N-of-1 trials for assessing the effects of deprescribing medications on short-term clinical outcomes in older adults: a systematic review

Publication date: Available online 22 September 2017
Source:Journal of Clinical Epidemiology
Author(s): Alexander J. Clough, Sarah N. Hilmer, Sharon L. Naismith, Luke Kardell, Danijela Gnjidic
ObjectiveTo determine the feasibility of using the N-of-1 method for deprescribing trials in older adults.Study Design and SettingSystematic review identifying any human studies conducted in older adults (≥ 50 years), deprescribing any long-term treatment over less than a year using the N-of-1 trial method. Two authors independently reviewed all articles for eligibility and extracted data. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality assessment of trials was carried out using the Physiotherapy Evidence Database (PEDro) scale.ResultsSix studies were identified and extracted. All trials investigated the efficacy of therapies for treating diseases. Four trials resulted in a significant number of patients (44-64%) discontinuing their medication due to non-significant benefits of treatment. In two studies, all participants remained on their respective treatment after trial completion.ConclusionThe use of the N-of-1 method was able to effectively determine the impact of individual treatments on patient-specific outcomes, improving the care of older adults. However, use of the N-of-1 method has rarely been reported in deprescribing research, although it has been utilised in other fields.



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