A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis

This systematic review aimed to determine the effectiveness of interventions for improving knowledge and/or self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis (RA). We searched four databases (MEDLINE, CINAHL, Cochrane Trials, PsycINFO) using a comprehensive search strategy. Studies were eligible if they were prospective, published in English from 2004 to 2015, included participants with RA and tested an intervention designed to improve knowledge and/or self-management skills relating to family planning, pregnancy or breastfeeding. As no studies met the latter criterion, the search strategy was expanded to include all prospective studies evaluating RA educational and/or self-management interventions. Data on study characteristics, participant characteristics and programme content were extracted to summarise the evidence base for interventions to support people with RA during their reproductive years. Expanded literature searches identified 2290 papers, of which 68 were eligible. Of these, nine papers (13 %) specifically excluded pregnant women/breastfeeding mothers or recruited only older people.Only one study (1 %) explicitly evaluated pregnancy-focused education via a motherhood decision aid, while eight studies (12 %) incorporated relevant (albeit minor) components within broader RA educational or self-management interventions. Of these, three studies provided methotrexate education in relation to conception/pregnancy/breastfeeding; three incorporated discussions on RA and relationships, impact of RA on the family or sexual advice; one provided information regarding contraception and fertility; and one issued a warning regarding use of biologic therapy in pregnancy/breastfeeding. In conclusion, information regarding family planning, pregnancy or breastfeeding represents a negligible part of published RA educational interventions, with scope to develop targeted resources

Characteristics and development of therapeutic patient education in rheumatology : analysis of the 2003-2008 literature

Objective:The aim of this study is to point out the recent characteristics and developments of therapeutic patient education(TPE) in rheumatoid arthritis through an analysis of the international articles published from 2003 to 2008. Method: Studies were selected from major databases,using the following keywords:rheumatoid arthritis, patient education, self-management, programs. Thre eauthors independently reviewed each studyand selected the data using the patient education research categories(PERC). Articles consistently related to patient education in rheumatoid arthritis(37among109) were included. Results: The selected articles have been published in 23 scientific journals.The majority of them concern TPE for adult patients with rheumatoid arthritis.TPE is delivered in several structures and group education represents the most widespread educational strategy mainly provided by a multiprofessional team.There are two types of programs:educational, aiming to make the patient competent in the daily management of his disease and psycho-educational ones, aiming to improve coping and to decrease stress, anxiety and depression. Twenty-eight studies show the effectiveness of TPE on the basis of bio-clinical, educational, psychosocial, economical criteria, but the majority of these positive results are observed in short-term. Barriers toTPE are linked to cultural and socio-economic factors. Conclusion: A large number of studies stilla ssess the positive effects of TPE. Nowadays, the problems of short-term efficacy of TPE and the cultural and social barrierst ot his practice havebecome a major issu