The Evidence Base for Occupational Therapy in Mental Health: More Systematic Reviews Are Needed

To shape its work, the Research Centre for Occupation & Mental Health is interested in research priorities. Systematic reviews develop an overview of the research available about an intervention, which can provide evidence to underpin practice. They also however, identify gaps in the knowledge base and so are useful for research-prioritization exercises. A rigorous literature search identified only four systematic reviews about occupational therapy in mental health, which suggests that more are needed to underpin practice. This article also explains a six-stage process for conducting a systematic review that can be used by occupational therapists in mental health.     

A systematic meta-review of evaluations of youth violence prevention programs: Common and divergent findings from 25 years of meta-analyses and systematic reviews

Violence among youth is a pervasive public health problem. In order to make progress in reducing the burden of injury and mortality that result from youth violence, it is imperative to identify evidence-based programs and strategies that have a significant impact on violence. There have been many rigorous evaluations of youth violence prevention programs. However, the literature is large, and it is difficult to draw conclusions about what works across evaluations from different disciplines, contexts, and types of programs. The current study reviews the meta-analyses and systematic reviews published prior to 2009 that synthesize evaluations of youth violence prevention programs. This meta-review reports the findings from 37 meta-analyses and 15 systematic reviews; the included reviews were coded on measures of the social ecology, prevention approach, program type, and study design. A majority of the meta-analyses and systematic reviews were found to demonstrate moderate program effects. Meta-analyses yielded marginally smaller effect sizes compared to systematic reviews, and those that included programs targeting family factors showed marginally larger effects than those that did not. In addition, there are a wide range of individual/family, program, and study moderators of program effect sizes. Implications of these findings and suggestions for future research are discussed.     

A Neuropsychologist’s Guide To Undertaking a Systematic Review for Publication: Making the most of PRISMA Guidelines

There is increasing impetus to improve the quality of research and scientific writing. Systematic reviews provide Class 1 research evidence, are based upon an established rigor and communicate results in a comprehensive manner, and are therefore particularly relevant to clinicians and researchers. Clinician requirements for quality systematic reviews are twofold: to keep up to date with research and to make informed decisions including those required for diagnoses, disease or risk assessment, and treatment. Researchers rely upon quality systematic reviews to compete for diminishing research funds, prove efficacy for intervention trials, and to meet increasing demand for evidence based intervention. However, insufficient systematic reviews are undertaken, and the methodological rigor and quality are often variable. The aim of this article is to guide researchers through the iterative systematic review process in order to improve quality and thereby increase publication rates. The step by step guide provides a road map through the EQUATOR network and practical suggestions in order to meet the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al. 2009) as well as encouraging high standards through the use of quality rating scales. Lastly, information is provided to encourage quantitative analysis to improve the synthesis of results and qualitative interpretation, such as calculating effect sizes or conducting a meta-analyses as the ultimate goal of a systematic review.     

On Conducting Construct Validity Meta-Analyses for the Rorschach: A Reply to Tibon Czopp and Zeligman (2016)

We respond to Tibon Czopp and Zeligman's (2016) critique of our systematic reviews and meta-analyses of 65 Rorschach Comprehensive System (CS) variables published in Psychological Bulletin (2013). The authors endorsed our supportive findings but critiqued the same methodology when used for the 13 unsupported variables. Unfortunately, their commentary was based on significant misunderstandings of our meta-analytic method and results, such as thinking we used introspectively assessed criteria in classifying levels of support and reporting only a subset of our externally assessed criteria. We systematically address their arguments that our construct label and criterion variable choices were inaccurate and, therefore, meta-analytic validity for these 13 CS variables was artificially low. For example, the authors created new construct labels for these variables that they called “the customary CS interpretation,” but did not describe their methodology nor provide evidence that their labels would result in better validity than ours. They cite studies they believe we should have included; we explain how these studies did not fit our inclusion criteria and that including them would have actually reduced the relevant CS variables’ meta-analytic validity. Ultimately, criticisms alone cannot change meta-analytic support from negative to positive; Tibon Czopp and Zeligman would need to conduct their own construct validity meta-analyses.     

Psychological interventions and the immune system: a meta-analytic review and critique.

This article reviews evidence for the hypothesis that psychological interventions can modulate the immune response in humans and presents a series of models depicting the psychobiological pathways through which this might occur. Although more than 85 trials have been conducted, meta-analyses reveal only modest evidence that interventions can reliably alter immune parameters. The most consistent evidence emerges from hypnosis and conditioning trials. Disclosure and stress management show scattered evidence of success. Relaxation demonstrates little capacity to elicit immune change. Although these data provide only modest evidence of successful immune modulation, it would be premature to conclude that the immune system is unresponsive to psychological interventions. This literature has important conceptual and methodological issues that need to be resolved before any definitive conclusions can be reached.     

From bench to bedside: Methods that help clinicians use evidence‐based practice

Despite the increasing number of evidence‐based practices and the significant use of public resources towards these, clinicians and practitioners do not consistently use evidence available to them. This paper examines methods that help clinicians and practitioners adopt evidence‐based practices. A review was done of 69 systematic reviews, meta‐analyses and literature reviews. Several methods can change the knowledge and skill base of professionals, and, to a lesser extent, patient health outcomes; namely, educational interventions; electronic methods; credible and skilled leadership; feedback; discussion; financial incentives; guidelines; portfolios; simulations; and visits from trained individuals. While robust evidence is lacking, effective interventions are likely to be multimodal; address the needs of the target group; be well‐planned; be intensive; encourage active participation; be relevant to the clinical context; and provide opportunities for ongoing professional development. The dissemination of evidence to clinicians and practitioners requires well‐considered multimodal interventions that are inclusive, comprehensive and ongoing.     

The importance of an evidence-based approach in the current Spanish policy for crime prevention

This introductory paper has two objectives. On the one hand, to present the guidelines of the evidence-based perspective on crime prevention as an alternative to the usual criminal policy, which often disregards conclusions based on scientific evidence. On the other hand, to discuss the contemporary situation in Spain regarding crime prevention and particularly the role psychology develops in terms of the utility/effectiveness dichotomy. The evidence-based perspective on crime prevention is guided by the main criteria of collecting the best scientific evidence in relation to 'what works best' in the different areas of crime prevention. In that purpose systematic reviews and meta-analyses are strongly recommended. The Campbell Collaboration in Crime and Justice is a scientific endeavour oriented to prepare rigorous and systematic reviews of high-quality evidence about 'what works'. Regarding crime prevention in Spain it is argued that psychology and other disciplines must make society and its rulers see that intervention based on evidence-based policy is essential for crime prevention.     

The effectiveness of family therapy and systemic interventions for adult-focused problems

This review updates a similar paper published in this Journal in 2000. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of couples and family therapy for adults with various relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multimodal programmes, for relationship distress, psychosexual problems, domestic violence, anxiety disorders, mood disorders, alcohol abuse, schizophrenia and adjustment to chronic physical illness.     

The being a patient effect: negative expectations based on group labeling and corresponding treatment affect patient performance

Patient studies provide insights into mechanisms underlying diseases and thus represent a cornerstone of clinical research. In this study, we report evidence that differences between patients and controls might partly be based on expectations generated by the patients’ knowledge of being invited and treated as a patient: the Being a Patient effect (BP effect). This finding extends previous neuropsychological reports on diagnosis threat. Participants with mild allergies were addressed either as patients or control subjects in a clinical study. We measured the impact of this group labeling and corresponding instructions on pain perception and cognitive performance. Our results provide evidence that the BP effect can indeed affect physiological and cognitive measures in clinical settings. Importantly, these effects can lead to systematic overestimation of genuine disease effects and should be taken into account when disease effects are investigated. Finally, we propose strategies to avoid or minimize this critical confound.     

Evidence-based treatment of stuttering: I. Definition and application

The philosophy guiding evidence-based treatment and its application to decision-making in stuttering treatment is described. Limitations to the use of evidence-based treatment principles to guide stuttering treatment, namely the lack of a substantial treatment research literature that can serve as the basis for meta-analyses and systematic reviews of effective treatment studies, are bemoaned. Guidelines are provided to aid clinicians in their own conduct of critical evaluations of treatment research. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to (1) describe the four steps that characterize evidence-based practice, (2) evaluate previous efforts to develop practice guidelines for stuttering, (3) assess the importance of an evidence-based approach to stuttering treatment, and (4) discuss the need for more research that will contribute to the evidence base.     

Panning for the gold in health research: Incorporating studies’ methodological quality in meta-analysis

Background: Systematic reviews now routinely assess methodological quality to gauge the validity of the included studies and of the synthesis as a whole. Although trends from higher quality studies should be clearer, it is uncertain how often meta-analyses incorporate methodological quality in models of study results either as predictors, or, more interestingly, in interactions with theoretical moderators.

Objective and methods: We survey 200 meta-analyses in three health promotion domains to examine when and how meta-analyses incorporate methodological quality.

Results: Although methodological quality assessments commonly appear in contemporary meta-analyses (usually as scales), they are rarely incorporated in analyses, and still more rarely analysed in interaction with theoretical determinants of the success of health promotions. The few meta-analyses (2.5%) that did include such an interaction analysis showed that moderator results remained significant in higher quality studies or were present only among higher quality studies. We describe how to model quality interactively with theoretically derived moderators and discuss strengths and weaknesses of this approach and in relation to current meta-analytic practice.

Conclusions: In large literatures exhibiting heterogeneous effects, meta-analyses can incorporate methodological quality and generate conclusions that enable greater confidence not only about the substantive phenomenon but also about the role that methodological quality itself plays.     

Social Biases and Solutions for Procedural Objectivity

An empirically sensitive formulation of the norms of transformative criticism must recognize that even public and shared standards of evaluation can be implemented in ways that unintentionally perpetuate and reproduce forms of social bias that are epistemically detrimental. Helen Longino's theory can explain and redress such social bias by treating peer evaluations as hypotheses based on data and by requiring a kind of perspectival diversity that bears, not on the content of the community's knowledge claims, but on the beliefs and norms of the culture of the knowledge community itself. To illustrate how socializing cognition can bias evaluations, we focus on peer‐review practices, with some discussion of peer‐review practices in philosophy. Data include responses to surveys by editors from general philosophy journals, as well as analyses of reviews and editorial decisions for the 2007 Cognitive Science Society Conference.     

Commentary: Bashful Boys and Coy Girls: A Review of Gender Differences in Childhood Shyness

In this commentary we argue that subjective reviews of gender differences, as opposed to empirical meta-analyses, can be more affected by influences which may not yield an objective evaluation of the available evidence, including the potential overrepresentation of articles that do versus do not find gender differences and lack of a systematic evaluation of factors that influence findings. We consider theoretical bases for considering shyness to be detrimental to the development and wellbeing of girls. These include perspectives that characterize girls as being particularly affected by their personal relationships and children of both genders as influenced by patterns of same-gender interaction. Some perspectives are helpful in conceptualizing why gender difference patterns can be nuanced over the course of development, across different outcomes, contexts, and historical periods. We also briefly consider the utility of diathesis × stress and differential susceptibility models in understanding gendered patterns of adjustment. We argue that reviews of gender differences in childhood shyness should address the gender difference paradox in childhood shyness and anxiety. That is, why are gender differences in the prevalence of shyness typically absent in early to middle childhood (as concluded in the review article), but girls and women consistently demonstrate higher rates of anxiety disorders, including social anxiety disorder, than their male counterparts in adolescence and adulthood? Finally, we conclude with comments encouraging researchers to consider the potential consequences of how they convey messages about gender differences in childhood shyness. We suggest how such information can be communicated in a responsible manner.     

The effectiveness of family therapy and systemic interventions for child-focused problems

This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, ADHD, delinquency and drug abuse); emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality); eating disorders (including anorexia, bulimia and obesity); and somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes).     

Complementary and alternative therapies for cerebral palsy

The optimal practice of medicine includes integrating individual clinical expertise with the best available clinical evidence from systematic research. This article reviews nine treatment modalities used for children who have cerebral palsy (CP), including hyperbaric oxygen, the Adeli Suit, patterning, electrical stimulation, conductive education, equine-assisted therapy, craniosacral therapy, Feldenkrais therapy, and acupuncture. Unfortunately, these modalities have different degrees of published evidence to support or refute their effectiveness. Uncontrolled and controlled trials of hippotherapy have shown beneficial effects on body structures and functioning. Studies of acupuncture are promising, but more studies are required before specific recommendations can be made. Most studies of patterning have been negative and its use cannot be recommended. However, for the other interventions, such as hyperbaric oxygen, more evidence is required before recommendations can be made. The individual with CP and his or her family have a right to full disclosure of all possible treatment options and whatever knowledge currently is available regarding these therapies.     

Is weight-related bullying addressed in school-based anti-bullying programs?

IntroductionThe high prevalence and numerous negative correlates of weight-related bullying among youth emphasize the need to prevent and counter this phenomenon in school settings. This scoping review aims at: (a) determining whether the anti-bullying programs identified in previous systematic reviews and meta-analyses take weight-related bullying into account, and (b) pinpointing effective intervention strategies against weight-related bullying.Literature findingsNone of the 10 systematic reviews and meta-analyses retained addressed weight-related bullying directly. However, their findings highlighted some intervention strategies that may help prevent and reduce this type of bullying.Discussion and conclusionThe results underscore the need to consider weight-related bullying more closely in anti-bullying programs implemented in elementary, middle, and high schools. It is also important to target the intervention strategies most likely to lead to the prevention and reduction of weight-related bullying. Such strategies could include, for example: (a) education, training, and awareness-raising, for school personnel, concerning weight bias, norms and prejudices; and (b) social and emotional support for students who are victims of weight-related teasing or bullying.     

DSM-IV Literature reviews: Rationale,process, and limitations

DSM-IV will benefit from the extensive research and interest in diagnosis generated in large part by DSM-III. The development of DSM-IV is proceeding through three stages of empirical documentation, including literature reviews, analysis of unpublished data sets, and field trials. This paper discusses the rationale, process, and limitations of the literature reviews. The purpose of the literature reviews is to provide and to document a comprehensive review of the clinical and empirical literature to facilitate objective and empirically based decisions. The review process is guided by the explicit and systematic methods developed within meta-analysis. Limitations of the reviews are also discussed.The opinions expressed in this paper are those of the authors and do not necessarily represent the position of the American Psychiatric Association and its Task Force on DSM-IV.     

Evaluating single-case research data for systematic review: A commentary for the special issue

The purpose of this commentary is to provide observation on the statistical procedures described throughout this special section from the perspective of researchers with experience in conducting systematic reviews and meta-analyses of single-case research to address issues of evidence-based practice. It is our position that both visual and statistical analyses are complimentary methods for evaluating single-case research data for these purposes. Given the recent developments regarding the use of single-case research to inform evidence-based practice and policy, the developments described in the present issue will be contextualized within the need for a widely accepted process for data evaluation to assist with extending the impact of single-case research. The commentary will, therefore, begin with providing an overview of the conceptual underpinnings of a systematic review of single-case research and will be followed by a discussion of several features that are essential to the development of a conceptually sound and widely used statistical procedure for single-case research. The commentary will conclude with recommendations and guidelines for the use of both visual and statistical analyses within primary research reports and recommendations for future research.     

Exercise and Depression: A Review of Reviews

There has been considerable research interest in the effects of exercise upon depression outcomes. Recently, health agencies in the United Kingdom (UK) and beyond have made several guidance statements on this issue. Therefore, this review seeks to provide a synthesis of evidence regarding the effectiveness of exercise in the management of depression (including postnatal depression) in adults. Studies were identified by searching PubMed, Medline, Cochrane Library (CENTRAL) and PsychINFO using relevant search terms. The article describes how meta-analyses from peer reviewed journals have reported exercise as treatment for depression is more effective than no treatment, as effective as traditional interventions in some instances, possibly a promising approach to postnatal depression and has equivalent adherence rates to medication. However, reviews have also raised concerns about the methodological quality of trials, possible overestimation of treatment effects and lack of data regarding long term benefits. Based on the available evidence it is concluded that while awaiting further high quality trial evidence it would seem appropriate for exercise to be recommended in combination with other treatments.     

Standards on how to develop and report systematic reviews in Psychology and Health

Systematic reviews are secondary studies that summarize the best scientific evidence available by means of explicit and rigorous methods to identify, select, appraise, analyse and summarise the empirical studies that enable responding to specific questions. The aim of this theoretical study is to set out a series of standards and recommendations for the planning, development and reporting of a systematic review in the field of the health sciences. The article describes the systematic reviews in the context of practice based on scientific evidence, their rise, justification, applicability and differences compared to traditional literature reviews. Secondly, the methodology is set out for their development and guidelines are established for their preparation; the stages of the process and preparation of a protocol are described with emphasis on the steps to follow to prepare and report a systematic review. Finally, some additional considerations are set out for their preparation and publication in a scientific journal. This guide is aimed both at authors and reviewers of a systematic review.