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      Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis

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          Abstract

          Aim

          To quantify recruitment, retention and differential retention rates and associated trial, participant and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity.

          Data sources

          MEDLINE, EMBASE, CINAHL and CENTRAL from 1990 to April 20, 2020.

          Study selection

          RCTs including people with multimorbidity comparing exercise therapy with a non-exposed comparator group reporting at least one of the following outcomes: physical function, health-related quality of life, depression symptoms, or anxiety symptoms.

          Data extraction and synthesis

          Recruitment rates (proportion of people randomised/proportion of people eligible), retention rates (proportion of people providing the outcomes of interest/proportion randomised) and differential retention rates (difference in proportion of people providing the outcomes in the intervention group and comparator group) were calculated. Meta-analysis using a random-effects model was used to estimate pooled proportions. Methodological quality was assessed using Cochrane ´Risk of Bias tool 2.0´ for individual studies, and the GRADE approach was used to assess the overall quality of the evidence.

          Results

          Twenty-three RCTs with 3363 people were included. The pooled prevalence for recruitment rate was 75% (95%CI 66 to 84%). The pooled prevalence for retention rate was 90% (95%CI 86 to 94%) at the end of the intervention (12 weeks; interquartile range (IQR) (12 to 12)). Meta-regression analyses showed that increasing age and including a higher proportion of people with hypertension was associated with lower retention rates. Retention rates did not differ between the intervention and comparator groups. The overall quality of the evidence was deemed very low.

          Conclusion

          Three in four eligible people with multimorbidity were randomised to RCTs using exercise therapy, of which nine out of 10 provided end of treatment outcomes with no difference seen between the intervention and comparison groups. However, the results must be interpreted with caution due to large differences between the included studies.

          Trial registration

          ClinicalTrials.gov CRD42020161329. Registered on 28 April 2020.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13063-021-05346-x.

          Related collections

          Most cited references56

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          The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

          Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realising these issues, an international group that included experienced authors and methodologists developed PRISMA (preferred reporting items for systematic reviews and meta-analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this explanation and elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA statement, this document, and the associated website (www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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            Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

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              Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.

              "Physical activity," "exercise," and "physical fitness" are terms that describe different concepts. However, they are often confused with one another, and the terms are sometimes used interchangeably. This paper proposes definitions to distinguish them. Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure. The energy expenditure can be measured in kilocalories. Physical activity in daily life can be categorized into occupational, sports, conditioning, household, or other activities. Exercise is a subset of physical activity that is planned, structured, and repetitive and has as a final or an intermediate objective the improvement or maintenance of physical fitness. Physical fitness is a set of attributes that are either health- or skill-related. The degree to which people have these attributes can be measured with specific tests. These definitions are offered as an interpretational framework for comparing studies that relate physical activity, exercise, and physical fitness to health.
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                Author and article information

                Contributors
                lasse.kindler.harris@regionh.dk
                stskou@health.sdu.dk
                cjuhl@health.sdu.dk
                msaracutu@health.sdu.dk
                abricca@health.sdu.dk
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                14 June 2021
                14 June 2021
                2021
                : 22
                : 396
                Affiliations
                [1 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, , University of Southern Denmark, ; 5230 Odense M, Denmark
                [2 ]GRID grid.480615.e, ISNI 0000 0004 0639 1882, Department of Physiotherapy and Occupational Therapy, , Næstved-Slagelse-Ringsted Hospitals, Region Zealand, ; 4200 Slagelse, Denmark
                [3 ]GRID grid.4973.9, ISNI 0000 0004 0646 7373, Department of Physiotherapy and Occupational Therapy, , University Hospital of Copenhagen Herlev and Gentofte, ; Copenhagen, Denmark
                Author information
                http://orcid.org/0000-0002-2732-4342
                Article
                5346
                10.1186/s13063-021-05346-x
                8204443
                34127042
                4bdae9c0-8c87-4805-9b9d-dd38860e503c
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 15 September 2020
                : 30 May 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100010663, H2020 European Research Council;
                Award ID: 801790
                Award Recipient :
                Categories
                Review
                Custom metadata
                © The Author(s) 2021

                Medicine
                multimorbidity,recruitment,retention,exercise therapy,randomised controlled trial,systematic review

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