Study Quality Appraisal
The quality of each of the eleven included studies was assessed using the 2018 updated MMAT (Supplementary Table 3).25 All RCTs reported appropriate randomization and all nonrandomized studies reported including participants representative of their identified target population. Yet, the confounders were reported as adequately accounted for in only 56% (5/9) of the nonrandomized studies and the intervention was explicitly reported to have been administered as intended in only 33% (3/9) of the nonrandomized studies. Four studies (36%) had at least one MMAT item with a negative response and seven (64%) had at least one MMAT item with the mention “can’t tell”. Additionally, even among studies adequately reporting all the outcomes mentioned in their methods section, p-values were not commonly reported.

Sensitivity analyses

Out of 11 studies, 4 had at least one MMAT item with a negative response (Supplementary Table 3).18,19,21,29 The general conclusions for each outcome did not change when removing these four studies from the data synthesis. After removing these four studies, only five different studies reported on quality of care: five on medication problems12,16,20,27,28 and none on advance directives. Four still showed favorable results12,16,27,28 with TCi and one showed better results in the control group.20
Additionally, after removing these four studies, only two different studies reported on clinical outcomes: two on mortality,16,17 one on mobility, function and pain17 and none on confusion/behavioral symptoms. There was still no beneficial effect of TCi on mortality and inconclusive results on mobility, function and pain.
For healthcare services use, after removing these four studies, only three different studies still reported data: two on hospital readmissions and ED visits16,17 and three on hospital days.16,17,28 The results were still inconclusive for both hospital readmissions and ED visits and hospital days.
Finally, after removing these four studies, only two different studies reported on satisfaction.12,30 Both caregivers and physicians still showed high levels of satisfaction with TCi.