the analysis in the text.
If multiple analyses are considered and undertaken, you should comment on any similarities and differences between these, and if relevant, consider potential reasons for any differences.
You should consider and report the strengths and weaknesses of your approach to the analyses you undertake. You may want to consider what additional information you would have liked to inform decisions around your analysis or to enable you to undertake further analyses.
Guide to marking
The marking scheme contains many items for which marks can be awarded and the total value of these items exceeds the marks that can be awarded for each section (maximum 50 marks for Task 1). The distribution of marks is such that the bulk of the marks can be awarded for appropriate justification, undertaking and interpreting of all relevant analyses, along with discussion of the strengths and weaknesses of the approaches. Additional marks can be gained for appropriately produced and labelled figures, consideration of publication bias and any thoughts on further analyses.
Any inappropriate analyses will not gain marks.
Any figures (including captions/labelling) will not be part of the word count. No referencing or reference list is required. There will be no need to research the condition, intervention or outcome, or to write about these other than in the context of interpreting the analyses you do and present.
Task 2 -critical appraisal (50 marks)
A PROSPERO systematic review protocol has been reproduced below.
PROSPERO 2017 CRD42017074763 Available
from:http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017074763
Your task is to undertake a critical appraisal of the protocol.
Under the following headings comment in detail on any strengths, weaknesses or omissions and make suggestions for improvements where necessary:
Review Question; Searches; Study Selection Criteria; Study Selection Process; Data Extraction; Risk of Bias Assessment; Synthesis; Other Comments.
Make sure you add justifications as to why a specific methodological component is a strength, a weakness, or is unclear.
No referencing or reference list is required. 1 or 2 marks will be given for relevant points (more complex points will gain 2 marks), up to a maximum of 50 marks.
*start of protocol*
Sexton B, Taylor N. A systematic review and meta-analysis of the effectiveness of chair-based exercises for older people with an impairment or health condition.
Review question
Do seated exercises improve outcomes for older people with an impairment or health condition?
Searches
We will search the following electronic bibliographic databases: MEDLINE, EMBASE, CINAHL, AMED and PsychInfo. The search terms will include only terms relating to or describing the intervention. There will be no limitations in study language. Studies will be limited to randomised controlled trials and controlled trials.
Types of study to be included
Inclusion: Randomised controlled trials and controlled trials. Exclusion: Study designs other than randomised controlled trials and controlled trials e.g. single group pre-post, qualitative.
Condition or domain being studied
It is common practice to conduct chair based exercise programs for older people with an impairment or health condition. This occurs in a range of settings including residential aged care facilities, sub-acute care and in the community. Elderly/older adults. Health outcomes related to chair based exercise.
Participants/population
Inclusion: Average age 65 years or older with an impairment or health condition.
Exclusion: Average age under 65; living independently in the community without a health condition or impairment.
Intervention(s), exposure(s)
Inclusion: Predominantly seated exercise program e.g. warm up/warm down/stretching may be done in other positions. Intervention period of >/= 3 weeks with a minimum of 6 sessions. Various exercise programs including combinations of different types of exercise e.g. resistance training, strength training, flexibility, range of movement, balance, functional exercises
Use of equipment e.g. exercise machines, theraband, weights, free standing pedals i.e. not on a bike
Various types of seating e.g. chair, wheelchair, swiss ball, seated exercise machine.
Upright seating. Target area of exercises - focus may be on any or all parts of the body e.g. may be only lower limb strengthening
Exclusion: Exercise program includes co-interventions e.g. sit to stand exercises plus seated exercises. Duration: < 3 weeks or < 6 sessions.
Cognitive training, training on a bike or exercise bike, training in the use of a wheelchair.
Seated on a bike; recumbent sitting e.g. on a Roman chair.
Comparator(s)/control
Various comparators considered: alternative intervention (exercise in position other than sitting); usual care/no intervention.
Primary outcome(s)
Inclusion: All patient outcomes e.g. physical, physiological, functional, psychological, quality of life.
Exclusion: Non-patient/non-older person outcomes: carer outcomes, clinician perceptions.
Secondary outcome(s)
None.
Data extraction (selection and coding)
Selection of studies:
Titles and abstracts of studies retrieved using the search strategy will be independently reviewed by 2 researchers applying the inclusion criteria. Selected studies will be compared and any difference of opinion will be resolved firstly, by discussion. The 2 researchers will then apply the study inclusion criteria to the full text of selected studies resolving differences as previously stated. We will also look at the reference list of included studies and relevant systematic reviews. The search and selection process will be transparent and summarised using a flowchart.
Data Extraction:
A data extraction form will be created including: study design; population characteristics and care setting; description of interventions using the TIDieR checklist; outcomes, outcome measures and analysis. The data extraction process will be conducted by one researcher (BS) and checked by a second researcher (NT).
Risk of bias (quality) assessment
Risk of bias of individual studies with be examined using the PEDro scale. For completed meta-analysis studies, risk of bias across studies with be evaluated using the GRADE approach.
Strategy for data synthesis
For continuous outcomes we will estimate the standard mean difference; and for dichotomous outcomes we will estimate risk ratios. For data that are clinically homogenous, meta-analysis will be completed using a random effects model (RevMan). Heterogeneity will be expressed with the I-squared statistic. Studies that are not able to be included in the meta-analysis will be synthesized descriptively.
Analysis of subgroups or subsets
Sub-group analysis of comparison with usual care groups and alternative intervention groups.
*end of protocol*
2023-03-30