Table 3

Included studies with limitations and risk of bias

StudyRisk of biasLimitation/methodological issues
Andreatta et al 26 ModerateAbsence of baseline period for comparison.
Participant composition not fully elucidated.
Presence of confounding variables.
Steinemann
et al 27
ModerateThough number of involved participants recorded, no mention of participant retention during study duration (1 year).
Riley et al 28 ModeratePresence of confounding variables (in situ simulation not isolated).
Arms of study differed at baseline.
Knight et al 29 ModerateParticipant composition not fully elucidated.
Presence of confounding variables (in situ simulation not isolated).
Braddock et al 30 ModerateNon-intervention control group differed from intervention group.
Presence of confounding variables (in situ simulation not isolated).
Sodhi et al 31 ModeratePresence of confounding variables (in situ simulation not isolated).
Participant composition not fully elucidated.
Riley et al 32 SeriousPresence of confounding variables (in situ simulation not isolated).
Potential outcome selection bias due to reporting on four of the eight initial outcomes.
Potential bias due to influence of private third-party entity.
Participant composition not fully elucidated.
Theilen et al 33 ModeratePresence of confounding variables (in situ simulation not isolated).
Gibbs et al 34 SeriousPotential outcome selection bias due to reporting on non-initial outcome.
Results affected by confounding factors (related to disease outbreak dynamics).
Participant composition not fully elucidated.
Small sample size.
Team characteristics not fully elucidated.