OBJECTIVE: To perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA). METHODS: The SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: From a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive-behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes. CONCLUSIONS: The findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.
BACKGROUND & AIMS: Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.
METHODS: A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.
RESULTS: Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.
CONCLUSION: This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
OBJETIVOS: Realizar una visión general sobre las intervenciones psicológicas, ortésica, la educación del paciente, ergonomía y 1⁰ / 2⁰ cuello prevención del dolor para adultos con dolor de cuello aguda-crónica.
Estrategia de búsqueda: bases de datos informatizadas y literatura gris se hicieron búsquedas (2006-2012).
Criterios de selección: Las revisiones sistemáticas de ensayos controlados aleatorios (ECA) sobre el dolor, la función / discapacidad, el efecto general percibido, se recuperaron de calidad de vida y la satisfacción del paciente.
RECOPILACIÓN DE DATOS Y AMP Dos autores independientes seleccionados, evaluaron el riesgo de sesgo mediante la herramienta AMSTAR y datos extraídos. La herramienta GRADE se utilizó para evaluar el acervo probatorio y un panel externo para proporcionar revisión crítica.
Resultados principales: Se recuperaron 30 comentarios (9.5 puntuación AMSTAR) informan sobre 75 ECA con la siguiente evidencia moderada GRADO. Para el trastorno asociado latigazo aguda (WAD), un vídeo de la educación en las salas de emergencia (1RCT, 405participants] reducción del dolor favorecido a largo plazo de seguimiento ayudando así a 1 de cada 23 personas [Standard Mean Diferencia: IC -0,44 (95%: -0,66 a -0,23)). El uso de un collarín blando (2RCTs, 1278participants) no era beneficioso en el largo plazo. Para el dolor de cuello crónico, una intervención cuerpo-mente (2RCTs, 1 meta-análisis, 191participants) mejoró a corto plazo del dolor / función en 1 de 4 o 6 participantes. En los trabajadores, a 2 minutos de entrenamiento de resistencia-escápula torácica diaria (1RCT, 127participants) más de 10 semanas fue beneficioso en 1 de 4 participantes. Una serie de intervenciones psicosociales, las intervenciones del lugar de trabajo, el uso del collar y estrategias educativas de autogestión no fuera beneficioso.
Existe evidencia moderada para la cuantificación de los efectos benéficos y no benéficos de un número limitado de intervenciones para WAD agudo y el dolor crónico de cuello: Conclusiones de los revisores. Ensayos más grandes con controles más rigurosos deben orientar las intervenciones prometedoras.
To perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA).
METHODS:
The SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation.
RESULTS:
From a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive-behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes.
CONCLUSIONS:
The findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.
