Author: Prothero L1, Barley E2, Galloway J3, Georgopoulou S4, Sturt J5
Affiliation:
1Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK. Electronic address: louise.prothero@kcl.ac.uk.
2College of Nursing, Midwifery and Healthcare, University of West London, Boston Manor Road, Brentford, Middlesex, TW8 9GA, UK. Electronic address: elizabeth.barley@uwl.ac.uk.
3Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK. Electronic address: james.galloway@kcl.ac.uk.
4Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ, UK; School of Psychology, University of East London, Water Lane, London, E15 4LZ, UK. Electronic address: s.georgopoulou@uel.ac.uk.
5Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London, SE1 8WA, UK. Electronic address: jackie.sturt@kcl.ac.uk.
Conference/Journal: Int J Nurs Stud.
Date published: 2018 Mar 13
Other:
Volume ID: 82 , Pages: 20-29 , Special Notes: doi: 10.1016/j.ijnurstu.2018.03.008. [Epub ahead of print] , Word Count: 416
BACKGROUND: Psychological interventions are an important but often overlooked adjunctive treatment option for patients with rheumatoid arthritis. Findings from systematic reviews of psychological interventions for this patient group are conflicting. A systematic review of reviews can explain inconsistencies between studies and provide a clearer understanding of the effects of interventions.
OBJECTIVES: To: 1) determine the effectiveness of psychological interventions in improving biopsychosocial outcomes for adults with rheumatoid arthritis, 2) determine the relationship between the intensity of the psychological interventions (number of sessions, duration of sessions, duration of intervention) on outcomes, and 3) assess the impact of comparator group (usual care, education only) on outcomes.
DESIGN: We conducted a systematic review of reviews using the following inclusion criteria: 1) randomised controlled trials of psychological interventions (including cognitive behavioural therapy, supportive counselling, psychotherapy, self-regulatory techniques, mindfulness-based cognitive therapy and disclosure therapy) provided as an adjunct to medication, 2) included rheumatoid arthritis patients aged ≥ 18 years, 3) reported findings for at least 1 of the primary outcomes: pain, fatigue, psychological status, functional disability and disease activity and 4) were published in English between January 2000 and March 2015 (updated January 2018).
DATA SOURCES: We searched in MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. Reference lists were searched for additional reviews.
REVIEW METHODS: Study selection and 50% of the quality assessments were performed by two independent reviewers. Methodological quality was measured using the Assessment of Multiple Systematic Reviews checklist. Data extraction was conducted by one reviewer using a predesigned data extraction form.
RESULTS: Eight systematic reviews met inclusion criteria (one review was excluded due to its low-quality score). Small post intervention improvements in patient global assessment, functional disability, pain, fatigue, anxiety and depression were observed. The effect on coping, self-efficacy and physical activity was greater. Improvements in depression, coping and physical activity were maintained (8.5-14 months). Interventions delivered over a longer period with a maintenance component appeared more effective. Attention, education, and placebo control groups produced some improvements but not as large as those produced by the psychological interventions.
CONCLUSIONS: Psychological interventions result in small to moderate improvements in biopsychosocial outcomes for patients with rheumatoid arthritis in addition to those achieved by standard care. Several priorities for future research were identified, including determining the cost effectiveness of non-psychologically trained health professionals delivering psychological interventions.
Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.
KEYWORDS: Assessment of Multiple Systematic Reviews checklist; Evidence-based practice; Mental health status; Physical health status; Psychological interventions; Rheumatoid arthritis; Systematic review of reviews
PMID: 29573593 DOI: 10.1016/j.ijnurstu.2018.03.008
