The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments.
The effect of changing the built environment on physical activity: a quantitative review of the risk of bias in natural experiments.
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DOI：
10.1186/s12966-016-0433-3
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发表时间：
2016-10-07
期刊：
影响因子：
--
通讯作者：
French DP
中科院分区：
文献类型：
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作者：
Benton JS;Anderson J;Hunter RF;French DP
有关建筑环境与身体活动之间关系的证据正在影响倡导改变建筑环境以增加人口水平身体活动的政策建议。然而，到目前为止，还没有对改变建筑环境影响的证据质量进行严格的评估。本综述的目的是对自然实验中存在的偏倚风险进行彻底的定量评估，这些实验设计最有力，用于评估建筑环境对身体活动的因果影响。符合条件的研究必须评估改变建筑环境对身体活动的影响，包括至少一个测量环境改变前和一个测量环境改变后的身体活动，并且至少有一个干预点和非干预点的比较点。鉴于该领域大量的系统综述，从三个范例系统综述中确定了研究；这些是在过去五年中出版的，并被选中提供一系列不同的建筑环境干预措施。使用Cochrane非随机干预研究偏倚风险评估工具（ACROBAT-NRSI）分析这些研究的偏倚风险。确定了12个符合条件的自然实验。对所有研究的每项体力活动结果进行了偏倚风险评估，共分析了15项结果。干预场地包括公园、城市绿道/小径、自行车道、小径、空地和老年人中心。所有结果的偏倚风险均为临界（n = 12）或严重（n = 3）。偏倚风险最高的领域是混淆（由于不充分的对照点和对混淆变量的控制不良）、结果的测量和报告结果的选择。本综述的重点是迄今为止进行的最强大的自然实验。鉴于此，现有研究未能充分控制潜在的偏见来源，因此需要进行更严格的研究，以支持改变建筑环境以增加身体活动的政策建议。对今后如何改进该地区的自然实验提出了建议。本文的在线版本（doi:10.1186/s12966-016-0433-3）包含补充材料，可供授权用户使用。
Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity. Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI). Twelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen’s centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result. The present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved. The online version of this article (doi:10.1186/s12966-016-0433-3) contains supplementary material, which is available to authorized users.