Abstract
Rheumatoid arthritis (RA), a long-term auto-immune condition is a challenging condition for patients to manage. Goals of treatment include reducing pain, decreasing inflammation, and improving an individual’s overall function. Increasingly technology is being utilised to support patients to self-manage their condition. The aim of this systematic narrative review was to synthesise and critically appraise published evidence concerning the effectiveness of tele-health interventions to support self-management in RA. Bibliographic databases searched from 2014 to March 2020 included MedLINE, Embase, Cochrane Library. Search strategy combined the following concepts: (1) rheumatoid arthritis, (2) tele-health interventions, and (3) self-management. Only randomised controlled trials (RCTs) involving adults with RA were included. Titles, abstracts, full-text articles were screened, any discrepancies were checked by a second reviewer. Risk of bias was assessed using Cochrane risk of bias tool and data were extracted utilising the Cochrane data collection form for RCT interventions along with the TiDier checklist. Due to high heterogeneity, results were not meta-analysed and instead data were synthesised narratively. The search identified 98 articles, seven were included. The completed RCTs varied in the nature of the interventions, duration/severity of RA, outcomes measured and effectiveness of the interventions. The completed RCTs included a total of 791 participants Disease duration was largely between 4 and 10 years and disease severity on average was moderate. There was extensive variation in intervention components, theories underpinning theories and outcomes measured. Five RCTs reported a positive effect on factors such as disease activity, medication adherence, physical activity and self-efficacy levels. This study suggests that tele-health interventions that are well-designed, tailored and multi-faceted can help to achieve positive self-management outcomes in RA. None of the studies showed evidence of harm.
Highlights
Rheumatoid arthritis (RA) is the most commonly diagnosed systemic inflammatory arthritis [1]
The seven studies included in this systematic review dates of publication ranged from 2015 to 2020, six of the studies were undertaken from 2019 onwards reflecting the increasing use of tele-health interventions within healthcare
This review has highlighted that the published literature regarding the effectiveness of tele-health intervention to support self-management in RA is extremely heterogeneous
Summary
Rheumatoid arthritis (RA) is the most commonly diagnosed systemic inflammatory arthritis [1]. RA is a painful longterm condition which results in wide spread systemic inflammation, and joint damage [2]. Women, smokers, and those who have a family history of the disease are at highest risk of developing the condition [3]. Uncontrolled active RA can result in erosive joint damage, increasing disability, poor quality of life, and other co-morbidities [5]. Patients with RA face a high disease burden including symptoms such as pain, stiffness, fatigue and decreased muscle strength which makes activities of daily living challenging. RA has been linked to psychological issues such as depression, helplessness and anxiety which further impacts on everyday life [6]
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