Abstract
BackgroundAdults with learning disabilities have an increased disposition to unhealthy lifestyle behaviours which often occur simultaneously. Existing studies focus on complex interventions targeting unhealthy diet, physical inactivity, sedentary behaviour, smoking, and alcohol use to reduce health risks experienced. It is essential to understand how well these interventions work, what works, for whom, in what context and why. This study aims to investigate the effectiveness and underlying mechanisms of lifestyle modification interventions for adults with learning disabilities.MethodsThis is a mixed-methods systematic review consisting of a network meta-analysis (NMA) and realist synthesis. Electronic databases (ASSIA, CINAHL, EMBASE, MEDLINE, and PsycINFO) will be searched from inception to 14 January 2021 with no language restriction. Additionally, trial registries, grey literature databases and references lists will be searched. Studies related to lifestyle modification interventions on the adult population (>18 years) with learning disabilities will be eligible for inclusion. Two independent researchers will screen studies, extract data and assess its quality and risk of bias using the Cochrane Collaboration’s Risk of Bias Assessment Tool (RoB Version 2) and ROBINS-I. The strength of the body of evidence will be assessed based on the GRADE approach. The NMA will incorporate results from RCTs and quasi-experimental studies to estimate the effectiveness of various lifestyle interventions. Where appropriate, a component NMA (CNMA) will be used to estimate effectiveness. The realist synthesis will complement and explain the findings of NMA and CNMA by including additional qualitative and mixed-methods studies. Studies will be included based on their relevance to the programme theory and the rigour of their methods, as determined by quality appraisal tools appropriate to the study design. Results from both syntheses will be incorporated into a logic model.DiscussionThe paucity of population-specific lifestyle interventions contributes to the challenges of behaviour change in adults with learning disabilities. This study will provide an evidence-base from which various stakeholders can develop effective interventions for adults with learning disabilities. The evidence will also help prioritise and inform research recommendations for future primary research so that people with learning disabilities live happier, healthier and longer lives.Trial registrationPROSPERO CRD 42020223290
Highlights
Adults with learning disabilities have an increased disposition to unhealthy lifestyle behaviours which often occur simultaneously
component network meta-analysis (NMA) (CNMA) allows assessment of the effectiveness of interventions and the components that contribute to improvements in modifiable health risk factors in adults with learning disabilities
The NMA and CNMA will allow us to assess the relative effectiveness of different lifestyle modification interventions and the components that contribute to improvements in modifiable health risk factors, respectively
Summary
Adults with learning disabilities have an increased disposition to unhealthy lifestyle behaviours which often occur simultaneously. Reintegration into the community has exposed them to social and environmental pressures [1] This is concerning as adults with learning disabilities engage in a cluster of health risk behaviours predominantly eating an unhealthy diet, physical inactivity, sedentary behaviour, smoking and alcohol use [2, 3]. Adults with learning disabilities experience higher comorbidity rates and premature mortality compared to the general population [6, 7]. They have an increased risk of developing preventable diseases such as cardiovascular disease, obesity, type-2 diabetes and some cancers [8]
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