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The Cochrane Database of Systematic... Jan 2021Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity.
OBJECTIVES
To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual.
SEARCH METHODS
We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies.
SELECTION CRITERIA
Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types.
MAIN RESULTS
We identified 17 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 11 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.63 to -0.2). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited.
AUTHORS' CONCLUSIONS
This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression in people with co-morbidity.
Topics: Age Factors; Amblyopia; Chronic Disease; Community Health Services; Disease Management; Growth Disorders; Health Behavior; Health Personnel; Health Services Needs and Demand; Humans; Intellectual Disability; Medication Adherence; Multimorbidity; Patient Reported Outcome Measures; Patient-Centered Care; Primary Health Care; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome
PubMed: 33448337
DOI: 10.1002/14651858.CD006560.pub4 -
Strabismus Mar 2023The objective of this review was to estimate the prevalence of strabismus and amblyopia in Africa. A systematic online literature search was conducted for articles on... (Meta-Analysis)
Meta-Analysis
The objective of this review was to estimate the prevalence of strabismus and amblyopia in Africa. A systematic online literature search was conducted for articles on strabismus and amblyopia in Africa. Meta-analysis was performed, using the Freeman-Tukey double arcsine transformation, to estimate the prevalence of strabismus and amblyopia in Africa. Subgroup analyses were conducted according to age, gender, study year, and type of amblyopia. Meta-regression was used to evaluate the influence of predetermined factors on the prevalence of amblyopia. 8 (1 population-based & 7 school-based) and 21 (3 population-based & 18 school-based) studies on strabismus and amblyopia with sample sizes of 22,355 and 46,841, respectively, were included in the review. Overall prevalence of strabismus in Africa was estimated to be 0.8% (95% CI: 0.4% - 1.4%); exotropia was 0.2% (95% CI: 0.1% - 0.5%) and esotropia was 0.5% (95% CI: 0.1% - 1.2%). Overall prevalence of amblyopia was estimated to be 0.6% (95% CI: 0.3% - 0.9%); refractive and strabismic amblyopia were 1.1% (95% CI: 0.2% - 2.5%) and 0.4% (95% CI: 0.2% - 0.6%), respectively. Prevalence estimate of amblyopia in males was 1.8% (95% CI: 0.7% - 3.3%) and in females was 1.3% (95% CI: 0.4% - 2.6%). There was a significant association between the prevalence of amblyopia and the type of amblyopia (p = .007) and the study year (p = .006). Although there appears to be a relatively low prevalence of strabismus and amblyopia in Africa, there is a dearth of well-designed population-based studies on strabismus and amblyopia in Africa, resulting in the lack of epidemiological information on strabismus and amblyopia within the general African population. Information about the prevalence of strabismus and amblyopia across Africa can inform policy making and design and implementation of public health intervention program.
Topics: Male; Female; Humans; Amblyopia; Visual Acuity; Strabismus; Esotropia; Prevalence; Africa
PubMed: 36576233
DOI: 10.1080/09273972.2022.2157023 -
Graefe's Archive For Clinical and... May 2023Amblyopia is a neurodevelopmental disorder characterized by functional deficits in the visual cortex. Functional magnetic resonance imaging (fMRI) is the most commonly... (Review)
Review
Amblyopia is a neurodevelopmental disorder characterized by functional deficits in the visual cortex. Functional magnetic resonance imaging (fMRI) is the most commonly used neuroimaging technique for investigating amblyopia. Herein, we systematically searched a PubMed database from inception to December 2021 to highlight the current progress and promises about fMRI technology in amblyopia; amblyopia's neural mechanism, the comparison of different types of amblyopia, and the evaluation of the therapeutic effect were explored. Relevant articles published in English and appropriate cross-references were considered for inclusion, including basic studies, imaging techniques, clinical diagnostic and therapeutic studies, case series, and reviews.
Topics: Humans; Amblyopia; Visual Cortex; Magnetic Resonance Imaging
PubMed: 36282454
DOI: 10.1007/s00417-022-05826-z -
Frontiers in Pediatrics 2022Epidemiological data about the prevalence of amblyopia around the world vary widely among regions and periods. This meta-analysis aimed to determine the global...
Epidemiological data about the prevalence of amblyopia around the world vary widely among regions and periods. This meta-analysis aimed to determine the global prevalence of amblyopia in children. PubMed, Embase, and the Cochrane Library were searched for prevalence studies published up to 5 November 2021. The outcome was the prevalence of amblyopia, analyzed as pooled estimates with 95% confidence intervals (CI). A total of 97 studies were included, including 4,645,274 children and 7,706 patients with amblyopia. The overall worldwide pooled prevalence of amblyopia was 1.36% (95%CI: 1.27-1.46%). The prevalence of amblyopia was higher in males (1.40%, 95%CI: 1.10-1.70%) than in females (1.24%, 95%CI: 0.94-1.54%) ( = 0.885, 95%CI: 0.795-0.985, = 0.025). The results of the meta-regression analysis showed that there were no significant associations between the prevalence of amblyopia and geographical area, publication year, age, sample size, and whether it was carried out in a developed or developing country (all > 0.05). Begg's test ( = 0.065) and Egger's test ( < 0.001) showed that there was a significant publication bias in the prevalence of amblyopia. In conclusion, amblyopia is a significant vision problem worldwide, and public health strategies of early screening, treatment, and management are important.
PubMed: 35601430
DOI: 10.3389/fped.2022.819998 -
Frontiers in Public Health 2023Virtual Reality (VR) has emerged as a new safe and efficient tool for the rehabilitation of many childhood and adulthood illnesses. VR-based therapies have the potential...
Virtual Reality (VR) has emerged as a new safe and efficient tool for the rehabilitation of many childhood and adulthood illnesses. VR-based therapies have the potential to improve both motor and functional skills in a wide range of age groups through cortical reorganization and the activation of various neuronal connections. Recently, the potential for using serious VR-based games that combine perceptual learning and dichoptic stimulation has been explored for the rehabilitation of ophthalmological and neurological disorders. In ophthalmology, several clinical studies have demonstrated the ability to use VR training to enhance stereopsis, contrast sensitivity, and visual acuity. The use of VR technology provides a significant advantage in training each eye individually without requiring occlusion or penalty. In neurological disorders, the majority of patients undergo recurrent episodes (relapses) of neurological impairment, however, in a few cases (60-80%), the illness progresses over time and becomes chronic, consequential in cumulated motor disability and cognitive deficits. Current research on memory restoration has been spurred by theories about brain plasticity and findings concerning the nervous system's capacity to reconstruct cellular synapses as a result of interaction with enriched environments. Therefore, the use of VR training can play an important role in the improvement of cognitive function and motor disability. Although there are several reviews in the community employing relevant Artificial Intelligence in healthcare, VR has not yet been thoroughly examined in this regard. In this systematic review, we examine the key ideas of VR-based training for prevention and control measurements in ocular diseases such as Myopia, Amblyopia, Presbyopia, and Age-related Macular Degeneration (AMD), and neurological disorders such as Alzheimer, Multiple Sclerosis (MS) Epilepsy and Autism spectrum disorder. This review highlights the fundamentals of VR technologies regarding their clinical research in healthcare. Moreover, these findings will raise community awareness of using VR training and help researchers to learn new techniques to prevent and cure different diseases. We further discuss the current challenges of using VR devices, as well as the future prospects of human training.
Topics: Humans; Child; Artificial Intelligence; Autism Spectrum Disorder; Disabled Persons; Motor Disorders; Virtual Reality; Nervous System Diseases
PubMed: 37033028
DOI: 10.3389/fpubh.2023.1143947 -
International Ophthalmology Feb 2024Pediatric keratoconus (pediatric KC) causes progressive deformation of the cornea in children and adolescents, leading to a gradual loss of vision and a need for... (Review)
Review
BACKGROUND
Pediatric keratoconus (pediatric KC) causes progressive deformation of the cornea in children and adolescents, leading to a gradual loss of vision and a need for rehabilitation. However, new treatments may halt the disease and prevent worse outcomes that require penetrating keratoplasty and its associated morbidity and high cost, irreversible loss of vision, and amblyopia. Few systematic reviews focus on keratoconus-and even fewer, on pediatric KC.
METHODS
Here, we report a systematic scoping review of pediatric KC epidemiology and discuss the studies reporting data on pediatric KC. We used PRISMA-ScR methodology and checklists in the elaboration of the manuscript. The inclusion criteria were: English language; publication between August 7, 1998, and August 7, 2019 (20 years); theme of the study pediatric KC epidemiology. The search strategy: searches of the PubMed-MEDLINE database and Cochrane Database of Systematic Reviews, using eight combinations of the following MeSH terms: keratoconus; child; incidence; prevalence; pediatrics; adolescent; epidemiology.
RESULTS
We charted and reviewed the selected articles. Initial searches included 1802 records; after the exclusion of article duplicates, we screened 777 records, read 97 articles in full text, and included 76 articles in this review.
CONCLUSIONS
Recent epidemiological studies with better methodologies demonstrated increased prevalence rates in comparison to the older literature. This effect may be due to better diagnostic methods and better sample selection than those in historical studies. Diagnosis remains a major challenge as the early disease is usually asymptomatic. Economic and social aspects of pediatric KC remain understudied in the pediatric literature. Global, inclusive, and proactive screening studies in schools are imperative to better understand the great impact of this disease in the young.
Topics: Adolescent; Humans; Child; Keratoconus; Cornea; Keratoplasty, Penetrating; Morbidity; Incidence
PubMed: 38347389
DOI: 10.1007/s10792-024-03010-2 -
Eye (London, England) Sep 2023Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic... (Review)
Review
Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic review. A systematic review was performed using Ovid MEDLINE, PubMed, The Cochrane Library, Embase, Web of Science Core Collection, and Clinicaltrials.gov. All studies reporting the diagnostic accuracy of home-based screening tools for amblyopia among children were included. Studies involving orthoptist or ophthalmologist-led screening and adult subjects were excluded. The main outcome measure was the diagnostic accuracy expressed as sensitivity and specificity. Among 3670 studies identified, 28 were eligible for inclusion in our systematic review. The age range of patients were less than 1 month to 16 years old. 7 studies used internet-based tools, 16 used smartphone/tablet applications, 3 used digital cameras, and 3 used home-based questionnaires and visual acuity tools. All studies included a reference standard except one, which was a longitudinal study. 21 studies had full ophthalmological examination whilst 6 studies had validated visual acuity measurement tools as gold standards. Of the 27 studies which compared against a reference test, only 25 studies reported sensitivity and specificity values. Using the QUADAS-2 tool, 50% of studies were deemed to have applicability concern due to patient selection from tertiary centres and unclear methods for recruitment. There is a need to improve the quality of diagnostic accuracy studies, standardise thresholds for detecting amblyopia, and ensure consistent reporting of results. Further research is needed to evaluate the suitability of these tools for amblyopia screening.
Topics: Adult; Child; Humans; Infant; Amblyopia; Longitudinal Studies; Sensitivity and Specificity; Physical Examination
PubMed: 36828959
DOI: 10.1038/s41433-023-02412-3 -
The British Journal of Ophthalmology May 2024Amblyopia is characterised by reduced visual acuity, poor binocular sensory fusion, and impaired or absent stereoacuity. Understanding the extent to which amblyopia... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Amblyopia is characterised by reduced visual acuity, poor binocular sensory fusion, and impaired or absent stereoacuity. Understanding the extent to which amblyopia affects everyday task performance is important to quantifying the disease burden of amblyopia and can assist clinicians to understand patients' likely functional capability.
METHODS
A systematic literature search identified published studies comparing fine visuomotor performance in either children or adults with amblyopia and those with normal binocular vision. The included studies (22 studies involving 835 amblyopes and 561 controls) reported results of self-perception patient reported outcome measures, tests of motor proficiency and video recorded reaching and grasping. The outcomes of 17 studies were grouped into four meta-analyses, with pooled results reported as standardised mean difference (SMD) with corresponding 95% CI.
RESULTS
Regardless of the cause of amblyopia (anisometropia, strabismus, mixed, deprivation), significant reduction in self-perception of physical competence and athletic competence (SMD=-0.74, 95% CI -1.23 to -0.25, p=0.003); fine motor skills scores (SMD=-0.86, 95% CI -1.27 to -0.45, p<0.0001); speed of visually guided reaching and grasping movements (SMD=0.86, 95% CI 0.65 to 1.08, p<0.00001); and precision of temporal eye-hand coordination (SMD=0.75, 95% CI 0.26 to 1.25, p=0.003) occurred in amblyopes compared with those with normal visual development.
CONCLUSION
Reports of the impact of amblyopia on fine motor skills performance find poorer outcomes in participants with amblyopia compared with those with normal vision development. Consistency in the outcome measure used to assess the functional impact of amblyopia would be valuable for future studies.
Topics: Humans; Amblyopia; Motor Skills; Visual Acuity; Vision, Binocular; Psychomotor Performance; Child
PubMed: 37669851
DOI: 10.1136/bjo-2022-322624 -
International Journal of Ophthalmology 2019To conduct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis.
AIM
To conduct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis.
METHODS
We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP databases for studies reporting the prevalence of amblyopia in patients with congenital ptosis. The reference lists of relevant studies were scanned. Heterogeneity of effect sizes across studies was tested. We calculated prevalence ratios to compare prevalence estimates for different causes of amblyopia in patients with congenital ptosis, as well as for different geographical regions, year of publication and sample size in subgroup analyses. A systematic review and Meta-analysis were performed.
RESULTS
We identified 29 eligible surveys with a total population of 2436. Prevalence rates of amblyopia ranged from 13.8% to 69%. We noted substantial heterogeneity in prevalence estimates for amblyopia in congenital ptosis (Cochran's significant at <0.0001; =90%). The pooled prevalence using random-effects models of 29 studies was 32.8% (95%CI: 27.3%-38.4%) in the overall population. Compared to the overall pooled prevalence, amblyopia prevalence was higher in studies in which only subjects with blepharophimosis syndrome were included.
CONCLUSION
We confirm that nearly one-third of congenital ptosis patients are suffering from or at risk for amblyopia. Patients with blepharophimosis syndrome are more likely to develop amblyopia. The identification and management of amblyopia should be integral to the treatment of congenital ptosis.
PubMed: 31341812
DOI: 10.18240/ijo.2019.07.21 -
Neural Regeneration Research Nov 2023Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging...
Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different. Therefore, we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia; this study is registered with PROSPERO (registration ID: CRD42022349191). We searched three online databases (PubMed, EMBASE, and Web of Science) from inception to April 1, 2022; 39 studies with 633 patients (324 patients with anisometropic amblyopia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria (e.g., case-control designed, peer-reviewed articles) and were included in this review. These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate cortices during task-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations, respectively; these may have arisen from abnormal visual experiences. Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state, as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometropic amblyopia and strabismic amblyopia patients. The shared dysfunction of anisometropic amblyopia and strabismic amblyopia patients, relative to controls, is also characterized by reduced spontaneous brain activity in the oculomotor cortex, mainly involving the frontal and parietal eye fields and the cerebellum; this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia. With regards to specific alterations of the two forms of amblyopia, anisometropic amblyopia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients, as reflected by diffusion tensor imaging, and more significant dysfunction and structural loss in the ventral pathway. Strabismic amblyopia patients experience more attenuation of activation in the extrastriate cortex than in the striate cortex when compared to anisometropic amblyopia patients. Finally, brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients, and the patterns of brain alterations are more limited in amblyopic adults than in children. In conclusion, magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alterations in anisometropic amblyopia and strabismic amblyopia patients; these alterations may improve our understanding of the neural mechanisms underlying amblyopia.
PubMed: 37282452
DOI: 10.4103/1673-5374.371349