Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

Ahmed M Negm; Courtney C Kennedy; Lehana Thabane; Areti-Angeliki Veroniki; Jonathan D Adachi; Julie Richardson; Ian D Cameron; Aidan Giangregorio; Maria Petropoulou; Saad M Alsaad; Jamaan Alzahrani; Muhammad Maaz; Muhammad M Ahmed; Eileen Kim; Hadi Tehfe; Robert Dima; Kalyani Sabanayagam; Patricia Hewston; Hajar Abu Alrob; Alexandra Papaioannou

doi:10.1016/j.jamda.2019.08.009

Management of Frailty: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

J Am Med Dir Assoc. 2019 Oct;20(10):1190-1198. doi: 10.1016/j.jamda.2019.08.009.

Authors

Ahmed M Negm¹, Courtney C Kennedy², Lehana Thabane³, Areti-Angeliki Veroniki⁴, Jonathan D Adachi⁵, Julie Richardson⁶, Ian D Cameron⁷, Aidan Giangregorio², Maria Petropoulou⁸, Saad M Alsaad⁹, Jamaan Alzahrani¹⁰, Muhammad Maaz¹¹, Muhammad M Ahmed¹¹, Eileen Kim¹¹, Hadi Tehfe¹¹, Robert Dima¹², Kalyani Sabanayagam¹¹, Patricia Hewston², Hajar Abu Alrob³, Alexandra Papaioannou¹³

Affiliations

¹ Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, Hamilton, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. Electronic address: anegm@ualberta.ca.
² Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, Hamilton, Ontario, Canada.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁴ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom.
⁵ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁶ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁷ John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
⁸ Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece.
⁹ Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
¹⁰ Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
¹¹ Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
¹² School of Interdisciplinary Science, McMaster University, Hamilton, Ontario, Canada.
¹³ Geriatric Education and Research for the Aging Sciences (GERAS), St Peter's Hospital, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

PMID: 31564464
DOI: 10.1016/j.jamda.2019.08.009

Abstract

Objective: To analyze and determine the comparative effectiveness of interventions targeting frailty prevention or treatment on frailty as a primary outcome and quality of life, cognition, depression, and adverse events as secondary outcomes.

Design: Systematic review and network meta-analysis (NMA).

Methods: Data sources-Relevant randomized controlled trials (RCTs) were identified by a systematic search of several electronic databases including MEDLINE, EMBASE, CINAHL, and AMED. Duplicate title and abstract and full-text screening, data extraction, and risk of bias assessment were performed. Data extraction-All RCTs examining frailty interventions aimed to decrease frailty were included. Comparators were standard care, placebo, or another intervention. Data synthesis-We performed both standard pairwise meta-analysis and Bayesian NMA. Dichotomous outcome data were pooled using the odds ratio effect size, whereas continuous outcome data were pooled using the standardized mean difference (SMD) effect size. Interventions were ranked using the surface under the cumulative ranking curve (SUCRA) for each outcome. The quality of evidence was evaluated using the GRADE approach.

Results: A total of 66 RCTs were included after screening of 7090 citations and 749 full-text articles. NMA of frailty outcome (including 21 RCTs, 5262 participants, and 8 interventions) suggested that the physical activity intervention, when compared to placebo and standard care, was associated with reductions in frailty (SMD -0.92, 95% confidence interval -1.55, -0.29). According to SUCRA, physical activity intervention and physical activity plus nutritional supplementation were probably the most effective intervention (100% and 71% likelihood, respectively) to reduce frailty. Physical activity was probably the most effective or the second most effective interventions for all included outcomes.

Conclusion and implications: Physical activity is one of the most effective frailty interventions. The quality of evidence of the current review is low and very low. More robust RCTs are needed to increase the confidence of our NMA results and the quality of evidence.

Keywords: Frailty; aging; geriatric; intervention; meta-analysis; network.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Aged
Aged, 80 and over
Aging
Female
Frailty / prevention & control*
Frailty / therapy*
Humans
Male
Middle Aged
Quality of Life
Randomized Controlled Trials as Topic*