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Review Papers
Effects of Non-Pharmacological Interventions on Major Adverse Cardiac Events in Patients Underwent Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis
Jo, Sojeong , Lee, Haejung , Park, Gaeun
J Korean Acad Nurs 2024;54(3):311-328.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24019
AbstractAbstract PDF
Purpose
In this study a systematic review and meta-analysis investigated the impact of non-pharmacological interventions on major adverse cardiac events (MACE) in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI).
Methods
A literature search was performed using PubMed, Cochrane Library, EMBASE, and Cumulative Index to Nursing & Allied Health Literature databases up to November 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software (version 4.3.2).
Results
Eighteen randomized studies, involving 2,898 participants, were included. Of these, 16 studies with 2,697 participants provided quantitative data. Non-pharmacological interventions (education, exercise, and comprehensive) significantly reduced the risk of angina, heart failure, myocardial infarction, restenosis, cardiovascular-related readmission, and cardiovascular-related death. The subgroup meta-analysis showed that combined interventions were effective in reducing the occurrence of myocardial infarction (MI), and individual and group-based interventions had significant effects on reducing the occurrence of MACE. In interventions lasting seven months or longer, occurrence of decreased by 0.16 times, and mortality related to cardiovascular disease decreased by 0.44 times, showing that interventions lasting seven months or more were more effective in reducing MI and cardiovascular disease-related mortality.
Conclusion
Further investigations are required to assess the cost-effectiveness of these interventions in patients undergoing PCI and validate their short- and long-term effects. This systematic review underscores the potential of non-pharmacological interventions in decreasing the incidence of MACE and highlights the importance of continued research in this area (PROSPERO registration number: CRD42023462690).
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Factors Related to Emotional Leadership in Nurses Manager: Systematic Review and Meta-Analysis
Jang, Se Young , Park, Chan Mi , Yang, Eun Hee
J Korean Acad Nurs 2024;54(2):119-138.   Published online May 31, 2024
DOI: https://doi.org/10.4040/jkan.24026
AbstractAbstract PDF
Purpose
This study aimed to identify research trends related to emotional leadership among nurse managers by conducting a systematic literature review and meta-analysis. This study sought to derive insights that could contribute to improving emotional leadership in nursing practice.
Methods
A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Research Information Sharing Service, Koreanstudies Information Service System, Korean Medical Database, KoreaMed, ScienceON, and DBpia were searched to obtain papers published in English and Korean. Literature searches and screenings were conducted for the period December 1, 2023 to December 17, 2023. The effect size correlation (ESr) was calculated for each variable and the meta-analysis was performed using the statistical software SPSS 29.0, R 4.3.1.
Results
Twenty-five (four personal, six job, and fifteen organizational) relevant variables were identified through the systematic review. The results of the meta-analysis showed that the total overall effect size was ESr = .33. Job satisfaction (ESr = .40) and leader-member exchange (ESr = .75) had the largest effect size among the job and organizational-related factors.
Conclusion
Emotional leadership helps promote positive changes within organizations, improves organizational effectiveness, and increases member engagement and satisfaction. Therefore, it is considered an important strategic factor in improving organizational performance.
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Research Papers
Effects of Health Education Using Virtual Reality for Adolescents: A Systematic Review and MetaAnalysis
Park, SoMi , Chung, ChaeWeon , Kim, Gaeun
J Korean Acad Nurs 2023;53(2):177-190.   Published online April 30, 2023
DOI: https://doi.org/10.4040/jkan.23003
AbstractAbstract PDF
Purpose
This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents.
Methods
This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors.
Results
This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).
Conclusion
The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.
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Effect of Digital Health Interventions on Psychotic Symptoms among Persons with Severe Mental Illness in Community: A Systematic Review and Meta-Analysis
Oh, Eunjin , Gang, Moonhee
J Korean Acad Nurs 2023;53(1):69-86.   Published online February 28, 2023
DOI: https://doi.org/10.4040/jkan.22121
AbstractAbstract PDF
Purpose
This study aimed to evaluate the effects of digital health interventions on the psychotic symptoms among people with severe mental illness in the community.
Methods
A systematic review and meta-analysis were conducted in accordance with the Cochrane Intervention Research Systematic Review Manual and PRISMA. A literature search was conducted of published randomized controlled trials (RCTs) for digital health interventions from January 2022 to April 2022. RevMan software 5.3 was used for quality assessment and meta-analysis.
Results
A total 14 studies out of 9,864 studies were included in the review, and 13 were included in meta-analysis. The overall effect size of digital health interventions on psychotic symptoms was - 0.21 (95% CI = - 0.32 to - 0.10). Sub-analysis showed that the reduction of the psychotic symptoms was effective in the schizophrenia spectrum group (SMD = - 0.22; 95% CI = - 0.36 to - 0.09), web (SMD = - 0.41; 95% CI = - 0.82 to 0.01), virtual reality (SMD = - 0.33; 95% CI = - 0.56 to - 0.10), mobile (SMD = - 0.15; 95% CI = - 0.28 to - 0.03), intervention period of less than 3 months (SMD = - 0.23; 95% CI = - 0.35 to - 0.11), and non-treatment group (SMD = - 0.23; 95% CI = - 0.36 to - 0.11).
Conclusion
These findings suggest that digital health interventions alleviate psychotic symptoms in patients with severe mental illnesses. However, well-designed digital health studies should be conducted in the future.
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Review Papers
Effects of Leadership Styles of Nursing Managers on Turnover Intention of Hospital Nurses: A Systematic Review and Meta-Analysis
Cho, Yunjeong , Jeong, Seok Hee , Kim, Hee Sun , Kim, Young Man
J Korean Acad Nurs 2022;52(5):479-498.   Published online October 31, 2022
DOI: https://doi.org/10.4040/jkan.22039
AbstractAbstract PDF
Purpose
This study aimed to examine effect sizes of leadership styles of nursing managers on turnover intention of hospital nurses.
Methods
A systematic review and meta-analysis were conducted in accordance with the PRISMA and MOOSE guidelines. Participants were nurses working in hospitals. The intervention involved nursing managers’ leadership styles; the outcome assessed was nurses’ turnover intention. This was an observational study design. Eleven databases were searched to obtain articles published in Korean or English. Of the 14,428 articles reviewed, 21 were included in systematic review and meta-analysis. Comprehensive Meta-Analysis and R software programs were used.
Results
The total effect size r (ESr) was - 0.25 (95% confidence interval: - 0.29 to - 0.20). Effect sizes of each leadership style on turnover intention were as follows: ethical leadership (ESr = - 0.34), transformational leadership (ESr = - 0.28), authentic leadership (ESr = - 0.23), transactional leadership (ESr = - 0.21), and passive avoidant leadership (ESr = 0.13). Ethical leadership was the most effective style in decreasing turnover intention of hospital nurses.
Conclusion
Positive leadership styles of nurse managers effectively decrease turnover intention of hospital nurses, and negative leadership styles of nurse managers effectively increase turnover intention of hospital nurses. The ethical leadership style is the most effective in decreasing turnover intention of hospital nurses; however, it requires careful interpretation as its effects are reported by only two studies. This study contributes to addressing the high turnover rate of hospital nurses and developing positive leadership styles of nurse managers in hospital settings.
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Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis
Jeong, Seohee , Jeong, Seok Hee
J Korean Acad Nurs 2022;52(4):363-377.   Published online August 31, 2022
DOI: https://doi.org/10.4040/jkan.22022
AbstractAbstract PDF
Purpose
This study aimed to test a hypothetical model of Korean nurses’ patient safety management activities using meta-analytic path analysis.
Methods
A systematic review, meta-analysis, and meta-analytic path analysis were conducted following the PRISMA and MOOSE guidelines. Seventy-four studies for the meta-analysis and 92 for the meta-analytic path analysis were included. The R software program (Version 3.6.3) was used for data analysis.
Results
Four variables out of 49 relevant variables were selected in the meta-analysis. These four variables showed large effect sizes (ESr = .54) or median effect sizes (ESr = .33∼.40) with the highest k (number of studies) in the individual, job, and organizational categories. The hypothetical model for the meta-analytic path analysis was established using these variables and patient safety management activities. Twelve hypothetical paths were set and tested. Finally, the perception of the importance of patient safety management and patient safety competency directly affected patient safety management activities. In addition, self-efficacy, the perception of the importance of patient safety management, patient safety competency, and patient safety culture, indirectly affected patient safety management activities.
Conclusion
Self-efficacy, the perception of the importance of patient safety management, patient safety competency, and the organization’s patient safety culture should be enhanced to improve nurses’ patient safety management activities.
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Effect of Auriculotherapy on Musculoskeletal Pain: A Systematic Review and Meta-Analysis
Choi, Sun Yeob , Kim, Yeo Ju , Kim, Bomi
J Korean Acad Nurs 2022;52(1):4-23.   Published online February 28, 2022
DOI: https://doi.org/10.4040/jkan.21121
AbstractAbstract PDF
Purpose
The aim of this study was to evaluate the effect of auriculotherapy on musculoskeletal pain in adults.
Methods
A total of 885 studies were retrieved from nine databases (PubMed, Scopus, CINAHL, Web of Science, Ovid Medline, Cochrane Library, RISS, KMbase, and KISS). Sixteen studies were selected for meta-analysis, which satisfied the inclusion criteria and the evaluation of risk of bias. Demographic data, auriculotherapy types, intervention characteristics, auricular points, and outcomes related to pain (subjective pain scale, and amount of analgesic) were extracted from all included studies. The effect size of auriculotherapy was analyzed through comprehensive meta analysis 3.0, and the presence of publication bias was analyzed through a funnel plot and Egger’s regression.
Results
The results of the meta-analysis (n = 16) revealed that the auriculotherapy was significantly superior to the control group on present pain in adults (Hedges’ g = - 0.35, 95% Confidence Interval [CI] = - 0.55~- 0.15). According to the results of subgroup analysis, the effect size of auricular acupuncture therapy (Hedges’ g = 0.45, 95% CI = - 0.75~- 0.15) was higher than the auricular acupuncture (Hedges’ g = 0.27, 95% CI = - 0.53~0.00): the longer the intervention period, the greater the effect size.
Conclusion
In this study, auriculotherapy demonstrates a significant reduction in musculoskeletal pain in adults. Therefore, it is necessary to refine the curriculum to include auriculotherapy as a nursing intervention to relieve musculoskeletal pain in adults and encourage its use in clinical settings.
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The Effects of Programs on Body-Image Improvement in Adolescents: A Systematic Review and Meta-Analysis
Yun, Hyun Jung , Seo, Kyoungsan , Han, Dallong
J Korean Acad Nurs 2021;51(5):597-616.   Published online October 31, 2021
DOI: https://doi.org/10.4040/jkan.21104
AbstractAbstract PDF
Purpose
This study’s objective was to investigate the effects of programs that improve adolescents’ body image, using a systematic review and meta-analysis.
Methods
A literature search was performed in eleven electronic databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Population characteristics, contents of the programs, and measured outcomes were systematically reviewed from 21 selected studies. To estimate the size of the effects, meta-analysis was conducted using Comprehensive Meta-Analysis software.
Results
The contents of the programs that aimed to improve body image included physical, psychological, interpersonal, and sociocultural interventions. Sixteen studies were meta-analyzed to estimate the effect size of body-image improvement programs. Results showed that the program for body-image improvement had significant effects on body satisfaction (effect size [ES] = 0.56, 95% confidence interval [CI] = 0.23 to 0.89), and body dissatisfaction (ES = - 0.15, 95% CI = - 0.23 to - 0.08).
Conclusion
The program for body image improvement in adolescents includes a combination of physical, psychological, interpersonal relationship, and socio-cultural dimensions. The program that seeks to improve body image appears to be effective at increasing body satisfaction, and at reducing body dissatisfaction in adolescents. Thus, it is necessary to develop and apply multidimensional programs for adolescents to have a positive body image.
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Effect of 2% Chlorhexidine Bathing on the Incidence of Hospital-Acquired Infection and Multidrug-Resistant Organisms in Adult Intensive Care Unit Patients: Systematic Review and Meta-Analysis
Seo, Jisu , Song, Rhayun
J Korean Acad Nurs 2021;51(4):414-429.   Published online August 31, 2021
AbstractAbstract PDF
Purpose
This systematic review and meta-analysis analyzed the effects of 2% chlorhexidine bathing on the incidence of hospital-acquired infection (HAI) and multidrug-resistant organisms (MDRO) in adult intensive care units.
Methods
PubMed, CINAHL, Cochrane library, and RISS database were systematically searched, and 12 randomized studies were included in the analysis. Comprehensive Meta-Analysis version 3.0 was used to calculate the effect size using the odds ratio (OR) and a 95% confidence interval (CI). Subgroup analysis was performed according to the specific infection and intervention types.
Results
In general, 2% chlorhexidine bathing has a significant effect on the incidence of HAI (OR, 0.59; 95% CI, 0.40~0.86) and MDRO (OR, 0.52; 95% CI, 0.34~0.79). Subgroup analyses show 2% chlorhexidine bathing is effective in bloodstream infections (OR, 0.51; 95% CI, 0.39~0.66) but not for urinary tract infections, ventilator-associated pneumonia infections, and Clostridium difficile infections. Moreover, 2% chlorhexidine bathing alone or its combination with other interventions has a significant effect on the incidence of HAI and MDRO (OR, 0.59; 95% CI, 0.38~0.92).
Conclusion
This meta-analysis reveals that 2% chlorhexidine bathing significantly reduces the incidence of HAI and MDRO in intensive care units. The effect of 2% chlorhexidine bathing on pediatric patients or patients at general wards should be further assessed as a cost-effective intervention for infection control.
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A Meta-Analytic Path Analysis on the Outcome Variables of Nursing Unit Managers’ Transformational Leadership: Systemic Review and Meta-Analysis
Kim, Sunmi , Seok Hee, Jeong
J Korean Acad Nurs 2020;50(6):757-777.   Published online December 31, 2020
DOI: https://doi.org/10.4040/jkan.20205
AbstractAbstract PDF
Purpose
The purpose of this study was to identify the outcome variables of nursing unit managers’ transformational leadership and to test a hypothetical model using meta-analytic path analysis.
Methods
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data analysis, conducted using R version 3.6.2 software, included 49 studies for the meta-analysis and 119 studies for meta-analytic path analysis.
Results
In the meta-analysis, four out of 32 outcome variables were selected. These four variables were empowerment, nursing performance, job satisfaction, and organizational commitment, which showed larger effect sizes than the median and more than five k. The hypothetical model for the meta-analytic path analysis was established by using these four variables and transformational leadership. A total of 22 hypothetical paths including nine direct effects and 13 indirect effects were set and tested. The meta-analytic path analysis showed that transformational leadership had direct effects on the four variables. Finally, eight direct effects, 12 indirect effects, and six mediating effects were statistically significant, and the hypothetical model was verified.
Conclusion
Nursing unit managers can use the transformational leadership to improve empowerment, nursing performance, job satisfaction, and organizational commitment of nurses. This study empirically showed the importance of transformational leadership of nursing managers. This finding will be used as evidence to develop strategies for enhancing transformational leadership, empowerment, nursing performance, job satisfaction, and organizational commitment in nursing science and practice.
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Characteristics of Aerobic Exercise as Determinants of Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-Analysis
Lee, Sun Hee , Chae, Young Ran
J Korean Acad Nurs 2020;50(6):740-756.   Published online December 31, 2020
DOI: https://doi.org/10.4040/jkan.20169
AbstractAbstract PDF
Purpose
The purpose of this study was to evaluate the effect on blood pressure (BP) and heart rate (HR) according to aerobic exercise characteristics in adults with hypertension using a systematic review and meta-analysis.
Methods
The related researches were selected from PubMed, EMBASE, Cochrane library, CINAHL, PsycINFO, SPORTDiscus and 5 domestic databases up to September 4, 2019. To estimate the effect size, random effect models were used to derive weighted mean differences (WMD) and their 95% confidence intervals (CI) of aerobic exercise on BP and HR.
Results
A total of 37 RCTs with 1,813 samples were included. Aerobic exercise was found to significantly reduce systolic BP (WMD, - 8.29 mmHg; 95% CI, - 10.12 to - 6.46), diastolic BP (WMD, - 5.19 mmHg; 95% CI, - 6.24 to - 4.14) and HR (WMD, - 4.22 beats/min; 95% CI, - 5.36 to –3.09). In detail, systolic BP and diastolic BP were significantly decreased in all groups of exercise types, frequency and duration. Systolic BP and diastolic BP were significantly decreased in the moderate and vigorous-intensity group. Exercise characteristics with the most dramatical change in systolic BP were water-based training, moderate-intensity, 3 times a week and 8 to 11 weeks of duration. In diastolic BP, the greatest effect size was over 24 weeks of exercise.
Conclusion
Moderate aerobic exercise, especially water-based exercise can be an important part of lifestyle modification for hypertensive patients. Also, it can be recommended in a variety of clinical settings for lowering BP and HR. However, there is insufficient evidence that low-intensity exercise is effective in lowering BP.
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Review Articles
A Meta-Analysis on the Effects of Mind-Body Therapy on Patients with Irritable Bowel Syndrome
Choi, Eun Hui , Kim, Moon Ja , Lee, Eun Nam
J Korean Acad Nurs 2020;50(3):385-400.   Published online June 30, 2020
DOI: https://doi.org/10.4040/jkan.19224
AbstractAbstract PDF
Purpose
Previous randomized controlled trials (RCT) found that mind-body therapy can improve the health outcomes of patients with irritablebowel syndrome (IBS). The purpose of this meta-analysis was to identify the combined effects of mind-body therapy on patients’ IBSsymptoms, quality of life, anxiety, and depression.
Methods
A systematic literature search was conducted using various databases such asPubMed, EMBASE, CINAHL CENTRAL, DBpia, RISS, and KISS. The primary outcome variables were IBS symptoms and quality of life; the secondaryoutcome variables were anxiety and depression. Comprehensive Meta-Analysis version 3.0 was used to analyze the extracted data.The effect size was calculated using standardized mean difference (SMD) and 95% confidence interval (CI).
Results
Eleven final RCTs wereused for this meta-analysis. Mind-body therapy was found to have a significant effect on the IBS patients’ symptoms (SMD, -0.63; 95% CI,-0.77 to -0.48), quality of life (SMD, 1.03; 95% CI, 0.40 to 1.66), anxiety (SMD, -0.28; 95% CI, -0.47 to -0.09), and depression (SMD,-0.31; 95% CI, -0.06 to -0.12).
Conclusion
This meta-analysis reveals that mind-body therapy significantly improves IBS patients’ symptoms,quality of life, anxiety, and depression. The results suggest that, in the future, appropriate mind-body therapy should be applied toKoreans suffering from IBS. Moreover, the therapy’s long-term effects should be assessed.
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Effects of First Assisted Reproductive Technologies on Anxiety and Depression among InfertileWomen: A Systematic Review and Meta-Analysis
Ha, Ju-Young , Ban, Seon-Hwa , Lee, Hae-Jung , Lee, Misoon
J Korean Acad Nurs 2020;50(3):369-384.   Published online June 30, 2020
DOI: https://doi.org/10.4040/jkan.19187
AbstractAbstract PDF
Purpose
The purpose of this study was to analyze anxiety and depression among infertile women at different time points during the firstIn Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) treatment through a systematic review and meta-analysis.
Methods
Seven out of 3,011 studies were included for meta-analysis. To estimate the effect size, a meta-analysis of the studies was performedusing the RevMan 5.3 program. We compared the measurement outcomes at three time points: before the start of treatment (T0), cancellationof treatment after pregnancy detection (T2), one to six months after treatment (T3). The effect size used was the standardizedmean difference (SMD).
Results
In comparing the different time points of the pregnant women from their cycle, significantly lower levelsof depression were found at T2 than at T0. In non-pregnant women, anxiety at T2 and depression at T2 and T3 were significantly higherthan those at T0. At T2 and T3, the non-pregnant women reported higher levels of anxiety and depression compared with the pregnantwomen.
Conclusion
Anxiety and depression in infertile women undergoing the first IVF or ICSI are associated with the time points andpregnancy status after treatment. These findings suggest that attention should be paid to helping infertile women prepare for and copewith treatment and treatment failure.
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Factors Related to Persistent Postoperative Pain after Cardiac Surgery: A Systematic Review and Meta-Analysis
Bae, Jaewon , Shin, Sujin
J Korean Acad Nurs 2020;50(2):159-177.   Published online April 30, 2020
DOI: https://doi.org/10.4040/jkan.2020.50.2.159
AbstractAbstract PDF
Purpose
This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes.
Methods
The literature search and selection was conducted in four different databases (CINAHL, Cochrane Library, PubMed, and PQDT) using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. A total of 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, R was used to analyze 30 effect sizes of for both individual and operative factors as well as publication biases from a total of nine studies.
Results
The meta-analysis revealed that persistent postoperative pain after cardiac surgery was related to one individual factor (gender) and two operative factors (acute postoperative pain and use of the internal mammary artery). Operative factors (OR=5.26) had a larger effect size than individual factors (OR=1.53).
Conclusion
Female gender, acute pain after surgery, and use of the internal mammary artery are related factors to persistent postoperative pain. The development of interventions focusing on modifiable related factors, such as acute postoperative pain, may help to minimize or prevent PPP after cardiac surgery.
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Effect of Autogenic Training for Stress Response: A Systematic Review and Meta-Analysis
Eunju Seo, Soukyoung Kim
J Korean Acad Nurs 2019;49(4):361-374.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.361
AbstractAbstract PDF
Abstract Purpose

This study was conducted to evaluate the effectiveness of autogenic training on stress responses through a systematic review and meta-analysis.

Methods

A systematic search was conducted using eight core electronic databases (Embase, CENTRAL, Medline, CINAHL, PsycInfo, DBpia, KISS, and RISS). To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3.5 program.

Results

A total 21 studies out of 950 studies were included in the review, and 11 were included for meta-analysis. These studies showed that autogenic training decreased anxiety and depression, and increased the high frequency of heart rate variability. Calculations to understand the effect of autogenic training on anxiety, through a meta-analysis, observed a reduction effect of anxiety score by 1.37 points (n=85, SMD=-1.37: 95% CI -2.07 to -0.67), in the studies on short-term intervention targeting healthy adults. On the other hand, similar calculations to understand the effect of autogenic training on depression observed, a reduction effect on the depression score by 0.29 point (n=327, SMD=-0.29: 95% CI -0.50 to -0.07), in the studies on long term intervention targeting the patient group.

Conclusion

Autogenic training is effective for adults’ stress management, and nurses will be able to effectively perform autogenic training programs for workers’ stress relief at the workplace.

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Effects of Reminiscence Therapy on Depressive Symptoms in Older Adults with Dementia: A Systematic Review and Meta-Analysis
Kyungsoo Kim, Jia Lee
J Korean Acad Nurs 2019;49(3):225-240.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.3.225
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to evaluate the effects of reminiscence therapy on depressive symptoms in older adults with dementia using a systematic review and meta-analysis.

Methods

Randomized controlled trials (RCTs) published from January 2000 to January 2018 were searched through Research Information Sharing Service (RISS), Korean Studies Information Service System (KISS), Korean Medical Database (KMbase), KoreaMed, PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ovid MEDLINE. Two researchers independently performed the search, selection, and coding. Comprehensive Meta-Analysis 3.0 was used for meta-analysis, and Review Manager program 5.3 was used for quality assessment.

Results

Out of the 1,250 retrieved articles, 22 RCTs were selected for analysis. The overall effect size of reminiscence therapy for mitigating depressive symptoms in older adults with dementia was -0.62 (95% Cl: -0.92 to -0.31). The effect size was greater in older adults under 80, those with less disease severity, and those for whom the therapy session lasted less than 40 minutes.

Conclusion

Reminiscence therapy is an effective non-pharmacological therapy to improve depressive symptoms in older adults with dementia. Because its effectiveness is also influenced by age, disease severity, and application method, it is necessary to consider treatment designs based on individual characteristics as well as methodological approaches.

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Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis
Youjin Jung, Jimin Kim, Dong Ah Park
J Korean Acad Nurs 2018;48(4):389-406.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.4.389
AbstractAbstract PDF
Abstract Purpose

This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma.

Methods

We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies.

Results

Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) -0.20~0.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.43~2.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence.

Conclusion

The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.

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Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis
Pok-Ja Oh, You Lim Kim
J Korean Acad Nurs 2018;48(2):123-142.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.2.123
AbstractAbstract PDF
Abstract Purpose

This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN).

Methods

PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses.

Results

Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=-0.71) and CIPN pain (d=-0.73) (p<.001). Massage and foot bath were also effective in reducing CIPN symptoms (d=-0.68; 95% CI=-1.05, -0.30; p<.001; I2=19%).Exercis-es were effective in improving muscle strength and endurance(d=-0.55) and quality of life (d=-2.96), but they were not significantly effective in improving CIPN.

Conclusion

Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. PROSPERO registration: CRD42017076278.

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Effects of Psychoeducational Intervention for Cancer Survivors: A Systematic Review and Meta-Analysis
Jin-Hee Park, Sun Hyoung Bae
J Korean Acad Nurs 2017;47(2):143-163.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.143
AbstractAbstract PDFSupplementary Material
Purpose

This study was a systematic review and meta-analysis designed to investigate effects of psychoeducational intervention for cancer survivors.

Methods

Ten databases were searched. Two reviewers independently performed the selection of the studies, data extraction and assessment. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, meta-analysis of the studies was performed using Comprehensive Meta-Analysis and RevMan programs.

Results

Of 18,781 publications identified, 35 met inclusion criteria, and 25 studies were used to estimate effect size of psychoeducational intervention. Effect sizes (standardized mean difference [SMD]) were heterogeneous and random effects models were used in the analyses. Psychoeducational intervention was effective for quality of life (n=2,410, ES=0.23; 95% CI: 0.09~0.37), coping and self-efficacy (n=179, ES=0.68; 95% CI: 0.26~1.11), anxiety (n=1,786, ES=-0.26; 95% CI: -0.37~-0.15), depression (n=1,910, ES=-0.28; 95% CI: -0.37~-0.18), and psychological distress (n=2,242, ES=-0.31; 95% CI: -0.46~-0.17). Subgroup analysis showed that counseling was the most effective intervention for quality of life, and behavioral therapy was an effective intervention for all positive and negative outcomes. Publication bias was not detected except for psychological distress.

Conclusion

Psychoeducational intervention appears to be effective in improving quality of life and coping and self-efficacy, and it is effective in reducing psychological symptoms in cancer survivors. Behavioral therapy, especially, is commonly effective in improving psychosocial outcomes. However, low-quality evidence, variability in the designs of existing studies, and publication bias suggest that additional high-quality trials should be conducted in the future.

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Original Articles
A Meta-Analysis of the Effects of Imagery
Won Oak Oh, Min Hyun Suk
Journal of Korean Academy of Nursing 2002;32(2):265-276.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.2.265
AbstractAbstract PDF

PURPOSE: This study was to identify the trends and contents of imagery interventions and to evaluate the effects of imagery interventions by using meta-analysis. METHOD: The materials used for this study were 15 imagery intervention studies carried out from Jan. 1995 to Dec. 2001. The studies were analyzed and evaluated in different categories: 1) types of dependent variables 2) types of imagery 3) interval of imagery 4) total duration of imagery 5) sample characteristics 6) intervention method. RESULT: 1) Behavioral imagery was more prevalent than dynamic imagery. There were wide variations in duration, and interval of interventions. Imagery intervention had moderate effects on psychological variables (state of anxiety, depression & and stress etc.) and had moderate to large effects on physiological variable(pulse rate, cortisol etc.). Behavioral imagery had larger effects than dynamic imagery. Imagery applied to the public had larger effect on decreasing the state of anxiety and stress than applied to the patients. But imagery applied to the patients had a larger effect on decreasing depression than applied to the public. The imagery intervention method by using the individual approach had greater effect than group approach method. CONCLUSION: These results of this study will be used to guide the development of imagery interventions to nursing practice. Also, various types of imagery interventions need to be developed based on the characteristics of nursing practice.

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A Meta-Analysis of Explanatory Variables of Health Promotion Behavior
Young Joo Park, Sook Ja Lee, Eun Sook Park, Ho Shin Ryu, Jae Won Lee, Sung Ok Chang
Journal of Korean Academy of Nursing 2000;30(4):836-846.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.4.836
AbstractAbstract PDF

This Meta-Analysis of 18 studies was conducted to determine the magnitude of th relationship between health promotion behavior and each of explanatory variables. The studies were measured using Health Promoting Life Style(HPLP) developed by Walker and others based on Pender's definiton of health promoting behavior. The sample was collected by searching for The Journal of Korean Academy Nursing Society, The Journal of Korean Women's Health Nursing Academic Society,The Journal of Korean Academic Society of Adult Nursing, Journal of Korean Community Nursing, The Journal of Fundamentals of Nursing, The Journal of Korean Nursing Administration Academic Society, The Korean Journal of Child Health Nursing, The Journal of Korean Psychiatric Academic Society, the dissertations for mater degree or doctoral dissertations for the period from 1980 to 1998. The explanatory variables measured more than 2 times in studies were self-efficacy, perceived health status, self-esteem, internal, powerful- others and chance dimensions of health locus of control, perceived benefits, hardiness, wellbeing and clinical demensions of health concepts, and quality of life(life satisfaction). Effect sizes were calculated by unweighted mean r, weighted mean r by sample size and weighted mean r by quality index score after homogeneity test. The mean r effect size indicator range of each predictor variable were as follows; quality of life (0.50- 0.52), self-efficacy(0.46-0.47), hardiness (0.42-0.44), self-esteem(0.41-0.43), health locus of control- internal(0.32-0.34), health locus of control- powerful others (0.25-0.31), perceived health status(0.18-0.19) and clinical dimensions of health concepts (0.16-0.17).

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A Meta-Analysis of Effects of Relaxation Therapy on Anxiety and Blood Pressure
Hee Seung Kim, Hae Hiang Song, So Eun Choi
Journal of Korean Academy of Nursing 2000;30(2):282-292.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.2.282
AbstractAbstract PDF

A meta-analysis of 14 quasi-experimental studies was conducted to compare the effect of size on various relaxation therapies applied to patients and health volunteer students. These studies were selected from theses, dissertations and papers that have been done between 1982 to 1993. Also They have a randomized or nonequivalent control group in a pre test-post test design. The studies were evaluated in different ways; 1) types of relaxation therapy, 2) total amount of time of relaxation therapy, and 3) types of outcome variables. For a group of homogenious studies, the weighted mean effect size and standard error were estimated. Some findings are summarized as follows : 1. Jacobson relaxation therapy had a larger effect on systolic and diastolic blood pressures than on state anxiety. 2. For the total time of relaxation therapy, (longer than 60 minutes) had a much larger effect in decreasing systolic and diastolic blood pressures than in the case of a time period shorter than 60 minutes. 3. Relaxation therapy applied to surgery patients also had a larger effect in decreasing state anxiety than when applied to other patients.

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Self-Efficacy as a Predictor of Self-Care in Persons with Diabetes Mellitus: Meta-Analysis
Hyang Yeon Lee
Journal of Korean Academy of Nursing 1999;29(5):1087-1102.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.5.1087
AbstractAbstract PDF

Diabetes mellitus, a universal and prevalent chronic disease, is projected to be one of the most formidable worldwide health problems in the 21st century. For those living with diabetes, there is a need for self-care skills to manage a complex medical regimen. Self-efficacy which refers to one's belief in his/her capability to monitor and perform the daily activities required to manage diabletes has found to be related to self-care. The concept of self-efficacy comes from social cognitive theory which maintains that cognitive mechanism mediate the performance of behavior. The literature cities several research studies which show a strong relationship between self-efficacy and self-care behavior. Meta-analysis is a technique that enables systematic review and quantitative integration of the results from multiple primary studies that are relevant to a particular research question. Therefore, this study was done using meta-analysis to quantitatively integrate the results of independent research studies to obtain numerical estimates of the overall effect of a self-efficacy with diabetic patient on self-care behaviors. The research proceeded in three stages : 1) literature search and retrieval of studies in which self-efficacy was related to self-care, 2) coding, and 3) calculation of mean effect size and data analysis. Seventeen studies which met the research criteria included study population of adults with diabetes, measures of self-care and measures of self-efficacy as a predictive variable. Computation of effect size was done on DSTAT which is a statistical computer program specifically designed for meta-analysis. To determine the effect of self-efficacy on self-care practice homogeneity tests were conducted. Pooled effect size estimates, to determine the best subvariable for composite variables, metabolic control variables and component of self-efficacy and self-care, indicated that the effect of self-efficacy composite on self-care composite was moderate to large. The weighted mean effect size of self-efficacy composite and self-care composite were +.76 and the confidence interval was from +.66 to +.86 with the number of subjects being 1,545. The total for this meta-analysis result showed that the weighted mean effect sizes ranged from +.70 to +1.81 which indicates a large effect. But since reliabilities of the instruments in the primary studies were studies were low or not stated, caution must be applied in unconditionally accepting the results from these effect sizes. Meta-analysis is a useful took for clarifying the status of knowledge development and guiding decision making about future research and this study confirmed that there is a relationship between self-efficacy and self-care in patients with diabetes. It, thus, provides support for nurses to promote self-efficacy in their patients. While most of the studies included in this meta-analysis used social cognitive theory as a framework for the study, some studies use Fishbein and Ajzen's attitude model as a model for active self-care. Future research is needed to more fully define the concept of self-care and to determine what it is that makes patients feel competent in their self-care activities. The results of this study showed that self-efficacy can promote self-care. Future research is needed with experimental design to determine nursing interventions that will increase self-efficacy.

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A Meta-Analysis of the Effects of a Self-Efficacy Promoting Program
Bo Kyoung Cha, Hae Kyung Chang, Jung Nam Sohn
Journal of Korean Academy of Nursing 2004;34(6):934-944.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.6.934
AbstractAbstract PDF
Purpose

This meta-analysis was conducted to evaluate the effects of a self-efficacy promoting program and analyze its components.

Method

The material used for this study were 18 self-efficacy promoting program studies carried out from Jan. 1980 to Oct. 2003. The studies were analyzed in different categories: 1) types of dependent variables 2) sample characteristics 3) types of experimental treatment conditions 4) types of self-efficacy source and 5) total amount of time.

Result

1) The weighted mean of a self-efficacy promoting program ranged from 1.383 to 0.015 2) for the experimental treatment condition, exercise had a much larger effect in increasing general self-efficacy and self-care than education 3) the studies using 3 sources had a much larger effect in increasing self-care than the studies using 4 sources 4) a time period longer than 900 minutes had a much larger effect in increasing specific self-efficacy, general self-efficacy and self-care than in a time period shorter than 900 minutes. 5) effect size of specific self-efficacy was significantly higher than general self-efficacy.

Conclusion

These results can be used to guide the development of a self-efficacy promoting program for nursing practice.

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A Meta-analysis of the Effects of Smoking Prevention Programs in Korea
Eun Ok Park
Journal of Korean Academy of Nursing 2004;34(6):1004-1013.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.6.1004
AbstractAbstract PDF
Purpose

The purpose of this paper was to describe the characteristics of smoking prevention programs in Korea, to estimate overall effect size of Korean smoking prevention programs, and to investigate effect size variations by program modality and instruction method.

Method

Meta-analysis was performed on21 programs in 20 studies.

Result

The estimation of overall effect size for knowledge and attitude was not possible because effect sizes were not homogeneous in this meta-analysis. However, effect sizes of studies that were socially influential programs or active/interactive methods were larger than information-oriented programs or passive/non-interactive methods in the pictures. The effects for behavioral outcomes were generally not as positive and not statistically significant. Q statistics showed that variations among effect sizes within program modality and instruction method classifications were heterogeneous.

Conclusion

The results from this meta-analysis support the continued use of socially influential programs and active/interactive methods for smoking prevention programs. Because behavioral effect might be the fundamental objective of smoking prevention programs, the present results indicate that smoking prevention programs should consider adopting more effective programs.

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Meta-Analysis of the Research Findings Concerning Functional Relationships of Explanatory Variables to Hope
Dal Sook Kim, Weon Hee Moon, Seong Yoon Ahn, Hyun Sook Oh, Kyung Hee Kwon, Moon Kyoung Park, Hyeon Sook Choi, Mee Ok Lee, Young Ju Kim
Journal of Korean Academy of Nursing 2004;34(5):673-684.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.5.673
AbstractAbstract PDF
Purpose

The purpose of the study was to meta-analyze the relationships of major concepts, which were made by synthesizing similar explanatory variables into more comprehensive concepts, to hope.

Method

The relevant researches from Jan 1980 to Dec 2003, performed in adults or adult patients, were collected. Using the SAS program, meta-analysis were done with the input data of the number of subjects, the correlation coefficients provided from most of the studies or a few transformed correlation coefficients from F value. In order to get the analysis to be done in homogeneous status of the data regarding each relationship of each major concept to hope(p>0.05), heterogeneous data were eliminated in repeating Q-test.

Result

The major variable regarding relationship to self/transcendental being/life(spiritual wellbeing & self esteem) and social support(social support & family support) have very large positive effects on hope(D̅=1.72, D̅=1.27). The negative effect of the variable regarding captive state(uncertainty in illness, perceived unhealthiness status, & fatigue) and positive effect of coping(approach coping) on hope are in the level between moderate to large(D̅=-0.61,D̅=0.78). All the effects of the major concepts on hope were verified as significant statistically(p=.000). The Fail -Safe numbers showed the significant effects of the three major concepts except coping on hope were reliable.

Conclusion

The results can be a guide to advance hope theory for nursing.

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Review Articles
Effects of Breastfeeding Interventions on Breastfeeding Rates at 1, 3 and 6 Months Postpartum: A Systematic Review and Meta-Analysis
Seol Hui Park, Seang Ryu
J Korean Acad Nurs 2017;47(6):713-730.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.6.713
AbstractAbstract PDF
Abstract Purpose

This study was a systematic review and meta-analysis designed to evaluate the effects of breastfeeding intervention on breastfeeding rates.

Methods

Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a systematic search was conducted using eight core electronic databases and other sources including gray literature from January 9 to 19, 2017. Two reviewers independently select the studies and assessed methodological risk of bias of studies using the Cochrane criteria. The topics of breastfeeding interventions were analyzed using descriptive analysis and the effects of intervention were meta-analyzed using the Review Manager 5.2 software.

Results

A total of 16 studies were included in the review and 15 were included for meta-analysis. The most frequently used intervention topics were the importance of good latch-on and frequency of feeding and determining adequate intake followed. The pooled total effect of breastfeeding intervention was 1.08 (95% CI 1.03~1.13). In the subgroup analysis, neither pre-nor post-childbirth intervention was effective on the breastfeeding rates at 1, 3, and 6 months, and neither group nor individual interventions had an effect. Only the 1 month breastfeeding rate was found to be affected by the individual intervention with the persistent strategies 1.21 (95% CI 1.04~1.40).

Conclusion

Effective breastfeeding interventions are needed to help the mother to start breastfeeding after childbirth and continue for at least six months. It should be programmed such that individuals can acquire information and specific breastfeeding skills. After returning home, there should be continuous support strategies for breastfeeding as well as managing various difficulties related to childcare.

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Stimulation-Oriented Interventions for Behavioral Problems among People with Dementia: A Systematic Review and Meta-Analysis
Eun Young Kim, Sung-Dong Hwang, Eun Joo Kim
J Korean Acad Nurs 2016;46(4):475-489.   Published online August 15, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.4.475
AbstractAbstract PDF
Abstract Purpose

This study was a systematic review and meta-analysis designed to investigate the effects of stimulation-oriented interventions for behavioral problems among people with dementia.

Methods

Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a literature search was conducted using seven electronic databases, gray literature, and other sources. Methodological quality was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) for randomized controlled trials (RCTs). Data were analyzed using R with the ‘meta’ package and the Comprehensive Meta-Analysis (CMA 2.0) program.

Results

Sixteen studies were included for meta-analysis to investigate the effect of stimulation-oriented interventions. The quality of individual studies was rated as ‘++’ for eight studies and ‘+’ for the rest. The effect sizes were analyzed according to three subgroups of interventions (light, music, and others); Hedges’ g=0.04 (95% CI: -0.38~0.46), -0.23 (95% CI: -0.56~0.10), -0.34 (95% CI: -0.34~0.00), respectively. To explore the possible causes of heterogeneity (I2=62.8%), meta-regression was conducted with covariates of sample size, number of sessions, and length of session (time). No moderating effects were found for sample size or number of sessions, but session time showed a significant effect (Z=1.96, 95% CI: 0.00~0.01). Finally, a funnel plot along with Egger's regression test was performed to check for publication bias, but no significant bias was detected.

Conclusion

Based on these findings, stimulation-oriented interventions seem to have a small effect for behavioral problems among people with dementia. Further research is needed to identify optimum time of the interventions for behavioral problems among dementia patients.

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Correlates of Cognitive Impairment of Rheumatic Disease: Systematic Review and Meta-analysis
JinA Mo, JiSuk Park, HyunSoo Oh
J Korean Acad Nurs 2016;46(1):1-18.   Published online February 29, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.1.1
AbstractAbstract PDF
Purpose

This study was conducted to synthesis the results of research on relationships of cognitive impairment with multi-dimensional correlates of rheumatic disease through a systematic literature review and meta-analysis.

Methods

For the study purpose, 23 studies were selected through a systematic process of searching the literature.

Results

The study results showed that among general characteristics, age and education were the variables having a significant relationship with cognitive impairment. Among health risk factors, obesity appeared to have a significant positive relationship with cognitive impairment. For past history, diabetes and hypertension were shown to have a significant positive relationship with cognitive impairment. It was noted also that aPL, one of the physiological factor, had significant association with cognitive impairment. None of the medication related factors had a significant relationship with cognitive impairment. Results showed that among disease related factors, disease activity had the highest relationship with cognitive impairment. Depression, among psychological factors, was the only variable having a significant relationship with cognitive impairment.

Conclusion

The findings indicate that the variables strongly impacting on cognitive impairment in rheumatic disease are depression and disease activity.

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Effects of Family Support Programs for Caregivers of People with Dementia - Caregiving Burden, Depression, and Stress: Systematic Review and Meta-analysis
Seyeon Park, Myonghwa Park
J Korean Acad Nurs 2015;45(5):627-640.   Published online October 15, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.5.627
AbstractAbstract PDF
Abstract Purpose

The objective of this systematic review was to assess the effects of family support programs on caregiving burden, depression, and stress in family caregivers of people with dementia.

Methods

A literature search was conducted of electronic databases to identify randomized controlled studies with family support programs done between 2000 and 2014. Studies published in English and/or Korean were included for the analysis with search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. Studies were rated for quality assessment by two independent reviewers using the appraisal checklist developed by Cochrane Reviews and Dissemination. Of 8,334 articles identified in the literature search, full texts of 76 articles that met the inclusion criteria were reviewed and 38 were found to include relevant outcomes.

Results

Results from selected studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed using the Chi-square test. Meta-analysis showed that the effect sizes of family caregiver support programs were small to medium for categories of caregiving burden (Hedge's g= - 0.17, 95% CI= - 0.30~ - 0.04), depression (Hedge's g= - 0.30, 95% CI= - 0.40~ - 0.20), and stress (Hedge's g= - 0.39, 95% CI= - 0.52~ - 0.25).

Conclusion

The review results indicate that a support programs can assist family care-givers in reducing their psycho-emotional distress.

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