Non-Pharmacological Interventions Targeting Sense of Coherence Among Older Adults and Adults With Chronic Conditions: A Meta-Analysis With Trial Sequential Analysis.
Yaqian Liu, Bohan Zhang, Jed Montayre and 2 others
PMID 39749849WHAT IT FOUND
Non-drug programmes improved older adults' and chronic disease patients' sense of coherence, their confidence that life is manageable, for up to 3 months.
Salutogenic programmes had short-term benefit; self-management was less firm; exercise, cognitive behavioural therapy and nurse-led education did not show stable benefit.
Key findings
01Across 27 randomised trials with 2178 participants, non-drug interventions improved sense of coherence after intervention (standardised mean difference 0.52, 95% confidence interval 0.28 to 0.75).
02The improvement was significant within 3 months but not beyond 3 months (standardised mean differences 0.07 and 0.10 at later time points).
03Within 3 months, salutogenic-based and self-management interventions showed significant effects, while cognitive behavioural, nurse-led health education and exercise training did not in the main analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The pooled analysis had high heterogeneity (I2 = 85%), and the authors could not identify a single source for it. Nine trials were rated high risk and four had some concerns, mainly because blinding was difficult and sense of coherence was measured by patient-reported questionnaires. Attrition was high in some trials, reaching 32% overall and 44% in an intervention group. Trial sequential analysis showed that some positive subgroups, including salutogenic-based interventions, had not reached the needed sample size. The review included only English-language studies. The chronic disease populations were broad, including stroke, diabetes, heart failure, mental disorders and chronic pain, so the result may not apply to a given clinic's patient mix.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the overall positive result as evidence of lasting benefit. The pooled effect was significant within 3 months, but analyses beyond 3 months were not significant (standardised mean differences 0.07 and 0.10).