More information about text formats
We have read the article, “Systematic review of systematic reviews of non-pharmacological interventions to treat behavioral disturbances in older patients with dementia. The SENATOR-OnTop series” by Abraha et al. published in BMJ Open in March 2017 with a lot of interest. This systematic review study presents very important findings on the use of non-pharmacological interventions to treat behavioral disturbances in elderly dementia population.
However, we have a specific concern about the database searched and relevant articles included in this systematic review of systematic reviews study. An important omission we found in this study was the systematic review by Kong et al.1 published in Aging & Mental Health Journal in July 2009. This systematic review and meta-analysis assessed the effectiveness of the nonpharmacological interventions for agitation in the older adults with dementia. It qualifies all the criteria for inclusion in the present study since it is published within the range of search duration (2009-2015 March) used in the present study. Furthermore, the present study has included the systematic reviews by Yu et al.2 published in March 2009 along with other systematic reviews such as Kverno et al.3 and Lai et al.4 published in the same year.
Also, the systematic review by Kong et al.1 assessed the effect on agitation (a type of behavioral disturbance) not assessed by many of the other systematic reviews included in the present study hence m...
Also, the systematic review by Kong et al.1 assessed the effect on agitation (a type of behavioral disturbance) not assessed by many of the other systematic reviews included in the present study hence making this systematic review even more important to include in the study to comprehensively shape the evidence around the research question.
Though the study provides the search strategy used to find the systematic reviews, it is still unclear to understand the reason for missing the inclusion of this important relevant systematic review in the present study. The study protocol mentioned MEDLINE, the Cochrane Library, CINAHL and PsychINFO as the database searched to retrieve the relevant systematic review. However, while performing the systematic review of systematic reviews we suggest searching the Epistemonikos database as well since it is a database which specifically provides access to systematic reviews in health.5 A preliminary search at the Epistemonikos database with the keywords from the search strategy easily retrieved the systematic review by Kong et al.1 along with others. Also, the PubMed’s inbuilt systematic review filter can be activated using the command systematic[sb] while searching for systematic reviews.6
1. Kong EH, , Evans LK, Guevara JP. Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis.Aging Ment Health. 2009;13(4):512-20.
2. Yu F , Rose KM, Burgener SC, Cunningham C, Buettner LL, Beattie E et al. Cognitive training for early-stage Alzheimer's disease and dementia.J Gerontol Nurs. 2009;35(3):23-9.
3. Kverno KS , Black BS, Nolan MT, Rabins PV Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998-2008: a systematic literature review.Int Psychogeriatr. 2009 Oct;21(5):825-43.
4. Lai CK , Yeung JH, Mok V, Chi I. Special care units for dementia individuals with behavioural problems.Cochrane Database Syst Rev. 2009;(4):CD006470.
5. About Epistemonikos, Available at: https://www.epistemonikos.org/en/about_us/who_we_are (Accessed: 6th July 2017).
6. U.S. National Library of Medicine. Search Strategy Used to Create the Systematic Reviews Subset on PubMed. Available at: https://www.nlm.nih.gov/bsd/pubmed_subsets/sysreviews_strategy.html (Accessed: 6th July 2017).
March 31th, 2017
Dear authors and concerned readers,
We are writing in reference to Abraha, I., Rimland, J.M., Trotta, F.M., et al. (2017), “Systematic review of systematic reviews of non-pharmacologic interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series”. The authors are to be commended for their effort to summarize the results of 38 systematic reviews and 142 primary studies.
In addition to summarizing the results of these studies the authors also, very usefully proposed a categorization of these studies. Unfortunately, at least for the first two categories of non-pharmacologic interventions, the categorizations presented in the abstract differ from the categorizations presented in the text. These differences raise questions about the number of systematic reviews and associated primary studies reported for each category in the abstract and cloud scientific efforts to report on the results of this important scientific project.
Specifically, the abstract states in part in the Results, “38 SR’s [systematic reviews] and 142 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (12 SR’s, 27 primary studies) that encompassed: acupressure, aromatherapy, massage/touch therapy, light therapy and sensory gardens; (2) cognitive/emotion-oriented interventions ( 33 SR’s; 70 primary studies) that included cognitiv...
Specifically, the abstract states in part in the Results, “38 SR’s [systematic reviews] and 142 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (12 SR’s, 27 primary studies) that encompassed: acupressure, aromatherapy, massage/touch therapy, light therapy and sensory gardens; (2) cognitive/emotion-oriented interventions ( 33 SR’s; 70 primary studies) that included cognitive stimulation, music/ dance therapy, dance therapy, snoezelen, transcutaneous electrical nerve stimulation, reminiscence therapy, validation therapy, simulated presence therapy;”
However, a somewhat different classification is presented in the text of the publication. Most troubling is the disturbing reality that many items from the abstract category “2”, the “Cognitive/emotion-oriented interventions”, appear in category “1” in the text of the publication.
Specifically, in the publication text, the “Sensory stimulation interventions” are presented beginning on page 9. The subcategories are: “Shiatsu and acupressure” (page 9), “Aromatherapy” (page 9), “Massage therapy” (page 9-10), “Light therapy” (pages 10-11), “Sensory garden and horticultural activities” (page 11), “Music and dance therapy” (pages 11-12), “Dance therapy” (page 12), “Snoezelen multisensory stimulation therapy” (page 13), and “Transcutaneous electrical nerve stimulation” (page 14).
The publication text has a category termed, “Cognitive/ emotion-oriented interventions” beginning on page 14. Included in this category are, “Cognitive stimulation” (pages 14-15), “Reminiscence therapy” (page 15-16), “Validation therapy” (page 16), and “Simulated presence therapy” (pages 16-17).
In summary, the “Sensory stimulation interventions” in the text including music and dance therapy, dance therapy, snoezelen multisensory stimulation therapy, and transcutaneous electrical nerve stimulation; all appear in the abstract under the “Cognitive/emotion-oriented interventions” category.
In the opinion of the readers named herein, the authors of this very formidable review should clarify the categorical confusion between the abstract and the text and remedy and/or clarify any resulting errors in the publication.