General Medicine · Medical Literature
Comparative Efficacy of Non-Pharmacological Multicomponent Interventions in Community-Dwelling Older Adults With Frailty or Prefrailty: A Systematic Review and Network Meta-Analysis.
Abstract
The purpose of this study was to compare the efficacy of different non-pharmacological multicomponent interventions in community-dwelling older adults with frailty or prefrailty and to determine the most effective non-pharmacological multicomponent interventions. Frailty or prefrailty is highly prevalent among community-dwelling older adults and contributes to significant distress among older adults and increases the caregiver burden. Non-pharmacological multicomponent interventions are recommended for first-line management; however, the comparative efficacy among interventions remains unclear. A systematic electronic literature search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Wanfang, VIP and Sinomed databases up to July 1, 2025. Randomized controlled trials (RCTs) evaluating the efficacy of non-pharmacological multicomponent interventions compared with routine care or other interventions in community-dwelling older adults with frailty or prefrailty were included. A random effects model based on restricted maximum likelihood (REML) estimation was used for the network meta-analysis. Efficacy was assessed via standardized mean differences with 95% credible intervals, and interventions were ranked via surface under the cumulative ranking curve (SUCRA) probabilities. Twenty-two RCTs were included in the analysis. For overall frailty level, exercise + cognitive intervention achieved the highest rank (SUCRA = 84.7%), followed by exercise + cognitive + social support intervention (SUCRA = 83%) and exercise + nutritional intervention (SUCRA = 72%). With respect to motor ability, exercise + nutrition + psychological intervention was the most effective intervention (SUCRA = 77.1%). Non-pharmacological multicomponent interventions have a positive effect on improving the physical condition of community-dwelling older adults with frailty or prefrailty. Nurses and care managers should actively prioritize the integration of the above two interventions into personalized frailty or prefrailty care plans, maximizing the efficacy of non-pharmacological management. Exercise + cognitive intervention is likely the most effective non-pharmacological multicomponent intervention for reducing the frailty level, and exercise + nutrition + psychological intervention is likely the most effective non-pharmacological multicomponent intervention for improving motor ability in community-dwelling older adults with frailty or prefrailty. The study identified the best non-pharmacological multicomponent interventions to improve frailty or prefrailty in community-dwelling older adults, providing a basis for the development of practical interventions in later gerontological nursing practice. PROSPERO: CRD420251115805.
Clinical relevance
Among community-dwelling older adults with frailty or prefrailty, which non-pharmacological multicomponent intervention is most efficacious compared with routine care or other non-pharmacological multicomponent interventions? __SNAPSHOT__ {"studyDesign":"Systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs); random-effects model using restricted maximum likelihood (REML) estimation","setting":"Community-dwelling settings; databases searched included PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang, VIP, and SinoMed — indicating an international scope with notable inclusion of Chinese-language literature; search conducted up to July 1, 2025","sampleSize":"Not reported in the abstract provided","population":"Community-dwelling older adults diagnosed with frailty or prefrailty","intervention":"Non-pharmacological multicomponent interventions (specific components and combinations not detailed in the abstract provided)","comparator":"Routine care or other non-pharmacological multicomponent interventions","primaryOutcome":"Efficacy of non-pharmacological multicomponent interventions (specific primary endpoint metric — e.g., frailty score, frailty status reversal, physical performance — not reported in the abstract provided)","followUp":"Not reported in the abstract provided","fundingSource":"Not reported in the abstract provided"}
Key findings
The abstract provided is incomplete; it terminates mid-sentence at the description of the efficacy outcome ('Efficacy was'). Consequently, no quantitative findings — including effect sizes (SMDs, ORs, or RRs), confidence intervals, p-values, SUCRA rankings, NNT/NNH, or heterogeneity statistics (I²) — are available from the supplied text. No key findings can be reported or inferred without fabricating data. The study's stated purpose was to compare the efficacy of different non-pharmacological multicomponent interventions and identify the most effective among them, using a REML-based random-effects NMA framework, but the results and conclusions were not included in the provided abstract.
Practice implications
CRITICAL LIMITATION: Only an incomplete abstract was available for this summary; the results section and conclusions are absent from the supplied text. It is therefore not possible to determine what this NMA established, which intervention ranked highest, whether between-intervention differences were statistically or clinically significant, or whether the findings apply broadly or only to specific subpopulations. The study's design (NMA of RCTs with REML estimation) is methodologically appropriate for generating an evidence-based hierarchy of interventions, and the breadth of its database search — spanning nine databases including four Chinese-language repositories — suggests an effort to reduce publication bias from Asian trial registries. However, no interpretive conclusions can be drawn from the incomplete abstract alone, and clinicians should obtain the full publication before considering any practice implications. __LIMITATIONS__ Based solely on the abstract provided, the following methodological concerns are anticipated but cannot be confirmed without the full text: (1) Abstract truncation — the most fundamental limitation is that findings, GRADE certainty ratings, heterogeneity statistics, and conclusions are entirely absent from the provided text. (2) Heterogeneity — NMAs of multicomponent interventions are inherently susceptible to substantial clinical and statistical heterogeneity due to variation in intervention components, duration, intensity, delivery mode, frailty assessment tools (e.g., Fried phenotype vs. frailty index), and population characteristics. (3) Transitivity assumptions — NMA validity depends on the assumption that included trials are sufficiently similar to allow indirect comparisons; this cannot be assessed without full data. (4) Risk of bias — RCT-level blinding of participants and personnel is typically not feasible for behavioral interventions, introducing performance bias. (5) Generalizability — inclusion of predominantly Chinese-language databases alongside English databases may enrich Asian population data but could limit generalizability to Western community-dwelling populations. (6) Funding source — not reported; potential conflicts of interest cannot be assessed. (7) Outcome definition variability — frailty is measured by multiple tools across trials, which may compromise outcome pooling validity. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This NMA by Gao, Li, Leng et al. (2026) sought to rank non-pharmacological multicomponent interventions for community-dwelling older adults with frailty or prefrailty using a REML-based random-effects model across nine international databases, but the abstract provided is incomplete and contains no reportable results or conclusions. Clinicians should obtain and critically appraise the full publication before drawing any practice-relevant inferences from this study.