The Effects of Patient Education on Psychological Status and Clinical Outcomes in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

BackgroundRheumatoid arthritis (RA) is a common systemic inflammatory autoimmune disease. The disease has a serious impact on mental health and requires more effective non-pharmacological interventions.ObjectiveThis study aims to systematically evaluate the effectiveness of patient education on psychological status and clinical outcomes in rheumatoid arthritis.MethodsThis systematic review and meta-analysis was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, EMBASE database, and Web of Science database were screened for articles published until November 2, 2021. Randomized controlled trials (RCTs) of patient education for RA were included. Outcomes measures included pain, physical function, disease activity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anxiety, depression, Arthritis Self-Efficacy (pain, other symptoms, total), and General health. For each outcome, standardized mean differences or mean differences and 95% confidence intervals (CIs) were calculated.ResultsA total of 24 RCTs (n = 2,276) were included according to the inclusion and exclusion criteria. Meta-analysis revealed a statistically significant overall effect in favor of patient education for physical function [SMD = −0.52, 95% CI (−0.96, −0.08), I2 = 93%, P = 0.02], disease activity [SMD = −1.97, 95% CI (−3.24, −0.71), I2 = 97%, P = 0.002], ASE (pain) [SMD = −1.24, 95% CI (−2.05, −0.43), I2 = 95%, P = 0.003], ASE (other symptoms) [SMD = −0.25, 95% CI (−0.41, −0.09), I2 = 25%, P = 0.002], ASE (total) [SMD = −0.67, 95% CI (−1.30, −0.05), I2 = 90%, P = 0.03], and general health [SMD = −1.11, 95% CI (−1.36, −0.86), I2 = 96%, P < 0.00001]. No effects were found for anxiety [SMD = 0.17, 95% CI (−0.64, 0.98), I2 = 82%, P = 0.68], depression [SMD = −0.18, 95% CI (−0.52, 0.15), I2 = 52%, P = 0.28], pain [SMD = −0.37, 95% CI (−0.80, 0.05), I2 = 89%, P = 0.08], and CRP [SMD = −0.27, 95% CI (−0.57, 0.02), I2 = 0%, P = 0.07].ConclusionsPatient education may be effective in improving clinical outcomes and psychological status in patients with rheumatoid arthritis. Considering the methodological limitations of the included RCTs, more high-quality and large-sample RCTs are needed to confirm this conclusion in the future.Systematic Review Registrationhttp://www.crd.york.ac.uk/prospero, identifier: CRD42021250607.

Characteristics Associated with Good Self-Perceived Mental Health among United States Adults with Arthritis

“…This information is important for future work to investigate the barriers to mental health help-seeking and to improve mental health access for low-income people. Finally, a systematic review and meta-analysis found that patient education may help people with rheumatoid arthritis improve their clinical outcomes and psychological well-being [ 42 ]. The findings from our study add support to the notion of providing educational intervention to help US adults with arthritis better manage their health conditions.…”

Perspective chapter: NURSE-LED EDUCATION FOR PATIENTS WITH CHRONIC INFLAMMATORY ARTHRITIS

“…The feedback received from patients is a commonly used way to measure learning outcomes. The effectiveness of patient education may be affected by multiple factors, such as patient's learning ability, literacy level, cultural environment, lack of resources and educational tools, lack of sufficient time, and so forth [56].…”

Correlation analysis of outcomes assessed by patients and healthcare professionals: Exploration in adherence and education in Rheumatoid Arthritis

“…La educación del paciente en el tratamiento de la AR es importante ya que diversos factores sociodemográficos y educativos impactan en su progresión y mortalidad. Algunos estudios sugieren que promover la educación hacia los pacientes puede aumentar su comprensión sobre la enfermedad, lo que a su vez mejora su capacidad para gestionarla por sí mismos (9,10). Enseñar estrategias de autocuidado y conocimiento sobre la AR ayuda a mejorar la adherencia al tratamiento y facilita que los pacientes implementen correctamente la autoclinimetría.…”