Kirsten Hanrahan

Objective: This review will critically appraise, compare, and summarize the quality of the measurement properties of vulnerability tools for older people. Introduction: Various tools exist to assess the vulnerability of older adults. These tools evaluate different dimensions of vulnerability, including identifying vulnerable older adults and conceptualizing vulnerability as an accumulation of social deficits. They also quantify vulnerability based on health, social, and economic risk factors; evaluate perceptions of vulnerability according to physiological, psychological, socioeconomic, social, and environmental dimensions; and evaluate risks or uncontrollable events. Identifying the most precise tools for vulnerability assessments will help health care professionals anticipate complications and prevent injuries. Eligibility criteria: Eligibility will be determined according to the following criteria: Population (older people); Instrument (self-reported questionnaires); Construct (health vulnerability); Outcomes (measurement properties); and Types of studies (methodological and observational studies—all types of studies that evaluate the measurement properties of patient-reported outcome measures). Methods: This review will follow the COnsensus-based Standards for the selection of health Measurement INstruments for systematic reviews of patient-reported outcome measures (COSMIN). The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Outcome Measurement Instruments (PRISMA-COSMIN for OMIs). Two independent reviewers will conduct study selection, assessment of methodological quality, data extraction, data synthesis, and assessment of certainty in the findings. The COSMIN Risk of Bias checklist will be used to evaluate methodological quality. The evidence will be summarized for each measurement property and the overall result will be rated against the criteria for measurement properties to determine the grading of evidence as high, moderate, low, or very low. The certainty of the evidence will be assessed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Review registration: PROSPERO CRD42023460483

Background: Multisite studies offer larger, more diverse samples to successfully capture populations and clinical practices of interest at the point of care. However, investigators face challenges with site recruitment and sampling, differences in clinical practices across sites, and data integrity. Addressing these issues a priori can improve the rigor and reproducibility of the research. Objective: This article aims to describe a cascading approach to multisite research. An exemplar is provided of a study using this approach, which aimed to evaluate the prevalence of pain and the pain management practices provided to critically ill children in pediatric intensive care units in the United States. Methods: The cascading approach includes two or more pilot study procedures with a progressively increasing number of sites prior to a full-scale study. Following each pilot, study procedures are evaluated; feedback was obtained from site personnel and content experts; procedures were revised accordingly; approvals were obtained; sites were trained; and the revised procedures are repeated with a larger, more diverse number of sites. Results: In the exemplar provided, improvements in the efficiency and integrity of data collection were noted for the full-scale study following the pilots. All sites that completed the agreements and approvals for study participation were retained for the duration of the two pilots and full-scale study. Discussion: Borrowing from principles of process improvement, the cascading approach allows knowledge to be gained regarding site differences and informs the revision of study procedures while potentially maximizing efficiency and data integrity, minimizing site burden, and maintaining site engagement for multisite studies.