OBJECTIVE: To determine the impact of occupational therapy (OT) on the self-management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA).
METHODS: Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE- Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type.
RESULTS: Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long-term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self-management for fatigue.
CONCLUSION: Although patient education is promising for self-managing RA, no strong evidence was found to support OT programs for self-managing fatigue or patient experience and long-term effectiveness. More research is required on lived experience, and the long-term efficacy of self-management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date.
OBJECTIVE: To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs.
METHODS: Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses.
RESULTS: From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=-0.23, 95% CI=-0.37 to -0.1), systemic lupus erythematosus (SLE) (SMD=-0.54, 95% CI=-1.07 to -0.01) and spondyloarthritis (SMD=-0.94, 95% CI=-1.23 to -0.66); reduction of fatigue was not significant in Sjögren's syndrome (SMD=-0.83, 95% CI=-2.13 to 0.47) and systemic sclerosis (SMD=-0.66, 95% CI=-1.33 to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=-0.32, 95% CI=-0.48 to -0.16), but not in SLE (SMD=-0.19, 95% CI=-0.46 to 0.09). Follow-up models in consultations (SMD=-0.05, 95% CI=-0.29 to 0.20) and multicomponent interventions (SMD=-0.20, 95% CI=-0.53 to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results.
CONCLUSIONS: Physica activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs.
BACKGROUND: Chronic non-cancer pain, a disabling and distressing condition, is common in adults. It is a global public health problem and economic burden on health and social care systems and on people with chronic pain. Psychological treatments aim to reduce pain, disability and distress. This review updates and extends its previous version, published in 2012.
OBJECTIVES: To determine the clinical efficacy and safety of psychological interventions for chronic pain in adults (age > 18 years) compared with active controls, or waiting list/treatment as usual (TAU).
SEARCH METHODS: We identified randomised controlled trials (RCTs) of psychological therapies by searching CENTRAL, MEDLINE, Embase and PsycINFO to 16 April 2020. We also examined reference lists and trial registries, and searched for studies citing retrieved trials.
SELECTION CRITERIA: RCTs of psychological treatments compared with active control or TAU of face-to-face therapies for adults with chronic pain. We excluded studies of headache or malignant disease, and those with fewer than 20 participants in any arm at treatment end.
DATA COLLECTION AND ANALYSIS: Two or more authors rated risk of bias, extracted data, and judged quality of evidence (GRADE). We compared cognitive behavioural therapy (CBT), behavioural therapy (BT), and acceptance and commitment therapy (ACT) with active control or TAU at treatment end, and at six month to 12 month follow-up. We did not analyse the few trials of other psychological treatments. We assessed treatment effectiveness for pain intensity, disability, and distress. We extracted data on adverse events (AEs) associated with treatment.
MAIN RESULTS: We added 41 studies (6255 participants) to 34 of the previous review's 42 studies, and now have 75 studies in total (9401 participants at treatment end). Most participants had fibromyalgia, chronic low back pain, rheumatoid arthritis, or mixed chronic pain. Most risk of bias domains were at high or unclear risk of bias, with selective reporting and treatment expectations mostly at unclear risk of bias. AEs were inadequately recorded and/or reported across studies. CBT The largest evidence base was for CBT (59 studies). CBT versus active control showed very small benefit at treatment end for pain (standardised mean difference (SMD) -0.09, 95% confidence interval (CI) -0.17 to -0.01; 3235 participants; 23 studies; moderate-quality evidence), disability (SMD -0.12, 95% CI -0.20 to -0.04; 2543 participants; 19 studies; moderate-quality evidence), and distress (SMD -0.09, 95% CI -0.18 to -0.00; 3297 participants; 24 studies; moderate-quality evidence). We found small benefits for CBT over TAU at treatment end for pain (SMD -0.22, 95% CI -0.33 to -0.10; 2572 participants; 29 studies; moderate-quality evidence), disability (SMD -0.32, 95% CI -0.45 to -0.19; 2524 participants; 28 studies; low-quality evidence), and distress (SMD -0.34, 95% CI -0.44 to -0.24; 2559 participants; 27 studies; moderate-quality evidence). Effects were largely maintained at follow-up for CBT versus TAU, but not for CBT versus active control. Evidence quality for CBT outcomes ranged from moderate to low. We rated evidence for AEs as very low quality for both comparisons. BT We analysed eight studies (647 participants). We found no evidence of difference between BT and active control at treatment end (pain SMD -0.67, 95% CI -2.54 to 1.20, very low-quality evidence; disability SMD -0.65, 95% CI -1.85 to 0.54, very low-quality evidence; or distress SMD -0.73, 95% CI -1.47 to 0.01, very low-quality evidence). At follow-up, effects were similar. We found no evidence of difference between BT and TAU (pain SMD -0.08, 95% CI -0.33 to 0.17, low-quality evidence; disability SMD -0.02, 95% CI -0.24 to 0.19, moderate-quality evidence; distress SMD 0.22, 95% CI -0.10 to 0.54, low-quality evidence) at treatment end. At follow-up, we found one to three studies with no evidence of difference between BT and TAU. We rated evidence for all BT versus active control outcomes as very low quality; for BT versus TAU. Evidence quality ranged from moderate to very low. We rated evidence for AEs as very low quality for BT versus active control. No studies of BT versus TAU reported AEs. ACT We analysed five studies (443 participants). There was no evidence of difference between ACT and active control for pain (SMD -0.54, 95% CI -1.20 to 0.11, very low-quality evidence), disability (SMD -1.51, 95% CI -3.05 to 0.03, very low-quality evidence) or distress (SMD -0.61, 95% CI -1.30 to 0.07, very low-quality evidence) at treatment end. At follow-up, there was no evidence of effect for pain or distress (both very low-quality evidence), but two studies showed a large benefit for reducing disability (SMD -2.56, 95% CI -4.22 to -0.89, very low-quality evidence). Two studies compared ACT to TAU at treatment end. Results should be interpreted with caution. We found large benefits of ACT for pain (SMD -0.83, 95% CI -1.57 to -0.09, very low-quality evidence), but none for disability (SMD -1.39, 95% CI -3.20 to 0.41, very low-quality evidence), or distress (SMD -1.16, 95% CI -2.51 to 0.20, very low-quality evidence). Lack of data precluded analysis at follow-up. We rated evidence quality for AEs to be very low. We encourage caution when interpreting very low-quality evidence because the estimates are uncertain and could be easily overturned.
AUTHORS' CONCLUSIONS: We found sufficient evidence across a large evidence base (59 studies, over 5000 participants) that CBT has small or very small beneficial effects for reducing pain, disability, and distress in chronic pain, but we found insufficient evidence to assess AEs. Quality of evidence for CBT was mostly moderate, except for disability, which we rated as low quality. Further trials may provide more precise estimates of treatment effects, but to inform improvements, research should explore sources of variation in treatment effects. Evidence from trials of BT and ACT was of moderate to very low quality, so we are very uncertain about benefits or lack of benefits of these treatments for adults with chronic pain; other treatments were not analysed. These conclusions are similar to our 2012 review, apart from the separate analysis of ACT.
This systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxiety and/or depression were reported. The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (<i>n</i> = 6), fibromyalgia (<i>n</i> = 3), pain (<i>n</i> = 7), rheumatoid arthritis (<i>n</i> = 3), cardiovascular disease (<i>n</i> = 2), diabetes (<i>n</i> = 1), cancer (<i>n</i> = 1), heterogeneous chronic disease population (<i>n</i> = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression. Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVE: Lack of adherence to treatment is frequent in chronic inflammatory rheumatic diseases and is associated with poorer outcomes. The objective of this study was to describe and evaluate interventions that have been proposed to enhance medication adherence in these conditions.
METHODS: A systematic literature review was performed in Pubmed, Cochrane, Embase and clinicaltrials.gov databases completed by the rheumatology meeting (ACR, EULAR and SFR) abstracts from last 2 years. All studies in English or French evaluating an intervention to improve medication adherence in chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal related diseases, connective tissue diseases, vasculitis and Still's disease) were included. Interventions on adherence were collected and classified in five modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others).
RESULTS: 1325 abstracts were identified and 22 studies were finally included (18 studies in RA (72%), 4 studies in systemic lupus erythematosus (16%), 2 studies in SpA (8%) and 1 study in gout (4%)). On 13 randomised controlled trials (RCT) (1535 patients), only 5 were positive (774 patients). Educational interventions were the most represented and had the highest level of evidence: 8/13 RCT (62%, 1017 patients) and 4/8 were positive (50%). In these studies, each patient was individually informed or educated by different actors (physicians, pharmacists, nurses and so on). Supports and contents of these educational interventions were heterogenous.
CONCLUSION: Despite the importance of medication adherence in chronic inflammatory rheumatic disorders, evidence on interventions to improve medication adherence is scarce.
OBJECTIVE: In this study, we systematically reviewed the effectiveness of educational interventions falling within the scope of occupational therapy practice for people with rheumatoid arthritis (RA). These interventions included disease education, joint protection and energy conservation, psychosocial techniques, pain management, and a combination category.
METHOD: Two databases, MEDLINE and CINAHL, and select journals were searched for randomized controlled trials published between January 2002 and June 2015. Qualitative synthesis was used for between-study comparisons.
RESULTS: Twenty-two studies, with approximately 2,600 participants, were included. The interventions were found to have strong evidence for constructs that dealt with increasing coping with pain and fatigue as well as maintaining positive affect. There was limited or no evidence supporting the effectiveness of these interventions on most other measured constructs.
CONCLUSION: Interventions in which a combination of educational techniques is used may complement pharmacological therapies in the care of people with RA. Future research is needed to identify specific mechanisms of change.
Esta revisión sistemática tuvo como objetivo determinar la efectividad de las intervenciones para mejorar el conocimiento y / o auto-gestión de habilidades relativas a la anticoncepción, el embarazo y la lactancia materna en las personas con artritis reumatoide (AR). Se realizaron búsquedas en cuatro bases de datos (Medline, CINAHL, Cochrane de Ensayos, PsycINFO) utilizando una estrategia de búsqueda exhaustiva. Los estudios fueron elegibles si fueran prospectivo, publicado en Inglés 2004-2015, incluidos los participantes con AR y probaron una intervención diseñada para mejorar el conocimiento y / o auto-gestión de habilidades relacionadas con la planificación familiar, el embarazo o la lactancia. A medida que los estudios no cumplieron este último criterio, la estrategia de búsqueda se amplió para incluir todos los estudios prospectivos que evaluaron las intervenciones educativas con AR y / o auto-gestión. Los datos sobre las características del estudio, características de los participantes y el contenido del programa se extrajeron para resumir la base de pruebas para las intervenciones para apoyar a las personas con AR durante sus años reproductivos. búsquedas bibliográficas expandido identificaron 2290 artículos, de los cuales 68 fueron elegibles. De estos, nueve documentos (13%) excluidos específicamente a las mujeres embarazadas / madres lactantes reclutados o sólo las personas mayores. Sólo un estudio (1%) evaluaron de forma explícita la educación centrado con el embarazo a través de una ayuda en la decisión la maternidad, mientras que ocho estudios (12%) incorporan relevante (aunque menores) componentes dentro de las intervenciones educativas o de auto-gestión de la AR más amplios. De éstos, tres estudios proporcionaron la educación metotrexato en relación con la concepción / embarazo / lactancia; tres mesas incorporadas en la AR y las relaciones, el impacto de la AR en la familia o el asesoramiento sexual; uno proporcionan información sobre la anticoncepción y la fertilidad; y uno emitió una advertencia acerca del uso de la terapia biológica en el embarazo / lactancia. En conclusión, la información con respecto a la planificación familiar, embarazo o la lactancia representa una parte insignificante de las intervenciones educativas con AR publicados, con la posibilidad de desarrollar recursos específicos.
ANTECEDENTES: En los pacientes con trastornos inflamatorios inmunes mediadas por la baja adherencia a la medicación se asocia con un aumento de los costes sanitarios, disminución de la satisfacción del paciente, reducción de la calidad de vida y los resultados de tratamiento desfavorable.
Objetivo: Determinar el impacto de diferentes intervenciones en la adherencia a la medicación en los pacientes con trastornos inflamatorios inmunes mediadas.
DISEÑO: Revisión sistemática.
FUENTES DE INFORMACIÓN: MEDLINE, EMBASE y Cochrane Library.
CRITERIOS DE ELEGIBILIDAD DE ESTUDIO PARA LA SELECCIÓN DE ESTUDIOS: Los estudios incluidos eran ensayos clínicos y estudios observacionales en pacientes adultos tratados para la psoriasis, enfermedad de Crohn, la colitis ulcerosa, la artritis reumatoide, espondiloartritis, artritis psoriásica o la esclerosis múltiple.
ESTUDIO DE EVALUACIÓN Y SÍNTESIS MÉTODOS: Los tipos de intervención se clasificaron en cuatro categorías: educación, comportamiento, cognitivo conductual, y las intervenciones de múltiples componentes. El riesgo de sesgo limitaciones / estudio de cada estudio se evaluó utilizando el sistema GRADE.
RESULTADOS: Quince estudios (14 ensayos clínicos y un estudio observacional) cumplieron con los criterios de elegibilidad y reclutaron un total de 1958 pacientes. El cuarenta por ciento de los estudios (6/15) se llevó a cabo en pacientes con enfermedad inflamatoria del intestino, un medio (7/15) en pacientes con artritis reumatoide, una en pacientes con psoriasis y uno en pacientes con esclerosis múltiple. Siete de cada 15 intervenciones fueron clasificadas como de varios componentes, cuatro como educativa, dos como de comportamiento y dos como de comportamiento cognitivo. Nueve estudios, de los cuales cinco intervenciones multicomponentes, no tenían serias limitaciones en función de criterios de grado. Nueve de cada 15 intervenciones mostraron una mejora de la adherencia: tres intervenciones multicomponente en la enfermedad inflamatoria intestinal; una intervención de cada categoría en la artritis reumatoide; uno de varios componentes en la psoriasis y uno de varios componentes en la esclerosis múltiple.
CONCLUSIÓN: La evaluación de las intervenciones diseñadas para aumentar la adherencia a la medicación en el IMIDA es poco frecuente en la literatura y su calidad metodológica se puede mejorar en próximos estudios. No obstante, las intervenciones de múltiples componentes mostraron la evidencia más fuerte para promover la adherencia en pacientes con IMIDA.
OBJETIVO: Revisar la eficacia de las visitas de grupo (citas de múltiples pacientes) sobre la calidad de vida, la función, la autoeficacia, la utilización y los resultados biofísicos en los ensayos controlados aleatorios de pacientes con enfermedades crónicas.
MÉTODOS: Se realizaron búsquedas en MEDLINE (®), Cochrane, CINAHL y PsycINFO hasta enero de 2013 para los ensayos en idioma Inglés de visitas de grupos educativos dirigidos por facilitadores no prescripción (por ejemplo, los educadores inter pares).
RESULTADOS: Presentamos el 80 artritis / cae (n = 22), el asma / EPOC (n = 10), CHF / hipertensión (n = 12), la diabetes (n = 29), varias condiciones (n = 4), y el dolor (n = 4) estudios. Encontramos evidencia moderada de mejorar la auto-eficacia a corto plazo en pacientes con artritis (10 estudios) y la diabetes (10 estudios). No se encontraron pruebas consistentes de una mejor calidad de vida; sin embargo, una moderadamente fuerte cuerpo de evidencia sugiere programas comunitarios dirigidos por compañeros podrían mejorar la calidad de vida y la utilización en pacientes con múltiples enfermedades crónicas. Los metanálisis encontraron corto (14 estudios, con una media de cambio de HbA1c = -0.27; IC = -0,44, 0,11) y largo plazo (10 estudios; el cambio medio de HbA1c = -0.23; IC = -0.44, -0.02) la mejora de la glucemia.
CONCLUSIONES: Las visitas en grupo pueden mejorar la autoeficacia y el control de la glucemia. Hubo pocas pruebas consistentes de una mejor calidad de vida, el estado funcional, o utilización.
IMPLICACIONES DE PRÁCTICA: Visitas de grupos representan una alternativa razonable para educar a los pacientes con enfermedades crónicas, aunque variada participación / retención sugiere que no deben ser la única alternativa.
