Albarqouni Loai, Ringsten Martin, Montori Victor, Jørgensen Karsten Juhl, Bulbeck Helen, Johansson Minna
Institute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, QLD, Australia.
Lund University, Lund, Sweden.
BMJ Med. 2022 Sep 13;1(1):e000130. doi: 10.1136/bmjmed-2022-000130. eCollection 2022.
To assess whether recommendations of individually oriented lifestyle interventions (IOLIs) in guidelines from the National Institute for Health and Care Excellence (NICE) were underpinned by evidence of benefit, and whether harms and opportunity costs were considered.
Cross sectional survey.
UK.
NICE guidelines and supporting evidence.
All NICE pathways for IOLI recommendations (ie, non-drug interventions that healthcare professionals administer to adults to achieve a healthier lifestyle and improve health) were searched systematically on 26 August 2020. One author screened all retrieved pathways for candidate guidelines, while a second author verified these judgments. Two authors independently and in duplicate screened all retrieved guidelines and recommendations for eligibility, extracted data, and evaluated the evidence cited and the outcomes considered. Disagreements were noted and resolved by consensus.
Within 57 guidelines, 379 NICE recommendations were found for IOLIs; almost all (n=374; 99%) recommended the lifestyle intervention and five (1%) recommended against the intervention. Of the 379 recommendations, 13 (3%) were supported by moderate or high certainty evidence of a beneficial effect on patient relevant outcomes (n=7; 2%) or surrogate outcomes (n=13; 3%). 19 (5%) interventions considered psychosocial harms, 32 (8%) considered physical harms, and one (<1%) considered the opportunity costs of implementation. No intervention considered the burden placed on individuals by these recommendations.
Few NICE recommendations of lifestyle interventions are supported by reliable evidence. While this finding does not contest the beneficial effects of healthy habits, guidelines recommending clinicians to try to change people's lifestyle need to be reconsidered given the substantial uncertainty about the effectiveness, harms, and opportunity costs of such interventions.
评估英国国家卫生与临床优化研究所（NICE）指南中针对个体的生活方式干预（IOLIs）建议是否有获益证据支持，以及是否考虑了危害和机会成本。
横断面调查。
英国。
NICE指南及支持证据。
2020年8月26日系统检索了所有关于IOLIs建议的NICE路径（即医疗保健专业人员为成年人实施的非药物干预措施，以实现更健康的生活方式并改善健康状况）。一位作者筛选所有检索到的路径以寻找候选指南，另一位作者核实这些判断。两位作者独立且重复筛选所有检索到的指南和建议以确定其是否符合纳入标准，提取数据，并评估所引用的证据和所考虑的结果。记录分歧并通过共识解决。
在57项指南中，发现了379项针对IOLIs的NICE建议；几乎所有建议（n = 374；99%）都推荐生活方式干预，5项（1%）建议不进行该干预。在379项建议中，13项（3%）有中度或高度确定性证据支持对患者相关结局（n = 7；2%）或替代结局（n = 13；3%）有有益影响。19项（5%）干预措施考虑了心理社会危害，32项（8%）考虑了身体危害，1项（<1%）考虑了实施的机会成本。没有干预措施考虑这些建议给个人带来的负担。
NICE关于生活方式干预的建议很少有可靠证据支持。虽然这一发现并不质疑健康习惯的有益影响，但鉴于此类干预措施在有效性、危害和机会成本方面存在很大不确定性，建议临床医生试图改变人们生活方式的指南需要重新考虑。
