Name : Anggi Putri Aria Gita

NIM : S021808006 (Semester 2, Epidemiologi dan Biostatistik)

Tittle of Journal : Aerobic exercise training may improve nerve function in type 2
diabetes and pre-diabetes: A systematic review

Authors : Gu Y, Dennis SM, Kiernan MC, & Harmer AR

Year : 2019

Critical Appraisal of A Systematic Review

CRITERIA YES NO

√
Q1. Did the authors have a clearly focused question [population, intervention (strategy), and
outcome(s)]?
√
Q2. Were appropriate inclusion criteria used to select primary studies?
√
Q3. Did the authors describe a search strategy that was comprehensive?
Circle all strategies  health databases  handsearching
used:
 psychological  key informants
databases
 social science  reference lists
databases
 educational databases  unpublished
 other
√
Q4. Did search strategy cover an adequate number of
years?
√
Q5. Did the authors describe the level of evidence in the primary studies included in the review?
 Level I RCTs only
 Level II non-randomized, cohort, case-
control
 Level uncontrolled studies
III
 √
Q6. Did the review assess the methodological quality of the primary studies, including:
(Minimum requirement: 4/7 of the following)
Research design
Study sample
Participation rates
Sources of bias (confounders, respondent bias)
Data collection (measurement of independent/dependent variables)
Follow-up/attrition rates
Data analysis
√
Q7. Are the results of the review transparent?
√
Q8. Was it appropriate to combine the findings of results across studies?
√
Q9. Were appropriate methods used for combining or comparing results across studies?
√
Q10. Do the data support the author’s interpretation?

Q1. Did the authors have a clearly focused question [population, intervention (strategy), and
outcome(s)]?
Answer: Yes, the review have a clearly focused research question that contains the
following components: Population, Intervention, Comparisons, and Outcomes (PICO)

Population : people with pre-diabetes and with type 2 diabetes

Intervention : exercise training
Comparisons : -
Outcomes : exercise training may positively influence nerve function among people with
type 2 diabetes mellitus and with pre-diabetes.

There is no comparison of intervention, but it would be enough if the population, intervention

and outcome are clearly described.

Q2. Were appropriate inclusion criteria used to select primary studies?

Answer : Yes, the review clearly describe the criteria that were used to select included
studies.

The review have two criteria that were used to select included studies:
1. Inclusion criteria
Studies were included if participants had physician-diagnosed pre-diabetes, or T2DM; if
exercise training (of any type) was the main intervention compared with usual care,
another form of exercise, passive treatment, or no comparison intervention; and if nerve
 function or nerve conduction parameters or neuropathy-related questionnaires were used
as outcome measures. Studies were not excluded because of their design or quality.
2. Exclusion criteria
Studies were excluded if they did not include nerve function or a neuropathy score as an
outcome measure; did not use exercise training as the main intervention; or if neuropathy
was caused by a condition other than diabetes.

Q3. Did the authors describe a search strategy that was comprehensive?
Answer : No, the review just describe two components of search strategy:
1. Health database : A comprehensive search of MEDLINE (OVID), CINAHL, AMED,
PEDro, Cochrane Library, EMBASE and Scopus databases from their inception to 4
December 2017 was conducted.
2. Reference list : The reference lists of included studies were also reviewed to identify any
further studies that met the inclusion criteria.

Q4. Did search strategy cover an adequate number of years?

Answer : Yes, the search strategy covered a sufficient time period. The search strategy
covered enough years that it is unlikely that important studies were missed. The authors state the
years searched, of the 14 publications consist time period from 2011 to 2017.

Q5. Did the authors describe the level of evidence in the primary studies included in the review?
Answer : Yes, the study designs of the included studies is clearly identified in the review;
and, indicate the appropriate level of evidence.
Level I : Of the 14 publications, there were five RCTs, two quasi-experimental studies, one pre-
post parallel group study, and five pre-post single group studies.

Q6. Did the review assess the methodological quality of the primary studies, including: Research
design, Study sample, Participation rates, Sources of bias (confounders, respondent bias), Data
collection (measurement of independent/dependent variables), Follow-up/attrition rates, and Data
analysis.

Answer : Yes,

1. Research design : A Systematic Review

2. Study sample : A systematic search of MEDLINE (OVID), CINAHL, AMED, PEDro,
the Cochrane Library, EMBASE and Scopus databases identified a total of twelve studies
that were eligible for inclusion in this systematic review.
3. Participation rates : The twelve included studies examined people with pre-diabetes (n
= 1) and with type 2 diabetes (n = 11).
4. Sources of bias (respondent bias, instrument bias, ect) :
 Respondent Bias : The major weaknesses of this review are the limited number of
included studies (particularly among people with pre-diabetes)
Instrument Bias : the heterogeneity of exercise interventions and outcome measures
used.
Only three included studies were RCTs and most had relatively small sample sizes
that may have reduced the statistical power of their results.
5. Data collection (measurement of independent/dependent variables) :
a. There was heterogeneity with regard to exercise type and dosage, but nearly all
studies employed exercise of moderate intensity.
b. Quality of life (QoL) measures (questionnaires)
c. Quality scores for the included studies ranged from one to seven out of ten on the
PEDro Scale
d. Each exercise has its own measuring instrument
6. Follow-up/attrition rates : comprehensive search of seven major databases from their
inception, and screening of the reference lists of included studies, likely ensures that all
relevant studies were identified. Two reviewers independently extracted data from
included studies to reduce error and any potential bias.
7. Data analysis : Data analysis used meta-analysis

Q7. Are the results of the review transparent?

Answer : Yes, two independent reviewers assessed each included study for methodological
quality, with a method of conflict resolution identified.

Q8. Was it appropriate to combine the findings of results across studies?

Answer : Yes, a test of homo/heterogeneity has been conducted and the corresponding model
applied. The individual study results have been disclosed graphically or narratively. Study results
are listed narratively, the information must have been provided consistently for all studies within
the review text.

Q9. Were appropriate methods used for combining or comparing results across studies?
Answer : No, the riview overall measure of effect not be determined by assigning those studies
of highest methodological quality greater weight.

Q10. Do the data support the author’s interpretation?

Answer: Yes, the data for the included studies supports the interpretations outlined in the review.
Numerical values or p values/confidence intervals are given, then the reviewer can determine
whether any conclusions are supported by the data. The review author’s interpretation of the
results of the included studies are supported by the data.