Meta-Analysis on the Literature Related to Nonpharamcological

¶ … meta-analysis on the literature related to nonpharamcological interventions for agitation in older adults with dementia. The authors intended to investigate which, if any, of the interventions used were the most effective.

Since the results of the effects of nonpharmacological interventions on decreasing agitation in dementia have varied, with some of these studies showing contradictory results, and since nursing staff need to know which particular intervention(s) to employ, a meta-analysis (which investigates and analyses the reliability of the various studies, comparing one against the other) is in order.

The procedures for this review were based on the eight steps suggested by Egger and Smith (2001). These are to: (1) formulate review question; (2) define inclusion and exclusion criteria; (3) locate studies; (4) select studies; (5) assess study quality; (6) extract data; (7) analyze and present results; and (8) interpret results.

Being that this is non-experimental study, no issues of control were used here. Rather, inclusion criteria was involved in order to define the studies that they felt pertinent to their research. Nonetheless, one of the inclusion criterion used included the fact that all accepted studies should employ a randomized controlled parallel or a randomized crossover study design. (Other inclusion criteria included the facts that they enrolled subjects with dementia; included nonpharmacological interventions for agitation; published study in English or Korean; included a published scale measuring agitation as outcome variable; and included sufficient information to determine the effect of nonpharmacological intervention).

Feasibility issues are taken into account. These include taking into account possibility of disagreement (in this case all three reviewers discussed issue and arrived at a joint consensus); contacting original authors by e-mail if disagreement persisted; how to assess methodological quality (it was assessed by two reviewers according to allocation concealment (which used the Cochrane criteria as base), and according to withdrawals and dropouts); issues of inconsistent and missing data; potential sources of heterogeneity (both clinical and statically) across the data; and all aspects of data extraction and analysis.

The design used certainly does flow from the proposed question. The authors intended to assess, compare and discover the most effective intentions that could be used to control for agitation in patients with dementia. To that end, they carefully formulated their inclusion and exclusion criteria; carefully formulated their review question; conducted a thorough literature review; used specific methods to locate their studies; used special methods (scientifically and carefully conducted) to select their studies; assessed the quality of these studies using the Cochrane instrument; extracted the data using a data extraction form specifically formulated for this review; analyzed the results using Review manager Software, taking into account random effects, and interpreted these results.

There seems to be little threat to validity or bias. Two reviewers were generally involved, and if a disagreement occurred, the issue was laid before the third reviewer for his or her opinion. If disagreement persisted, the author of the original study was contacted. Regarding heterogeneity and sensitivity analysis, two independent reviewers investigated potential sources of clinical heterogeneity and statistical heterogeneity across the included studies. These same two reviewers were also independently involved in data extraction. In fact, during no point in the study did the two reviewers work together, and consultation always involved a third impartial individual. These served as protection to both internal and external validity issues, although both interval and external validity threats are mostly (if not exclusively) pertinent to empirical studies rather than to theoretical research such as this.

The fact that the two reviewers worked independently and that they consulted the third reviewer in cases of disagreement, as well as the fact that original authors were contacted for data clarification or explanation served to mitigate bias and served as controls.