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      Digital technologies to prevent falls in people living with dementia or mild cognitive impairment: a rapid systematic overview of systematic reviews

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          Abstract

          Objective

          Falls are a common cause of potentially preventable death, disability and loss of independence with an annual estimated cost of £4.4bn. People living with dementia (PlwD) or mild cognitive impairment (MCI) have an increased fall risk. This overview evaluates evidence for technologies aiming to reduce falls and fall risk for PlwD or MCI.

          Methods

          In October 2022, we searched five databases for evidence syntheses. We used standard methods to rapidly screen, extract data, assess risk of bias and overlap, and synthesise the evidence for each technology type.

          Results

          We included seven systematic reviews, incorporating 22 relevant primary studies with 1,412 unique participants. All reviews had critical flaws on AMSTAR-2: constituent primary studies were small, heterogeneous, mostly non-randomised and assessed as low or moderate quality. Technologies assessed were: wearable sensors, environmental sensor-based systems, exergaming, virtual reality systems. We found no evidence relating to apps. Review evidence for the direct impact on falls was available only from environmental sensors, and this was inconclusive. For wearables and virtual reality technologies there was evidence that technologies may differentiate PlwD who fell from those who did not; and for exergaming that balance may be improved.

          Conclusions

          The evidence for technology to reduce falls and falls risk for PlwD and MCI is methodologically weak, based on small numbers of participants and often indirect. There is a need for higher-quality RCTs to provide robust evidence for effectiveness of fall prevention technologies. Such technologies should be designed with input from users and consideration of the wider implementation context.

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          Most cited references78

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          AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both

          The number of published systematic reviews of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions. Systematic reviews are subject to a range of biases and increasingly include non-randomised studies of interventions. It is important that users can distinguish high quality reviews. Many instruments have been designed to evaluate different aspects of reviews, but there are few comprehensive critical appraisal instruments. AMSTAR was developed to evaluate systematic reviews of randomised trials. In this paper, we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic reviews, including those based on non-randomised studies of healthcare interventions.
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            Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

            Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
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              GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables.

              This article is the first of a series providing guidance for use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of rating quality of evidence and grading strength of recommendations in systematic reviews, health technology assessments (HTAs), and clinical practice guidelines addressing alternative management options. The GRADE process begins with asking an explicit question, including specification of all important outcomes. After the evidence is collected and summarized, GRADE provides explicit criteria for rating the quality of evidence that include study design, risk of bias, imprecision, inconsistency, indirectness, and magnitude of effect. Recommendations are characterized as strong or weak (alternative terms conditional or discretionary) according to the quality of the supporting evidence and the balance between desirable and undesirable consequences of the alternative management options. GRADE suggests summarizing evidence in succinct, transparent, and informative summary of findings tables that show the quality of evidence and the magnitude of relative and absolute effects for each important outcome and/or as evidence profiles that provide, in addition, detailed information about the reason for the quality of evidence rating. Subsequent articles in this series will address GRADE's approach to formulating questions, assessing quality of evidence, and developing recommendations. Copyright © 2011 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Age Ageing
                Age Ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                January 2024
                12 January 2024
                12 January 2024
                : 53
                : 1
                : afad238
                Affiliations
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                Division of Nursing , Midwifery and Social Work, School of Health Sciences, The University of Manchester , Manchester M13 9PT, UK
                National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                Division of Nursing , Midwifery and Social Work, School of Health Sciences, The University of Manchester , Manchester M13 9PT, UK
                Division of Nursing , Midwifery and Social Work, School of Health Sciences, The University of Manchester , Manchester M13 9PT, UK
                National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                Division of Nursing , Midwifery and Social Work, School of Health Sciences, The University of Manchester , Manchester M13 9PT, UK
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , Population Health Sciences Institute, Newcastle University , Newcastle-upon-Tyne NE4 5PL, UK
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AE, UK
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , Population Health Sciences Institute, Newcastle University , Newcastle-upon-Tyne NE4 5PL, UK
                National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                Division of Nursing , Midwifery and Social Work, School of Health Sciences, The University of Manchester , Manchester M13 9PT, UK
                National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester , School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester , Manchester M13 9PL, UK
                Author notes
                Address correspondence to: Charlotte Eost-Telling, Jean McFarlane Building, The University of Manchester, Oxford Road, Manchester M13 9PL, UK. Email: charlotte.eost-telling@ 123456manchester.ac.uk
                Author information
                https://orcid.org/0000-0002-9568-3195
                Article
                afad238
                10.1093/ageing/afad238
                10788098
                38219225
                00ee7ad3-7ff1-4863-925a-79ec64c6fc77
                © The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs licence ( https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 14 June 2023
                : 27 September 2023
                : 6 December 2023
                Page count
                Pages: 16
                Funding
                Funded by: National Institute for Health and Care Research Policy Research Unit;
                Award ID: PR-PRU-1217-21,502
                Funded by: National Institute for Health and Care Research Applied Research Collaboration Greater Manchester;
                Award ID: NIHR200174
                Categories
                Review
                AcademicSubjects/MED00280
                ageing/7
                ageing/10

                Geriatric medicine
                aged,dementia,falls,older people,rapid review,technology
                Geriatric medicine
                aged, dementia, falls, older people, rapid review, technology

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