Summary of findings for the main comparison. Interventions for treating anxiety after stroke.
| Interventions for treating anxiety after stroke | ||||||
| Patient or population: stroke survivors with anxiety Settings: out of hospital Intervention: pharmacological or psychological treatment | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Interventions | |||||
| Proportion of stroke patients without clinical diagnosis of an anxiety disorder | See comment | See comment | Not estimable | 19 (1 study) | ⊕⊝⊝⊝ very lowa,b | Clinical anxiety at 3 months: 4/9 in intervention group no longer had anxiety, 1/10 in control group no longer had anxiety |
| Proportion of stroke patients scoring outside anxiety range; or changes from baseline on an anxiety rating scale | See comment | See comment | Not estimable | 196 (3 studies) | ⊕⊝⊝⊝ very lowc,d | Statistically significant difference in anxiety scores on HADS‐A scale at 3 months, with reduction in anxiety for those using therapeutic CD (P value = 0.001); statistically significant differences in HAM‐A scores at 6 weeks and 4 weeks with reduced anxiety for those taking paroxetine and paroxetine with psychological therapy and those taking buspirone, respectively (P value < 0.01) |
| Co‐morbid depression | See comment | See comment | Not estimable | 175 (2 studies) | See comment | Reduction in depression symptoms according to HAM‐D at 6 weeks and at 4 weeks for those taking paroxetine and paroxetine with psychological therapy and those taking buspirone, respectively |
| Quality of life ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | Outcome not reported in any study |
| Social activities ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | Outcome not reported in any study |
| Activities of daily living | See comment | See comment | Not estimable | 81 (1 study) | ⊕⊝⊝⊝ very lowb,e | Improvement in activities of daily living in all groups, but greatest improvement in those taking paroxetine with psychological therapy |
| Principal caregiver burden ‐ not reported | See comment | See comment | Not estimable | ‐ | See comment | Outcome not reported in any study |
| *The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate | ||||||
aStudy was unblinded, with further risks of recruitment bias and drop‐outs. Downgraded one level for risk of bias bOnly one study with small number of participants, downgraded two levels for imprecision cLimited detail in Wang 2005 and Zhang 2005 for effective assessment of bias; lack of blinding, risks of recruitment bias, and drop‐outs in Golding 2016. Downgraded two levels for risk of bias dOnly three studies with few participants, all with different interventions that are not comparable. Downgraded one level for indirectness and one level for imprecision eLimited detail in studies, unable to effectively assess risk of bias; downgraded one level