Title: Clinical effectiveness of interventions for treatment-resistant anxiety in older people; a systematic review Produced by
Download 0.71 Mb.
|
- Navigate this page:
- Methods
- Limitations
- Conclusions
- Study registration
- ABBREVIATIONS
Data sourcesElectronic databases (MEDLINE, MEDLINE In-Process and Other Non-Indexed citations, EMBASE, the Cochrane Library databases, PsycINFO, and Web of Science) were searched in September 2013. Bibliographies of relevant systematic reviews were hand-searched to identify additional potentially relevant studies. ClinicalTrials.gov was searched for ongoing and planned studies. MethodsA systematic review of the clinical effectiveness of treatments for treatment-resistant anxiety in older adults was carried out. ResultsNo randomised controlled trial or prospective comparative observational study was identified meeting the prespecified inclusion criteria. Therefore, it was not possible to draw conclusions on clinical effectiveness. LimitationsAs no study was identified in older adults, there is uncertainty as to which treatments are clinically effective for older adults with an anxiety disorder that has not responded to prior treatment. The comprehensive methods implemented to carry out the review are a key strength of the research presented. However, the review highlights the extreme lack of research in this area, identifying no comparative studies, which is a marked limitation. ConclusionsSpecific studies evaluating interventions in older adults with an anxiety disorder that has not responded to first-line treatment are needed to address the lack of evidence. The lack of evidence in this area means that older adults are perhaps receiving inappropriate treatment or are not receiving a particular treatment because there is no limited evidence to support its use. At this time, there is scope to develop guidance on service provision, and, as a consequence, to advance the standard of care received by older adults with a treatment-resistant anxiety disorder in primary and secondary care. Study registrationThe protocol for the systematic review is registered on PROSPERO (registration number CRD42013005612). FundingThe National Institute for Health Research Health Technology Assessment programme. Table of contentsAbstract (488 words) 4 Background 4 Objectives 4 Data sources 4 Methods 4 Results 4 Limitations 4 Conclusions 5 Study registration 5 Funding 5 Table of contents 6 ABBREVIATIONS 7 Scientific summary 8 Background 8 Objectives 9 Methods 9 Summary of findings of included studies 9 Discussion 9 Strengths and limitations 11 Conclusions 11 Study registration 11 Funding 11 Plain English Summary 12 1BACKGROUND 13 1.1Description of health problem 13 1.1.1Diagnosis of an anxiety disorder 14 1.1.2Aetiology, pathology and prognosis 16 1.1.3Incidence and prevalence 20 1.1.4Impact of health problem 21 1.1.5Significance for the NHS 21 1.2Current service provision 22 1.3Description of technology under assessment 24
2.1Decision problem 36 2.1.1Key issues 36 2.2Overall aims and objectives of assessment 37 3ASSESSMENT OF CLINICAL EFFECTIVENESS 38 3.1Methods for reviewing effectiveness 38 3.1.1Identification of studies 38 3.1.2Inclusion and exclusion criteria 39 3.2Results of the review of clinical effectiveness evidence 41 3.2.1Quantity and quality of research available 41 3.2.2Assessment of effectiveness 42 4DISCUSSION 43 4.1Statement of principal findings 43 4.2Strengths and limitations of the assessment 43 4.3Uncertainties 43 5CONCLUSIONS 44 5.1Implications for service provision 44 5.2Suggested research priorities 44
Appendix . Diagnostic criteria for anxiety disorders set out in DSM-IV and ICD10 classification systems 61 Appendix . Doses of selective reuptake inhibitors for individual anxiety disorders as listed in the British National Formulary(60)(59) 68 Appendix . Literature search strategies 70 Appendix . Final protocol 77 Appendix . Table of excluded studies with rationale 102 ABBREVIATIONS
Download 0.71 Mb. Share with your friends:
|