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SAT0591-HPR Patient Education Programs (PEP) for Patients with Rheumatoid Arthritis (RA): an Updated Systematic Review
  1. R. O. Ferreira1,
  2. A. Marques1,
  3. A. C. Mendes2,
  4. J. A. P. da Silva3
  1. 1Rheumatology, Centro Hospitalar e Universitário de Coimbra
  2. 2Unidade de Investigação em Ciências da Saúde - Enfermagem, Escola Superior de Enfermagem de Coimbra
  3. 3Rheumatology, Centro Hospitalar e Universitário de Coimbra. Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal

Abstract

Background Patient education (PE) is broadly accepted as an integral part of the management of people with Rheumatoid arthritis (RA)(1), completing clinical care. However, previous reviews, till 2003,(2, 3) concluded that studies show small short-term results with lack of evidence of long-term benefits as well as updated results are not known on this evidence.

Objectives To sistematically review the effectiveness of behavior and/or psychoeducational interventions on health status of patients with RA.

Methods We searched on MEDLINE for randomized controlled trials (RCT’s), evaluating long term (≥1year) outcomes, controlled with standard care and published between 2003 (inclusion date of latest systematic review) and 2012. Keywords used were “rheumatoid arthritis” in conjunction with each of the following “education AND group intervention/programme”. Two reviewers examined and screened search results and evaluated their quality with a checklist (4).

Results Forty-seven results were obtained. From thirteen RCT’s published after 2003, four studies were included. Exclusions were due to: outcome evaluation inferior to 1 year (three); other disease than (only) RA (three); no behaviour and/or psychoeducational intervention (two); parallel intervention comparison (one).

Three studies showed that PEP was associated with positive results at long-term, mainly on: adherence to joint protection behaviour; coping; knowledge; quality of life (symptoms); care satisfaction; early morning stiffness duration, functional capacity (AIMS2). One of these studies hasn’t proved differences on functional capacity (HAQ). Only one study hasn’t showed any statistical significant difference between groups in any outcome [functional capacity (AIMS2), self efficacy].

Conclusions Long-term efficacy was proven in some outcomes. However, primary outcomes and measures differ frequently between studies. Standard interventions are also difficult to be homogeneous. Better methodological quality studies are needed, even if good ones are already published5, 6. One of the most important decisions for future studies is to decide what (main/primary) outcomes should be used.

References

  1. - van Eijk-Hustings, Y., et al. (2012). EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Annals of the Rheumatic Diseases, 71(1):13- 19.

  2. - Riemsma, R.P. et al. (2003). Patient education for adults with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003688.

  3. - Niedermann, K. et al. (2004). Gap Between Short- and Long-Term Effects of Patient Education in Rheumatoid Arthritis Patients: A Systematic Review. Arthritis & Rheumatism, 51:3, 388–398.

  4. - Kmet, L.; Lee, R.; Cook, S. (2004). Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Alberta, Edmonton: Alberta Heritage Foundation for Medical Research.

  5. - Niedermann, K. et al. (2012). Six and 12 months’ effects of individual joint protection education in people with rheumatoid arthritis: A randomized controlled trial. Scandinavian Journal of Occupational Therapy, 19: 360–9.

  6. - Quintrec, J. et al. (2007). Effect of a collective educational program for patients with rheumatoid arthritis: a prospective 12-month randomized controlled trial. J Rheumatol., 34(8):1684-91.

Disclosure of Interest None Declared

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