Suitability for e-health of non-pharmacological interventions in connective tissue diseases: scoping review with a descriptive analysis

Abstract

ObjectiveNon-pharmacological interventions support patients with connective tissue diseases to better cope with and self-manage their diseases. This study aimed to map existing evidence on non-pharmacological interventions in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and mixed connective tissue diseases regarding content, feasibility and potential suitability in an e-health setting.MethodsA literature search was performed in eight different databases in July 2020. The intervention’s content was extracted using the ‘Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide’. A Sankey diagram and descriptive statistics were used to analyse the data and illustrate the relationships between the interventions.ResultsOf 8198 identified records, 119 papers were eligible. One hundred and four of them (87.4%) were conducted between 2000 and 2020, mainly in the USA (SLE n=24 (21.2%), SSc n=16 (14.2%)), Brazil (SLE n=8 (7.1%), SSc n=5 (4.4%)) and Italy (SLE n=0 (0%), SSc n=12 (10.6%)). Fifty-two studies (SLE n=24 (21.2%), SSc n=28 (24.8%)) used multicomponent interventions. The single interventions were physical exercises (SLE n=16 (14.2%), SSc n=17 (15.0%)), coaching/counselling (SLE n=11 (18.0%), SSc n=0 (0%)) and education (SLE n=2 (1.8%), SSc n=3 (2.7%)). Primary outcomes focused on physical function (SLE n=1 (0.9%), SSc n=15 (13.3%)), mouth opening in SSc (n=4 (5.9%)) and physical capacity (SLE n=2 (1.8%), SSc n=1 (0.9%)). No interventions for mixed connective tissue disease were found.ConclusionThere was a great variety in the intervention’s content due to differences in body structure, activity limitations and participation restrictions in SLE and SSc. These results highlight the need for personalised, multicomponent, non-pharmacological interventions, which could be delivered as e-health interventions.

EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis

“…Moderate to strong evidence existed in the literature for the benefits of physical activity and exercise for SLE and SSc patients, including documented benefits regarding HRQoL, fatigue and cardiovascular burden 33 91–104. Despite sparse evidence regarding smoking cessation for improving disease activity and treatment outcomes and avoidance of cold exposure for the prevention of Raynaud’s phenomenon, the task force agreed on the crucial importance of these two recommendations.…”

Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis

“…RMD Open RMD Open RMD Open SLE and SSc in particular, physical activity and exercise have been shown to reduce fatigue and improve HRQoL. 4 5 7 8 The appropriateness and efficacy of different delivery methods for non-pharmacological management have also been addressed in the literature, including e-health settings, 9 which recently were urgently necessitated due to the pandemic caused by SARS-CoV-2. Although many studies have been conducted on nonpharmacological interventions, evidence-driven recommendations are sparse.…”

Health disparities in systemic lupus erythematosus—a narrative review

“…McDougall has discussed how this modality can also be leveraged to improve healthcare access to minorities in particular [ 94 •]. The use of telehealth intervention focused on patient education and supervised non-pharmacological interventions such as physical exercise in SLE were found to be feasible in a recent review [ 95 ]. Using telehealth for such interventions can overcome some of the logistical challenges faced by minority populations.…”