Effectiveness of interventions by non-professional community-level workers or family caregivers to improve outcomes for physical impairments or disabilities in low resource settings: systematic review of task-sharing strategies

Kumurenzi, Anne; Richardson, Julie; Thabane, Lehana; Kagwiza, Jeanne; Urimubenshi, Gerard; Hamilton, Leah; Bosch, Jackie; Jesus, Tiago

doi:10.1186/s12960-023-00831-7

Human Resources for Health

Table 3 Quality of the evidence included in the review (GRADE)

From: Effectiveness of interventions by non-professional community-level workers or family caregivers to improve outcomes for physical impairments or disabilities in low resource settings: systematic review of task-sharing strategies

Certainty assessment						№ of patients		Quality of the evidence (GRADE)	Comment
№ of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Intervention	Usual care	Quality of the evidence (GRADE)	Comment
Randomized trials
Mobility (assessed with FAC, EQ-5D, WHODAS; follow-up: 6 months)
3	Randomised trials	Not serious^a	Serious^b	Not serious^c	Serious^b	779	793	⨁⨁◯◯ Low	One study reported an effect after adjusting for confounders (Zhou et al.), effect size of 0.3, CI 121.81–122.19; (p = 0.04)
Activities of daily living (assessed with BI; follow-up: 6 months)
3	Randomised trials	Not serious^a	Serious^d	Not serious^e	Serious^d	772	785	⨁⨁◯◯ Low	One study reported an effect (Chu et al.) effect size of 0.40, CI 25.92–35.08; (p = 0.03)
Quality of life (assessed with EQ-5Q and WHOQOL; follow-up: 6 months)
3	Randomised trials	Not serious^a	Serious^f	Not serious^c	Serious^f	187	196	⨁◯◯◯ Very low	All studies showed no effect of intervention
Non-RCT studies
Activities of daily living (assessed with BI and BADL assessment tool; follow-up: 2–3 months)
1	Observational studies (non-RCTs)	Serious^a	Not serious^g	Serious^h	Serious^g	27		⨁◯◯◯ Very low	This study demonstrated a statistically significant improvements, effect size: 0.3; CI 10.143–16.857; (p < 0.000)
2	Observational studies (non-RCTs)	Serious^a	Not serious^g	Serious^h	Serious^g	376		⨁◯◯◯ Very low	Both studies reported statistically significant improvements, effect size for Ru et al. (effect size: 0.2 CI 180.202–184.789; p = 0.001) and Chinchai et al. 2021 (effect size: 0.4, CI − 7.643–18.643; p = 0.02)
Quality of life (assessed with WHOQOL–BREF; follow-up: 3 months)
2	Observational studies (non-RCTs)	Very seriousⁱ	Not serious^d	Serious^j	Serious^d	55		⨁◯◯◯ Very low	One study reported statistically significant improvement, Chinchai et al. 2020 (effect size of 1.3; CI 8.492–16.508 ([p < 0.05])

Grading: no serious concerns exist, do not downgrade quality from baseline quality (e.g., for RCTs); serious concern exists, downgrade the evidence one level, e.g., from high to moderate (− 1); very serious concern exists, downgrade the evidence two levels, e.g., from high to low (− 2)
Quality of the evidence: ⊕⊕⊕⊕ High: we are very confident that the true effect lies close to that of the estimate of the effect; ⊕⊕⊕◯ Moderate: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; ⊕⊕◯◯ Low: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect; ⊕◯◯◯ Very low: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
FAC functional ambulation category, WHODAS World Health Organization disability assessment schedule, CI confidence interval, BI Barthel Index, WHOQOL World Health Organization Quality of Life, BADL basic activities of daily living, WHOQOL–BREF World health organization quality of life–BREF
^aMost information is from studies at a low risk of bias (blinded outcome assessors)
^bStudies used various tools to measure the outcome, and only one study demonstrated an effect
^cAssessed different populations, same interventions and comparison (usual care), and outcome
^dStudies used the same tools to measure the outcome, and only one study demonstrated an effect
^eAssessed same populations, same interventions and comparison (usual care) and outcome
^fStudies used various tools, and none of the studies demonstrated an effect
^gStudies used various tools to measure the outcome, and both demonstrated an effect
^hAssessed the same populations, interventions, and outcomes (ADLs)
ⁱMost information is from studies at low or unclear risk of bias
^jAssessed different populations, same interventions and outcome

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ISSN: 1478-4491

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