Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Sources of Information and Search Strategy
2.2. Selection of Studies for the Systematic Methods Review
2.3. Data Management, Collection Process and Data Items
2.4. Summary Measures and Risk of Bias Assessment
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Component | |
---|---|
Physical exercise | Supervised and structured exercise training at least twice a week [2] |
Information | Advice on cardiovascular risk reduction [1] |
Motivational techniques | Strategies to ensure patients adequately adhere to medications and implement lifestyle changes [3] |
Education | Health education includes information on medication, exercise training, individual nutritional advice and support to stop smoking [3] |
Psychological support and interventions | Psychological counselling, support of individual’s disease management and coping strategies, relaxation methods and individual behavior changes [3] |
Social and vocational support | Support in social reintegration and reuptake of work [3] |
Quality Aspect | Literature on Guidance | Assessment Procedure |
---|---|---|
Selection of variables … | ||
…based on domain expertise and preceding studies (background knowledge) | [21,22] |
|
…based on background knowledge with causal diagrams known as directed acyclic graphs (DAGs) | [7,8,22] |
|
Assumption of … | ||
…pretreatment covariates. | [7,22] |
|
…conditional exchangeability. This means that conditional on the IVs, association is causation. | [7,22] |
|
…positivity. This means each value of the confounders is observed for all treatment groups. | [7,22,23] |
|
…consistency. This means that the mode of receiving, as opposed to the choice of treatment level per se, does not affect the outcome. | [7,22,23] |
|
…linearity. This means that the relationship between a continuous IV and the outcome is linear. | [24] |
|
Missing values | [20,25] |
|
Highly influential points/outliers | [26] |
|
Events-per-variable (EPV) | [13], p. 72; [27,28] |
|
Dichotomization of continuous variables | [29] |
|
Selection Method * | for Regression (n = 24) | for Propensity Score (n = 13) | ||
---|---|---|---|---|
n | % | n | % | |
Background knowledge | 5 | 21 | 2 | 15 |
Univariable screening | 8 | 33 | 3 | 23 |
Stepwise selection | 4 | 17 | 0 | 0 |
Shrinkage methods | 1 | 4 | 1 | 8 |
Not described | 11 | 46 | 8 | 62 |
Propensity Score Methods | Studies (n = 13) | |
---|---|---|
n | % | |
Matching | 7 | 54 |
Stratification | 4 | 31 |
Multivariable analysis included: | ||
as covariate | 5 | 38 |
inverse probability weighting | 1 | 8 |
inclusion not described | 1 | 8 |
Studies (n = 24) | ||
---|---|---|
n | % | |
Missing values reported | 10 | 42 |
Missing value imputation applied | 4 | 17 |
Highly influential points reported | 0 | 0 |
Multicollinearity reported | 1 | 4 |
Pair-wise interactions reported | 8 | 33 |
Pair-wise interactions applied | 6 | 25 |
Mixed Models applied | 2 | 8 |
Reconstruction of EPV possible | 16 | 67 |
Dichotomization of continuous variables applied | 12 | 50 |
Study | Rauch 2014 [3] | Norris 2004 [34] | Kutner 2006 [35] | Milani 2007 [36] | Hansen 2009 [37] | Suaya 2009 [38] | Jünger 2010 [39] | Schwaab 2011 [40] | Martin 2012 [41] | Prince 2014 [42] | Doimo 2018 [43] | Sunamura 2018 [44] | Goel 2011 [45] | Marzolini 2013 [46] | Schlitt 2015 [47] | Pack 2013 [48] | Meurs 2015 [49] | Nielsen 2008 [50] | Alter 2009 [51] | Coll-Fernandez 2013 [52] | Lee 2016 [53] | Beauchamp 2013 [54] | Goel 2013 [55] | De Vries 2015 [56] |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Confounders selected based on background knowledge? | NC | NC | NC | NC | NC | NC | N | NC | NC | NC | NC | NC | N | N | N | Y | Y | N | N | N | N | Y | Y | Y |
Was a DAG used? | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N |
Only pretreatment covariates included? | Y | Y | NC | Y | N | Y | Y | Y | NC | NC | Y | Y | Y | Y | Y | Y | Y | NC | Y | Y | NC | Y | Y | Y |
Exchangeability mentioned? | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N |
Positivity mentioned? | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N |
Consistency reported? | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N | N |
Incorporation of non-linear functional forms? | Y | N | N | N | N | N | N | N | N | N | N | N | Y | N | N | N | N | N | N | N | N | N | N | N |
Missing data reported? | NC | NC | NC | NC | NC | NC | Y | NC | Y | NC | NC | NC | Y | Y | NC | Y | Y | Y | Y | NC | NC | Y | NC | Y |
Missing data imputation? | NC | NC | NC | NC | NC | NC | Y | NC | NN | NC | NC | NC | Y | Y | NC | NC | Y | NN | NC | NC | NC | NN | NC | NC |
Highly influential points/outliers? | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC |
Multicollinearity? | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | NC | N |
Events-per-variable (EPV) >15 | N | NC | NC | N | N | NC | Y | Y | Y | NC | NC | NC | Y | N | N | Y | Y | NC | N | N | NC | Y | N | Y |
Dichotomization of continuous variables? | Y | Y | N | N | Y | Y | Y | NI | N | N | N | N | Y | NI | N | Y | Y | Y | N | Y | N | N | Y | Y |
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Akbari, N.; Heinze, G.; Rauch, G.; Sander, B.; Becher, H.; Dunkler, D. Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review. Int. J. Environ. Res. Public Health 2023, 20, 3182. https://doi.org/10.3390/ijerph20043182
Akbari N, Heinze G, Rauch G, Sander B, Becher H, Dunkler D. Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review. International Journal of Environmental Research and Public Health. 2023; 20(4):3182. https://doi.org/10.3390/ijerph20043182
Chicago/Turabian StyleAkbari, Nilufar, Georg Heinze, Geraldine Rauch, Ben Sander, Heiko Becher, and Daniela Dunkler. 2023. "Causal Model Building in the Context of Cardiac Rehabilitation: A Systematic Review" International Journal of Environmental Research and Public Health 20, no. 4: 3182. https://doi.org/10.3390/ijerph20043182