Systematic review of self-management interventions for people with eczema

Abstract

Eczema 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.

Figure 1

Flowchart showing the flow of studies through the systematic review.

Figure 2

Forest plot of outcomes by intervention type. (a) Online‐only education. (b) Face‐to‐face education. POEM, Patient‐Oriented Eczema Measure; CI, confidence interval; HCP, healthcare professional; SCORAD, SCORing Atopic Dermatitis; IDQOL, Infant's Dermatitis Quality of Life Index; CDLQI, Children's Dermatology Life Quality Index; DFI, Dermatitis Family Impact Questionnaire.

Figure 3

Risk of bias summary. Review authors’ judgements about each risk of bias item for each included study.