Publications by authors named "Anne-Kirstine Dyrvig"

15 Publications

  • Page 1 of 1

Patient-Reported Outcomes From Patients With Heart Failure Participating in the Future Patient Telerehabilitation Program: Data From the Intervention Arm of a Randomized Controlled Trial.

JMIR Cardio 2021 Jul 2;5(2):e26544. Epub 2021 Jul 2.

Laboratory for Welfare Technology - Telehealth & Telerehabilitation, Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark.

Background: More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients' recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year.

Objective: The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year.

Methods: In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients' sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group.

Results: The changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P<.05).

Conclusions: There was a significant increase in clinical and social well-being and quality of life during the 1-year period of participating in a telerehabilitation program. These results suggest that patient-reported outcome questionnaires may be used as a tool for patients in a telerehabilitation program that can both monitor and guide patients in mastering their own symptoms.

Trial Registration: ClinicalTrials.gov NCT03388918; https://clinicaltrials.gov/ct2/show/NCT03388918.
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http://dx.doi.org/10.2196/26544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285740PMC
July 2021

Diagnostic accuracy of imaging modalities in detection of histopathological extranodal extension: A systematic review and meta-analysis.

Oral Oncol 2021 03 22;114:105169. Epub 2021 Jan 22.

Department of ORL - Head and Neck Surgery and Audiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.

Objective: To present an up to date systematic review and meta-analysis evaluating the diagnostic accuracy of the most used imaging modalities in detection of histopathological extra nodal extension (ENE) in head and neck squamous cell carcinoma.

Materials And Methods: Medline, Embase, and Cochrane databases were systematically searched on March 27th 2020. Screening, inclusion, quality assessment, and data extraction were done by two reviewers. Meta-analysis was conducted using the bivariate model approach after pooling the studies according to imaging modality. Heterogeneity was explored by meta-regression. Comparison was done by meta-regression and sub-group analyses.

Results: Out of 476 initial hits, 25 studies were included for analysis. Of these, 14 dealt with CT, nine with PET/CT, four with MRI, two with ultrasound, and none with PET/MRI. Meta-analysis based on a total sample size of 3391 showed that CT had a sensitivity of 76% [67-82%] and specificity of 77% [69-83%], MRI a sensitivity of 72% [64-79%] and specificity of 78% [57-90%], and PET/CT a sensitivity of 80% [76-84%] and specificity of 83% [74-90%] in the ability to predict ENE. No meta-analysis could be done on ultrasound. There were no significant differences between modalities in overall accuracy; however, PET/CT had significantly higher sensitivity than CT and MRI.

Conclusion: There was no significant difference in the ability of CT, MRI, and PET/CT to diagnose histopathological ENE, except that PET/CT had a significantly higher sensitivity than CT and MRI.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105169DOI Listing
March 2021

Elective neck dissection in patients with salivary gland carcinoma: A systematic review and meta-analysis.

J Oral Pathol Med 2020 Aug 14;49(7):606-616. Epub 2020 Jun 14.

Research Unit for ORL Head & Neck Surgery and Audiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.

Objective: Elective neck dissection in patients with salivary gland carcinoma and clinically negative lymph nodes is controversial. Reported proportion of occult nodal metastases vary with histological subtype, tumour classification and preoperative diagnostic methods. This is a systematic review and meta-analysis on the role of END in salivary gland carcinoma.

Methods: A search in PubMed, Embase and Cochrane was performed. Original articles in English with data on tumour characteristics, clinical and pathological N-classification, and neck dissection were included. Reporting Items for Systematic Reviews and Meta-analyses were followed. Random effect modelling was performed to pool the data. Meta-analysis of proportions was performed for occult metastases overall, for T3/T4 versus T1/T2 tumours and for tumours with high-grade versus low-grade histology. Heterogeneity across studies was assessed with I-squared statistics.

Results: We included 22 articles in the qualitative synthesis and meta-analysis. The pooled proportion of occult metastases was 21%. In patients with T3/T4 tumour, the pooled proportion of occult metastases was 36%, and in patients with high-grade histology, it was 34%. Most studies concluded that END should be performed in patients with advanced T-classification and high-grade histology tumours. Nine studies assessed occult metastases per level.

Conclusion: The overall occult metastases proportion does not require END in all patients with salivary gland carcinoma. We recommend END in patients with high-grade or unknown histology or T3/T4 tumours. END should involve level II and III, and level I should be included in tumours in the submandibular gland, sublingual gland and minor oral salivary glands.
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http://dx.doi.org/10.1111/jop.13034DOI Listing
August 2020

Booster medication to achieve capsule excretion in colon capsule endoscopy: a randomized controlled trial of three regimens.

Endosc Int Open 2018 Nov 7;6(11):E1363-E1368. Epub 2018 Nov 7.

Department of Surgery, Odense University Hospital, Odense, Denmark.

 To achieve a complete colon capsule endoscopy, the entire colon must be visualized, clean and filled with clear fluids. The primary aim was to compare three booster regimens in colon capsule endoscopy in achieving capsule excretion within recording time. Secondary aims were quality of bowel cleansing and completion rate (both adequate cleansing and capsule excretion).  Patients scheduled for follow-up colonoscopy due to previous neoplastic findings or familial history of colorectal cancer aged 18 to 70 years were eligible. Bowel preparation was 2-L split doses of polyethylene glycol. Patients were randomized to three booster regimens of either polyethylene glycol (Group A), sulfate-based solution (Group B) or polyethylene glycol with iodine oral contrast (Group C).  One hundred eighty participants were included and randomized into three groups of 60. Capsule excretion was 70 % (95 % CI: 58 - 80) in Group A, 73 % (95 % CI: 61 - 83) in Group B and in 68 % (95 % CI: 56 - 79) in Group C, no statistically significant differences. Bowel cleansing grade was statistically significant better in Group B compared to Group A (  = 0.03), but there were no statistically significant differences between Groups C and A (  = 0.40). Complete examination rate was 65 % (95 % CI: 53 - 77), 72 % (95 % CI: 61 - 83) and 62 % (95 % CI: 50 - 74) in Group A, B and C respectively, not statistically significant different.  Sulfate-based solution resulted in statistically significant better bowel cleansing compared to polyethylene glycol. Overall the excretion and completion rate was suboptimal. Achieving a high completion rate using patient-tolerable and low-risk compounds is still a challenge.
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http://dx.doi.org/10.1055/a-0732-494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221809PMC
November 2018

Therapeutic Use of the Human Papillomavirus Vaccine on Recurrent Respiratory Papillomatosis: A Systematic Review and Meta-Analysis.

J Infect Dis 2019 03;219(7):1016-1025

Department of ORL-Head & Neck Surgery and Audiology, Odense University Hospital, Odense.

Background: Recurrent respiratory papillomatosis is a benign condition caused by human papillomavirus (HPV). Surgery is the mainstay of treatment, but numerous adjuvant therapies have been applied to improve surgical outcome. Recently, HPV vaccination has been introduced, but only smaller studies of its effect have been published. The present meta-analysis is intended as a possible substitute for a proposed but not yet realized multicenter randomized controlled trial.

Methods: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. PubMed, Embase, and Cochrane were systematically searched. All retrieved studies (n = 593) were reviewed and qualitatively assessed. In addition, 2 previously unpublished data sets were included. The systematic review included 11 studies, comprising 133 patients, of whom 63 patients from 5 studies were eligible for meta-analysis. A random-effects meta-analysis was conducted for the mean difference in number of surgical procedures per month before and after vaccination.

Results: The number of surgical procedures per month was significantly reduced after HPV vaccination compared with before vaccination (estimated mean, 0.06 vs 0.35). The mean intersurgical interval increased from 7.02 months (range, 0.30-45 months) before to 34.45 months (2.71-82 months) after HPV vaccination.

Conclusion: The present study supports the continued use of the HPV vaccine as an adjuvant treatment for recurrent respiratory papillomatosis.
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http://dx.doi.org/10.1093/infdis/jiy616DOI Listing
March 2019

Reproducibility of Automated Voice Range Profiles, a Systematic Literature Review.

J Voice 2018 May 21;32(3):273-280. Epub 2017 Jun 21.

Department of ORL Head & Neck Surgery, Odense University Hospital, Odense C, Denmark.

Objective: Reliable voice range profiles are of great importance when measuring effects and side effects from surgery affecting voice capacity. Automated recording systems are increasingly used, but the reproducibility of results is uncertain. Our objective was to identify and review the existing literature on test-retest accuracy of the automated voice range profile assessment.

Study Design: Systematic review.

Data Sources: PubMed, Scopus, Cochrane Library, ComDisDome, Embase, and CINAHL (EBSCO).

Methods: We conducted a systematic literature search of six databases from 1983 to 2016. The following keywords were used: phonetogram, voice range profile, and acoustic voice analysis. Inclusion criteria were automated recording procedure, healthy voices, and no intervention between test and retest. Test-retest values concerning fundamental frequency and voice intensity were reviewed.

Results: Of 483 abstracts, 231 full-text articles were read, resulting in six articles included in the final results. The studies found high reliability, but data are few and heterogeneous.

Conclusion: The reviewed articles generally reported high reliability of the voice range profile, and thus clinical usefulness, but uncertainty remains because of low sample sizes and different procedures for selecting, collecting, and analyzing data. More data are needed, and clinical conclusions must be drawn with caution.
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http://dx.doi.org/10.1016/j.jvoice.2017.05.013DOI Listing
May 2018

Can the Ni classification of vessels predict neoplasia? A systematic review and meta-analysis.

Laryngoscope 2018 01 10;128(1):168-176. Epub 2017 Jun 10.

Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Odense, Denmark.

Objectives: The Ni classification of vascular change from 2011 is well documented for evaluating pharyngeal and laryngeal lesions, primarily focusing on cancer. In the planning of surgery it may be more relevant to differentiate neoplasia from non-neoplasia. We aimed to evaluate the ability of the Ni classification to predict laryngeal or hypopharyngeal neoplasia and to investigate if a changed cutoff value would support the recent European Laryngological Society (ELS) proposal of perpendicular vascular changes as indicative of neoplasia.

Data Sources: PubMed, Embase, Cochrane, and Scopus databases.

Review Methods: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched for publications from 2011 until 2016. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of the Ni classification with two different cutoffs were calculated, and bubble and summary receiver operating characteristics plots were created.

Results: The combined sensitivity of five studies (n = 687) with Ni type IV-V defined as test-positive was 0.89 (95% confidence interval [CI]: 0.76-0.95), and specificity was 0.82 (95% CI: 0.72-0.89). The equivalent combined sensitivity of four studies (n = 624) with Ni type V defined as test-positive was 0.82 (95% CI: 0.75-0.87), and specificity was 0.93 (95% CI: 0.82-0.97).

Conclusions: The diagnostic accuracy of the Ni classification in predicting neoplasia was high, without significant difference between the two analyzed cutoff values. Implementation of the proposed ELS classification of vascular changes seems reasonable from a clinical perspective, with comparable accuracy. Attention must be drawn to the accompanying risk of exposing patients to unnecessary surgery. Laryngoscope, 128:168-176, 2018.
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http://dx.doi.org/10.1002/lary.26721DOI Listing
January 2018

Cancer of unknown primary: Registered procedures compared with national integrated cancer pathway for illuminating external validity.

Medicine (Baltimore) 2017 Apr;96(16):e6693

aCentre for Innovative Medical Technology, Odense C bDepartment of Surgery, Svendborg cDepartment of Endocrinology dDepartment of Nuclear Medicine, Odense University Hospital, Odense C eCentre of Health Economics Research, University of Southern Denmark, Odense M fOdense Patient data Explorative Network (OPEN), Odense University Hospital gDepartment of Clinical Research, University of Southern Denmark, Odense C hDepartment of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg, Denmark.

Cancer of unknown primary (CUP) ranges within top 10 cancers in both incidence and mortality. As primary identification is crucial to choosing treatment, guidelines on CUP emphasize the diagnostic strategy. Whether guidelines are complied with, or if they are indeed helpful, is however unclear. We compared procedures performed in suspected CUP patients with recommendations of national guidelines to assess external validity of guidelines.The Danish National Patient Registry (NPR) comprising population data was utilized to identify the suspected CUP patients during 2009 to 2010 and explore exposure to procedures and patient survival. The cohort was investigated in terms of validity of diagnosis through cross-referencing with the Cancer Registry (CR), which served as gold standard for cancer diagnoses and patients' cancer histories.The NPR cohort consisted of 542 patients (275 males, 264 females) of whom 210 (38.7%) had a CUP diagnosis confirmed. Within the cohort, 347 patients (64.0%) had a registration in CR matching with the NPR registration. Exposure to diagnostic procedures included biopsy (n = 439, 81.0%) and image modalities (n = 532, 98.2%). Survival was poor with 67 (12.4%) individuals alive after 4 years.The validity of a CUP diagnosis in NPR was low when using data from CR as reference. More than half the suspected CUP patients had a previous cancer diagnosis with CUP being the most frequent. Patients were diagnosed in compliance with guidelines indicating high external validity, but less than 1 quarter had their primary identified and the 1-year survival was approximately 20%. Research is needed to develop efficacious methods for primary detection.
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http://dx.doi.org/10.1097/MD.0000000000006693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406101PMC
April 2017

[More research is needed in telemedicine for well-defined patient groups].

Ugeskr Laeger 2015 Apr;177(18):861-5

The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was initiated in 2008 including 3.230 patients from 179 general practices. The objective of this review is to summarize the results from WSD based on publications made so far. Results from five publications show that telehealth reduces mortality (odds ratio 0.54) during 12 months. The use of secondary care is reduced, however, when including costs of telehealth, the total costs are higher for
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April 2015

Can videostroboscopy predict early glottic cancer? A systematic review and meta-analysis.

Laryngoscope 2016 09 3;126(9):2079-84. Epub 2015 Nov 3.

Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital, Odense, Denmark.

Objective: Correct assessment of patients with a glottic lesion is crucial for ensuring proper treatment in cases of cancer or premalignancy and for avoiding unnecessary surgery. For years, videostroboscopy (VS) has been the gold standard for assessing such lesions, but diagnostic difficulties have been described. We aim to estimate the diagnostic accuracy of VS in differentiating early glottic cancer from noninvasive lesions by conducting a systematic review and meta-analysis of published studies.

Data Sources: PubMed and Embase databases were searched without restrictions on publication date.

Review Methods: A systematic review and subsequent meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We systematically searched the literature for publications on stroboscopic diagnosis of cancer or premalignant lesions on the vocal cords. All retrieved studies were reviewed and qualitatively assessed. The pooled sensitivity and specificity of VS were calculated, and bubble and summary receiver operating characteristics plots were created.

Results: A meta-analysis was conducted on five studies with a total of 307 patients. The sensitivities of VS within the single studies ranged from 86% to 100% and specificities ranged from 7% to 93%. The meta-analysis showed that the sensitivity of the combined results was 0.96 (95% confidence interval [CI]: 0.89-0.98), and the specificity was 0.65 (95% CI: 0.21-0.93).

Conclusion: VS is able to identify almost all patients with cancer, but only approximately two-thirds of patients with noninvasive lesions are correctly identified as not having cancer. Further research concerning assessment of patients with vocal cord lesions is needed.

Level Of Evidence: NA Laryngoscope, 126:2079-2084, 2016.
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http://dx.doi.org/10.1002/lary.25745DOI Listing
September 2016

A cohort study following up on a randomised controlled trial of a telemedicine application in COPD patients.

J Telemed Telecare 2015 Oct 10;21(7):377-84. Epub 2015 Mar 10.

Centre of Health Economics Research (COHERE), Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark Center for applied services research and technology assessment, University of Southern Denmark Department of Health, Technology and Services Research (HTSR), University of Twente, Enschede, the Netherlands.

Introduction: The studies that constitute the knowledge base of evidence based medicine represent only 5%-50% of patients seen in routine clinical practice. Therefore, whether the available evidence applies to the implementation of a particular service often remains unclear. Chronic obstructive pulmonary disease (COPD) is no exception.

Methods: In this article, the effects of implementing a telemedicine intervention for COPD patients were analysed using data collected before, during, and after a randomised controlled trial (RCT).More specifically, regression techniques using robust variance estimators were used to analyse whether the use of telemedicine, patient age, and gender could explain the risk of readmission, length of hospital admission, and death during a five-year observation period.

Results: Increased risk of readmission was significantly related to both use of telemedicine and increased age in three sub-periods of the study, whereas women showed a more pronounced risk of readmission than men only during and after the RCT period. The number of days admitted to hospital was higher for patients using telemedicine and being of older age. Risk of death during the observation period was decreased for patients using telemedicine and for female patients and increased for elderly patients. No interaction between intervention and time period was observed.Statistically significant relationships were identified between use of telemedicine and risk of readmission, days admitted to hospital, and death.

Discussion: Research on effect modification in telemedicine is essential in designing future implementation of interventions as it cannot be taken for granted that effectiveness follows from efficacy.
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http://dx.doi.org/10.1177/1357633X15572202DOI Listing
October 2015

[More research is needed in telemedicine for well-defined patient groups].

Ugeskr Laeger 2014 Mar;176(12A)

Vestervang 6, 5750 Ringe.

The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was initiated in 2008 including 3.230 patients from 179 general practices. The objective of this review is to summarize the results from WSD based on publications made so far. Results from five publications show that telehealth reduces mortality (odds ratio 0.54) during 12 months. The use of secondary care is reduced, however, when including costs of telehealth, the total costs are higher for patients using telehealth. Many questions regarding differences between patient groups and the mechanism behind the effects remain unanswered.
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March 2014

[A guide to obtain validity and reproducibility in systematic reviews].

Ugeskr Laeger 2014 Mar;176(7)

Afdeling for Kvalitet og Forskning/MTV, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense C.

Validity and reproducibility are key concepts in the execution and reporting of the literature searches underlying a systematic review as it enables the reader to assess the quality of the performed searches. However, often the reporting of searches is lacking crucial information. This article provides guidelines for the process from development of a search protocol to quality assessment of the retrieved literature in order to obtain validity and reproducibility. The concepts of recall and precision are introduced to enable quality assessment of the literature searches.
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March 2014

18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography in diagnosis of head and neck squamous cell carcinoma: a systematic review and meta-analysis.

Eur J Cancer 2014 Sep 7;50(13):2271-9. Epub 2014 Jul 7.

Department of ENT Head & Neck Surgery, Odense University Hospital, DK-5000 Odense C, Denmark.

Unlabelled: 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography-scan (PET/CT) is used increasingly for detection of cancer. Precise diagnostic assessment of tumour extension in head and neck squamous cell carcinoma (HNSCC) is of critical importance for ensuring that patients receive proper treatment. Preliminary studies have shown divergent results of PET/CT in diagnosis and staging of HNSCC. The aims of this study were (1) to systematically review and meta-analyse published data about the diagnostic accuracy of PET/CT for diagnosing patients with HNSCC and (2) to compare the diagnostic accuracy of PET/CT with that of standard conventional imaging (SCI).

Methods: A systematic literature search in the PubMed, Embase and Cochrane databases on publications of PET/CT diagnostics of HNSCC from January 2005 to July 2013 was carried out. All retrieved studies were reviewed and qualitatively analysed. Along with the calculated pooled sensitivity and specificity of PET/CT and SCI, bubble- and summary receiver operating characteristics (SROC) plots were created.

Findings: Two meta-analyses of diagnostic accuracy were conducted. The first, on PET/CT, included 987 patients distributed across nine studies. The second, on SCI, included 517 patients participating in a total of six studies among those comparing PET/CT to SCI. The meta-analyses showed a pooled sensitivity of 89.3% (95% confidence interval [95% CI]: 83.4-93.2%) and specificity of 89.5% (95% CI: 82.9-93.7%) for PET/CT and correspondingly, a pooled sensitivity and specificity of 71.6% (95% CI: 44.3-88.9%) and 78.0% (95%CI: 30.2-96.7%) for SCI. A graphical comparison to SCI showed a clear difference in favour of PET/CT.

Interpretation: PET/CT is highly accurate in diagnosing patients suffering from HNSCC.
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http://dx.doi.org/10.1016/j.ejca.2014.05.015DOI Listing
September 2014

Checklists for external validity: a systematic review.

J Eval Clin Pract 2014 Dec 15;20(6):857-64. Epub 2014 May 15.

Odense University Hospital and University of Southern Denmark, Odense, Denmark.

Rationale, Aims And Objectives: The quality of the current literature on external validity varies considerably. An improved checklist with validated items on external validity would aid decision-makers in judging similarities among circumstances when transferring evidence from a study setting to an implementation setting. In this paper, currently available checklists on external validity are identified, assessed and used as a basis for proposing a new improved instrument.

Method: A systematic literature review was carried out in Pubmed, Embase and Cinahl on English-language papers without time restrictions. The retrieved checklist items were assessed for (i) the methodology used in primary literature, justifying inclusion of each item; and (ii) the number of times each item appeared in checklists.

Results: Fifteen papers were identified, presenting a total of 21 checklists for external validity, yielding a total of 38 checklist items. Empirical support was considered the most valid methodology for item inclusion. Assessment of methodological justification showed that none of the items were supported empirically. Other kinds of literature justified the inclusion of 22 of the items, and 17 items were included on the basis of consensus. On 36 occasions, the items were presented without methodological justification for inclusion. Assessment of frequency/occurrence showed that items were mentioned in one to at most 17 checklists.

Conclusion: This paper provides building blocks for the development of a new checklist for external validity. The next step is provision of empirical evidence for the checklist items to be selected, and finally, development and validation of a checklist on external validity.
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http://dx.doi.org/10.1111/jep.12166DOI Listing
December 2014
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