Summary of findings for the main comparison. MBSR compared to active control for family carers of people with dementia.
| MBSR (mindfulness‐based stress reduction) compared to active control for family carers of people with dementia | ||||||
| Patient or population: family carers of people with dementia Setting: community Intervention: MBSR Comparison: active control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with active control | Risk with MBSR | |||||
| Depressive symptoms assessed with: CESD, POMS‐depression subscale Scale from 0 to 60 follow‐up: range 7 weeks to 8 weeks | ‐ | SMD 0.63 SD lower (0.98 lower to 0.28 lower) | ‐ | 135 (3 RCTs) | ⊕⊕⊝⊝ LOW a b | Moderate effect size;c lower score represents lower depressive symptoms |
| Anxiety assessed with: STAI‐state anxiety subscale Scale from 20 to 80 follow‐up: 8 weeks | The mean anxiety was 47.4 score. | MD 7.5 score lower (13.11 lower to 1.89 lower) | ‐ | 78 (1 RCT) | ⊕⊕⊝⊝ LOW a b | Moderate effect size;c lower score represents lower level of anxiety |
| Carer burden assessed with: MBCBS‐subjective stress burden, RMBPC‐reaction, ZBI Scale from 0 to 100 follow‐up: range 7 weeks to 8 weeks | ‐ | SMD 0.24 SD higher (0.11 lower to 0.58 higher) | ‐ | 135 (3 RCTs) | ⊕⊕⊝⊝ LOW a b | Small effect size;c lower score represents lower level of carer burden |
| Dropout rates follow‐up: range 7 weeks to 8 weeks | Study population | RR 1.39 (0.32 to 5.99) | 166 (4 RCTs) | ⊕⊝⊝⊝ VERY LOW a d | Important effect sizee | |
| 88 per 1000 | 122 per 1000 (28 to 524) | |||||
| *The risk in the intervention group (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). CESD: Center for Epidemiological Studies Depression Scale; CI: confidence interval; MBCBS: Montgomery Borgatta Caregiver Burden Scale; MD: mean difference; POMS: Profile of Mood States: RCT: randomised controlled trial; RMBPC: Revised Memory and Behavior Problems Checklist; RR: risk ratio; SD: standard deviation; SMD: standardised mean difference; STAI: State‐Trait Anxiety Inventory; ZBI: Zarit Burden Interview | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: 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 quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aWe downgraded the quality of evidence by one level due to serious concern about high risk of bias in blinding of participants and personnel. bAs suggested by Ryan 2016a, we downgraded the quality of evidence by one level due to serious concern about imprecision. cTo assess the magnitude of effect for continuous outcomes, we used the criteria suggested by Cohen 1988: 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. dAs suggested by Ryan 2016a, we downgraded the quality of evidence by two levels due to very serious concern about imprecision. eAs suggested by Ryan 2016b, we considered an RR < 0.75 or RR > 1.25 an important effect size for dichotomous outcomes.