Zhianfar Leila, Nadrian Haidar, Shaghaghi Abdolreza
Health Education & Promotion Department, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Ther Clin Risk Manag. 2020 Apr 6;16:233-243. doi: 10.2147/TCRM.S240125. eCollection 2020.
To systematically retrieve and condense the best possible evidence on the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in hemodialysis patients (HDPs).
An umbrella review of interventional studies.
A comprehensive search of the Cochrane Database of Systematic Reviews, Ovid, PubMed, Scopus, EMBASE and Web of science databases to identify relevant publications in 2000-2018 (June) timeframe.
Two reviewers independently applied inclusion criteria to select potential systematic reviews assessing the successful interventions that targeted enhancement of therapeutic and lifestyle recommendations adherence in HDPs. Data were summarized for information about the first author(s)' names, year of publication, type(s) of the intervention and output variables, main findings and also the applied quality appraisal tools in the retrieved research evidence.
Eligible studies were selected and data were extracted independently by two reviewers. The Joanna Briggs Institute (JBI)'s critical appraisal tool for systematic reviews was used to assess the quality of the identified publications, and discrepancies were resolved by consensus with a third reviewer.
Thirteen systematic reviews (12 solely systematic reviews and 1 systematic review with meta-analyses) were eligible to be enrolled in the study. The range of interventions that had been reported to boost therapeutic and lifestyle recommendations adherence in HDPs' included psycho-educational programs, physical activity enhancement initiatives, information technology (IT)-based interventions and aromatherapy. Depression, diet biomarkers and interdialytic weight gain (IDWG) were among the myriad of output variables that had been measured as proxies to assess impacts of the implemented interventions. Psycho-educational interventions were among the prevalent initiatives to boost therapeutic and lifestyle recommendations adherence among the HDPs.
This umbrella review revealed that various intervention approaches and strategies can be used for HDPs' better therapeutic and lifestyle recommendations adherence with considerable methodological heterogeneity. The pinpointed research evidence is also supporting application of multifaceted interventional modalities to reach an improved acquiescence form the patients' side and their families. Further studies are recommended to address the interactions across various interventions in discordant socio-cultural contexts.
系统检索并归纳关于旨在提高血液透析患者（HDPs）对治疗和生活方式建议依从性的成功干预措施的最佳证据。
对干预性研究的伞状综述。
全面检索Cochrane系统评价数据库、Ovid、PubMed、Scopus、EMBASE和科学网数据库，以识别2000年至2018年6月期间的相关出版物。
两名评审员独立应用纳入标准，选择评估旨在提高HDPs对治疗和生活方式建议依从性的成功干预措施的潜在系统评价。汇总数据以获取关于第一作者姓名、出版年份、干预类型和产出变量、主要发现以及检索到的研究证据中应用的质量评估工具的信息。
选择符合条件的研究，由两名评审员独立提取数据。使用乔安娜·布里格斯研究所（JBI）的系统评价批判性评估工具来评估已识别出版物的质量，分歧通过与第三位评审员达成共识来解决。
13项系统评价（12项单纯的系统评价和1项带有荟萃分析的系统评价）符合纳入该研究的条件。据报道，在HDPs中提高对治疗和生活方式建议依从性的干预措施范围包括心理教育项目、增强身体活动的举措、基于信息技术（IT）的干预措施和芳香疗法。抑郁、饮食生物标志物和透析间期体重增加（IDWG）是作为评估所实施干预措施影响的替代指标而测量的众多产出变量之一。心理教育干预是提高HDPs对治疗和生活方式建议依从性的常见举措之一。
这项伞状综述表明，各种干预方法和策略可用于提高HDPs对治疗和生活方式建议的依从性，但存在相当大的方法学异质性。所确定的研究证据也支持应用多方面的干预方式，以从患者及其家属方面获得更好的默许。建议进一步开展研究以解决不同社会文化背景下各种干预措施之间的相互作用。
