Background Although supportive follow-up has been implemented in a variety of treatment practices and is recommended by clinical guidelines, little is known about the unique effects on clinical outcomes in patients with rheumatic diseases.
Objectives To describe the design and determine the clinical effects of follow-up interventions delivered after or alongside non-surgical treatment or rehabilitation of patients with rheumatic diseases.
Methods We performed a systematic review of randomized controlled trials searching the Ovid Medline, Embase, Cinahl, AMED, PsychINFO and Cochrane Library databases up to February 2013. Trials evaluating the additional effects of interventions designed to enhance and/or prolong the effects of treatment or rehabilitation for patients with rheumatic diseases were included. Risk of bias was assessed by two independent reviewers. Data on pain, depression and physical function were pooled in separate meta-analyses, including analyses to calculate short-term (0-2 months) and long-term (5-6 months after follow-up intervention) effects. The GRADE (Grading of Recommendation Assessment Development and Evaluation) approach was used to judge the quality of the evidence.
Results The searches generated 3231 citations, of which 11 original trials were included. The results demonstrated a great variety in the design of follow-up interventions, with telephone support as the most frequent mode of delivery. We found moderate quality evidence for small effects of follow-up on self-reported physical function, with standardized mean differences of -0.15 (95% confidence interval (95% CI) -0.31, 0.01, p=0.07) at short term, and -0.21 (95% CI) -0.40, -0.03, p=0.03) at long-term. Moderate quality evidence showed no effect of follow-up interventions on short-term depression. Low quality evidence showed no significant effects on short-term pain, and very low quality evidence showed no significant effects on long-term pain and depression.
Conclusions Currently, there is no clear evidence concerning what constitutes an optimal design of follow-up interventions. No significant positive effects of follow-up interventions were found for pain and depression. There is evidence that follow-up interventions are effective in improving long-term physical function in patients with rheumatic diseases.
Disclosure of Interest None declared