Article type
Year
Abstract
Background: The aim of the ONTOP project, a workpackage of the EU-funded SENATOR project (grant number 305930), is to develop explicit and transparent recommendations for non-pharmacological interventions of prevalent conditions in older adults.
Objectives: To illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations.
Methods: A Delphi process was used to identify clinically relevant outcomes. A systematic search of reviews was performed through MEDLINE, EMBASE, CINAHL, and PsycINFO. GRADE was used to rate the quality of evidence and the strength of recommendations. Ten recommendations concerning non-pharmacological interventions for delirium were formulated based on benefit and harm, preferences and values, and resource use.
Results: The outcomes rated critical, from the Delphi process, were delirium incidence for prevention and delirium improvement and functional status for therapy. The following settings were used to formulate the clinical questions: medical, surgical, and nursing home. Thirty-one primary studies from 24 reviews were identified. Multicomponent interventions were decomposed and common elements were identified to account for the results of meta-analyses of delirium prevention in medical and surgical settings. Recommendations for multicomponent interventions to prevent delirium in those two settings were substantially based on evidence of a moderate quality.
Conclusion: In addition to critical outcomes, GRADE helped identify the importance of setting and the type of approach (prevention or treatment). Critical outcomes differed for prevention and treatment of non-pharmacological interventions. Compared to other guidelines GRADE provided systematically and transparently formulated recommendations regarding non-pharmacological interventions. Assessments for other conditions (falls, dementia, pressure ulcer, urinary incontinence) will be presented at the Colloquium.
Objectives: To illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations.
Methods: A Delphi process was used to identify clinically relevant outcomes. A systematic search of reviews was performed through MEDLINE, EMBASE, CINAHL, and PsycINFO. GRADE was used to rate the quality of evidence and the strength of recommendations. Ten recommendations concerning non-pharmacological interventions for delirium were formulated based on benefit and harm, preferences and values, and resource use.
Results: The outcomes rated critical, from the Delphi process, were delirium incidence for prevention and delirium improvement and functional status for therapy. The following settings were used to formulate the clinical questions: medical, surgical, and nursing home. Thirty-one primary studies from 24 reviews were identified. Multicomponent interventions were decomposed and common elements were identified to account for the results of meta-analyses of delirium prevention in medical and surgical settings. Recommendations for multicomponent interventions to prevent delirium in those two settings were substantially based on evidence of a moderate quality.
Conclusion: In addition to critical outcomes, GRADE helped identify the importance of setting and the type of approach (prevention or treatment). Critical outcomes differed for prevention and treatment of non-pharmacological interventions. Compared to other guidelines GRADE provided systematically and transparently formulated recommendations regarding non-pharmacological interventions. Assessments for other conditions (falls, dementia, pressure ulcer, urinary incontinence) will be presented at the Colloquium.