Study Quality Appraisal
The quality of each of the eleven included studies was assessed using
the 2018 updated MMAT (Supplementary Table 3).25 All
RCTs reported appropriate randomization and all nonrandomized studies
reported including participants representative of their identified
target population. Yet, the confounders were reported as adequately
accounted for in only 56% (5/9) of the nonrandomized studies and the
intervention was explicitly reported to have been administered as
intended in only 33% (3/9) of the nonrandomized studies. Four studies
(36%) had at least one MMAT item with a negative response and seven
(64%) had at least one MMAT item with the mention “can’t tell”.
Additionally, even among studies adequately reporting all the outcomes
mentioned in their methods section, p-values were not commonly reported.
Sensitivity analyses
Out of 11 studies, 4 had at least one MMAT item with a negative response
(Supplementary Table 3).18,19,21,29 The general
conclusions for each outcome did not change when removing these four
studies from the data synthesis. After removing these four studies, only
five different studies reported on quality of care: five on medication
problems12,16,20,27,28 and none on advance directives.
Four still showed favorable results12,16,27,28 with
TCi and one showed better results in the control
group.20
Additionally, after removing these four studies, only two different
studies reported on clinical outcomes: two on
mortality,16,17 one on mobility, function and
pain17 and none on confusion/behavioral symptoms.
There was still no beneficial effect of TCi on mortality and
inconclusive results on mobility, function and pain.
For healthcare services use, after removing these four studies, only
three different studies still reported data: two on hospital
readmissions and ED visits16,17 and three on hospital
days.16,17,28 The results were still inconclusive for
both hospital readmissions and ED visits and hospital days.
Finally, after removing these four studies, only two different studies
reported on satisfaction.12,30 Both caregivers and
physicians still showed high levels of satisfaction with TCi.