Core outcome sets for trials of interventions to prevent and to treat multimorbidity in adults in low and middle-income countries: the COSMOS study.
Journal: BMJ global health
Volume: 9
Issue: 8
Year of Publication: 2024
Affiliated Institutions:
Department of Health Sciences, University of York, York, UK aishwarya.vidyasagaran@york.ac.uk.
Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan.
Department of Health Sciences, University of York, York, UK.
Centre for Biostatistics, The University of Manchester, Manchester, UK.
Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
UCL Respiratory, University College London, London, UK.
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
The Healing Triad Pakistan, Lahore, Pakistan.
Section for Global Health, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Nigerian Heart Foundation, Lagos, Nigeria.
Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
Khyber Medical University, Peshawar, Pakistan.
Foundation University Islamabad, Islamabad, Pakistan.
Physical Therapy Department, Anton de Kom University of Suriname, Paramaribo, Suriname.
Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
Family Medicine and Primary Health Care, Universidade Federal de Goiás, Goiania, Brazil.
Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Queretaro, Mexico.
ARK Foundation, Dhaka, Bangladesh.
The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Centro de Investigación del Envejecimiento (CIEN), Facultad de Medicina Humana, Universidad de San Martin de Porres, La Molina, Peru.
Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
Research and development, ARK Foundation, Dhaka, Bangladesh.
Uganda Cancer Institute, Kampala, Uganda.
Pakistan Institute of Living and Learning, Karachi, Pakistan.
Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh.
Community and Family Aid Foundation, Accra, Ghana.
Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Masira Research Institute, Universidad de Santander, Bucaramanga, Colombia.
Public Health Foundation of India, New Delhi, India.
National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, Pakistan.
Circulatory Health Research Laboratory, University of Abuja College of Health Sciences, Abuja, Nigeria.
College of Health Solutions, Arizona State University, Tempe, Arizona, USA.
The George Institute for Global Health India, Hyderabad, India.
Department of Public Health, KIST Medical College, Kathmandu, Nepal.
Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium.
Private Researcher, New York, NY, USA.
Centre for Reviews and Dissemination, University of York, York, UK.
Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium.
The Friendship Bench, Harare, Zimbabwe.
Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Abstract summary
The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. Core outcome sets (COS) appropriate for the study of multimorbidity in LMICs do not presently exist. These are required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at preventing and treating multimorbidity in adults in LMICs.To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals and policymakers) with representation from 33 countries. Consensus meetings were used to reach agreement on the two final COS.https://www.comet-initiative.org/Studies/Details/1580.The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention and 6 treatment outcomes were added from Delphi round 1. Delphi round 2 surveys were completed by 95 of 132 round 1 participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) adverse events, (2) development of new comorbidity, (3) health risk behaviour and (4) quality of life; and four for the treatment COS: (1) adherence to treatment, (2) adverse events, (3) out-of-pocket expenditure and (4) quality of life.Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to adults in LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs.CRD42020197293.
Authors & Co-authors:
Vidyasagaran Aishwarya Lakshmi AL
Ayesha Rubab R
Boehnke Jan R JR
Kirkham Jamie J
Rose Louise L
Hurst John R JR
Miranda Juan Jaime JJ
Rana Rusham Zahra RZ
Vedanthan Rajesh R
Faisal Mehreen Riaz MR
Afaq Saima S
Agarwal Gina G
Aguilar-Salinas Carlos Alberto CA
Akinroye Kingsley K
Akinyemi Rufus Olusola RO
Ali Syed Rahmat SR
Aman Rabeea R
Anza-Ramirez Cecilia C
Appuhamy Koralagamage Kavindu KK
Baldew Se-Sergio SS
Barbui Corrado C
Batista Sandro Rogerio Rodrigues SRR
Caamaño María Del Carmen MDC
Chowdhury Asiful Haidar AH
de Siqueira-Filha Noemia Teixeira NT
Del Castillo Fernández Darwin D
Downey Laura L
Flores-Flores Oscar O
García Olga P OP
García-Ulloa Ana Cristina AC
Holt Richard Ig RI
Huque Rumana R
Kabukye Johnblack K JK
Kanan Sushama S
Khalid Humaira H
Koly Kamrun Nahar KN
Kwashie Joseph Senyo JS
Levitt Naomi S NS
Lopez-Jaramillo Patricio P
Mohan Sailesh S
Muliyala Krishna Prasad KP
Naz Qirat Q
Odili Augustine Nonso AN
Oyeyemi Adewale L AL
Pacheco-Barrios Niels Victor NV
Praveen Devarsetty D
Purgato Marianna M
Ronquillo Dolores D
Siddiqi Kamran K
Singh Rakesh R
Tran Phuong Bich PB
Tufail Pervaiz P
Uphoff Eleonora P EP
van Olmen Josefien J
Verhey Ruth R
Wright Judy M JM
Zafra-Tanaka Jessica Hanae JH
Zavala Gerardo A GA
Zhao Yang William YW
Siddiqi Najma N
Study Outcome
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