停用增加跌倒风险药物（FRID）预防跌倒及跌倒相关并发症的疗效：系统评价与荟萃分析方案
The efficacy of fall-risk-increasing drug (FRID) withdrawal for the prevention of falls and fall-related complications: protocol for a systematic review and meta-analysis.
作者信息
Lee Justin Yusen, Holbrook Anne
机构信息
Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton Health Sciences, 88 Maplewood Avenue, Hamilton, ON, L8M 1W9, Canada.
Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
出版信息
Syst Rev. 2017 Feb 20;6(1):33. doi: 10.1186/s13643-017-0426-6.
BACKGROUND
Despite limited evidence of effectiveness, withdrawal (discontinuation or dose reduction) of high risk medications known as "fall-risk increasing drugs" (FRIDs) is typically conducted as a fall prevention strategy based on presumptive benefit. Our objective is to determine the efficacy of fall-risk increasing drugs (FRIDs) withdrawal on the prevention of falls and fall-related complications.
METHODS/DESIGN: We will search for all published and unpublished randomized controlled trials evaluating the effect of FRID withdrawal compared to usual care on the rate of falls, incidence of falls, fall-related injuries, fall-related fractures, fall-related hospitalizations, or adverse effects related to the intervention in adults aged 65 years or older. Electronic database searches will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. A grey literature search will be conducted including clinical trial registries and conference proceedings and abstracts. Two reviewers will independently perform in duplicate citation screening, full-text review, data abstraction, and risk of bias assessment. Conflicts will be resolved through team discussion or by a third reviewer if no consensus can be reached. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria will be used to independently rate overall confidence in effect estimates for each outcome. Results will be synthesized descriptively, and a random effects meta-analysis will be conducted for each outcome if studies are deemed similar methodologically, clinically, and statistically.
DISCUSSION
We will attempt to determine whether a FRID withdrawal strategy alone is effective at preventing falls in older adults. Our results will be used to optimize and focus fall prevention strategies and initiatives internationally with a goal of improving the health of older adults.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42016040203.
背景
尽管有效性证据有限，但作为一种基于假定益处的预防跌倒策略，通常会停用（停药或减药）被称为“跌倒风险增加药物”（FRIDs）的高风险药物。我们的目的是确定停用跌倒风险增加药物（FRIDs）对预防跌倒及跌倒相关并发症的疗效。
方法/设计：我们将检索所有已发表和未发表的随机对照试验，评估与常规护理相比，停用FRIDs对65岁及以上成年人跌倒发生率、跌倒事件、跌倒相关损伤、跌倒相关骨折、跌倒相关住院或干预相关不良反应的影响。将在MEDLINE、EMBASE、Cochrane对照试验中心注册库（CENTRAL）和护理学与健康领域数据库（CINAHL）中进行电子数据库检索。将进行灰色文献检索，包括临床试验注册库、会议论文集和摘要。两名评审员将独立进行重复的文献筛选、全文评审、数据提取和偏倚风险评估。如有冲突，将通过团队讨论解决，若无法达成共识，则由第三位评审员决定。将使用推荐分级、评估、制定与评价（GRADE）标准独立评估每个结局效应估计值的总体可信度。结果将进行描述性综合分析，如果研究在方法学、临床和统计学上被认为相似，则对每个结局进行随机效应荟萃分析。
讨论
我们将试图确定仅采用停用FRIDs策略是否能有效预防老年人跌倒。我们的研究结果将用于优化和聚焦国际上的跌倒预防策略与举措，目标是改善老年人的健康状况。
系统评价注册
国际前瞻性系统评价注册库（PROSPERO）CRD42016040203
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