Affiliations: [a] Tel-Aviv University, Tel-Aviv, Israel | [b] George Washington University, Washington, DC, USA | [c] The University of Iowa, Iowa City, IA, USA | [d] Queensland University of Technology, Kelvin Grove QLD, Australia | [e] University of Virginia, Charlottesville, VA, USA | [f] The University of Queensland, Brisbane, St Lucia QLD, Australia | [g] Penn State University, State College, PA, USA
Correspondence:
[*]
Correspondence to: Jiska Cohen-Mansfield, Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, and Herczeg Institute on Aging, Tel Aviv University. Address: Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv, 69978, Israel. Tel.: +972 3 6407337; Fax: +972 3 6407339; E-mail: Jiska@post.tau.ac.il.
Abstract: This paper challenges the assumptions underlying many reviews and offers alternative criteria for examining evidence for nonpharmacological interventions. We evaluated 27 reviews examining interventions for persons with dementia as they relate to the issues of selection based on randomized controlled trial (RCT) design. Reviews were described by type of intervention, level of cognitive function, and criteria for inclusion. Of the 27 reviews, 46% required RCTs for inclusion and most had stringent inclusion criteria. This resulted in poor utilization of the literature and low ecological validity. Eliminating most of the available data poses a critical problem to clinical and research development. Studies meeting strict methodological criteria may not generalize to the greater population or may exclude sub-populations and interventions. Limitations of double-blind RCTs and potential design solutions are set forth based on appropriate populations, problems, interventions, and settings characteristics.
