Abstract
BackgroundAttrition is a major obstacle for lifestyle interventions sustained for the medium-to-long term and can have significant consequences on the internal validity of a trial. When the degree of attrition differs between active and control arms this is termed differential attrition and is an important consideration during initial stages of trial planning.ObjectivesThe primary research question of this study was: what is the differential attrition between treatment arms in lifestyle interventions for prevalent chronic diseases?MethodsWe performed a systematic review and meta-analysis of 23 studies involving a lifestyle intervention component in cohorts with chronic diseases. The search accessed three databases: Scopus, Medline Ovid and Web of Science. Attrition between treatment arms was analysed using a random-effects model and examined the relationship between the relative attrition and potential moderators, such as time to final follow-up, time to first follow-up, type of disease, type of control, type of intervention and length of treatment.ResultsThe pooled risk ratio was 1.00 (95% CI 0.97 – 1.03) and only one study fell outside this range. A univariable association was described between the pooled risk ration and length (years) to final follow-up, which did not remain in the multivariable model.ConclusionsUltimately, we found no evidence of differential attrition in medium-to-long term lifestyle intervention studies for chronic disease, increasing confidence in conducting such studies with minimal potential of attrition bias.Trial registrationPROSPERO registration number CRD42018084495.
Highlights
Attrition is a major obstacle for lifestyle interventions sustained for the medium-to-long term and can have significant consequences on the internal validity of a trial
Conclusions: we found no evidence of differential attrition in medium-to-long term lifestyle intervention studies for chronic disease, increasing confidence in conducting such studies with minimal potential of attrition bias
The chronic diseases that were considered for inclusion were: cardiovascular disease, chronic obstructive pulmonary disease (COPD), asthma, arthritis, type 2 diabetes and cancers with a 5-year survival rate of greater than 50%
Summary
Attrition is a major obstacle for lifestyle interventions sustained for the medium-to-long term and can have significant consequences on the internal validity of a trial. When the degree of attrition differs between active and control arms this is termed differential attrition and is an important consideration during initial stages of trial planning. Differential attrition (DA) is the difference in degree of loss to follow-up between the intervention and control arms of a trial. Analysing DA may reveal useful information about factors that contribute to the engagement with new interventions [2]. A wide-ranging difference in attrition was found in a meta-analysis examining first versus second generation antipsychotic drugs [4]. No DA was found in another two meta-analyses, one appraising type 2 diabetes monitoring and the other medication use for posttraumatic stress disorder [6]
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