Background Patient education (PE) is a planned, interactive process between patients and health professionals (HPs), aimed at supporting and enabling patients to manage their life with arthritis and optimising their health and well being. PE is an integral part of the management of inflammatory arthritis (IA) in many European countries. However, the content, methods of delivery and who is involved in delivering PE vary widely across countries. HPs within EULAR have identified a need to define a set of recommendations/points to consider on PE for people with IA.
Objective The aim of this study was to identify existing evidence on PE for people with IA as a basis for developing evidence-based recommendations/points to consider
Methods The EULAR standard Operating Procedures  were followed. A multidisciplinary Task Force defined 10 research questions to guide the systematic review. A comprehensive systematic literature search was conducted in the databases Medline, Embase, Cochrane library, PsychINFO and CINAHL. Studies were eligible for inclusion if they included people with IA (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis), adults (18 or above), reported any kind of PE, information or counselling interventions, were published between January 2003 to September 2014, and were published English, German, French or Spanish languages. There were no limitations regarding study design. Studies were categorised by design and type of intervention and presented to the Task Force as basis for discussion of recommendations.
Results From a total number of 2238 papers, 381 were included for abstract screening and 188 for full-text reading. Finally, 113 studies were included, comprising 11 systematic reviews/meta-analyses, 43 randomised controlled trials, 7 clinical controlled trials, 9 pre-post-test studies, 23 observational and 20 qualitative studies. PE interventions comprised self-management, cognitive behavioural therapy, stress management, didactic information and counselling related to pharmacological and non-pharmacological treatment and were delivered individually, in groups or combined. The trials reported a variety of outcomes, such as disease activity, symptoms, adherence to therapy, knowledge, and physical and psychological health status. Most studies reported statistically significant improvements in main outcomes at follow-up compared to controls. Improvements were small to moderate. The cross-sectional and qualitative studies reported several aspects of patients' educational needs and preferences that should be taken into account when designing interventions. Patients' needs were related to living with the disease, disease management and support from HPs and peers. High levels of disease knowledge seemed to be positively associated with involvement in own health care.
Conclusions There is substantial evidence to support the need for integrating PE as part of standard care for people with IA. However, there is lack of evidence regarding which modes of delivery are best suited at which time point in the disease trajectory to optimise the outcomes for each patient. Further studies should be conducted on the mechanisms that modify or mediate the effects of PE. Further development and harmonisation of PE outcomes is needed.
Dougados, M. et al. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Ann. Rheum. Dis. 63, 1172-1176, doi:10.1136/ard.2004.023697 (2004).
Disclosure of Interest None declared
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