Design and effects of supportive followup interventions in clinical care of patients with rheumatic diseases: A systematic review with meta-analysis

Abstract

Objective. To describe the design and determine the clinical effects of supportive followup interventions delivered after or alongside nonsurgical treatment or rehabilitation of patients with rheumatic diseases. Methods. We performed a systematic review of randomized controlled trials searching the Ovid Medline, Embase, Cinahl, AMED, PsychINFO, and Cochrane Library databases. Trials evaluating the effects of interventions designed to enhance and/or prolong the effects of rheumatic treatment or rehabilitation were included. Data on pain, depression, and physical function were pooled in separate meta-analyses, including analyses made to calculate short-term (0-2 months) and long-term (5-6 months after followup intervention) effects. Risk of bias was assessed by 2 independent reviewers. Results. The searches generated 3,231 citations, of which 11 original trials were included. The results demonstrated a great variety in the design of followup interventions. We found moderate quality evidence for small effects on self-reported physical function, with standardized mean differences of -0.15 (95% confidence interval [95% CI] -0.30, 0.00; P = 0.05) at short term, and -0.18 (95% CI -0.37, 0.00; P = 0.05) at long-term followup. Moderate quality evidence showed no effect of supportive followup interventions on short-term depression. Low quality evidence showed no significant effects on short-term pain, and very low quality evidence showed no significant effects on long-term pain and depression. Conclusion. Currently there is no clear evidence concerning what constitutes an optimal design of supportive followup interventions. There is evidence that supportive followup can improve physical function in patients with rheumatic diseases, whereas no significant effects were found for pain and depression.