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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Patient education in chronic skin diseases: a systematic review

J de Bes, CM Legierse, CA Prinsen, and J de Korte.

Review published: 2011.

Link to full article: [Journal publisher]

CRD summary

The review concluded that patient education appeared to be effective in improving quality of life and reducing the perceived severity of skin diseases, even in the long-term management of chronic skin diseases. The potential for some bias in the review process and the limited evidence available mean that the authors' conclusion should be interpreted with some caution.

Authors' objectives

To determine the effects of patient education on quality of life and disease severity in patients with chronic skin diseases.

Searching

PubMed and EMBASE were searched up to September 2008 for articles published in English, Dutch or German; search terms were reported online. Reference lists were screened.

Study selection

Randomised controlled trials (RCTs) of patients with skin diseases who received patient education were eligible for inclusion in the review. Eligible trials had to report the outcomes of patient education. Trials were excluded if the primary focus was the prevention of skin diseases, the education of specialists, students or residents, or teledermatology.

The primary outcome was quality of life. The secondary outcome was disease severity.

Most of the included trials focused on atopic dermatitis; two trials focused on atopic dermatitis plus psoriasis. In over half the trials, patient education focused on children. The content, frequency and duration of the education programmes varied across the trials. The programmes were delivered by a number of different health professionals, including specialist dermatology nurse, dermatologist, and medical students (where reported). Included trials were carried out in a variety of settings (dermatology, paediatric and interdisciplinary outpatient clinics). Eleven different quality of life measures were used across the trials; the most frequently used was the Scoring of Atopic Dermatitis Scale for monitoring the severity of eczema. Quality of life was measured using age-specific questionnaires in paediatric populations. Participant ages ranged from three months to 65 years.

One reviewer selected studies for inclusion in the review.

Assessment of study quality

Two reviewers independently assessed the quality of the included trials using the CONSORT (Consolidated Standards of Reporting Trials) statement checklist including: eligibility criteria and setting; details of intervention; primary and secondary outcomes clearly defined; sample size; randomisation; statistical method; blinding; loss to follow-up; baseline characteristics; results; and generalisability. Each item was rated as excellent, sufficient, moderate or insufficient.

Data extraction

Where statistically significant effects were found, their related p-values were reported.

The authors did not state how data were extracted.

Methods of synthesis

A narrative synthesis was presented, grouped by outcome.

Results of the review

Ten parallel-group RCTs were included in the review (n=1,731 participants, range 32 to 823). Randomisation was considered sufficient in four trials, moderate in two trials and insufficient in four trials. Sample size was considered insufficient in four trials. Blinding was considered insufficient in five trials. Loss to follow-up was considered insufficient in three trials.

Five out of 10 trials demonstrated significant improvements in quality of life as a result of patient education in patients with chronic skin diseases ((three paediatric and two adult populations). Three trials found statistically significant improvements in the severity of skin disease using objective and subjective measures (one adult and two paediatric populations).

Authors' conclusions

Patient education appeared to be effective in improving quality of life and reducing the perceived severity of skin diseases, even in the long-term management of chronic skin diseases.

CRD commentary

The review question was supported by clear but broad inclusion criteria. Two databases were searched, restricted to articles published in English, Dutch or German, with no attempt made to search grey literature, so some studies may have been missed. Appropriate steps were taken to minimise error and bias for quality assessment but not for study selection; it was unclear whether appropriate procedures were used for data extraction.

The quality of the included trials was assessed and individual criterion reported on; overall quality varied across trials but was generally low. The authors highlighted a number of limitations, including the small sample sizes and the use of different methodologies. There were also differences in the severity of disease between primary and secondary care patients, child and adult responses to educational interventions, and the possible influence of seasonal factors on skin diseases for outcome scores. Differences between the trials, particularly for interventions and populations, suggest that a narrative synthesis was appropriate.

Given the potential for some bias in the review process and the limited evidence available, the authors' conclusion should be interpreted with some caution.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that good quality research on the cost effectiveness and suitability for dermatological practice of patient education programs were required, as well as further studies in adult populations. The need for standard education models for various skin diseases was also highlighted.

Funding

Not reported.

Bibliographic details

de Bes J, Legierse CM, Prinsen CA, de Korte J. Patient education in chronic skin diseases: a systematic review. Acta Dermato-Venereologica 2011; 91(1): 12-17. [PubMed: 21264451]

Indexing Status

Subject indexing assigned by NLM

MeSH

Chronic Disease; Dermatitis, Atopic /therapy; Eczema /therapy; Humans; Patient Education as Topic; Quality of Life; Self Care; Skin Diseases /therapy

AccessionNumber

12011002645

Database entry date

27/02/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21264451