Mindfulness-Based Stress Reduction: An Implementation Science-Informed Systematic Review and Meta-Analysis

基于正念的减压：基于科学的实施系统回顾和荟萃分析

• 批准号: 10614500
• 负责人: BLAIR T JOHNSON
• 金额: $ 64.08万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614500
• 关键词: Address; Adherence; Anxiety; Automobile Driving; Certification; Chronic; Clinical; Clinical Trials; Code; Databases; Decision Making; Development; Diagnostic; Dose; Educational Status; Effectiveness; Elements; Ensure; Ethnic Population; Evaluation; Gender; Health; Health Insurance; Home; Insurance; Insurance Carriers; Insurance Coverage; Intervention Trial; Interview; Investigation; Knowledge; Length; Level of Evidence; Literature; Longterm Follow-up; Mental Depression; Meta-Analysis; Methodology; Methods; Modality; Outcome; Pain; Participant; Patients; Persons; Physical Function; Policies; Policy Maker; Population; Process; Quality of life; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Science; Scientist; Stress; System; Taxonomy; Teacher Professional Development; Techniques; Time; United States; active control; behavior change; burden of illness; chronic pain; cost effectiveness; empowerment; evidence base; formative assessment; future implementation; implementation science; knowledge integration; knowledge translation; meetings; mindfulness; mindfulness-based stress reduction; opioid use; people of color; programs; racial population; social capital; sound; systematic review; teacher; translational approach

PROJECT SUMMARY/ABSTRACT Mindfulness-Based Stress Reduction (MBSR) is a promising approach to treat major health problems, such as depression, anxiety, and chronic pain. The last extensive MBSR systematic review was for trials (k=101 studies; N= 8,135 participants) available through 2015. It showed a moderate evidence level using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, with a call for more and higher quality randomized controlled trials. This literature has expanded with hundreds of clinical trials. It is past time to conduct a systematic review and meta-analysis to determine how strong the evidence is. This will inform whether and how MBSR should be included in health insurance coverage to reduce the global burden of disease and to aid development of better MBSR-related treatments. To do so, scientists recommend integrated knowledge translation (iKT), where researchers and knowledge users co-create knowledge. Although iKT has been used in systematic reviews, it has not been used in a mindfulness systematic review. Primary aims are: 1. Perform stakeholder evaluations to identify: (a) Key questions they have to make decisions about if, how, and when MBSR should be covered by health insurance; (b) what is the highest priority evidence they need on MBSR’s effectiveness and cost-effectiveness; (c) barriers that are important to understand and resolve in order for MBSR to be covered by health insurance. 2. Through a systematic review and meta-analysis, determine the impacts of MBSR on key health-related outcomes informed by the iKT strategy in Aim 1b, such as: (a) anxiety, (b) depression, (c) stress, (d) physical functioning, (e) quality of life, (f) pain with related opioid use, and (g) cost effectiveness. 3. Evaluate whether meta-analytic effects differ based on implementation-related factors informed by stakeholders, such as length adherence (e.g., session length), program fidelity (e.g., teacher training, home practice), delivery modality (in-person vs. online), setting and population (e.g., clinical vs. non-clinical, specific genders and racial/ethnic groups), and effect sustainability (e.g., whether benefits last ≥1 year). Aim 1 methods include stakeholder meetings to conduct formative evaluations involving qualitative interviews and a modified Delphi approach. Methods for Aims 2 and 3 will be state-of-the-science systematic evidence syntheses. These will utilize all major databases to identify MBSR trials that address the primary health outcomes; examine the robustness of evidence across both randomized controlled trials and uncontrolled trials (facilitated by a comprehensive behavior change technique taxonomy to characterize active content); and analyze effect sizes following the best standards. Throughout the review process, we will engage stakeholders, guided by the SPIRIT (Supporting Policy In health with Research: an Intervention Trial) Action Framework. Overall, these evidence syntheses will provide evidence that may transform not only the science of MBSR and related treatments but also increase health insurance coverage and access for millions of people.

项目概要/摘要 基于正念的减压（MBSR）是治疗重大健康问题的一种有前途的方法，例如 最后一次广泛的 MBSR 系统评价是针对试验（k=101）。 研究； 8,135 名参与者）截至 2015 年可用。使用 GRADE 显示了中等证据水平 （建议评估、制定和评估的分级）系统，呼吁更多和 该文献已扩展为数百项临床试验。 过去的时间进行系统审查和荟萃分析以确定证据的强度。 告知是否以及如何将MBSR纳入健康保险范围，以减轻全球负担 疾病并帮助开发更好的 MBSR 相关治疗方法为此，科学家建议进行综合治疗。 知识翻译（iKT），研究人员和知识用户共同创造知识。 已用于系统评价，但尚未用于正念系统评价。 主要目的是： 1. 进行利益相关者评估，以确定： (a) 他们必须做出决策的关键问题是：是否、如何、 以及何时应将 MBSR 纳入健康保险范围；(b) 最优先的证据是什么？ (c) 需要理解和理解的重要障碍 做出决定，以便将 MBSR 纳入健康保险范围。 2. 通过系统回顾和荟萃分析，确定 MBSR 对关键健康相关的影响 目标 1b 中的 iKT 策略告知的结果，例如：(a) 焦虑，(b) 抑郁，(c) 压力，(d) 身体功能，(e) 生活质量，(f) 与阿片类药物使用相关的疼痛，以及 (g) 成本效益。 3. 评估荟萃分析效果是否根据实施相关因素而有所不同 利益相关者，例如持续时间（例如课程时长）、计划保真度（例如教师培训、家庭培训） 实践）、交付方式（面对面与在线）、环境和人群（例如，临床与非临床、 特定性别和种族/族裔群体），以及影响可持续性（例如，福利是否持续≥1年）。 目标 1 方法包括召开利益相关者会议以进行涉及定性访谈的形成性评估 目标 2 和目标 3 的改进德尔菲方法将是最新的系统证据。 这些将利用所有主要数据库来确定解决初级卫生问题的 MBSR 试验。 结果；检查随机对照试验和非对照试验证据的稳健性 （通过全面的行为改变技术分类来描述活动内容）； 在整个审查过程中，我们将让利益相关者参与进来，并按照最佳标准分析效果大小。 以 SPIRIT（健康研究支持政策：干预试验）行动框架为指导。 总体而言，这些证据综合将提供的证据不仅可能改变 MBSR 的科学， 相关治疗，还增加了数百万人的医疗保险覆盖范围和获得机会。