Table 3 Summary characteristics of the three reviews, review challenges and approaches and strengths and limitations of chosen methods
From: The use of rapid review methods in health technology assessments: 3 case studies
| Report and no. RCTs | Populations, interventions and comparators | Review challenges and approaches | Strengths and limitations of chosen method |
|---|---|---|---|
|
Kaltenthaler et al. 2014 [12] Sexual health of people with severe mental illness 13 RCTs |
Review aims: summarise effectiveness evidence, determine applicability in UK NHS setting and identify key areas for primary research. Population: people with severe mental illness Interventions: strategies to increase knowledge, assess and reduce sexual health risk, change behaviour and develop condom skills Comparators: educational sessions on HIV, money management or substance abuse, health promotion, wait list or no treatment |
Challenges due to evidence base: • Wide variation in populations and settings (patients in psychiatric clinics, residential centres and homeless shelters) • Wide range of outcomes including: biological (sexually transmitted infections, pregnancy), behavioural (number of partners, uptake of services, use of contraception/condoms) and proxy (knowledge, attitudes, behaviours, facilitators and barriers etc.) Approaches: • Focussed definition of severe mental illness • Brief summary of results presented, narrative synthesis, grouping of results from included studies by outcome (biological, behavioural and proxy) |
Strengths: • Enabled rapid synthesis of a disparate evidence base to ensure policy makers were aware of areas where evidence was available. This informed the design of relevant RCTs Limitations: • Quantitative data synthesis not generated for use by policy makers (only effect size by intervention and outcome) • In-depth narrative synthesis not possible • Non-RCT evidence excluded |
|
Cooper et al. (2015) [13] Premature ejaculation 101 RCTs and 1 CT (65 RCTs from existing reviews and 36 new RCTs and 1 new CT reports) |
Review aims: synthesise effectiveness evidence for behavioural, topical and systemic treatments. Population: men with premature ejaculation Interventions: topical anaesthetics, antidepressants, phosphodiesterase-5 inhibitors, opioid analgesics, behavioural therapies, acupuncture, Chinese medicine Comparators: placebo, wait list, other therapies |
Challenges due to evidence base: • Very large number of RCTs (over 100) and existing systematic reviews covering wide range of interventions (several drug classes plus behavioural approaches) • Several existing systematic reviews Approaches: • Meta-analysis of primary outcome using data extracted from existing systematic reviews, with new primary study data added • Narrative synthesis of secondary outcomes |
Strengths: • Meta-analysis able to be used for primary outcome (consistent primary outcome) • Use of data from existing reviews enabled meta-analysis of large dataset in shorter time Limitations: • Potential for data errors or synthesis errors in original reviews to be repeated in new report • Methodological quality of studies extracted from existing reviews not assessed separately • Although use of data from existing reviews saved some time, triangulation of data from multiple reviews was still time-consuming • Original RCT publications not revisited for data extraction and quality assessment. |
|
Cooper et al. (2015) [14] Cannabis cessation 33 RCTs |
Review aims: summarise effectiveness evidence for psychological and psychosocial interventions and identify key areas for primary research. Population: adults who use cannabis regularly Interventions: cognitive behavioural therapy, motivational interviewing, motivational enhancement therapy, supportive-expressive dynamic psychotherapy, social support groups, case management, contingency management (vouchers as incentive/reward) Comparators: waitlist, treatment as usual, other interventions, assessment only, education controls, written cannabis information, cannabis education |
Challenges due to evidence base: • Wide variation in study populations (extent of cannabis dependence), interventions (type, duration) and comparators • Very little consistency in outcome measures, time points, and statistics reported • Large number of RCTs for a short report Approaches: • For each pair of interventions compared, narrative summary of outcomes reported and how many showed a statistically significant effect |
Strengths: • Inclusive approach, covering a wide range of populations, interventions and outcomes • Included all psychosocial or psychological interventions undertaken in the adult, community dwelling population of cannabis users Limitations: • Detailed numerical outcome data not presented, since outcome measures and statistics reported were so disparate • Outcome measures in RCTs not converted to consistent measures to compare across studies as not feasible in timeframe |