This systematic review was certified according to the international Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY register) (registration number: INPLASY202040048). INPLASY202060016
Eligibility Criteria
Eligibility criteria considered for selecting studies in the review include:
Inclusion criteria:
- Type of study:
Original research manuscripts in peer-review journals and conferences proceeding were included if published in the English Language. Original research manuscripts in peer-reviewed journals and conferences proceeding were included if published in the English language. This review included Randomized control trials (RCTs). Studies for the review of the following objectives were evaluated: the effect of mobile text in (i). improving quality of life, (ii) adherence of HAART medication, and (iii) physical exercise prescription in PLWHA.
- Participants:
The review included studies involving adult human participants aged ≥18 years. Studies that investigated PLWHA on HAART were included. No specific limitation was considered concerning the setting of the studies to be incorporated. Thus, studies carried out in clinics, health centres, hospitals, or community settings were also included.
- Intervention:
RCTs that accessed or evaluated the impact of mobile text reminders in HIV patients were included. Inclusion was not restricted to a type, frequency, and duration of intervention or follow-up period after the intervention.
- Comparator:
Studies comparing mobile text reminders with other treatment options including usual care or no treatment were included in this systematic review.
- Duration of intervention:
There was no confinement on the length of the administration of the intervention and the follow-up should be ≤ 6 months post-intervention.
- Outcome measures:
The primary outcomes of interest included: adherence to drug prescription and physical activity. Studies that also investigated intervention effectiveness or quality of life were included in this review. Studies were included irrespective of the type of outcome measure utilized, provided any of the outcomes of interest were accessed.
Exclusion criteria:
- Studies not published in the English language
- Studies that included in addition to mobile text reminders, other behavioural change components.
- Non-randomized controlled trials, pre-test post-test designs, crossover designs and other quasi-experimental studies will be excluded
- In the case of similar publications from the same study, the most recent or most comprehensive publication was used.
Information sources and search strategy
An extensive search strategy, which was formulated to identify applicable studies to be used for the review was piloted (Appendix I) and implemented. The search strategy formulated to search the bibliographic database and grey literature was conducted utilizing keywords, terms from medical subject heading (MeSH), with a combination of Boolean logic in the title, abstract and text for the population, intervention, study design, and outcomes. This strategy was used differently for the three selected outcomes. PubMed search strategy is shown in Appendix I. This strategy was modified to the syntax and subject heading of other databases. This includes the search of the eight bibliographic databases Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, EMBASE, EMCARE, Ovid MEDLINE, PsycINFO, and PubMed), trial registers and directory of open-access repository websites by the reviewers – N.S.C and E.F.E) - using controlled vocabularies and keywords: HIV/AIDS, Seropositive, aerobic exercises, resistance exercises, strengthen exercises, physical exercises, exercise program, exercise intervention, mobile text reminders, SMS, and QoL. Additionally, searches were performed from the reference lists of identified studies. and grey literature; and the selection of studies for inclusion was based on eligibility criteria. This procedure was created following the rules of the Cochrane Handbook for Systematic Reviews [15] and advice for Health Care Review by the Centre for Reviews and Dissemination [16].
Study record, selection process, and data management
Literature search results were exported into RefWorksTM to check for duplication of studies. Considering the inclusion criteria, eligibility questions, and structures for the studies, considerations to the two levels of eligibility assessment were produced, piloted, and if required, refined. Bibliographic records were exported from RefWorks™ into Microsoft Excel (Microsoft 2013), to facilitate the management selection of articles for inclusion. The screening was performed in two phases: the first phase involved the screening of titles and abstracts utilizing the inclusion and exclusion criteria to identify potentially important articles and was carried out by E.F.E (reviewer 1). The results of the first screening were independently cross-checked by I.F.O (reviewer 2) based on the review eligibility criteria. The second phase of screening involved a screening of the articles selected from phase one screening by reviewer 1. This was cross-checked by reviewer 2. Differences of opinions occurring at any stage regarding inclusion or exclusion were resolved by discussion and reflection, in consultation with S.C.I. The reasons for excluding studies were properly documented in the QUOROM flow chart (Figure 1).
Quality appraisal for included studies
The methodological rigour of the selected studies was assessed using the Physiotherapy Evidence Database (PEDro) quality appraisal tool. The PEDro is an 11-item scale in which the first item relates to external validity and the other ten items assess the internal validity of a clinical trial. One point is given for each satisfying criterion (except for the first item) yielding a maximum score of 10. The higher the score, the better the quality of the study and the following point scale is used: 6-10 (High); 4-5 (fair or moderate); ≤3 (poor). A point for a particular criterion was awarded only if the article explicitly reported that the criterion was met. A score of one was given for each yes answer and zero for no, unclear, and not applicable (N/A) answers. The overall score was reported as a tally of all “yes” answers out of 10 based on the applicable answers for each study. Scores of individual items from the critical appraisal tool were added to present the total score. The reviewers thoroughly appraised the selected studies independent of each other. Areas of differences were resolved by discussion and reflection, or in consultation with the third reviewer. Appraisal of the qualities of the included studies was carried out upon completion of study selection and full-text screening during data extraction and synthesis. After this, the quality of the review was reported.
Data Item
Data were collected from variables including authors’ references, participants’ characteristics, inclusion and exclusion criteria, study sample size, components of the intervention, the intervention setting, who delivered the intervention, the duration of the intervention and follow-up (where available), attrition rate, aspects of outcome assessed, the outcome measurement, methods/techniques, results, conclusions and funding sources.
The variables for which data were collected include:
- Authors
- Participants' characteristics (including age range, gender, sample size)
- Study sample size (also groups sample size where available)
- Intervention (setting, blinding, intervention delivery, type of intervention, duration of intervention and components of intervention)
- Attrition rate
- Control
- Outcome(s) assessed and outcome measures/techniques
- Summary of Results.
- Conclusions and funding sources
Quality appraisal and risk of bias
Adopting the Cochrane Collaboration Tool for Risk of Bias Assessment (Table 8.5a of the Cochrane Handbook for Systematic Reviews of Interventions), risk of bias for each of the included studies was evaluated by two reviewers in six key domains: (i) selection bias (random sequence generation, allocation concealment); (ii) performance bias (blinding of personnel and participants); (iii) detection bias (blinding of outcome assessments); (iv) bias due to attrition (incomplete outcome data, including dropouts and withdrawals); (v) reporting bias (selective reporting) and (vi) other bias (other sources of bias not elsewhere addressed).18 To facilitate the assessment of the possible risk of bias for each intervention study, reviewer 1 and reviewer 2 independently collected information using the PEDro tool for risk of bias assessment including sequence generation, allocation concealment, blinding, adequate follow-up, between-group comparison and selective outcome reporting [15]. The procedures undertaken to assess each domain for each study was explicitly described and rated as 'high risk' or 'low risk'. The risk of bias in a study was reported as unclear if there were insufficient details in the original study. In such instances, the study investigators were contacted to provide the required details. The judgments for the risk of bias was made independently by the first reviewer and the same with the second reviewer, based on the criteria for judging the risk of bias [15]. Both reviewers made judgments regarding the risk of bias independent of each other. Areas of differences were resolved by discussion and reflection, or in consultation with SCI.
Data synthesis and assessment of heterogeneity
The review question on the effectiveness of mobile text reminders in enhancing the quality of life, adherence to HAART medication and physical exercise prescription in PLWHA was answered. In doing this, all quantitative study outcomes which analyzed the effectiveness of this intervention were presented, examined, and combined in a proof table (Table 4). The proper statistical method was used for different variables: for a continuous variable, weighted mean differences were applied when outcomes are uniform or standard mean difference when different outcomes are used with CI of 95% while for a dichotomous variable, the Risk ratio was applied with CI of 95%. Meta-analysis was not done to find pooled effect sizes across studies, using a random-effect model due to the high level of heterogeneity of intervention effects. Heterogeneity was assessed through the Cochran’s x2 test (10% significance level) and Higgins 12 for which values of 25%, 50% and 75% show low, medium, and high heterogeneity respectively (as stipulated by the guidance in/the Cochrane Handbook for Systemic Reviews of Interventions).
Data and Sensitivity analysis
Heterogeneous studies were interpreted by narrative synthesis following the guideline of the Centre for Reviews and Dissemination to explore the relationship and findings between and included studies [16].
Rating quality of evidence and strength of recommendation.
The quality of evidence of the studies was not evaluated to determine the strength of recommendation in the systematic review, due to the high level of heterogeneity of intervention effects. The individual study was graded as high risk of bias or low risk of bias, and then again individual evidence statement for this review was graded from ‘High Quality’ to ‘Very Low Quality’ according to the criteria.
How this review is reported
This systematic review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guidelines [17], with all items relevant to the review included.