Key Message

Patient navigation programs are generally community-based service delivery interventions (such as collaborative care, coordinated care, and case management) intended to enhance timely access to the diagnosis and treatment of individuals with chronic conditions, including dementia. Overall, for coordinated care compared with usual care, clinical findings were either mixed or there were no between-group differences in terms of hospitalization, institutionalization, or nursing home admissions; quality of life; or symptoms. For coordinated care compared with usual care, there was no statistically significant between-group difference in mortality. However, there was evidence of improvement in terms of behaviour with coordinated care compared with usual care. According to 1 economic evaluation, for patients with dementia, with the majority having no or mild cognitive impairment, collaborative dementia care management provided increased benefit (quality-adjusted life-years gained) at decreased cost. Three guidelines were identified that provided recommendations for care coordination. One guideline recommends coordinated care for people living with dementia that is organized by a single-named health or social care professional. The second guideline recommends the use of digital technology to enhance care coordination in persons with mental illness. The third guideline recommends coordinated care for people with delirium, dementia, and depression. Findings need to be interpreted in the light of limitations (such as lack of information in the study populations’ type of dementia, mixed findings in outcomes, and lack of information beyond 24 months of follow-up).

Key Message

Two systematic reviews with meta-analyses and three randomized controlled trials were identified regarding the clinical effectiveness of codeine with or without acetaminophen or ibuprofen for patients with pain related to osteoarthritis of the knee or hip. While one systematic review did not contain primary studies relevant to this report, one systematic review contained three randomized controlled trials relevant to this report. Although pooled results from one systematic review with meta-analysis suggested that, compared to placebo or no codeine, codeine has a moderate benefit for pain and function in patients with osteoarthritis pain of the knee or hip, codeine resulted in a significantly higher risk for withdrawal due to adverse events. Furthermore, findings from one randomized controlled trial suggested a significantly reduced need for rescue pain medications in the codeine controlled-released versus control group, while two randomized controlled trials did not detect significant differences between codeine plus acetaminophen or ibuprofen versus control groups for this outcome. Finally, findings from all three randomized controlled trials suggested higher rates of adverse events (e.g., nausea, constipation) in codeine versus control groups, with significant differences detected in two randomized controlled trials. Although the systematic reviews were generally well-conducted, the limitations of the included literature (e.g., respiratory depression incidence not reported in systematic reviews and primary studies, co-authors from the drug manufacturer in one primary study, short follow-up durations for all three primary studies) should be considered when interpreting these results. Furthermore, there was a lack of recently conducted primary studies published after 2000, as well as studies comparing codeine with or without acetaminophen or ibuprofen with different opioids or non-steroidal anti-inflammatory drugs other than ibuprofen. Finally, there was a limited quantity of evidence for each of the specific codeine combinations (i.e., codeine alone, codeine plus acetaminophen, codeine plus ibuprofen).

Key Message

Three relevant systematic reviews and one relevant economic evaluation were identified.

Generally, rates of complication, readmission, and reoperation were not statistically different or appeared numerically comparable between the outpatient and inpatient total hip arthroplasty (THA) groups. Mortality rates were low and appeared to be numerically comparable between the outpatient and inpatient THA groups.

Generally, rates of complication, readmission, and reoperation were not statistically different or appeared numerically comparable between the outpatient and inpatient total knee arthroplasty (TKA) groups. There were inconsistencies with respect to mortality rates in the outpatient and inpatient TKA groups; this finding was based on two studies included in one systematic review.

Inpatient THA was considered not to be cost-effective compared to outpatient THA at a willingness to pay threshold of US$50,000 as the incremental cost effectiveness ratio (ICER) for inpatient THA was US$81,116 per quality adjusted life year (QALY) for Medicare and US$140,917 per QALY for private payer insurance.

Findings need to be interpreted in the light of limitations such as evidence of limited quantity and low quality; and lack of long-term data.

No evidence was identified regarding the cost effectiveness of outpatient or short stay TKA.

No evidence-based guidelines regarding the outpatient or short stay THA or TKA were identified.

Key Message

Two systematic reviews and one randomized controlled trial were identified regarding hypodermoclysis in patients who are frail or who are in long term care. Hypodermoclysis appeared to have fewer adverse effects or complications when compared with intravenous fluids but did not have a significantly better clinical improvement of dehydration. The studies were of low quality, with poor reporting of methods and small sample sizes. No economic evaluations were identified regarding hypodermoclysis in frail patients or patients in long term care, and no evidence-based guidelines were identified.

Key Message

Key Message

Evidence from two traditional systematic reviews and one systematic umbrella review suggested that in patients with knee osteoarthritis, physical activity significantly reduced pain and improved function, performance, and health-related quality of life compared with usual care (not consistently defined), no treatment, or sham interventions.

Limited evidence from one systematic review suggested higher temporary increases in minor pain with exercise than with sham interventions, and no difference in worsening pain, falls, or death between exercise and control groups. Also, limited evidence from a systematic review included in the systematic umbrella review indicated that three to 30 weeks of low-impact activity combining muscle-strengthening, stretching, and aerobic elements were not associated with serious adverse events in older adults, and the number of total knee replacement surgeries was not significantly different between patients who underwent physical activity compared to no-activity control groups over a two month to 24-month observation period.

Sources of uncertainty included the fact that the systematic reviews were based on studies of unclear or low methodological quality. Also, all three included systematic reviews reported significant heterogeneity of their included studies, lacked a standardized definition of "usual care", and had no information on symptom duration, clinical characteristics, comorbid conditions, and concomitant treatments. Therefore, it was difficult to determine if the findings were due entirely to the investigated interventions and controls or if other factors influenced the results.

There was no study identified that examined the comparative clinical effectiveness of physical activity versus pharmacological interventions in individuals with knee osteoarthritis.