Mats Jong, Trine Stub, Miek C Jong
Supporting Personal Growth in Childhood, Adolescent and Young-Adult Cancer Survivors Through Challenges in Nature - A Qualitative Study of WAYA Wilderness Programme Participation
Global advances in integrative medicine and health
multiple sclerosis ms chronic inflammatory disease central nervous system affects millions people worldwide disease course varies greatly across individuals many diseasemodifying treatments different safety efficacy profiles developed recently prognostic models evaluated shown valid different settings potential support people ms physicians decisionmaking process treatment diseaselife management allow stratified precise interpretation interventional trials provide insights disease mechanisms many researchers turned prognostic models help predict clinical outcomes people ms however knowledge widely accepted prognostic model ms used clinical practice yet identify summarise multivariable prognostic models validation studies quantifying risk clinical disease progression worsening activity adults ms searched medline embase cochrane database systematic reviews january 1996 july 2021 also screened reference lists included studies relevant reviews references citing included studies included statistically developed multivariable prognostic models aiming predict clinical disease progression worsening activity measured disability relapse conversion definite ms conversion progressive ms composite adult individuals ms also included studies evaluating performance ie validating models restrictions based language data source timing prognostication timing outcome pairs review authors independently screened titlesabstracts full texts extracted data using piloted form based checklist critical appraisal data extraction systematic reviews prediction modelling studies charms assessed risk bias using prediction model risk bias assessment tool probast assessed reporting deficiencies based checklist items transparent reporting multivariable prediction model individual prognosis diagnosis tripod characteristics included models validations described narratively planned metaanalyse discrimination calibration models least three external validations outside model development study model met criterion summarised betweenstudy heterogeneity narratively could perform planned metaregression included 57 studies identified 75 model developments 15 external validations corresponding 12 16 models six authorreported validations two models externally validated multiple times none identified external validations performed researchers independent developed model outcome related disease progression 39 41 relapses 8 8 conversion definite ms 17 18 conversion progressive ms 27 28 96 models validations disease treatmentrelated characteristics included participants definitions considered predictors outcome highly heterogeneous amongst studies based publication year observed increase percent participants treatment diversification diagnostic criteria used increase consideration biomarkers treatment predictors increased use machine learning methods time usability reproducibility identified models contained least one predictor requiring skills medical specialist measurement assessment models 44 59 contained predictors require specialist equipment likely absent primary care standard hospital settings half 52 developed models accompanied model coefficients tools instructions hinders application independent validation reproduction data used model developments made publicly available reported available request studies two six respectively risk bias rated one model developments validations high overall risk bias main reason statistical methods used development evaluation prognostic models rated two included model developments validations high risk bias analysis domain none model developments externally validated models external validations low risk bias concerns related applicability models research question onethird 38 models validations reporting deficiencies reporting poor overall observable increase quality reporting time items unclearly reported reported included models validations related sample size justification blinding outcome assessors details full model obtain predictions amount missing data treatments received participants reporting preferred model performance measures discrimination calibration suboptimal current evidence sufficient recommending use published prognostic prediction models people ms clinical routine today due lack independent external validations ms prognostic research community adhere current reporting methodological guidelines conduct many stateoftheart external validation studies existing newly developed models