Abstract
SummaryEczema is a common long‐term condition, but inadequate support and information can lead to poor adherence and treatment failure. We have reviewed the international literature of interventions designed to promote self‐management in adults and children with eczema. MEDLINE, MEDLINE in process, Embase, CINAHL and the Global Resource for EczemA Trials database were searched from their inception to August 2016, for randomized controlled trials. Two authors independently applied eligibility criteria, assessed risk of bias for all included studies and extracted data. Twenty studies (3028 participants) conducted in 11 different countries were included. The majority (n = 18) were based in secondary care and most (n = 16) targeted children with eczema. Reporting of studies, including descriptions of the interventions and the outcomes themselves, was generally poor. Thirteen studies were face‐to‐face educational interventions, five were delivered online and two were studies of written action plans. Follow‐up in most studies (n = 12) was short term (up to 12 weeks). Only six trials specified a single primary outcome. There was limited evidence of effectiveness. Only three studies collected and reported outcomes related to cost and just one study undertook any formal cost‐effectiveness analysis. In summary, we have identified a general absence of well‐conducted and well‐reported randomized controlled trials with a strong theoretical basis. Therefore, there is still uncertainty about how best to support self‐management of eczema in a clinically effective and cost‐effective way. Recommendations on design and conduct of future trials are presented.
Highlights
We wanted to answer the following questions: What evidence is there that interventions designed to promote self-management of atopic eczema are clinically effective and cost-effective? What have the interventions evaluated to date comprised? Has previous research established the contribution of the different components of self-management interventions to the outcomes assessed?
We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines[8] and the protocol was prospectively registered with PROSPERO (PROSPERO 2015: CRD42015025314).[9]
We restricted our search to randomized controlled trials (RCTs) of interventions that promote patient/carer self-management in children and adults with atopic eczema/ atopic dermatitis, compared with no intervention, usual care, or an alternative intervention
Summary
20% of children in industrialized countries have eczema, and in developing countries the prevalence is heading towards this figure.[2] In adults, population studies report an overall prevalence of 2–18%.3 It is a condition for which a high degree of self-care is needed.[4]. Families of children with eczema state that they do not receive adequate support and information about symptom management.[4] A lack of education about therapy can lead to poor adherence (patients/carers not using creams effectively) and treatment failure.[7]. We sought to review the evidence on the effectiveness of interventions designed to promote self-management for children, their caregivers and adults with eczema. We wanted to answer the following questions: What evidence is there that interventions designed to promote self-management of atopic eczema are clinically effective and cost-effective? What have the interventions evaluated to date comprised? Has previous research established the contribution of the different components of self-management interventions to the outcomes assessed?
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