Quake3World

What do you think? Comprehensive coverage or do you see some gaps?

TITLE
A systematic review of the effectiveness of spiritual activity/beliefs on quality of life and healthcare outcomes in older adults in residential care facilities.


OBJECTIVES
The primary objective of this systematic review will be to:
To evaluate the effectiveness of spiritual activity/beliefs on quality of life and healthcare outcomes among older adults in residential care facilities.

The specific questions to be addressed are:
• What is the effectiveness of spiritual activity and/or beliefs on quality of life indicators for older adults living in residential care facilities, and
• What is the effectiveness of spiritual activity and/or beliefs on health care outcomes for older adults living in residential care facilities

CRITERIA FOR REVIEW

Types of studies
This review will include randomised controlled trials (RCTs) for the evaluation of health care outcomes; in the absence of RCTs, other controlled designs will be sought. For the evaluation of quality of life, RCTs will be sought, in the absence of RCTs, longitudinal and prospective controlled designs will be included.

Participants
Participants of interest are older adults aged 65 and over in residential care facilities, indigenous participants will be included from the age of 45 with an expressed or otherwise communicated form of spiritual belief or activity.

Interventions
The interventions of interest are spiritual activity and/or beliefs of older adults. Spiritual activity and/or beliefs may include religious activities or attendance at a religious institution or faith.

Spiritual activities considered in this review will include:
Prayer
Attendance at a religious institution
Religious-based social support
Specific religious rituals associate with a particular form of belief, including rites, passages, and reading of texts


Spiritual beliefs considered in this review will include:
Concepts of forgiveness
Religious coping
Faith
Spiritual “connectedness” as determined via individual studies


Outcomes
For evaluation of quality of life measures, validated single or multidimensional tools that addressed spiritual, physical, mental and/or emotional measures of wellbeing will be included.
For evaluation of health care outcomes, papers that report morbidity and/or mortality data will be included, this review will not be limited to specific health care outcomes.

SEARCH STRATEGY
A three step search strategy will be utilised, step one will seek to identify initial key words used to identify papers that will be reviewed to identify database specific, comprehensive search strategy terms, this initial search will be repeated for each database used in the review to ensure the search terms are specific to the particular database being searched.
The second step will be the comprehensive search of each database using all identified key words for each specific database.
The third step will be to review the reference lists of all included studies to capture any additional papers that may not have been registered with the databases.
The search strategy will include the identification of published and unpublished literature, which is reported in the English language.

Initial key words to assist in step one of the search strategy are:
Spiritual beliefs
Faith
Spirituality
Residential
Aged
Older adults
Quality of life
Morbidity
Mortality

Databases included in the identification of studies will include:
Medline, cinahl, psychlit, embase, Cochrane Collaboration Controlled Trials Register, Australian Medical Index, AUSThealth,

The search for unpublished literature will include:
Current contents, dissertation abstracts international, Expanded Academic Index, Science Citation Index


METHODS OF REVIEW

Assessment of methodological quality
Methodological quality of studies will be assessed using an evaluation tool developed by the XXXXX and based on the work of the Cochrane Collaboration (Oxman, 1994), and the Centre for Reviews and Dissemination at the University of York (NHS Centre for Reviews and Dissemination 1996).
Two reviewers will independently assess all the articles and disagreements between reviewers will be resolved by discussion.

Data Collection/Extraction

Data will be extracted by two independent reviewers using a data extraction tool developed by the XXXXX. When necessary, the principal primary researcher will be contacted to obtain missing information.

Data Synthesis

If a sufficient number of studies are identified focusing on a particular intervention of interest with appropriate available data, results from comparable groups of studies will be pooled in a meta- analysis. Data synthesis for randomised controlled trials will utilise review manager 4.2 from The Cochrane Collaboration. Based on the analysis, a relative positive and or negative effect of the intervention in each of the sub-topics will be estimated. When pooling of results is inappropriate the findings will be considered for inclusion in a narrative summary.
Heterogeneity between combined studies will be tested using standard chi-square test. Where possible, odds ratio (for categorical outcome data) or standardised mean differences (for continuous data) and their 95% confidence intervals will be calculated for each included study.

peer review on the cheap...

I just skimmed through, but I'd question the participant sample.
First of all, what do you mean by "indigenous", and why are they afforded a lower age limit? That seems like an added variable. Even if that sample is isolated during data analysis, there isn't a justification as to why they are there.

Second, actively seeking participants from residential care facilities may skew the morbid./mortal. and quality of life analyses.

Just some thoughts right out of my ass.

hmmm, this protocol goes out for double blinded peer review next week, im just after cutious comments here really...

Weldhed - the focus is on older adults, hence the participant descriptions - I want to see what (if anything) works for them. Indigenous is like native, or original inhabitants (grey area) and they die younger than the average population, so also go in to nursing homes younger, hence that allowance.

thanks for your comments..

edit fixed typos lunch & typing

Ahh... that indigenous lifespan thing makes sense (although I still don't know if you need to include justification for it... do we assume the reviewers will understand?)

I realize that the study focuses on older people, but my point about the resident care facilities is that I'm not sure it is really representative of quality of life for the population.
Generally, QOL in such places is thought to be lower (anecdotally, at least), so I'd be worried that the results will reflect quality of particular facilities instead of quality of spirituality. I'd think that a more random sampling of all aged people -- in care facilities or not -- would give better results.
(Unless the point of the study is to look at spirituality specifically in these facilities, but I didn't gather that from the proposal )

edit: fuck me, it says it right in the objectives. :icon32:
I guess it's time for me to go to bed

I will clarify the validation for lower age of indigenous populations,
the other bit is in the title, objectives, and participants etc so like you say, I think its covered
nighty night!!!

pretty narrow measures of spiritual (in my philosophic opinion), but so long as you're consistent it seems a good operational definition.

e.g. i'm thinking of those who may practice yoga or tai chi, which are arguably spiritual on a fundamental level - course you have confounds then - is it the spirituality of these activities which benefits them, or the physical exercise component?

Sounds interesting, who is this study being done for and why?